JR, a 67-year-old with type 2 diabetes for seven years and an A1C of 9.7% was started on empagliflozin 10mg two weeks ago. Other labs include a GFR of 49 and a UACR of 34 mg/g. Other diabetes medications include glucotrol 10mg twice daily and sitagliptin 100mg daily. JR sometimes has a few shot’s of whiskey before bed, especially if they had a stressful day. JR’s partner calls you in a panic and says JR is admitted to the hospital in DKA.
What is the most likely explanation?
- Excess alcohol intake leading to starvation ketosis
- Potential side effect of SGLT-2 Inhibitors
- Low GFR and elevated UACR increase hyperglycemic risk
- JR is misdiagnosed and likely has type 1 diabetes
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