Featured Article| Volume 19, ISSUE 3, 104527, March 2023

Important Dietary Considerations for Sodium-Glucose Cotransporter 2 Inhibitors

Published:February 02, 2023DOI:


      • Ketoacidosis is a rare but serious potential adverse effect of sodium-glucose cotransporter 2 (SGLT2) inhibitors.
      • A variety of factors may precipitate SGLT2 inhibitor–associated ketoacidosis.
      • There is a relationship between low-carbohydrate diets and ketoacidosis for those who take SGLT2 inhibitors.
      • Preventive strategies may help avoid ketoacidosis associated with SGLT2 inhibitors.
      • Clinicians should educate patients regarding dietary regimens that could increase risk with SGLT2 inhibitors.


      Sodium-glucose cotransporter 2 (SGLT2) inhibitors are a pharmacologic option for type 2 diabetes, and several benefits beyond glycemic lowering, including cardiovascular and renal, are associated with their use. However, some rare but serious potential adverse effects have been reported, including diabetic ketoacidosis (DKA) and euglycemic DKA. Certain dietary factors may increase the risk of SGLT2 inhibitor–associated ketoacidosis, such as low-carbohydrate and ketogenic diets, prolonged fasting, dehydration, and excess alcohol consumption. Clinicians should remain cognizant of precipitating factors; discuss modifiable risk factors with patients; and implement preventive strategies, such as withholding a SGLT2 inhibitor in situations associated with risk.


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      Angelina Anthamatten, DNP, FNP-BC, is an assistant professor at Vanderbilt University School of Nursing in Nashville, TN, and can be contacted at [email protected]