SGLT2 illness and ketoacidosis ๐จ ๐
Educational on-call framework โ not a treatment protocol. SGLT2 inhibitors may be prescribed for diabetes, heart failure or CKD. DKA can occur with glucose that is not markedly elevated.
Recognition
- In a person taking an SGLT2 inhibitor who is vomiting, tachypnoeic, acidotic or unusually unwell, measure blood ketones and assess acidโbase status even if capillary glucose is not high.
- Escalate possible euglycaemic DKA promptly; follow the local diabetes/DKA pathway.
During acute illness
- MHRA advises interrupting SGLT2 treatment for major surgery or acute serious illness with blood ketone monitoring.
- Keep an explicit insulin and hydration plan; distinguish type 1 from type 2 diabetes and check all antidiabetic drugs.
Restart and handover
- Restart only after ketones normal and clinical stabilisation, with review of indication and specialist advice where appropriate; see empagliflozin and metformin.
- Document sick-day instructions and who will review restarting after discharge.
UK resources: MHRA SGLT2 interruption ยท NICE NG28 Feb 2026
Editorial draft 4 November 2026; not formally clinically signed off. Use local policy and senior advice.