Lessons from the bedside: ketoacidosis and SGLT2 inhibitors

Yvonne Y Chow, Roisin Worsley and Duncan J Topliss
Med J Aust 2016; 205 (4): . || doi: 10.5694/mja16.00435
Published online: 15 August 2016

Sodium–glucose cotransporter type 2 (SGLT2) inhibitors are an emerging oral glucose-lowering therapy. In May 2015, the United States Food and Drug Administration issued a warning amid observation of ketoacidosis cases that may have been associated with SGLT2 inhibitor use in people with type 2 diabetes (T2DM). Potential mechanisms include inhibition of insulin secretion through glycosuria, increased glucagon secretion and hypovolaemia.1-3

  • Alfred Hospital, Melbourne, VIC



We thank our two patients for kindly allowing us to describe their cases.

Competing interests:

No relevant disclosures.

  • 1. Bonner C, Kerr-Conte J, Gmyr V, et al. Inhibition of the glucose transporter SGLT2 with dapagliflozin in pancreatic alpha cells triggers glucagon secretion. Nat Med 2015; 21: 512-517.
  • 2. Alberti KG, Johnston DG, Gill A, et al. Hormonal regulation of ketone-body metabolism in man. Biochem Soc Symp 1978; 43: 163-182.
  • 3. Ogawa W, Sakaguchi K. Euglycemic diabetic ketoacidosis induced by SGLT2 inhibitors: possible mechanism and contributing factors. J Diabetes Investig 2016; 7: 135-138.


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