Serious and life-threatening cases of diabetic ketoacidosis have been reported in patients taking SGLT2 inhibitors. In several cases, blood glucose levels were only moderately elevated (eg, <14 mmol/L or 250mg/dL), which is atypical for diabetic ketoacidosis.
The MHRA has issued the following recommendations for prescribers:
- Test for raised ketones in patients with symptoms of diabetic ketoacidosis, even if plasma glucose levels are near-normal.
- Discontinue treatment if diabetic ketoacidosis is suspected.
- If diabetic ketoacidosis is confirmed, take appropriate corrective measures and monitor glucose levels.
- Continue to report suspected side-effects of SGLT2 inhibitors.
To avoid a delay in diagnosis and treatment of diabetic ketoacidosis, prescribers should inform patients of the symptoms and signs:
- abdominal pain
- excessive thirst
- difficulty breathing
- unusual fatigue or sleepiness.