Ketoacidosis on an SGLT2 inhibitor can occur with near-normal glucose, so a reading of 10 mmol/L does not exclude it. Older adults are prone to the triggers: reduced intake, vomiting, acute illness and surgery.
The established advice is to pause the drug during acute illness with poor oral intake, or before planned surgery, and restart once eating and drinking normally. Carers need to know this as much as the patient.
- Pause the SGLT2 inhibitor when the person cannot eat or drink normally, and restart when they can.
- Check ketones in an unwell patient on an SGLT2 inhibitor even if glucose looks acceptable.
- Give the sick-day advice to carers as well as the patient.
- Stop the drug before planned surgery in line with local perioperative guidance.
Why it matters
Sick-day counselling should not disappear after the first prescription.
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