Sodium-glucose co-transporter-2 inhibitors (SGLT2i) are oral medications that promote glucose excretion in the urine for the treatment of type 2 diabetes. Note that SGLT2i are not approved for use in the management of type 1 diabetes in Australia or New Zealand, although they are sometimes used off-label in this setting.
• Over the last few years there has been an increasing number of reports of patients with type 2 diabetes who are taking these medications developing severe acidosis requiring ICU/HDU admission during the peri-operative period.
• SGLT2i carry a small but definite risk of severe diabetic ketoacidosis (DKA). 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 and/or a surgical procedure, is dehydrated or has an intercurrent illness such as active infection.
• Blood ketone testing is strongly recommended to detect and monitor DKA as urine ketone testing may be unreliable
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