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SGLT2 inhibitor adverse effects — SCE Endocrinology MCQ

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ModerateDiabetesSGLT2 inhibitor adverse effectsSCE Endocrinology

A 57-year-old woman with type 2 diabetes has recurrent urinary tract infections after starting an SGLT2 inhibitor. She now reports vulval itching and dysuria but is afebrile, haemodynamically stable and ketones are 0.2 mmol/L. Urine dipstick shows glucose and leukocytes. What is the most likely diagnosis?

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Correct answer: B — Genital mycotic infection with lower urinary tract infection

SGLT2 inhibitors increase glycosuria and can predispose to genital mycotic infection and urinary symptoms. Euglycaemic DKA would require ketonaemia and metabolic acidosis, which are not present here. The pearl is to check ketones when unwell on SGLT2 therapy, but not every symptom is DKA.

Reference: BNF, NICE NG28