Practice Point for Sodium glucose co-transporter 2 (SGLT2) inhibitors
Jardiance (Empagliflozin) - SGLT2 inhibitor is now funded for those with T2DM with special authority from 1 February 2021. One of the adverse effects of SGLT2 inhibitors is the increased risk of diabetic ketoacidosis (DKA) Whilst the risk of DKA is rare (1 in 3000), patients and health professionals should be aware of the risk of DKA with SGLT2 inhibitors (including with normal glucose levels). Best Practice Advice: Stop SGLT2 inhibitors during an acute illness or 2 days before an elective procedure. Patients should be informed to present to their GP practice or hospital if experiencing symptoms of nausea, vomiting or abdominal pain to have their ketones checked. Capillary ketones > 1.5 mmol/L require urgent medical attention Cautious use of SGLT2inhibitors in type 2 diabetes is recommended for those at high risk for DKA • •
Previous DKA Insulin deficiency with low carbohydrate diet and/or significant alcohol use
Every practice should have access to a Dual Meter for measuring blood ketones if someone presents unwell and is taking Jardiance.
Understanding Blood Ketone Numbers
0.6mmol - indicates within the normal range. 0.6-1.5mmol - is an alert - medication adjustments may need to be made 1.5mmol & above at risk of ketoacidosis - needs immediate medical treatment
WBOPPHO Diabetes Support team
Best Practice Update March 2021