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SGLT2i DKA Mechanism — ESENeph MCQ

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ModerateDiabetic Kidney DiseaseSGLT2i DKA MechanismESENeph

A 30-year-old woman with type 1 diabetes and recurrent DKA is advised that SGLT2 inhibitors are not recommended for her. She also has CKD G3aA3 (eGFR 55, uACR 45 mg/mmol). What is the DKA risk mechanism with SGLT2i?

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Correct answer: A — SGLT2i promote glucosuria, shifting metabolism toward ketogenesis; DKA can occur even at normal blood glucose (euglycaemic DKA)

SGLT2 inhibitors promote urinary glucose excretion, reducing plasma glucose. This lowers insulin secretion/demand and promotes counter-regulatory hormone activity, shifting metabolism toward lipolysis and ketogenesis. DKA can occur at relatively normal glucose levels (euglycaemic DKA), making it difficult to recognise. Risk is highest in type 1 diabetes, during fasting, surgery, or illness. KDIGO 2024 and BNF state SGLT2i should not be used in T1D or those with prior DKA history.

Reference: KDIGO 2024 – CKD; MHRA 2024 – SGLT2i DKA Warning; BNF