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Glucagonoma Syndrome — RACP Adult Medicine MCQ

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HardEndocrinologyGlucagonoma SyndromeRACP Adult Medicine

A patient taking empagliflozin is booked for elective colonoscopy requiring bowel preparation and prolonged fasting. Diabetes is otherwise stable. Which medicine plan best reduces procedural ketoacidosis risk?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: EWithhold empagliflozin before preparation and restart after normal oral intake

Explanation lettering: E = shown as A · C = shown as B · B = shown as C · A = shown as E

A is correct. Colonoscopy preparation creates fasting and dehydration risk; SGLT2 inhibition is withheld in advance and restarted only after adequate oral intake and clinical stability. B ignores ketoacidosis risk outside incisional surgery. C increases risk. D is unsafe without an individual diabetes plan. E causes unnecessary prolonged dysglycaemia.

Reference: Australian Diabetes Society, Periprocedural diabetic ketoacidosis with SGLT2 inhibitors alert: https://www.diabetessociety.com.au/guideline/https-www-diabetessociety-com-au-wp-content-uploads-2023-05-ads-adea-anzca-nzssd_dka_sglt2i_alert_ver-may-2023-pdf/