Antidiabetic drugs: SGLT2 inhibitors: practice question

A Pharmacology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pharmacology · Antidiabetic drugs: SGLT2 inhibitors

Sample item

A woman with type 2 diabetes on empagliflozin presents with nausea, abdominal pain and deep breathing during an acute illness with poor oral intake. Glucose is 190 mg/dL, but blood ketones are high and the anion gap is raised. What is the diagnosis?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Euglycaemic diabetic ketoacidosis from SGLT2 inhibitor use

SGLT2 inhibitors cause glycosuria, lower insulin requirement and raise glucagon, which promotes ketogenesis. During illness, fasting or surgery, ketoacidosis can develop with near-normal glucose. They are stopped before surgery and during acute illness. They also predispose to genital mycotic infections.

Option by option

  • A. Alcoholic ketoacidosis

    Alcoholic ketoacidosis requires heavy drinking and no relation to this drug.

  • B. Euglycaemic diabetic ketoacidosis from SGLT2 inhibitor use (correct)

    Correct. Ketosis with only modestly raised glucose on this drug points to euglycaemic DKA.

  • C. Lactic acidosis from metformin

    Metformin lactic acidosis has high lactate but no marked ketonaemia and is rare.

  • D. Hyperosmolar hyperglycaemic state

    Hyperosmolar state shows very high glucose and minimal ketones.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Pharmacology question

What is the answer to this Pharmacology question?

The best answer is B, Euglycaemic diabetic ketoacidosis from SGLT2 inhibitor use. SGLT2 inhibitors cause glycosuria, lower insulin requirement and raise glucagon, which promotes ketogenesis.

Why is "Alcoholic ketoacidosis" not the answer?

Alcoholic ketoacidosis requires heavy drinking and no relation to this drug.

Why is "Lactic acidosis from metformin" not the answer?

Metformin lactic acidosis has high lactate but no marked ketonaemia and is rare.

Why is "Hyperosmolar hyperglycaemic state" not the answer?

Hyperosmolar state shows very high glucose and minimal ketones.

What concept does this question test?

It tests Antidiabetic drugs: SGLT2 inhibitors in Pharmacology. During illness, fasting or surgery, ketoacidosis can develop with near-normal glucose. They are stopped before surgery and during acute illness. They also predispose to genital mycotic infections.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Antidiabetic drugs: SGLT2 inhibitors?

Learn drugs as classes, then the exception in each class that an examiner would pick. Then use the flashcards and the other Pharmacology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.