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January 30 2025
A case report published recently in Proceedings of UCLA Health adds to the growing body of evidence indicating that SGLT2 inhibitor medications should...
A case report published recently in Proceedings of UCLA Health adds to the growing body of evidence indicating that SGLT2 inhibitor medications should not be combined with ketogenic diets owing to the increased risk for euglycemic ketoacidosis (eDKA).
A 50-year-old male with type 2 diabetes (T2D) presented to the hospital with numerous symptoms, including a blood glucose of 298 mg/dL, positive serum ketones, and a pH of 7.26. After ketoacidosis was identified, he was treated with an insulin drip and “judicious fluid resuscitation” and then transitioned onto scheduled long- and short-acting insulin.
The patient had recently started empagliflozin and metformin and also reported having been following a ketogenic diet combined with intermittent fasting.
As noted in the report, “Although ketogenic diets induce a state of ketosis, they alone are not commonly associated with DKA. However, their use with SGLT2 inhibitors has been reported to increase risk of eDKA.” The combination of a keto diet with this class of medication increases the risk, but as we covered in a past Research Forum, there have been reports of SGLT2is inducing ketoacidosis even in individuals not following keto.
Ketogenic diets are effective for helping reverse type 2 diabetes (T2D) and facilitating the reduction or discontinuation of numerous diabetes medications. Clinicians who recommend ketogenic diets for their patients with T2D typically advise discontinuing SGLT2is upon starting the diet precisely to avoid the risk of eDKA. This may be a more prudent approach for improving and possibly reversing the condition over the long term rather than encouraging a patient to continue on a high-carb diet “treated” with an SGLT2i and possibly other medications.
See this blog post for more details on the cautions that should be observed regarding medication management in patients who adopt a ketogenic diet.
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