A 33-Year-Old Man Presented with Abdominal Pain and Vomiting Starting a Day Ago

Abstract

Sodium-glucose cotransporter-2 (SGLT-2) inhibitors are expanding their role beyond the glucose-lowering effects to include reducing body weight and managing the risk of cardiovascular and renal diseases. Accordingly, the number of people with type 2 diabetes using these medications is rapidly increasing. To minimize the potential side effects and ensure safer use, it’s essential to time prescriptions correctly and educate patients thoroughly. Special caution is required when prescribing to patients with symptomatic and severe hyperglycemia who require insulin. Patients should be instructed to discontinue the medication immediately if they experience symptoms like abdominal pain, nausea, or vomiting. Moreover, if a patient taking SGLT-2 inhibitors is in poor general condition, diagnostic tests for euglycemic diabetic ketoacidosis should be performed, even if the blood glucose levels are not elevated. In such cases, prompt fluid resuscitation and intravenous insulin treatment should be initiated. Additionally, the risk of diabetic ketoacidosis may increase under acute stress conditions such as severe infections, trauma, or major surgery. Therefore, it may be necessary to discontinue SGLT-2 inhibitors and switch to other medications for blood glucose management in these situations.