Unexpected Acute Hyperglycemia Following Pre-Surgical Discontinuation of SGLT2 Inhibitors in a Type 1 Diabetic Patient

Abstract

Patient: Female, 47-year-old Final Diagnosis: Type 1 diabetes mellitus Symptoms: Hyperglycemia Clinical Procedure: — Specialty: Endocrinology and Metabolic Objective: Unusual or unexpected effect of treatment Background: Sodium-glucose transporter 2 (SGLT2) inhibitors serve as adjuncts in managing type 1 diabetes. Preoperative guidelines suggest discontinuing SGLT2 inhibitors to avoid associated adverse events. We report an unusual case of acute hyperglycemia following the discontinuation of SGLT2 inhibitors in a patient undergoing surgery, posing substantial challenges to glycemic control. Case Report: A 47-year-old female with type 1 diabetes was hospitalized for benign thyroid tumor surgery. She discontinued her SGLT2 inhibitors a day after admission. Unexpectedly, her glycemic control worsened with her mean sensor glucose value spiking from 109 mg/dL on admission to 273.9 mg/dL five days post-discontinuation. Despite increasing insulin doses, glycemic control remained suboptimal. The glucose level improved to a mean sensor value of 160.4 mg/dL only after SGLT2 inhibitors were resumed three days post-surgery. Conclusions: This report highlights a case of acute hyperglycemia following preoperative discontinuation of SGLT2 inhibitors in a patient with type 1 diabetes. Such changes in glucose levels were captured using intermittent continuous glucose monitoring. Given the potential for similar cases during preoperative discontinuation of SGLT2 inhibi-tors, it is advisable to intensify bolus insulin administration, under continuous glucose monitoring, in patients discontinuing SGLT2 inhibitors before surgery.