My prescription guide of #SGLT2I - as an early adopter since late 2015

4+1 tweets which can kick start your career as a slayer of diabetic kidney disease, savior of lives and kidneys.
Written from the perspective of cardiorenal reduction and includes level of evidence

1. Start low since you don't need to go high in dose (RCT)
2. Check eGFR at 4 weeks to detect acute drop. If less than 30%, it is expected (RCT)
3. Can use in those not taking ACEI/ARB (post hoc RCT analyses)
4. Don't do keto diet/but do sick days for ketoacidosis(common sense)

5. Insulin requirements will usually go down , so monitor the antiglycemic regimen the 1st month (observation)
6. Low risk for hypoglycemia if just on orals (RCT)
7. If insurance covers, use as combo with metformin (common sense)
8. Prescribe under the CV/renal indication (label)

9. You usually don't have to change the diuretics unless the patient is volume depleted *similar to ACEI/ARB* (common sense)
10. Use the @Medscape app to look up formularies - many plans have at least one SGLT2i on formulary. Use the one the insurance will cover

11. Remember people with diabetes will get fungal infections anyway. These are treatable but dialysis isn't, so the small additional excess of infections of a common problem is a nuisance than a major clinical issue (common sense)