From the FDA Drug Label
Before initiating JARDIANCE, consider factors in the patient history that may predispose to ketoacidosis including pancreatic insulin deficiency from any cause, caloric restriction, and alcohol abuse In patients treated with JARDIANCE consider monitoring for ketoacidosis and temporarily discontinuing JARDIANCE in clinical situations known to predispose to ketoacidosis (e.g., prolonged fasting due to acute illness or surgery).
The patient should check ketones frequently when first starting JARDIANCE due to the risk of euglycemic DKA, especially if they have factors that predispose to ketoacidosis. The exact frequency is not specified, but it is recommended to monitor for ketoacidosis in patients treated with JARDIANCE, particularly in clinical situations that may predispose to ketoacidosis 1.
From the Research
When starting a patient on Jardiance (empagliflozin), I recommend checking ketones daily for the first 1-2 weeks, especially in patients with type 1 diabetes or those at higher risk for euglycemic diabetic ketoacidosis (euDKA). Patients should use urine ketone strips or blood ketone meters, with the latter being more accurate 2. Instruct patients to check ketones when they feel unwell, even if blood glucose levels are normal (below 250 mg/dL), as euDKA can occur without significant hyperglycemia. Risk factors for euDKA include insulin deficiency, reduced carbohydrate intake, alcohol consumption, surgery, acute illness, or dehydration. Educate patients about euDKA symptoms including nausea, vomiting, abdominal pain, fatigue, and rapid breathing. If moderate to large ketones are detected, patients should contact their healthcare provider immediately, increase fluid intake, and may need to temporarily discontinue Jardiance. This monitoring approach is important because SGLT2 inhibitors like Jardiance increase urinary glucose excretion and can promote ketone production while maintaining relatively normal blood glucose levels.
Some key points to consider when monitoring ketones in patients starting Jardiance include:
- The importance of daily ketone monitoring for the first 1-2 weeks, especially in high-risk patients 3, 4
- The use of urine ketone strips or blood ketone meters, with blood ketone meters being more accurate 2
- The need to educate patients about euDKA symptoms and the importance of seeking immediate medical attention if moderate to large ketones are detected
- The potential for euDKA to occur without significant hyperglycemia, making it essential to monitor ketones even if blood glucose levels are normal 5, 2
Overall, the monitoring approach should prioritize the patient's safety and well-being, with a focus on preventing and promptly treating euDKA. By following these recommendations, healthcare providers can help minimize the risk of euDKA in patients starting Jardiance.