Low carbohydrate and SGLT2 inhibitors - warning

[LittleGreyCat]

From https://gpnotebook.com/en-GB/pages/...gy/nice-guidance-metformin-in-type-2-diabetes
"

• before starting an SGLT2 inhibitor, check whether the person may be at increased risk of diabetic ketoacidosis (DKA),for example if:
  • they have had a previous episode of DKA
  • they are unwell with intercurrent illness
  • they are following a very low carbohydrate or ketogenic diet
• address modifiable risks for DKA before starting an SGLT2 inhibitor. For example, for people who are following a very low carbohydrate or ketogenic diet, they may need to delay treatment until they have changed their diet
  
  
• advise adults with type 2 diabetes who are taking an SGLT2 inhibitor about the need to minimise their risk of DKA by not starting a very low carbohydrate or ketogenic diet without discussing it with their healthcare professional, because they may need to suspend SGLT2 inhibitor treatment

"

Just adding a note to the Low-carb diet forum after finding this during another thread.

 

[Guilty]

This happened to me (Empagliflozin).

It's rare. But not pleasant and can be fatal. I ended up in hospital.

You need to be aware of the symptoms of DKA.

Also, normally in DKA you'd also see high blood glucose alongside ketones. In this scenario your blood glucose can appear fine, but you're still going through DKA. This is why I didn't recognise it.

 

[HSSS]

This is what I keep warning people about. Too many drs don’t seem to do so and as the low carb and keto method of type 2 management gets more popular and known about the more this issue raises its head.

 

[Cragwood]

When this happened to me I had low blood sugars but was still in DKA. The dr In A&E had never heard of it and was going to send me home. I ended up being very ill and was in hospital for quite a while.