SGLT2 inhibitors: risk of diabetic ketoacidosis

Patients receiving SGLT2 inhibitors (canagliflozin, dapagliflozin or empaglifozin) should be monitored for diabetic ketoacidosis, the MHRA has advised.

Prescribers are reminded that SGLT2 inhibitors are not licensed for the treatment of type I diabetes.
Prescribers are reminded that SGLT2 inhibitors are not licensed for the treatment of type I diabetes.

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.

Further information
MHRA Drug Safety Update 
View SGLT2 inhibitor drug records

To avoid a delay in diagnosis and treatment of diabetic ketoacidosis, prescribers should inform patients of the symptoms and signs:

  • nausea
  • vomiting
  • anorexia
  • abdominal pain
  • excessive thirst
  • difficulty breathing
  • confusion
  • unusual fatigue or sleepiness.
Prescribers are reminded that SGLT2 inhibitors are not approved for the treatment of type I diabetes. 
Want news like this straight to your inbox?
Sign up for our bulletins

Have you registered with us yet?

Register now to enjoy more articles and free email bulletins

Already registered?
Sign in

More from MIMS

Sole of a foot with dry cracked skin on the heel.

New MIMS comparison table for urea-based emollients

Prescribers can now compare urea-based emollients with...

Drug shortages - live tracker

Use our constantly updated shortages tracker to check...

Logo of the webinar

Cow's Milk Allergy in Practice: free webinar series for UK healthcare professionals

Join us for a short webinar series offering insights...

Close up image of multicoloured capsules

MIMS antidepressants table updated

The MIMS table 'Antidepressants, a guide to switching...