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Updated: Aug 29, 2025

Improving IV Insulin Administration in a Community Hospital
Published on: June 11, 2012
[Hypoglycemia in a patient treated with a SGLT2-inhibitor with HFrEF without diabetes mellitus]
Hendrik Schmidt1,2, Axel Schlitt2,3
1Klinik für Kardiologie und Diabetologie, Klinikum Magdeburg.
Anamnese:
HFrEF (heart failure with reduced ejection fraction) with a left ventricular ejection fraction of 25-30 % was detected in a 79-year-old man. For further treatment, inpatient cardiac rehabilitation war carried out.
Clinical Findings:
At the start of the cardiac rehabilitation, patient complained of shortness of breath with little exertion, corresponding to NYHA III. Drug therapy included empagliflozin 10 mg, sacubitril/valsartan 24/26 mg, edoxaban 60 mg, torasemide 5 mg, verapamil 80 mg and amiodarone 200 mg.
Investigations:
The daily blood sugar profile showed hypoglycemia with values < 3.7 mmol/l (< 67 mg/dl). After consultation with the patient, these occurred with normal food intake and were symptomatic in form of dizziness during the period of hypoglycaemia.
Diagnosis:
Symptomatic hypoglycaemia on SGLT2(sodium-glucose linked transporter 2)-inhibitor therapy in a patient with HFrEF without diabetes mellitus.
Therapy And Progress:
The therapy with empaglifozin was stopped and a new daily blood sugar profile was carried out, which no longer showed any hypoglycaemic values.
Conclusion:
The presented case raises awareness of the side effect of hypoglycaemia, which occurs very rarely with SGLT2 inhibitors in studies in patients with HFrEF without the presence of diabetes mellitus.
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