SGLT2 Inhibitor Sick-Day Rules Every Patient Should Know

At the New England Institute of Ambulatory Care Pharmacists (NEIAP) 2026 Annual Forum in Boston, Massachusetts, Katelyn O'Brien, PharmD, BCPS, CDCES, BC-ADM, clinical pharmacy specialist in endocrinology at Boston Medical Center, highlighted the dosing, safety-monitoring, and patient-education priorities for sodium-glucose cotransporter 2 (SGLT2) inhibitors.

O'Brien said that when she initiates an SGLT2 inhibitor, she counsels patients on common genitourinary side effects and, importantly, on the risk of euglycemic diabetic ketoacidosis (DKA). Her core education point is sick-day management: holding the medication when patients are ill—for example, with influenza or COVID-19—and holding it before planned procedures, both to prevent DKA. She stressed that this counseling matters not only at initiation but on an ongoing basis, noting that patients established on therapy for years may forget these precautions if they haven't been sick, which makes reminders heading into flu season valuable.

On adjusting pharmacotherapy safely, O'Brien described a pharmacy "hub" that extends beyond clinical pharmacists. At her institution, pharmacy technicians help secure prior authorization approvals and coordinate with on-site outpatient pharmacies on filling, delivery, and swapping one medication for another. Retail-role pharmacists help ensure there is no duplication of therapy. Across that spectrum, she emphasized communicating changes to other care team members, since the pharmacist may not be the next provider to see the patient—for instance, noting that labs have been ordered or that a sulfonylurea is being stopped to reduce hypoglycemia and weight-gain risk, and confirming the discontinuation is executed at the pharmacy so it isn't refilled after being removed from the patient's profile.