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SGLT2 Inhibitors to be Stopped Prior to Surgery

The Food and Drug Administration has approved safety labeling changes to all sodium-glucose transporter 2 (SGLT2) inhibitors used to treat high blood sugar in patients with type 2 diabetes.

The new changes affect canagliflozin, dapagliflozin, empagliflozin, and ertugliflozin, and were made because surgery may put patients being treated with SGLT2 inhibitors at a higher risk of ketoacidosis. Canagliflozin, dapagliflozin, and empagliflozin should be discontinued 3 days before scheduled surgery, and ertugliflozin should be stopped at least 4 days before, the agency noted in a press release. Blood glucose should be monitored after drug discontinuation and appropriately managed before surgery.

“The SGLT2 inhibitor may be restarted once the patient’s oral intake is back to baseline and any other risk factors for ketoacidosis are resolved,” the agency added.

SGLT2 inhibitors lower blood sugar by causing the kidney to remove sugar from the body through urine. Side effects for the drugs vary, but include urinary tract infections and genital mycotic infection. Patients with severe renal impairment or end-stage renal disease, who are on dialysis treatment, or who have a known hypersensitivity to the medication should not take SGLT2 inhibitors, the FDA said.

Source : Medscape

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COVID-19 : How to quarantine yourself at home

The government issued the instructions for contacts who are being home quarantined.

The home quarantined person should :

  • Stay in a well-ventilated single-room preferably with an attached/separate toilet. If another family member needs to stay in the same room, it’s advisable to maintain a distance of at least 1 metre between the two.
  • Needs to stay away from elderly people, pregnant women, children and persons with co-morbidities within the household.
  • Restrict his/her movement within the house.
  • Under no circumstances attend any social/religious gathering e.g. wedding, condolences, etc.

The person should also follow the under mentioned public health measures at all times :

  • Wash hands as often thoroughly with soap and water or with alcohol-based hand sanitizer.
  • Avoid sharing household items e.g. dishes, drinking glasses, cups, eating utensils, towels, bedding, or other items with other people at home.
  • Wear a surgical mask at all the time. The mask should be changed every 6-8 hours and disposed off. Disposable masks are never to be reused.
  • Masks used by patients/care givers/close contacts during home care should be disinfected using ordinary bleach solution (5%) or sodium hypochlorite solution (1%) and then disposed of either by burning or deep burial.
  • Used mask should be considered as potentially infected.
  • If symptoms appear (cough/fever/difficulty in breathing), he/she should immediately inform the nearest health centre or call 011-23978046.

Instructions for the family members of persons being home quarantined :

  • Only an assigned family member should be tasked with taking care of the such person.
  • Avoid shaking the soiled linen or direct contact with skin.
  • Use disposable gloves when cleaning the surfaces or handling soiled linen.
  • Wash hands after removing gloves.
  • Visitors should not be allowed.
  • In case the person being quarantined becomes symptomatic, all his close contacts will be home quarantined (for 14 days) and followed up for an additional 14 days or till the report of such case turns out negative on lab testing.

Environmental sanitation :

  • Clean and disinfect frequently touched surfaces in the quarantined person’s room (e.g. bed frames, tables etc.) daily with 1% Sodium Hypochlorite Solution.
  • Clean and disinfect toilet surfaces daily with regular household bleach solution/phenolic disinfectants.
  • Clean the clothes and other linen used by the person separately using common household detergent and dry.

Duration of home quarantine :

The home quarantine period is for 14 days from contact with a confirmed case or earlier if a suspect case (of whom the index person is a contact) turns out negative on laboratory testing.