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The sodium–glucose cotransporter 2 (SGLT2) inhibitors (canagliflozin [Invokana], empagliflozin [Jardiance], and dapagliflozin [Farxiga]) increase urinary excretion of glucose. These drugs are approved for use in type 2 diabetes, but anecdotal reports suggest that off-label prescribing to type 1 diabetic patients is increasing.
In May 2015, the FDA noted a possible association between SGLT2 inhibitors and diabetic ketoacidosis (DKA). Now, several endocrinologists describe 13 cases of euglycemic DKA in 9 diabetic patients (7 patients with type 1, and 2 patients with type 2) who were taking canagliflozin in addition to insulin. The designation “euglycemic DKA” refers to presentations with anion-gap acidosis and ketosis but serum glucose levels …