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Risk Factors for Developing EKA SGLT-2 or GLP-1 usage (SGLT-2s are more strongly associated than GLP-1s) Higher medication doses Any action or condition that increases ketone production, including: Fasting (e.g., intermittent fasting, preoperative/preprocedural fasting) Ketogenic diet Gastrointestinal illness (poor appetite, nausea, vomiting, diarrhea) Eating disorders (anorexia/bulimia) Alcohol intoxication Liver cirrhosis Pancreatitis Gastroparesis Insulin pump malfunction Low muscle mass Recent infection or surgery Type 2 diabetes with longstanding poor glucose control Prevention Strategies Emphasize the importance of hydration with water and electrolyte solutions Minimize alcohol intake Ensure meals and snacks contain 3035% carbohydrate content Avoid ketogenic or prolonged fasting diets Clinicians should consider temporarily discontinuing SGLT-2 and GLP-1 therapy before surgery or during acute illness Patients should not decrease basal insulin dose by more than 20% without consulting their provider Patients should avoid taking these medications within 3 days prior to fasting longer than overnight Symptoms of EKA Fruity-smelling breath Excessive thirst Polyuria or nocturia Nausea and vomiting Abdominal pain Confusion or altered mental status Fever Shortness of breath Patient Education and Action Patients taking SGLT-2 or GLP-1 medications should be instructed that if they experience nausea, vomiting, or diarrhea: Sip calorically dense electrolyte solutions (approximately 200 mL every 30 minutes), or Suck on hard candy, or Consume one tablespoon of sugar every 1520 minutes If symptoms persist, patients should withhold further doses of the medication and contact their primary care provider or seek emergency care

The big B12 catch-22

Researchers originally built it into a treatment for type 2 diabetes, not weight loss

Orforglipron , an oral GLP-1 agonist, has shown the ability to maintain weight loss in patients switching from injectable therapies

Here's how it applies to specific conditions: BPC-157 for Knee Injuries Research supports BPC-157 for patellar tendinopathy, meniscus support, ACL recovery support, and post-surgical knee rehab

The manufacturer of tirzepatide (Mounjaro, Zepbound) advises females using birth control pills to switch to a non-oral contraceptive method or add a barrier method of contraception (like a condom) for 4 weeks after you start treatment and for 4 weeks after each dose increase