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SGLT2 inhibitor sick-day management — SCE Endocrinology MCQ

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HardDiabetes mellitusSGLT2 inhibitor sick-day managementSCE Endocrinology

A 60-year-old man has type 2 diabetes and recurrent urinary infections. HbA1c is 71 mmol/mol on metformin and empagliflozin. He presents with fever, loin pain, glucose 16 mmol/L, ketones 0.3 mmol/L and eGFR 38 ml/min/1.73 m2. What is the most appropriate management of empagliflozin?

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Correct answer: A — Withhold empagliflozin during acute illness and restart after recovery if benefits still outweigh risks

Withhold empagliflozin during acute illness and restart after recovery if benefits still outweigh risks is best because SGLT2 inhibitors should be paused during acute severe illness or dehydration to reduce ketoacidosis and renal risk. The alternatives are less appropriate because continuation or dose increase is unsafe in sepsis; antibiotics are still needed; SGLT2 inhibitors do not remove the need for standard hyperglycaemia management. The SCE teaching point is to integrate the clinical pattern, biochemistry and context rather than treating an isolated result.

Reference: NICE NG28; MHRA SGLT2 safety advice