From the Guidelines
Patients starting Jardiance (empagliflozin) should check for ketones daily for the first 1-2 weeks of treatment, then 2-3 times per week for the next few weeks, and during any illness, reduced food intake, or unusual symptoms. This monitoring is particularly important for patients with type 1 diabetes or those with type 2 diabetes who have low insulin production.
Key Considerations
- Patients should use urine ketone strips or a blood ketone meter (preferred if available) and contact their healthcare provider immediately if moderate to high ketone levels are detected, especially if accompanied by symptoms like nausea, vomiting, abdominal pain, or unusual fatigue.
- This monitoring is crucial because SGLT2 inhibitors like Jardiance increase the risk of diabetic ketoacidosis (DKA), sometimes with only mildly elevated blood glucose levels.
- Patients should be instructed on proper ketone testing technique and interpretation of results before starting treatment, as recommended by the American College of Cardiology 1.
Monitoring Frequency
- The frequency of ketone monitoring may vary depending on individual patient factors, such as history of diabetic ketoacidosis or presence of other comorbidities.
- However, the most recent consensus recommendations suggest that patients receiving SGLT2i, insulin, or on ketogenic diets should check ketones, especially during illness or reduced food intake 1.
Importance of Monitoring
- The risk of diabetic ketoacidosis associated with SGLT2 inhibitors like Jardiance highlights the importance of regular ketone monitoring, especially during the initial treatment period.
- By monitoring ketone levels and reporting any abnormalities to their healthcare provider, patients can help prevent and manage diabetic ketoacidosis, reducing the risk of morbidity and mortality.
From the Research
Ketone Checking for Patients Starting Jardiance
- The studies provided do not directly address the question of how long a patient should check for ketones when starting Jardiance (empagliflozin) 2, 3, 4, 5, 6.
- However, the studies do discuss the risk of diabetic ketoacidosis (DKA) associated with SGLT2 inhibitors like empagliflozin 2, 3, 4.
- Euglycemic DKA, a condition where DKA occurs with normal or only slightly elevated blood glucose levels, has been reported in patients taking empagliflozin 2, 4.
- The risk of DKA with SGLT2 inhibitors is a concern, and patients should be monitored for signs and symptoms of DKA, including ketones in the urine or blood 3, 4.
- The duration of ketone checking is not specified in the provided studies, but it is generally recommended that patients with type 2 diabetes who are starting SGLT2 inhibitors be educated on the risk of DKA and how to check for ketones 2, 3, 4.
Monitoring for DKA
- Patients should be advised to check for ketones if they experience symptoms such as nausea, vomiting, abdominal pain, or fatigue 2, 3, 4.
- The frequency and duration of ketone checking may vary depending on individual patient factors, such as the presence of other health conditions or the use of other medications 5, 6.
- Healthcare providers should use their clinical judgment to determine the appropriate monitoring plan for each patient starting Jardiance or other SGLT2 inhibitors 2, 3, 4.