SGLT2 Dangerous for Causing Diabetic Ketoacidosis

Allen and I were talking to a person with type 1 diabetes this last weekend and he was bragging about being on an oral medication for type 2 people with diabetes. I said that the doctor was prescribing it “off label” and there were some serious side effects to the SGLT2 medication. He asked what the side effects could be. Allen said that DKA (diabetic ketoacidosis) was the side effect and that it was not the same as that experienced generally by people with type 1 diabetes.

The person laughed and said he was not aware of any problems. Fortunately, I had just read this and had my wife's laptop with me. I pulled up the article and the definition for euglycemic, which is a condition or state in which the blood glucose level is within the normal range. See also glycemia. As reported…the presence of euglycemia appeared to delay correct diagnosis in some of the patients in their series.

• Euglycemic DKA may be associated with the use of a SGLT2-inhibitor in type 1's.
• Volume depletion associated with SGLT2-inhibitor use could exacerbate the problem by further increasing glucagon, cortisol, and epinephrine.
• If insulin levels are low and glucagon and other counterregulatory hormones are high, a perfect storm exists.

Now we had his attention and he asked to read the article. When he finished, he said that then he could be in trouble as he was scheduled to a surgery on Monday, June 29. He said that it is recommended that he be off the medication for three days before any surgery.

Then I opened the Medscape article and had him read that article. His first question was how he could get access to either article, as he was not aware of either source. I said he would have to join both sites to have access to them and that they were free. Allen said it would be good to be a journalist when applying, but that there was good information, he would email him some of the links for diabetes and other information, and then he could explore for his favorite topics.

He called his doctor at his home and informed the doctor of what he had read and that he needed to postpone this surgery at least two days if possible. He asked the doctor for his email address and sent the doctor the two links and his phone number and then the doctor called him and said he would see that the surgery was set back for at least two days. He went back to talking with us.

Next, he thanked both of us and said he was sorry he had acted so badly when we started the conversation. He explained that he had always felt that people type 2 diabetes had no interest in helping people with type 1 diabetes. I said that type 1 takes enough grief from people ignorant of the difference and accused them of many of the problems that type 2 people face on a regular basis. I said we need to work together to end the ignorance and help each other at every opportunity. He agreed and thanked us again.

I said that I had sent him the links for the two articles and would send him any more that I found. I said I was aware of at least one more, but I would need to get on my home computer to find it.

Then he asked to read the first article again. He said that he had not been counseled by his doctor when he started the medication as was recommended and was happy we could show him information. He was going to have a long discussion with his doctor and consider not taking the medication. He said that it was helping in the management of his daily blood glucose levels so the decision would be difficult without the doctor understanding what could happen.

He asked if anyone we knew was using the SGLT2 medication. Allen said no, as the members of our support group only used metformin or insulin. I added that we have a few members that have been able to stop all medications after lifestyle changes. They continue the monitor their blood glucose levels and have been successful so far.

He said he needed to head home and repeated his thanks and said he would stay in touch.

Diabetic Ketoacidosis – Part 1

Diabetic ketoacidosis (DKA) is generally a complication for people with type 1 diabetes, but some people with type 2 diabetes do develop DKA. If you have type 2, especially when you are older, you are more likely to have a condition with some similar symptoms called HHNS (hyperosmolar hyperglycemic nonketotic syndrome). I will cover this in some future blogs.

DKA starts with high ketone levels when you body doesn't have enough insulin. This means your cells can't use the glucose in your blood for energy, and your body starts using fat for fuel instead. The ketones start building in your blood and if not corrected soon, the excess can change the chemical balance of your blood and change how your body works.

People with type 1 diabetes are at risk for ketoacidosis, since their bodies don't make any insulin. Your ketones can also go up when -

1. You miss a meal,
2. You're sick or stressed,
3. You have an insulin reaction.

When your blood glucose level is over 240 mg/dl (13.3 mmol/L) or you have symptoms of high blood glucose, such as:

• Dry mouth
• Feeling really thirsty
• Peeing a lot

When you have the above symptoms, it is important to test your ketones. For this you can use your blood glucose meter that measure ketones or use a urine test strip. Try to bring your blood glucose level down and check you ketones again in 30 minutes. Call your doctor or go to the emergency room right away if that doesn't work. This is more important if your ketones aren't normal and if you have one or more of the following symptoms:

• You have been vomiting for more than 2 hours
• You feel queasy or your belly hurts
• Your breath smells fruity
• You are tired, confused, or woozy headed
• You are having a difficult time breathing

You may have to go to the hospital. You'll probably need insulin through an IV to bring your ketones down and fluids to get you hydrated and balance your blood chemistry again. If you don't treat ketoacidosis, you could pass out, go into a coma, and possibly die. Your doctor may change your insulin dose or the kind you use to prevent it from happening again.

Good glucose management should help you avoid ketoacidosis. Take your medicines as directed, follow your meal plan closely, maintain your exercise regimen, and test your blood glucose regularly. When you have an episode of ketoacidosis, always run down a checklist:

1. Make sure your insulin has not expired.
2. Do not use it if it has clumps (insulin should be either clear or evenly cloudy with small flecks.
3. If you are using an insulin pump, look closely for insulin leaks, and check your tube connections for air bubbles.
4. Lastly, talk to your doctor if your blood sugar levels are often out of your target range
   
   
   
   
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