When NOT to prescribe SGLT2 inhibitors ? By. Om J Lakhani

00:00 Discussing the interdisciplinary approach of nephrologists, cardiologists, and endocrinologists on prescribing SGLT2 inhibitors.
00:43 Highlighting the importance of prescribing SGLT2 inhibitors responsibly due to their powerful effects.
01:11 ⚠ Warning about the careful selection of patients for SGLT2 inhibitors to avoid negative outcomes.
02:06 Identifying Type 1 diabetes as a contraindication for SGLT2 inhibitors, with caveats for very specific cases.
03:34 Describing exceptional cases where SGLT2 inhibitors were prescribed to Type 1 diabetes patients with beneficial outcomes.
05:08 Discussing the grey area of ketosisprone Type 2 diabetes and the cautious approach required in prescribing SGLT2 inhibitors.
07:42 Explaining the complexity of identifying and managing patients with a history of ketosis before prescribing SGLT2 inhibitors.
08:10 Highlighting the challenge of diagnosing and managing euglycemic ketoacidosis in patients using SGLT2 inhibitors, especially postoperatively.
15:07 Advising against prescribing SGLT2 inhibitors to newly diagnosed diabetics with high HbA1c levels due to potential adverse effects.
17:44 Recommending a cautious approach to prescribing SGLT2 inhibitors to patients referred by urologists or those with a history of genitourinary tract infections.
18:40 Highlighting the potential for SGLT2 inhibitors to exacerbate conditions in patients already experiencing catabolism.
19:08 Cautioning against prescribing SGLT2 inhibitors to patients with a history of complicated or recurrent UTIs.
20:30 Sharing the significant impact of simple genital hygiene measures on reducing the risk of genitourinary tract infections (GTIs) in patients taking SGLT2 inhibitors.
21:39 ⚕ Advising caution when prescribing SGLT2 inhibitors to patients with acute or unknown kidney injuries due to the potential risk of triggering further complications.
23:14 Discussing the findings of a metaanalysis on the risk of perioperative euglycemic ketoacidosis, especially after bariatric surgery, in patients taking SGLT2 inhibitors.
27:25 Outlining the preoperative protocol for patients on SGLT2 inhibitors, including stopping the medication three days before elective surgery and monitoring for euglycemic ketoacidosis.
30:10 Highlighting that SGLT2 inhibitors are contraindicated for patients planning a pregnancy or already pregnant, and advising discontinuation before IVF treatments.
31:06 Sharing current guidelines on the safe use of SGLT2 inhibitors down to an eGFR of 20, and the recommendation to continue until dialysis is required, despite traditional contraindications suggesting stopping at an eGFR of 30.

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