[Sodium glucose cotransporter-2 inhibitors (SGLT2i) and risk of ketoacidosis].
Lina-Maria NordvallBertil EkstedtJörn SchneedePublished in: Lakartidningen (2024)
SGLT2i can induce euglycemic diabetic ketoacidosis (eDKA) in conditions with relative insulin deficiency, such as infections, surgery, or fasting state. In comparison with classical DKA, eDKA typically presents with lower blood glucose levels and more diffuse symptoms like tiredness, tachypnea, nausea and abdominal pain. The diagnosis is commonly delayed, and signs are often attributed to other factors. Early diagnosis and prevention are critical due to the risk of lethal outcome or prolonged hospital stay. Generous screening for ketonemia in risk situations allows identification of eDKA. To minimize the risk, we propose that SGLT2i should be discontinued 3-4 days before surgery (1-2 weeks prior to bariatric surgery) and during infections, acute disease, or poor oral intake. Postoperative slow infusion of low-dose insulin may prevent eDKA if SGLT2i could not be stopped in time or in prolonged fasting state. In this overview, the pathogenesis behind eDKA is discussed.
Keyphrases
- blood glucose
- glycemic control
- low dose
- type diabetes
- minimally invasive
- bariatric surgery
- coronary artery bypass
- abdominal pain
- blood pressure
- healthcare
- liver failure
- insulin resistance
- emergency department
- patients undergoing
- surgical site infection
- metabolic syndrome
- depressive symptoms
- high dose
- low grade
- acute coronary syndrome
- respiratory failure
- coronary artery disease
- sleep quality
- percutaneous coronary intervention
- obese patients
- atrial fibrillation
- skeletal muscle
- drug induced
- intensive care unit
- gestational age
- extracorporeal membrane oxygenation
- physical activity