Definition: Diabetic ketoacidosis (DKA) is a life-threatening build-up of acids called ketones in the blood. It is the first listed serious risk on SGLT2 inhibitor labels such as Jardiance, Farxiga and Invokana, which warn it can happen even when blood sugar is under 250 mg/dL, making it easy to miss.
The Jardiance label says it greatly raises the risk of DKA in type 1 diabetes, with fatal cases, and that fatal ketoacidosis has also been reported in type 2. It names these triggers:
The Invokana label adds that it can last longer than expected, up to 2 weeks after stopping. In the DECLARE trial on the Farxiga label, DKA was reported in 27 of 8,574 people on Farxiga vs 12 of 8,569 on placebo.
Nausea, vomiting, stomach pain, tiredness or trouble breathing. The labels say to stop the drug and get medical help right away, even if blood sugar is under 250 mg/dL, and the Invokana label says to check for ketones if possible.
Insulin labels such as Lantus and Toujeo say they are not recommended for treating DKA, and metformin is contraindicated in it.
Several triggers are day-to-day events: a missed insulin dose, a sick day, a new low-carb diet. Logging them next to your SGLT2 inhibitor doses helps you and your prescriber connect symptoms to causes quickly.
Read more on Dose Track: Jardiance side effects · Farxiga side effects · Invokana side effects · Jardiance vs Farxiga