Non-carbohydrate anaplerotic therapy counters empagliflozin-induced diabetic ketosis

Intravenous glycerol reduced empagliflozin-induced ketosis and provided protection against hypoglycemia. When used as an insulin adjunct, it enhanced insulin resolution of severe diabetic ketosis induced by empagliflozin. Dietary glycerol supplementation improved the energetic state and reduced the risk of ketosis in diabetic sheep undergoing SGLTi therapy. These findings may have clinical relevance for DKA management and nutritional prevention, particularly but not necessarily under SGLTi therapy.