NEW ORLEANS — Patients with diabetes who test urine ketones may miss a diagnosis of ketoacidosis because of the particular effects SGLT2 inhibitors have on urinary ketone excretion, Nestoras N. Mathioudakis, MD, MHS, the clinical director of the division of endocrinology, diabetes and metabolism at Johns Hopkins University, told Endocrine Today.
“These drugs block urinary excretion of ketones and if you have a patient who is checking urinary ketones, they may miss ketoacidosis,” he said. “Add to that the fact that glucose levels are often not as high when these patients are in ketoacidosis, and you’ve got a perfect storm for a missed diagnosis.”
In this video — the first in a series of items that discuss the risks and benefits of SGLT2 inhibitors in patients with type 1 and type 2 diabetes — Mathioudakis highlights a session in which Simeon I. Taylor, MD, PhD, of the University of Maryland School of Medicine, discussed the life-threatening risk for ketoacidosis in patients who use SGLT2 inhibitors.
“SGLT2 inhibitors shouldn’t be used for non-patients with type 1 diabetes,” he said. “Often when you start these drugs in patients with type 1 diabetes, it results in lowering the glucose which triggers providers to drop the insulin dose and in dropping the insulin dose, patients are at higher risk for ketoacidosis.”