Anne L. Peters, MD has published some thoughts on using sodium-glucose cotransporter 2 (SGLT2) inhibitors in people with Type 1 diabetes. Early on, she noted that patients found they had less glycaemic variability, experienced some weight loss and some HbA1c reduction, and found their diabetes was easier to manage.
However, after using them in people with Type 1 diabetes for a few months, she began to notice that an usually high number were developing diabetic ketoacidosis (DKA) and realised that the increase in rates of DKA was due to the use of SGLT2 inhibitors.
Dr Peters then developed a specific protocol for the off-label use of SGLT2 inhibitors in her own patients: they monitored their ketones and she educated them about what to do, how to prevent DKA and how and when to stop the SGLT2 inhibitor.
She found that the protocol worked really well on patients on multiple daily insulin injections, and nobody went into DKA. However, she still saw SGLT2-induced DKA in patients on insulin pumps. As a result she tried using injected basal insulin in combination with pump systems so that these patients would always have some basal insulin that would help prevent DKA.
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