Tips for Starting an SGLT2 Inhibitor

SGLT2 inhibitors (e.g., empagliflozin, dapagliflozin, and canagliflozin) have a strong evidence base in diabetes, heart failure, and chronic kidney disease. A safe start requires an individualized plan.

1. Have an individualized sick-day plan

Ask your prescriber when to pause the medication during vomiting, diarrhea, poor oral intake, fever, or another illness that could cause dehydration, and when it is safe to restart.

2. Make a perioperative plan

Ask your prescriber exactly when to stop the medication before surgery and when to restart it. Timing is drug- and procedure-specific, and temporary interruption reduces the risk of perioperative ketoacidosis.

3. Review diuretics and volume status with the prescriber

SGLT2 inhibitors have diuretic-like effects. The prescriber may need to review the diuretic dose and reassess blood pressure, volume status, and kidney function after initiation.

4. Review insulin and sulfonylurea doses with the prescriber

SGLT2 inhibitors rarely cause hypoglycemia on their own, but insulin or a sulfonylurea may need review when therapy begins. Do not reduce either medication without the prescriber’s plan.

5. Type 1 diabetes requires specialist guidance

Because of the risk of diabetic ketoacidosis, SGLT2 inhibitors are not routinely used for type 1 diabetes. Any exceptional use requires specialist supervision and detailed ketone and sick-day education.

6. Know how to reduce and recognize genital infection risk

SGLT2 inhibitors increase glucose in the urine and can increase genital yeast infections. Routine gentle hygiene, keeping the area dry, and seeking care promptly for new itching, irritation, discharge, pain, or recurrent infection can help. A clinician can discuss individual risk and prevention.

7. Use the evidence-based dose for the chosen indication

Dosing depends on the specific medication, indication, kidney function, and current product information. Do not start, stop, or adjust the dose without the prescriber’s plan.