Sglt2 inhibitors and ketogenic diet

Shampa Sinha, Corresponding Author. 0: Jan 31, 2020 · Collectively, our data suggest that fasting-associated ketosis and the ketogenic effects of SGLT2 inhibitors occur almost entirely independent of glucagon. Recently, there has been a growing interest in both treatments because of their potential combined health benefits, including weight loss, enhanced insulin sensitivity, and reduced cardiovascular risk [ 49 , 53 ]. 6 This type of diet causes metabolic changes including glycogen store depletion, ketogenesis and gluconeogenesis. 2023, 10, 465 7 of 35 characteristics of SGLT-2 inhibitors and ketogenic diets, along with the potential strengths and limitations of their synergy, are shown in Figure 3 and Table 2, respectively. It is possible that combining the Atkins diet with SGLT2 inhibition has a synergistic role in promoting a ketogenic state, resulting in DKA without any additional trigger. Despite evidence that ketones have multiple positive effects on kidney function, common misconceptions about ketogenic diets, such as high protein content and acid load, have prevented their widespread use in individuals with impaired kidney function. com; Aug 15, 2020 · A low fat diet high in green vegetables, lean protein and limited starchy and sugary foods: On-line ad libitum very low carbohydrate ketogenic diet providing 20–50g carbohydrate per day together with behavioural adherence strategies: Westman, 2008 17: 24: 46. 3, 6 A Ketogenic diets have been widely used for weight loss and are increasingly used in the management of type 2 diabetes. 19 Accordingly, SGLT-2 inhibitors should be stopped before starting a ketogenic diet owing to the risk of DKA that Mar 3, 2020 · By administering these agents in combination with sodium–glucose co-transporter 2 (SGLT2) inhibitors that cause the removal of glucose by the kidney, or a ketogenic diet that removes dietary Jan 18, 2023 · The authors concluded that a ketogenic diet affected glycemia control in type 1 diabetes, with a low rate of adverse effects, in both adults and children on a very low-carbohydrate diet (the mean value of 36 g of carbohydrates meets one criterion of a ketogenic diet) . Editorial Sources & Fact-Checking Jun 17, 2022 · SGLT-2 inhibitors. Shampa Sinha. Endocr Abstr 2018; 56: 324. No actual effort needed, no attempts to improve insulin management, diet, other medication etc. The case highlights the importance of identifying DKA early and treating the underlying cause. 50434. Nov 16, 2023 · Moreover, a ketogenic diet and SGLT-2 inhibitors may rarely raise the risk of hypoglycemia, particularly in diabetics who are taking insulin or other glucose-lowering drugs [96,104]. They are following a very low carbohydrate or ketogenic diet. In addition to dietary changes, Dr. Sodium glucose co-transporter 2 inhibitors (SGLT2i) have been shown to improve clinical outcomes in patients with heart failure and are widely accepted as one of the pillars of heart failure therapy regardless of diabetic status. Sodium-glucose cotransporter 2 (SGLT2) inhibitors have a risk of ketoacidosis that could facilitate induction of KD. Methods We explain the hospital course Jan 13, 2020 · Grammatiki M, Rapti E, Dina D, et al. shampas@gmail. Dapagliflozin and Atkins diet in a patient with type 2 diabetes mellitus: a combination that should be avoided. Given the potential increased risk of euDKA, we advise against SGLT2 inhibitor use in patients following a VLCKD. We report a case in which the combination of SGLT2i and a strict very low-carbohydrate diet led to severe diabetic ketoacidosis in a young Caucasian man with type 2 diabetes. In Ireland, two postoperative SGLT2 inhibitor-associated EDKA patients took 92 hours to fully recover from ketoacidosis after initiation of treatment [ 43 ]. the likely depleted glycogen stores in his liver as a result of his diet. Flozins are not fully SGLT2-selective and have an affinity for the SGLT1 receptor, which is associated with protection against ischemia/reperfusion brain damage. They are unwell with intercurrent illness. However, recent studies suggest that SGLT-2 inhibitors might also have a ketogenic effect, increasing ketone body Dec 28, 2020 · A ketogenic diet, low-carbohydrate, high-fat, or moderate-protein diet can also shift the body toward ketosis because the body begins to break down fats as a source of energy. 33, 34 This highlights the need to educate health care professionals on the risk of ketoacidosis during fasting Apr 23, 2020 · Sodium-glucose transporter-2 (SGLT-2) inhibitors have also become more heavily used in the control of diabetes, leading to an increased incidence of concomitant use of ketogenic diets and SGLT-2 inhibitors to control weight in diabetic patients. Address modifiable risks for DKA before starting an SGLT-2 inhibitor. 5 The Food and Drug Administration issued warnings for SGLT2 inhibitors, including an increased risk for ketoacidosis, urinary tract infections, and amputations. Euglycaemic diabetic ketoacidosis: a predictable, detectable, and preventable safety concern with SGLT2 inhibitors. Introduction The current view of glucagon physiology is that it acts as the catabolic counterbalance to insulin, maintaining adequate amounts of blood glucose in states where it is Mar 1, 2018 · Euglycemic DKA in the setting of SGLT2 inhibitor use may be precipitated by carbohydrate-restrictive diets, which is an important consideration when prescribing these agents. 38: Low glycaemic index, reduced energy diet providing 55% of energy as carbohydrate Aug 6, 2020 · Successful Reimplementation Of A Very Low Carbohydrate Ketogenic Diet After SGLT2 Inhibitor Associated Euglycemic Diabetic Ketoacidos is. While the authors acknowledged the possible risk of DKA to the patients, no adverse events were observed throughout the study period. Apr 10, 2023 · However, various strategies have been used to promote endogenous liver production of ketones, including intermittent fasting, ketogenic diets and administration of sodium-glucose cotransporter-2 May 13, 2021 · A Case of euglycemic diabetic ketoacidosis triggered by a ketogenic diet in a patient with type 2 diabetes using a sodium-glucose cotransporter 2 inhibitor. The benefits reported with empagliflozin are in stark contrast to reports of adverse events, such as euglycemic ketosis with the same class. , ketogenic diets (50 Nov 9, 2021 · While insulin is required to treat euglycemic DKA, insulin deficits alone are insufficient to explain the persistence of SGLT2 inhibitor effects—particularly for patients who did not previously require insulin. The safety of the keto diet has not been demonstrated in type 1 DM due to the risk of ketonemia and hypoglycemia[ 42 , 50 ]. Blood samples were drawn on day 1, 8 and 15 to assess ketone production. Patients taking SGLT2 inhibitors should be advised to avoid a ketogenic diet. Abstract Patients with type 2 diabetes (T2D) are often overweight/obese and affected by arterial hypertension, dyslipidaemia, and have high serum levels of uric acid. Next. [PMC free article] [Google Scholar] Nov 12, 2020 · Possible predisposing conditions for the development of diabetic ketoacidosis in patients taking SGLT2 inhibitors include: excessive alcohol use or illicit drug use; adherance to a very low carbohydrate or ketogenic diet; unwillingness or inability to monitor ketone bodies; pregnancy; past history of diabetic ketoacidosis; use of an insulin pump Oct 10, 2023 · This approach was cautious, and with an improved understanding of the increased risk of ketoacidosis specifically in people taking SGLT2 inhibitors (and following a ketogenic diet, a predisposing factor for developing this), Reference Musso, Saba, Cassader and Gambino 23 future recommendations would be to only exclude people with type II Apr 3, 2023 · We describe two patients with T2DM who developed euDKA caused by SGLT2 inhibitor use while on a ketogenic diet, and provide a review of the literature. But these powerful medications should be approached with knowledge and caution. 1,2 Given that both ketogenic diet and SGLT-2 inhibitors alone can result in euglycemic ketosis,3,4 Apr 8, 2022 · In recent years, the ketogenic diet has gained popularity as a regimen for rapid weight loss through consumption of low carbohydrate and high fat foods. Diabetes 38 , 204–207. Hallberg states that someone taking an SGLT2 inhibitor on a high-carb, low-fat diet is at risk for ketoacidosis, whereas on keto/LCHF, the risk is practically non-existent. Sep 6, 2015 · In addition, evidence suggests that the administration of SGLT2 inhibitors stimulates the secretion of glucagon 4, which might be either a secondary effect mediated by the decrease in insulin secretion or a direct effect of SGLT2 inhibitors on pancreatic α‐cells. If you take an SGLT2 inhibitor and become unwell, you should stop taking it. Jun 13, 2018 · Around 37:30, Dr. Ketogenic diets can be either Oct 1, 2021 · This may occur through multiple mechanisms, including reduction in insulin-mediated suppression of lipolysis and ketogenesis, volume contraction, promotion of glucagon secretion, and decrease in renal clearance of ketone bodies. Apr 28, 2022 · The randomized phase II TIFA trial 103 is testing whether a ketogenic diet (<35 g of carbohydrates daily), a low-carbohydrate diet (<100 g daily) or the SGLT2 inhibitor canaglifozin can lower the Nov 7, 2023 · The ketogenic diet (keto) is a low-carb, high-fat diet that causes weight loss and provides numerous health benefits. 3 to 0. Euglycaemic ketoacidosis from an SGLT2 inhibitor exacerbated by a ketogenic diet. 2020 Jan;212 (1):46-46. Euglycaemic ketoacidosis (EKA) is a recognised adverse effect of SGLT2i in the diabetic, but not yet in the non-diabetic, demographic. Jul 4, 2018 · We chose to evaluate metformin and inhibitors of sodium-glucose co-transporter 2 (SGLT2), both of which are extensively used to treat diabetes 17,18,19,20, as well as a ketogenic diet in our mouse Apr 8, 2022 · A thorough investigation into precipitating factors for his DKA was largely unrevealing; an extensive infectious work- up was negative and the patient's history was otherwise only significant for starting a ketogenic diet 1 month prior while simultaneously being on a sodium-glucose transport protein 2 (SGLT-2) inhibitor, namely empagliflozin. All four agents are sodium-glucose transport protein 2 (SGLT2) inhibitors acting on the SGLT-2 proteins expressed in the renal proximal convoluted tubules to reduce the reabsorption of Jan 8, 2020 · Three cardiovascular outcome trials of sodium glucose cotransporter 2 (SGLT2) inhibitors, including the EMPA-REG OUTCOME trial, CANVAS Program, and DECLARE TIMI 58 trial, revealed that SGLT2 inhibitors were superior to a matching placebo in reducing cardiovascular events, including mortality and hospitalization for heart failure, in patients with type 2 diabetes. 5694/mja2. e1. The article particularly discusses the benefits and risks of combining SGLT-2 inhibitors with the ketogenic diet and their clinical applications and compares them with other anti-diabetic agents in terms of ketogenic effects. It also highlights the potential increasing prevalence of ketoacidosis which may occur as more patients are prescribed SGLT2 inhibitors and adhere to carbohydrate-restricted diets. Dec 2, 2015 · A very low carbohydrate diet has 20 to 50 grams per day of carbohydrate or less than 10% of a 2000 kcal/day diet. Clin. First identified as a feasible treatment for intractable epilepsy, the ketogenic diet (KD) has recently gained popularity thanks to growing evidence on applications such as weight loss Sep 1, 2020 · The totality of experimental and clinical evidence raises the possibility that SGLT2 inhibitors may exert their favorable effects in the diabetic kidney by promoting ketogenic nutrient deprivation signaling through SIRT1, PGC-1α and FGF21. e. 8 mmol/L (normal 0–2), an ethanol level <10 mg/dL, and a negative salicylate level. Ketone bodies on day 15 (7 days after SGLT2 inhibitor initiation) were significantly higher in the low carbohydrate group. A systematic review of the literature was conducted to identify publications that detail the effect of Sep 15, 2020 · Severe ketosis in setting of ketogenic diets is a serious complication, which is infrequently reported in literature. 8 percent. pdf Content available from CC BY-NC-ND 4. Jun 1, 2018 · SGLT-2 inhibitors (ipragliflozin, dapagliflozin, luseogliflozin, tofogliflozin, Ketogenic diet therapies are high-fat, low-carbohydrate diets designed to mimic a fasting state. Nov 16, 2023 · The synergism of SGLT-2 inhibitors and ketogenic diets represents a promising therapeutic approach for managing T2DM and obesity. Jan 20, 2023 · SGLT2 inhibitors are, first and foremost, anti-hyperglycemic medicine. SGLT2 inhibitors, which confer cardiovascular benefits in T2DM patients, can also exert pro-ketogenic effects by mediating a metabolic switch from glucose to lipid utilization. A 47-year-old male with a history of poorly controlled T2DM on metformin and empagliflozin presented to the emergency department (ED) with several days of pharyngitis, dyspnea, emesis, abdominal pain, and anorexia. recent addition of an SGLT2 inhibitor suggests that this combination could be deadly. Some doctors choose to have patients stay on SGLT-2 inhibitors and decrease/stop insulin and sulfonylureas first. While this can be beneficial for some patients, it may also result in Nov 1, 2020 · Diabetic ketoacidosis (DKA) is a known side effect of SGLT2 inhibitors (4). Figure 3. Editorial Sources & Fact-Checking Aug 11, 2021 · In a Japanese case report, one dose of an SGLT2 inhibitor in a patient with a low-calorie diet caused EDKA lasting about 60 hours after treatment was started . Aug 13, 2020 · Most cases that describe EDKA in patients who are taking SGLT2 inhibitors discuss it in patients who have been on SGLT2 for a period of time who then started a ketogenic diet for one week or more Nov 16, 2023 · Sodium–glucose cotransporter-2 (SGLT-2) inhibitors, also called gliflozins or flozins, are a class of drugs that have been increasingly used in the management of type 2 diabetes mellitus (T2DM) due to their glucose-lowering, cardiovascular (CV), and renal positive effects. Also, consider need to stop or adjust other T2D medications (i. However, they can increase the risk of a dangerous condition called euglycemic ketoacidosis. you’re following a low carbohydrate diet or a ketogenic diet. Sep 27, 2022 · SGLT2 inhibitors cause a carbohydrate deficit by glucosuria, which leads to an increased glucagon/insulin ratio, the metabolic shift from glucose to lipid utilization causing ketogenesis, and hence euglycemic DKA. Additional factors like the ketogenic diet, illness, surgery, and pregnancy contribute to precipitating these episodes. Cantley’s group also examined whether two blood glucose-lowering drugs commonly used to treat diabetes, metformin and SGLT2 inhibitors, could disrupt the PI3K-related insulin feedback loop. In our case Apr 1, 2020 · R. 13 Apr 3, 2023 · Case reports and case series have demonstrated a class effect of SGLT2 inhibitor-associated DKA while on a ketogenic diet of either low-carbohydrate diet or intermittent fasting, especially within the first six months of initiation. High‐fat ketogenic diets (HFKD) are May 5, 2021 · The keto diet can precipitate DKA in type 2 DM, especially during pregnancy or SGLT-2 inhibitors with a higher incidence of euglycemic DKA[44-49]. Apr 5, 2019 · Sodium-Glucose Transporter 2 Inhibitors. 6 A growing population of patients with type 2 DM have adopted a ketogenic diet Nov 16, 2023 · SGLT-2 inhibitors can cause gastrointestinal symptoms such as nausea and diarrhea. 5-0. The SIRT1/PGC-1α pathway is suppressed in diabetes, and SGLT2 inhibitors act to reverse this suppression. F. , metformin, sulfonylureas, GLP-1 analogues). The punch-line is that ketogenic diets rarely lead to ketoacidosis and, in fact, reduce the need for SGLT-2 inhibitors in Jan 13, 2022 · Sodium-glucose cotransporter-2 (SGLT2) inhibitors have emerged as powerful drugs that can be used to treat heart failure (HF) patients, both with preserved and reduced ejection fraction and in the presence or absence of type 2 diabetes. 1C 6. Jul 10, 2020 · 1. Apr 19, 2024 · The KD and SGLT-2 inhibitors show great promise as treatment strategies for managing T2D and its associated problems. While the mechanisms underlying the salutary effects of SGLT2 inhibitors have not been fully elucidated Jan 1, 2021 · A ketogenic diet, low-carbohydrate, high-fat, or moderate-protein diet can also shift the body toward ketosis because the body begins to break down fats as a source of energy. While the ketogenic diet can also lower blood glucose levels by limiting carbohydrate consumption [ 105 ], SGLT-2 inhibitors lower blood glucose levels by SGLT2 inhibitors decrease circulating blood glucose by increasing its secretion into the urine which exacerbates the paucity of available glucose for metabolism and can worsen ketosis in patients Carbohydrate Diets and the Use of SGLT2-inhibitors in Adults with Type 2 Diabetes Ketogenic or Very-Low-Carbohydrate Diets The terms ‘ketogenic diet’ and ‘very-low-carbohydrate diet’ are often used interchangeably to describe a dietary pattern with the purpose of inducing ketosis 1,2. Dis. Research suggests that SGLT2 inhibitors lower the A1C of people with type 2 diabetes by 0. Mar 29, 2024 · SGLT2 inhibitors offer wonderful benefits for people with type 2 diabetes. This guideline covers care and management for adults (aged 18 and over) with type 2 diabetes. 4 Given that glucagon inhibits acetyl‐CoA carboxylase and thereby increases Euglycemic diabetic ketoacidosis [euDKA], a complication of SGLT2 therapy, can be exacerbated by a low carbohydrate diet. We report a case of a patient taking an SGLT2 inhibitor for T2DM Before starting an SGLT-2 inhibitor, check whether the person may be at increased risk of diabetic ketoacidosis (DKA), for example if: They have had a previous episode of DKA. They can be prescribed alongside metformin, or by themselves as a monotherapy. Although The risks of a ketogenic diet in insulin-deficient individuals are not well described. Nov 16, 2023 · However, recent studies suggest that SGLT-2 inhibitors might also have a ketogenic effect, increasing ketone body production. Reading more extensively about SGLT2 inhibitors ( Invokana) and it seems that one of the properties is that it causes a decrease in the renal clearance of Jan 17, 2022 · Caution should be exercised when prescribing the KD to T2DM patients on other drug treatments, such as sodium glucose cotransporter 2 (SGLT2) inhibitors and insulin. Because the ketone bodies are acids, one of the serious side-effects of SGLT-2 inhibitors is ketoacidosis, the life-threatening effect of unregulated ketosis; an FDA warning was issued in 2015 and recently updated [ 7 ]. SGLT receptors are present in the central nervous system (CNS). It also explores future directions regarding the ketogenic effects of SGLT-2 inhibitors. Oct 18, 2022 · Sodium–glucose cotransporter 2 (SGLT2) inhibitors are a class of medications used by individuals with type 2 diabetes that reduce hyperglycaemia by targeting glucose transport in the kidney, preventing its reabsorption, thereby inducing glucosuria. 8 Because SGLT2 receptors are not located in cardiomyocytes, indirect mechanisms, including ketosis, are likely to account for the benefit. Aug 6, 2020 · Furthermore, it is imperative for health care providers to inquire about their patients’ diets prior to initiating SGLT2 inhibitor treatment, as many patients initiate a VLCKD without their physician’s knowledge. Jan 3, 2023 · Physicians prescribing an SGLT2 inhibitor should consider a patient’s risk factors for developing euglycemic DKA, including prior episodes of DKA, a ketogenic diet, possible type 1 diabetes, and whether they currently require insulin . (SGLT2) inhibitors for type 2 diabetes can increase the risk for diabetic Stop the SGLT2 inhibitor and do not restart until eating/drinking fluids normally. Dec 28, 2020 · If a patient on an SGLT2 inhibitor and ketogenic diet presents with mildly elevated glucose levels, ketosis, and an elevated anion gap, euDKA should be suspected and included in the differential diagnosis. Ketogenic diet therapies are high-fat, low-carbohydrate diets designed to mimic a fasting state. A ketogenic diet is a very low carbohydrate, high fat diet that is designed to induce ketosis. Jan 1, 2018 · Participants were started on their protocol diet for 14 days with SGLT2 inhibitor initiation on days 8–15. One case study described a 37-year-old male with type 1 diabetes who, in 20 Sep 13, 2023 · Recent studies have found that infection, severe acute illness, cerebrovascular events, dehydration, ketogenic diet, and surgery, amongst other factors, can increase the likelihood of DKA in patients who use SGLT2 inhibitors [8-15]. Low-carbohydrate diets (LCD) mimic many effects of sodium–glucose co-transporter 2 inhibitors (SGLT2i). You need to check your ketones and your blood sugars (if you've been told to do this and have the kit) and speak to your healthcare team. These drugs lower blood sugar by causing the kidneys to excrete more glucose into the urine. Only one article was retrieved that discussed low carbohydrate diet and DKA associated with SGLT2 inhibitors. doi: 10. The ketogenic diet (KD) is defined as a dietary manipulation characterized by a very low carbohydrate content (5%–10% of total daily calorie intake, or 20–50 g per day 1 , 2 ), but the macronutrient composition may vary, defining different ways to reach nutritional ketosis. 93 SGLT2 inhibitors decrease the insulin-to-glucagon ratio and increase lipolysis, both of which Nov 28, 2021 · SGLT2 inhibitors (SGLT2i) are lipid-soluble and reach the brain/serum ratio from 0. Dec 28, 2020 · A ketogenic diet, low-carbohydrate, high-fat, or moderate-protein diet can also shift the body toward ketosis because the body begins to break down fats as a source of energy. 13 Jan 31, 2022 · Sodium–glucose cotransporter-2 (SGLT2) inhibitors (SGLT2i) were introduced as antidiabetic drugs; however, more recently clinical trials have shown that they have heart and kidney protective effects in person with or without diabetes . 5. 12 However, given the multiple case reports of euglycemic ketoacidosis with low- carb diets and SGLT-2 inhibitors, the risks of SGLT-2 inhibitors likely outweigh the benefits. We recommend always offering advice on sick day guidance when initiating SGLT-2 inhibitors and Jun 2, 2020 · SGLT2 inhibitors induce systemic ketosis, but it is currently unclear whether this is a mechanism of benefit. If you have type 1 diabetes, or if you eat a low-carb or ketogenic diet, the research suggests taking an SGLT2 medication can be dangerous. However, the detailed In the DAPA-diet study, participants consumed approximately 100 g of carbohydrate/per day while on the LCD, whereas ketogenic diets recommend the intake of 50 g or less of dietary carbohydrate . A week prior to Dev. It is also important to counsel patients about taking this medication with certain illnesses, particularly Nov 23, 2023 · Because euglycemic ketosis can be brought on by either a ketogenic diet or SGLT-2 inhibitors alone , there is probably a greater possibility that it will occur when both therapies are combined. To our knowledge, this is the first report of euglycemic DKA caused by an SGLT2 inhibitor during self-introduction of a ketogenic diet that has presented as concern for acute coronary syndrome (ACS). Epub 2019 Dec 1. INTRODUCTION. Oct 10, 2023 · Diabetic cardiomyopathy (DMCM) is a syndrome precipitated mainly by the detrimental effects of glucose metabolism disorders such as insulin resistance and diabetes. The attributes of SGLT-2 inhibitors and ketogenic diets, along with the potential benefits and risks of their combined influence. Besides improving HbA1c and reducing body weight and blood pressure, the SGLT2 inhibitors have also been demonstrated to improve cardiovascular Oct 4, 2023 · Euglycemic diabetic ketoacidosis (EDKA) is an emerging complication of diabetes associated with an increasing use of sodium-glucose transporter type 2 (SGLT-2) inhibitor drugs. ’s acidosis was thought to be the result of euglycemic DKA, likely triggered by his ketogenic diet; other etiologies, including infection and lactic acidosis secondary to metformin use, were ruled out with further testing, which revealed a lactic acid level of 1. 18 Jun 20, 2018 · Participants were started on their protocol diet for 14 days with SGLT2 inhibitor initiation on days 8–15. LCDs are a dietary pattern which can have significant and beneficial (A) Mean Blood glucose levels with standard deviation over time of wildtype c57/bl6 mice baring syngeneic K8484 KPC allografted tumors after treatment with a single dose of BKM120 in mice pretreated with metformin, SGLT2-inhibitor (SGLT2i), or a ketogenic diet (N = 5 mice). [8,9] The SGLT2 inhibitors have a ketogenic effect, which has been reported in both animal and human studies. . Case report: A 61-year-old man with a history of type 2 diabetes, taking an SGLT2 inhibitor empagliflozin 10 mg orally daily, presented to the emergency room with a 2-day history of nausea and chest pain. Successful reimplementation of a very low carbohydrate ketogenic diet after SGLT2 inhibitor associated euglycemic diabetic ketoacidosis. 2. You may also need to commence alternative treatment in the interim. 5 The Food and Drug Administration issued warnings for SGLT2 inhibitors, including an increased risk for ketoacidosis, urinary tract infections, and amputations. Dec 1, 2019 · Euglycaemic ketoacidosis from an SGLT2 inhibitor exacerbated by a ketogenic diet. Rosenstock J, Ferranini E. Med J Aust. Although initially developed nearly one century ago for seizure management, most clinical trials for the management of drug-resistant epilepsy in children as well as adults have been conducted over the last 3 decades. Multiple case reports discussed the development of EDKA in patients who are on a SGLT2 inhibitor after introducing a ketogenic diet for at least one week [13–16]. 2020; 6:e330–3. p-values calculated by Two-way repeated measures ANOVA for metformin Jan 25, 2017 · Prior case reports of SGLT2-inhibitor–associated DKA among patients with both type 1 and type 2 diabetes — including some with normal or only slightly elevated glucose levels — prompted a Abstract. 3, 6 A Mar 2, 2022 · No case report was found of a patient who developed EDKA following the start of keto diet for three days duration and stopped all of their oral medication for 2 days. Clinical trial evidence Nov 20, 2022 · Fieger EI, Fadel KM, Modarres AH, Wickham EP 3rd, Wolver SE. Jun 20, 2018 · Background: A ketogenic diet (KD) may have a role in treating patients in super-refractory status epilepticus (SRSE). A ketogenic diet may also increase the risk of yeast infections due to the high-fat content. Another potential risk is the possibility that the combination of SGLT-2 inhibitors and a ketogenic diet could result in dehydration [ 47 ] . 3, 6 A Aug 4, 2022 · A note on SGLT-2 inhibitors. These pills can effectively bring blood glucose levels down into a safer range. Diabetic euglycaemic ketoacidosis is a possible adverse effect of sodium-glucose co-transporter-2 inhibitors (SGLT2i). Here, patient, just take them pills and your BG will magically get better. Several of these factors were present for our patient and possibly contributed to the development of euglycemic DKA. Jul 10, 2020 · A critical revision of the literature behind each safety alert is provided, in order to guide through the treatment options in the case of subjects with an indication to the KD and a borderline safe situation. More than 2,500 cases of SGLT2 inhibitor-associated DKA have been reported in the United States Food and Drug Administration Adverse Event Reporting System, prompting new warnings about these risks (4). This review highlights the growing incidence of EDKA and its diagnostic challenges due to the absence of hallmark hyperglycemia seen in diabetic ketoacidosis (DKA). The exact mechanism of prolonged ketosis and glycosuria far beyond the standard drug clearance period of five half‐lives is unknown Jun 8, 2024 · SGLT2 inhibitors offer wonderful benefits for people with type 2 diabetes. However, a few case reports describe euDKA precipitated by carbohydrate-restricted diets in patients on SGLT2 inhibitors [4, 7]. Genital infections ! SGLT-2 inhibitors can increase the risk of genital infections such as yeast infections and UTIs. [10,11,12,13,14,15,16] As long as the body has adequate insulin to meet basic demands of insulin Jun 3, 2023 · Canagliflozin, dapagliflozin, empagliflozin, and ertugliflozin are FDA-approved for managing adult patients with type 2 diabetes mellitus (DM) to improve blood sugar control adjunct to diet and exercise. Moreover, T2D patient have a higher risk of developing When initiating SGLT-2 inhibitors, we suggest that individuals should be advised on the signs and symptoms of DKA and be instructed to temporarily withhold SGLT-2 inhibitors and to seek immediate medical advice if symptoms develop. Many of these diets and supplements may seem harmless, but as our case illustrates, when combined with other risk factors, patients can face serious adverse effects and even require hospitalization. By promoting weight loss and improving glycemic control, this combination may offer enhanced clinical benefits compared to either intervention alone. Unfortunately, SGLT-2 inhibitors are one of those kinds of meds that are very tempting for doctors, because they seem to make things so easy. AACE Clin Case Rep. Jul 13, 2023 · “A ketogenic diet that adheres to the principles of the Mediterranean diet and limits intake of saturated fat and red meat could be a promising therapeutic intervention for patients with HF,” the authors concluded. Aug 8, 2018 · Yet, when the mice were put on a ketogenic diet in combination with PI3K inhibitors, their tumors shrank significantly. illness/infection, fasting, carbohydrate deficient diet i. Aug 13, 2020 · In this case report, we present DKA in a patient on an SGLT2 inhibitor and ketogenic diet (KD). SGLT-2 inhibitors have generic names ending in -gliflozin, like canagliflozin, empagliflozin, and dapagliflozin. It should be noted that individuals with type 2 diabetes who are taking a sodium–glucose cotransporter 2 (SGLT2) inhibitor are at an increased risk of euglycemic DKA when following a low-carbohydrate ketogenic diet (4,8,9). Jan 1, 2020 · The evidence for extra-glycemic effects of SGLT2i and the potential mechanisms driving cardiorenal protection exerted by this class of medications are summarized. We performed a PubMed data base search using MeSH headings: diabetic ketoacidosis, SGLT2 inhibitors, low carbohydrate diets, and ketogenic diets. rj vi ct ht qd ur ff ei vo iv