How does SGLT2 inhibitors cause ketoacidosis?

SGLT2 inhibition lowers the renal threshold for glucose excretion, resulting in renal glycosuria, a shift in substrate utilisation from carbohydrate to fat oxidation and hyperglucagonaemia; this poses a theoretical risk for ketoacidosis (including euglycaemic ketoacidosis) in the presence of other precipitating factors …

Which drugs cause ketoacidosis?

— FDA targets SGLT2 inhibitors canagliflozin, dapagliflozin, and empagliflozin. This article is a collaboration between MedPage Today and: NASHVILLE — Three type 2 diabetes drugs — canagliflozin (Invokana), dapagliflozin (Farxiga), and empagliflozin (Jardiance) — may lead to ketoacidosis, the FDA warned today.

What are the most common side effects of SGLT2 inhibitors?

Common SGLT2 side effects include:

• Urinary tract infection.
• Female and male genital yeast infections.
• Upper respiratory tract infections.
• Increased urination.
• Dyslipidemia (increase in cholesterol)
• Joint pain.
• Nausea.
• Thirst.

What conditions cause ketoacidosis?

The most common cause of ketoacidosis is a deficiency of insulin in type 1 diabetes or late-stage type 2 diabetes. This is called diabetic ketoacidosis and is characterized by hyperglycemia, dehydration and metabolic acidosis. Other electrolyte disturbances such as hyperkalemia and hyponatremia may also be present.

Do SGLT2 inhibitors cause DKA?

Sodium-glucose cotransporter 2 (SGLT2) inhibitors are associated with an almost 3-fold increased risk of diabetic ketoacidosis (DKA) in some patients with type 2 diabetes (T2D), according to data from a retrospective cohort study published in Annals of Internal Medicine.

Can SGLT2 cause DKA?

When insulin-dependent patients are initiated on an SGLT2 inhibitor, the insulin dose should be decreased to avoid the risk of hypoglycemia. However, the decreased insulin dose may not be sufficient to suppress ketogenesis and therefore can increase the patient’s risk for developing DKA.

What is the difference between ketosis and ketoacidosis?

Differences between ketosis and ketoacidosis. Ketosis and ketoacidosis both involve the production of ketones in the body. However, while ketosis is generally safe, ketoacidosis can be life-threatening. Nutritional ketosis occurs when the body starts burning fat instead of glucose.

Will metformin help ketoacidosis?

(HealthDay News) — For patients with new-onset diabetic ketoacidosis (DKA) and severe hyperglycemia, metformin and sitagliptin treatment after normoglycemia remission correlate with increased relapse-free survival and prolonged remission, according to a study published online in Diabetes Care.

Who should not take SGLT2 inhibitors?

Prescribing SGLT2 inhibitors should be restricted if the patient has a history of type 1 DM, ketosisprone T2DM, and in those with a glomerular filtration rate of < 60 mL/min.

Which SGLT2 is best for heart failure?

The sodium–glucose cotransporter-2 inhibitors dapagliflozin and empagliflozin improved outcomes for patients with heart failure, whether or not they had diabetes.