SGLT2 Inhibitors and Ketoacidosis: Could Low Carb Diets Play a Role?

Published on January 26, 2017 by Sandy Liebhard

New research suggests that low-carb diets may play a role in cases of diabetic ketoacidosis seen among patients taking SGLT2 inhibitors like Farxiga and Invokana. The study, which was published online last month  in Diabetes, Obesity, and Metabolism, is the first to demonstrate that these Type 2 diabetes drugs can enhance ketone production under low carbohydrate conditions.

SGLT2 Inhibitors are a new class of diabetes medications that prevent the absorption of glucose by the kidneys, thus facilitating its removal from the body via urine. SGLT2 inhibitors currently approved for sale in the U.S. include:

• Invokana
• Invokamet
• Farxiga
• Jardiance
• Xigduo XR
• Glyxambi

This latest study involved luseogliflozin, an SGLT2 inhibitor that isn’t sold in the U.S. However, the authors of the paper surmised that some incidents of diabetic ketoacidosis reported among U.S. patients also resulted from the combination of SGLT2 inhibitor and strict carbohydrate restriction.

SGLT2 Inhibitor Lawsuits

In December 2015, new warnings regarding a possible association with diabetic ketoacidosis were added to the labels of all SGLT2 inhibitors sold in the U.S.. The Food & Drug Administration (FDA)  has advised patients to stop taking their SGLT2 inhibitor and seek medical attention immediately if they develop any symptoms of ketoacidosis, including: nausea, vomiting, abdominal pain, tiredness, and trouble breathing. If not resolved quickly, ketoacidosis can lead to diabetic coma and even death.

A growing number of lawsuits have been filed on behalf of individuals who allegedly suffered ketoacidosis and other complications while using SGLT2 inhibitors, including Invokana, Invokamet, Jardiance, and Farxiga. This past December, the U.S. Judicial Panel on Multidistrict Litigation  centralized all federally-filed claims involving Invokana and Invokamet in New Jersey federal court, where they will undergo coordinated pretrial proceedings. However, the panel declined to include cases involving other SGLT2 inhibitors or those that cite than one  drug in the litigation.