FOR PROVIDERS
What is euglycemic DKA and why are patients on SGLT2-inhibitors susceptible? What does this have to do with plant-based nutrition? Euglycemic diabetic ketoacidosis is a state of normal blood glucose in someone with diabetes who has elevated ketones and either low pH, low bicarbonate, and/or high anion gap. This condition can be deceiving in the ER, is dangerous, and has increased 7-fold since the wide prescription of SGLT2-inhibitors like Jardiance over the last decade. These drugs facilitate renal excretion of glucose, along with sodium and water. This feeds back on the liver to increase gluconeogenesis. Meanwhile, if the drug’s diuretic effect causes relative hypovolemia, the sympathetic response increases cortisol and glucagon which promote insulin resistance and fatty acid metabolism into ketones. This cascade can be triggered in patients on SGLT2-inhibitors if they skip their insulin, their pump malfunctions, they are busy/sick and skip meals, they go on a low-carb (eg, ketogenic) diet, etc. We owe patients on SGLT2-inhibitors education around these risk factors for EDKA including the need for regular meals containing complex carbohydrates. Keto diets and widespread SGLT2-inhibtor prescription are thus responses to the diabetes crisis with complications of their own–EDKA is just one. What would happen to diabetes prevalence if providers talked about whole plant foods as often as we talk about Jardiance and carb restriction?
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