Diabetic Ketoacidosis with Dapagliflozin

Introduction to DKA Risk Factors

Diabetic ketoacidosis with dapagliflozin occurs only in patients who have specific precipitating factors that trigger insulin deficiency or increased counterregulatory hormones, not from the drug alone 1
DKA requires two conditions: reduced effective insulin action AND elevated counterregulatory hormones (glucagon, catecholamines, cortisol, growth hormone) that drive lipolysis and ketone production 1
Patients with low C-peptide levels indicating minimal residual beta-cell function are vulnerable because they cannot compensate when insulin is reduced 1
The American Diabetes Association recommends that patients taking dapagliflozin should be aware of the risk of DKA, particularly in the presence of precipitating factors such as acute febrile illness or infection 1

Withhold dapagliflozin at least 3 days before major surgery or procedures requiring prolonged fasting to prevent postoperative ketoacidosis 2
Hold dapagliflozin during acute illness, particularly with fever, vomiting, diarrhea, or reduced oral intake 2
Maintain at least low-dose basal insulin in insulin-requiring patients even when dapagliflozin is held—complete insulin cessation dramatically increases DKA risk 2