Sodium-glucose co-transporter-2 inhibitors (SGLT2i) are oral medications approved for the management of blood glucose levels in type 2 diabetes. Over the last few years there has been an increasing number of reports of patients with type 2 diabetes who are taking SGLT2i developing severe diabetic ketoacidosis (DKA) requiring ICU or HDU admission, particularly during the peri-operative period. Sometimes this DKA is associated with near normal or only mildly elevated blood glucose levels (i.e. euglycaemic ketoacidosis [euDKA]). The risk is increased if the patient has been fasting or has very restricted dietary intake, has undergone bowel preparation, including for colonoscopy and/or a surgical procedure, is dehydrated or has an intercurrent illness such as active infection.
Read a recent Australian article outlining the risk of euDKA in patients with type 2 diabetes undergoing colonoscopy and the alert on periprocedural diabetic ketoacidosis (DKA) with SGLT2i use developed by ADS, ADEA, DA, NZSSD and ANZCA.
More information can be found at the Australian Diabetes Society.