People taking SGLT2 inhibitors can develop volume depletion and, rarely, ketoacidosis when they are acutely unwell, are not eating or drinking, or are about to have surgery. A short conversation at the time of prescribing saves a harder one later.
Tell patients to pause the drug when they have vomiting, diarrhoea or poor oral intake, and to restart when they are eating and drinking normally again. Make sure they know it is the sick day, not the tablet, that needs managing. For planned surgery, follow your hospital's pre-operative stop guidance.
If someone on an SGLT2 inhibitor presents unwell with nausea, abdominal pain or breathlessness, check ketones even if the glucose is only mildly raised.
- Give the sick-day instruction in writing when you first prescribe.
- Ask about intake and fluid loss at every acute presentation.
- Check blood ketones in an unwell patient on an SGLT2 inhibitor, whatever the glucose.
- Follow local protocol for stopping before planned surgery.
Why it matters
Euglycaemic ketoacidosis is easy to miss because the glucose does not look alarming.
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