Euglycaemic Diabetic Ketoacidosis

 People with type 2 diabetes are urged to check medications before their operation

Anaesthetists are warning people with type 2 diabetes that a particular type of medication prescribed in Australia for some patients with the condition may affect their recovery after an operation.

People taking the medication can occasionally become unwell with a condition called euglycaemic diabetic ketoacidosis (a potentially dangerous build-up of acid in the blood) during or after their operation and diagnosis can be delayed or missed because the patient’s blood sugar level does not increase.

Diabetic ketoacidosis is a serious complication when the body does not have enough insulin. This leads to the body using fat to produce energy and this process leads to the accumulation of acids (ketones) in the body.

“The stress on the body of surgery combined with prolonged fasting can increase the risk of diabetic ketoacidosis,” 

If diabetic ketoacidosis is not diagnosed and treated, more serious signs and symptoms including dehydration, confusion and coma can potentially develop. Some patients need Intensive Care Unit admission.

To try to avoid this complication, patients may be advised to stop these drugs one to three days before more major procedures such as a knee replacement, and one day before more minor procedures such as a colonoscopy.

These medications include dapagliflozin (Forxiga), empagliflozin (Jardiance), ertugliflozin (Steglatro) as well as fixed dose combinations with metformin (Xigduo, Jardiamet, Segluromet) or with gliptins (Glyxambi, Qtern, Steglujan).