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Perioperative SGLT2 inhibitor-associated ketoacidosis — SCE Endocrinology MCQ

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HardDiabetesPerioperative SGLT2 inhibitor-associated ketoacidosisSCE Endocrinology

A 61-year-old man with type 2 diabetes on empagliflozin is listed for elective colectomy. Pre-assessment notes eGFR 68 ml/min/1.73 m² and HbA1c 61 mmol/mol. He asks what to do with his diabetes medicines before surgery. What is the underlying pathophysiology?

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Correct answer: D — SGLT2-driven glycosuria with relative insulin deficiency and increased ketogenesis

SGLT2 inhibitors can predispose to perioperative euglycaemic DKA through glycosuria, lower insulin secretion needs and increased glucagon-to-insulin ratio. The key mechanism is ketogenesis despite modest glucose values. This is why perioperative omission and ketone vigilance are emphasised.

Reference: Centre for Perioperative Care diabetes guideline, BNF