While SGLT-2 inhibitors are often used off label in type 1 diabetes (aka not FDA approved for use in type 1 diabetes), FDA rejected expanding indication of dapagliflozin (Farxiga) for type 1 diabetes. This is disappointing news yet hope is not lost .
For those with type 1 diabetes using SGLT-2 inhibitor, risk for DKA is real and serious so it is important to check for ketones daily. Please seek medical attention immediately if you suspect DKA. Below is the STICH protocol for treating DKA associated with SGLT-2 inhibitors.
STop SGLT inhibitor immediately (will need to do stop for a few days)
Insulin administration
Carbohydrate (30 grams or less) consumption
Hydration with beverage (water or non-caloric athletic drink with balanced carbohydrates. Adults 8 oz of fluid every 30 – 60 minutes)
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