DOI: 10.36347/sjmcr.2020.v08i11.008

Pages: 961-964

Beneficial effects of sodium-glucose co-transporter 2 (SGLT2) inhibitors, a new class of oral antidiabetic medications, have been shown in patients with type 2 diabetes and subsequently with type 1 diabetes. Since SGLT2 inhibitors lower blood glucose levels by increasing urinary glucose excretion, insulin doses often need to be reduced to avoid hypoglycemia, leading to increased ketone body formation and, possibly, euglycemic diabetic ketoacidosis. In this case report, we present a type 1 diabetic patient treated with a sensor-augmented insulin pump, who was satisfied with almost normal HbA1c levels and favorable weight loss after adding ipragliflozin, an SGLT2 inhibitor. The insulin pump MiniMed 640G featured with automated suspension and restart of insulin delivery was demonstrated to be effective and useful to prevent severe hypoglycemia and, probably, diabetic ketoacidosis. The extent of ketonemia seemed to vary with changes in pathophysiological factors. Patients and clinicians should be aware of a STICH protocol to mitigate the risk of diabetic ketoacidosis in patients with type 1 diabetes on adjunctive treatment with SGLT inhibitors.