Which condition increases the risk of developing euglycemic DKA in patients taking SGLT2 inhibitors?

Which condition increases the risk of developing euglycemic DKA in patients taking SGLT2 inhibitors?

• A. Illness or dehydration.
• B. Regular hydration and meals.
• C. Absence of illness.
• D. Adequate insulin levels.

Answer: (A)

Illness or dehydration raises the risk of euglycemic DKA for patients on SGLT2 inhibitors. SGLT2 inhibitors cause the kidneys to excrete glucose, which lowers blood glucose levels and can mask the onset of ketosis. When a person is ill or dehydrated, stress hormones like glucagon, cortisol, and catecholamines rise, driving more fat breakdown and ketone production. At the same time, dehydration reduces kidney clearance of ketones, allowing them to accumulate and acidify the blood even if glucose stays near normal. This combination creates a higher chance of a diabetic ketoacidosis episode without the hallmark very high glucose. In contrast, staying well hydrated and eating regularly helps maintain stable insulin and glucose balance, which suppresses excessive ketone formation. Absence of illness and adequate insulin levels also reduce the drive toward ketosis; without sufficient counter-regulatory hormone surge or lipolysis, the risk of DKA remains low.

Illness or dehydration raises the risk of euglycemic DKA for patients on SGLT2 inhibitors. SGLT2 inhibitors cause the kidneys to excrete glucose, which lowers blood glucose levels and can mask the onset of ketosis. When a person is ill or dehydrated, stress hormones like glucagon, cortisol, and catecholamines rise, driving more fat breakdown and ketone production. At the same time, dehydration reduces kidney clearance of ketones, allowing them to accumulate and acidify the blood even if glucose stays near normal. This combination creates a higher chance of a diabetic ketoacidosis episode without the hallmark very high glucose.

In contrast, staying well hydrated and eating regularly helps maintain stable insulin and glucose balance, which suppresses excessive ketone formation. Absence of illness and adequate insulin levels also reduce the drive toward ketosis; without sufficient counter-regulatory hormone surge or lipolysis, the risk of DKA remains low.