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SGLT2 inhibitors: updated advice on the risk of diabetic ketoacidosis
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<blockquote data-quote="ringi" data-source="post: 1517166" data-attributes="member: 410240"><p>We have two separate issues</p><ul> <li data-xf-list-type="ul">a <strong>possible </strong>increased risk of ketoacidosis</li> <li data-xf-list-type="ul">the <strong>clear </strong>risk that A&E sends someone with ketoacidosis home</li> </ul><p>Personally I think SGLT2 inhibitors are too great a risk unless it has <strong>been proved</strong> that someone is producing a reasonable amount of their own insulin, hence is of low risk of ketoacidosis. Maybe (SGLT2) inhibitors should only be used if someone's self produced insulin levels are above normal. (Classic Type2 with clear insulin resistance is after all what the drug maker targeted them at.)</p><p></p><p>I would like to see everyone taking SGLT2 inhibitors be given a card and medical bracelet stating that<strong> BG level must not be used to rule out ketoacidosis</strong>, along with a ketones meter that is good enough to <strong>clearly </strong>show the difference between normal levels of ketones for someone not eating carbs and ketoacidosis. (Drip sicks may not be good enough to clearly show the difference.)</p><p></p><p>We have seen many people with clear cases of Type1 (but believed to have Type2) being send home just because their BG is "only" in the 20s due to them eating low carb, clearly (SGLT2) inhibitors can greatly increase this risk.</p><p></p><p>Remember that it is someone who may have been on duty for 12hrs, dealing with lots of people who have just gone into A&E for no good reasons, and without having any experience of diabetes decides if you should be seen now or in 4 hours time, or just send home.</p><p></p><p><strong>I have not seen anything that makes me believe that SGLT2 inhibitors increases the risk of ketoacidosis regardless of carb intake, but they clearly increase the risk of the ketoacidosis being ignored until it is too late. </strong>But SGLT2 inhibitors ate still new so not well understood.</p></blockquote><p></p>
[QUOTE="ringi, post: 1517166, member: 410240"] We have two separate issues [LIST] [*]a [B]possible [/B]increased risk of ketoacidosis [*]the [B]clear [/B]risk that A&E sends someone with ketoacidosis home [/LIST] Personally I think SGLT2 inhibitors are too great a risk unless it has [B]been proved[/B] that someone is producing a reasonable amount of their own insulin, hence is of low risk of ketoacidosis. Maybe (SGLT2) inhibitors should only be used if someone's self produced insulin levels are above normal. (Classic Type2 with clear insulin resistance is after all what the drug maker targeted them at.) I would like to see everyone taking SGLT2 inhibitors be given a card and medical bracelet stating that[B] BG level must not be used to rule out ketoacidosis[/B], along with a ketones meter that is good enough to [B]clearly [/B]show the difference between normal levels of ketones for someone not eating carbs and ketoacidosis. (Drip sicks may not be good enough to clearly show the difference.) We have seen many people with clear cases of Type1 (but believed to have Type2) being send home just because their BG is "only" in the 20s due to them eating low carb, clearly (SGLT2) inhibitors can greatly increase this risk. Remember that it is someone who may have been on duty for 12hrs, dealing with lots of people who have just gone into A&E for no good reasons, and without having any experience of diabetes decides if you should be seen now or in 4 hours time, or just send home. [B]I have not seen anything that makes me believe that SGLT2 inhibitors increases the risk of ketoacidosis regardless of carb intake, but they clearly increase the risk of the ketoacidosis being ignored until it is too late. [/B]But SGLT2 inhibitors ate still new so not well understood. [/QUOTE]
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