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With Diabetes, Symptoms Are Not Always as Expected

Dec 7, 2015

Male, 72 years of age, type 2, insulin requiring diabetes, also taking SGLT-2. Annual physical. No urinary complaints during the visit. Received annual lab work end of work day, glucose elevated much higher than he reports. WBC elevated, 1200, no urine culture, but U/A did show cloudy, leukocyte esterase 2+, wbc >60 H, bacteria many (>50) H, RBC 3-10, H.

Knowing patient could not get to lab for urine culture, increased risk for sepsis. Called patient, prescribed antibiotic, discontinued SGLT-2. Patient said he recently noticed increased nocturia. Going to the urologist to check that out the next day.


Spoke with patient the next day, urologist agreed with antibiotic orders and prescribed an alpha blocker for BPH.

Lessons Learned:

  • Importance of knowing and being aware of side effects of certain medications, such as an increase in risk UTI when taking SGLT-2 inhibitors. Stop if suspect UTI.
  • Although best to get a urine culture before treating UTI, sometimes not always possible to either obtain or get results in a timely manner
  • People with diabetes do not always have the typical symptoms of UTI. Look at the whole picture and treat. Antibiotic therapy is better than sepsis!


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