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SGLT2 inhibitors known as the “flozins” including Jardiance, Farxiga, and Invokana lower blood glucose by forcing the kidneys to excrete sugar in the urine, normal blood glucose does not equal metabolic safety, SGLT2 inhibitors reduce insulin signaling and increase glucagon leading to rapid fat breakdown and ketone production, euglycemic DKA presents with severe metabolic acidosis despite glucose readings that appear normal, common symptoms include nausea vomiting abdominal pain weakness fruity breath and deep rapid respirations, nurses must check serum ketones and blood gas rather than relying on fingerstick glucose, the SAD MANS sick-day rule identifies medications to hold during acute illness including SGLT2 inhibitors ACE inhibitors diuretics metformin ARBs NSAIDs and sulfonylureas, dehydration dramatically increases risk for acute kidney injury and DKA, urine output is the earliest and most reliable indicator of kidney distress, SGLT2 inhibitors must be stopped 72 hours prior to surgery per updated FDA guidance, treatment of euglycemic DKA requires IV insulin with concurrent dextrose infusion and close potassium monitoring, prevention through patient education sick-day kits and early nursing recognition is far safer than ICU-level rescue care

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The content presented in The Super Nurse Podcast is for educational purposes only and should not be considered medical advice. The host and creators are not responsible for any clinical decisions made based on this content. Always adhere to your institution’s policies and consult appropriate healthcare professionals when making patient care decisions.