In Patients With Type 2 Diabetes Who Are Taking A SGLT-2 Inhibitor And Have A History Of Diabetic Ketoacidosis, What Is The Optimal Protocol For Safely Discontinuing The SGLT-2 Inhibitor Prior To Elective Surgery, And What Specific Biomarkers And Clinical Parameters Should Be Monitored In The Perioperative Period To Minimize The Risk Of Recurrent DKA?
To safely discontinue SGLT-2 inhibitors in patients with type 2 diabetes and a history of DKA before elective surgery, the following protocol is recommended:
Preoperative Protocol:
- Discontinuation Timing: Stop the SGLT-2 inhibitor 3-4 days before surgery to allow the drug to be cleared and reduce DKA risk.
Monitoring:
- Blood Glucose: Monitor frequently to manage hyperglycemia and prevent hypoglycemia. Adjust insulin or other medications as needed.
- Ketones: Regularly check ketone levels, especially if symptoms like nausea or abdominal pain occur, using a meter or lab tests.
- Electrolytes: Monitor sodium, potassium, and phosphate levels to manage imbalances.
- Renal Function: Assess creatinine and BUN to evaluate kidney function.
Perioperative Management:
- Hydration: Ensure adequate hydration to prevent dehydration, a DKA risk factor.
- Stress Response: Manage hyperglycemia with insulin, considering surgery's stress-induced effects.
Postoperative Care:
- Restart Medications: Resume insulin and other antidiabetic medications as needed once stable. Consider restarting SGLT-2 inhibitors after the patient is eating and blood sugar is controlled.
- Individualized Approach: Tailor management based on the patient's history, usual blood sugar control, and medications.
Consultation:
- Endocrinologist: Involve for personalized advice, especially for complex cases.
This approach balances the risks of DKA and hyperglycemia, ensuring a safe surgical outcome.