A 64-year-old client with type 2 diabetes and heart failure with reduced ejection fraction is starting empagliflozin 10 mg orally daily. Which teaching by the nurse is most important?

SGLT-2 inhibitors — patient teaching
SGLT-2 inhibitors (the gliflozins): empagliflozin (Jardiance), dapagliflozin (Farxiga), canagliflozin (Invokana), ertugliflozin (Steglatro). Block renal glucose reabsorption → glucosuria → glucose lowering, weight loss, BP reduction, cardiovascular and renal benefits in HF and CKD (independent of glucose).

Key teaching priorities:
• Sick-day hold: hold the SGLT-2 during prolonged vomiting, dehydration, hypoxia, planned surgery (3 days before), low oral intake, or any acute illness that could trigger ketoacidosis. Resume only when fully eating/drinking.
• Euglycemic DKA: severe nausea, vomiting, abdominal pain, dyspnea, fatigue — even with normal/low BG; check ketones; emergency evaluation. Mortality risk if missed.
• Genitourinary infections: monilial vaginitis, balanitis, UTI; teach hygiene, hydration, prompt reporting.
• Volume depletion / orthostatic hypotension: maintain adequate hydration; watch in elderly, diuretic users.
• Fournier gangrene (rare): severe perineal pain, swelling, fever — emergency.
• Lower-limb amputation (canagliflozin signal — historical; updated data): monitor foot care.
• Hypoglycemia risk LOW as monotherapy; risk increases with insulin or sulfonylurea co-prescription.
• Renal limits: dapagliflozin/empagliflozin generally allowed down to eGFR 20-25 for HF/CKD benefit; do not start in advanced CKD outside specific approvals.
• Strong CV/renal benefits in HFrEF and CKD — class is now recommended even without diabetes for these indications.

Clinical reasoning summary
SGLT-2 inhibitors — patient teaching
SGLT-2 inhibitors (the gliflozins): empagliflozin (Jardiance), dapagliflozin (Farxiga), canagliflozin (Invokana), ertugliflozin (Steglatro). Block renal glucose reabsorption → glucosuria → glucose lowering, weight loss, BP reduction, cardiovascular and renal benefits in HF and CKD (independent of glucose).

Key teaching priorities:
• Sick-day hold: hold the SGLT-2 during prolonged vomiting, dehydration, hypoxia, planned surgery (3 days before), low oral intake, or any acute illness that could trigger ketoacidosis. Resume only when fully eating/drinking.
• Euglycemic DKA: severe nausea, vomiting, abdominal pain, dyspnea, fatigue — even with normal/low BG; check ketones; emergency evaluation. Mortality risk if missed.
• Genitourinary infections: monilial vaginitis, balanitis, UTI; teach hygiene, hydration, prompt reporting.
• Volume depletion / orthostatic hypotension: maintain adequate hydration; watch in elderly, diuretic users.
• Fournier gangrene (rare): severe perineal pain, swelling, fever — emergency.
• Lower-limb amputation (canagliflozin signal — historical; updated data): monitor foot care.
• Hypoglycemia risk LOW as monotherapy; risk increases with insulin or sulfonylurea co-prescription.
• Renal limits: dapagliflozin/empagliflozin generally allowed down to eGFR 20-25 for HF/CKD benefit; do not start in advanced CKD outside specific approvals.
• Strong CV/renal benefits in HFrEF and CKD — class is now recommended even without diabetes for these indications.