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reinforce the importance of taking some form of regular carbohydrate the patient should be advised to contact their health care professional if glucose level increases beyond 17 mmol/L and/or the patient feels unwell, medical advice should be sought (2) SGLT2 inhibitors and risk of diabetic ketoacidosis: SGLT2 inhibitors increase the risk for diabetic ketoacidosis, particularly in patients with type 1 diabetes and those with certain high risk conditions in some cases blood glucose levels are normal or only mildly elevated, a condition known as euglycaemic ketoacidosis - this can delay the diagnosis it is advised to check ketones in patients taking SGLT2 inhibitors with symptoms or precipitating factors for ketoacidosis regardless of blood glucose levels (6) In DKA associated with use of SGLT2 inhibitors: over a third of patients with ketoacidosis associated with SGLT2 inhibitor have normal or only mildly elevated blood glucose levels ( = 3 mmol/L) or urine (ketonuria ++ or higher on urine dipsticks) - note that blood ketone testing is preferred over urine test strips as it is more accurate for detecting onset and resolution of ketosis acidosisserum bicarbonate 25 mmols/mol (3) It is appropriate to provide the patient with a simple and individualised plan for adjusting insulin based on blood glucose results Admission or specialist advice in type 2 diabetes (3,4) The decision to admit a person or seek specialist advice will depend on clinical judgement, taking into account the person's age, underlying comorbidities and complications, and the presence of hyperglycaemia and ketosis
Patience is not just a virtue here
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