SGLT2抑制剂（sodium-glucose cotransporter-2 inhibitors ，SGLT2i，如卡格列净），可导致酮体升高，甚至糖尿病酮症酸中毒，这篇综述了这种现象发生的机制
SGLT2i on kidney enhance glucose excretion and causes the reabsorption of ketone bodies. In pancreas, there is contemplation that SGLT2i inhibit beta cells causing increased lipolysis, adding to the pool of ketone bodies [16-18]. They also have been found to stimulate alpha cells of the pancreas, inciting the release of glucagon and causing an imbalance in glucagon/insulin levels [18,19].
看到这一段受到启发，也许糖尿病是患者本身就需要血糖提高，原来5mmol/L就能满足需要，患者血糖利用率下降，现在需要10mmol/L才够
当使用SGLTi时，快速降低血糖到看起来正常的5mmol/L，但此时的血糖所能提供的能量对于患者的代谢是不够的，就得通过增加脂肪分解以及胰高血糖素的分泌（拉高血糖）提供更多能量