SGLT2 Inhibitors and Fournier’s Gangrene: What You Need to Know Now

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SGLT2 Inhibitors and Fournier’s Gangrene: What You Need to Know Now
By Kalisha Nurse-Dash 8 January 2026

Fournier's Gangrene Risk Calculator

Assess Your Risk

This tool helps you understand your risk of Fournier's gangrene while taking SGLT2 inhibitors based on key medical factors. The FDA reports 1.9 cases per 100,000 patient-years. Early detection is critical - each hour of delay increases mortality by 9%.

When you’re managing type 2 diabetes, taking a medication like SGLT2 inhibitors can feel like a win-better blood sugar control, less weight gain, and real protection for your heart and kidneys. But there’s a rare, dangerous side effect you won’t hear much about: Fournier’s gangrene. It’s not common. But when it happens, it can kill you in days if you don’t act fast. This isn’t a scare tactic. It’s a reality backed by the FDA, the UK’s MHRA, and dozens of medical case reports. If you’re on one of these drugs, you need to know the warning signs-and what to do the moment they show up.

What Are SGLT2 Inhibitors?

SGLT2 inhibitors are a class of diabetes medications that work by making your kidneys flush out extra sugar through urine. That’s it. No insulin needed. The first one, canagliflozin (Invokana), got FDA approval in 2013. Since then, four others joined the list: dapagliflozin (Farxiga), empagliflozin (Jardiance), ertugliflozin (Steglatro), and a few generics. They’re popular because they don’t cause low blood sugar like some older drugs, and they’ve been shown to cut heart failure hospitalizations by up to 30% in high-risk patients.

But here’s the catch: when sugar ends up in your urine, it doesn’t just disappear. It sticks around near your genitals and anus. Bacteria love sugar. And in some people, that creates the perfect storm for a rare, aggressive infection called Fournier’s gangrene.

What Is Fournier’s Gangrene?

Fournier’s gangrene is a type of necrotizing fasciitis-it’s not just a skin infection. It eats through the layers of tissue under your skin, starting in the genital or anal area. The bacteria involved are often a mix of E. coli, staph, and anaerobic bugs that normally live harmlessly in your gut. But when they get into the wrong place, they spread fast. Within hours, the tissue turns black. Swelling explodes. Fever spikes. Pain becomes unbearable.

It’s rare. But deadly. About 4 to 8% of people who get it die-even with surgery and antibiotics. And while it mostly affects men, about one-third of reported cases in Europe were in women. That’s important. This isn’t just a male problem.

The Link Between SGLT2 Inhibitors and Fournier’s Gangrene

The FDA first flagged this link in 2018 after 12 cases were reported between 2013 and 2018. That’s not a lot-but each case was severe. Since then, more have popped up. By 2024, the estimated risk was about 1.9 cases per 100,000 patient-years. That sounds tiny. But here’s the math: if 10,000 people take an SGLT2 inhibitor for a year, roughly one might develop Fournier’s gangrene. For comparison, the risk of a heart attack from stopping your blood pressure meds? Much higher. But this one? It’s silent. Fast. And avoidable-if you know what to look for.

Why does this happen? Three reasons:

  • Sugar in urine = bacteria buffet
  • High glucose levels weaken local tissue defenses
  • Some evidence suggests these drugs may slightly dampen immune response in the genital area

And here’s something critical: almost all the reported cases involved people with poorly controlled diabetes. HbA1c above 9%. That’s not a coincidence. High blood sugar already weakens your immune system. Add sugar in your urine? That’s a double hit.

Silhouette with spreading black infection and emergency icons beside a clock

Early Warning Signs You Can’t Ignore

If you’re on an SGLT2 inhibitor, here’s your checklist of red flags. Don’t wait. Don’t think it’s a yeast infection or a pimple. Don’t brush it off. If you have any of these, go to the ER now:

  • Sudden, severe pain in your genitals, perineum, or anus
  • Swelling that spreads quickly-within hours
  • Red, hot, or shiny skin that looks bruised or discolored
  • Fever over 101°F (38.3°C)
  • Malaise-feeling like you’re dying, even if you don’t know why
  • Crackling under the skin (crepitus) when you touch the area
  • Black or dead-looking skin patches

These symptoms don’t show up slowly. They explode. One day you feel fine. The next, you can’t sit down. That’s not normal. That’s an emergency.

What to Do If You Suspect Fournier’s Gangrene

Time is tissue. And tissue is life. If you think this is happening:

  1. Stop taking your SGLT2 inhibitor immediately.
  2. Call 911 or go to the nearest emergency room. Say: “I’m on an SGLT2 inhibitor and I think I have Fournier’s gangrene.”
  3. Don’t wait for a primary care appointment. Don’t call your pharmacist. Go now.
  4. Bring your medication bottle with you.

At the hospital, they’ll do a CT scan or ultrasound to check for gas in the tissue-signs of infection spreading under the skin. Blood tests will show infection markers. But the real treatment? Surgery and antibiotics. Fast. Within hours.

Each hour of delay increases your risk of death by about 9%. That’s not a guess. That’s from a 2022 study in Cureus. If you wait 24 hours, your survival odds drop sharply. This isn’t a “wait and see” situation.

Who’s at Highest Risk?

Not everyone on SGLT2 inhibitors will get this. But some people are more vulnerable:

  • Men over 50 with diabetes
  • People with HbA1c above 9%
  • Those with a history of genital yeast infections or urinary tract infections
  • People with obesity, poor hygiene, or weakened immune systems (from steroids, chemo, HIV, etc.)
  • Anyone with recent genital trauma or surgery

Women are at lower risk-but not zero. One-third of cases in Europe were in women. Don’t assume it can’t happen to you.

Doctor and patient with medical checklist highlighting risk factors

Should You Stop Taking Your SGLT2 Inhibitor?

No-not unless you have symptoms. These drugs save lives. They reduce heart failure hospitalizations. They slow kidney disease. For most people, the benefits far outweigh the risk. The FDA, the American Diabetes Association, and the European Medicines Agency all still recommend them.

What you need is awareness, not fear. Talk to your doctor. Ask: “Am I at higher risk for this?” If your HbA1c is 7.5% and you’ve never had a yeast infection? You’re fine. If your HbA1c is 10.5% and you get urinary infections every few months? Maybe it’s time to reconsider.

But don’t quit cold turkey. Stopping suddenly can spike your blood sugar. Work with your provider to switch safely if needed.

What Doctors Are Doing Now

Since 2018, every SGLT2 inhibitor label has a boxed warning-the strongest type the FDA gives. Pharmacists are supposed to hand out patient guides. But many don’t. That’s why you need to be your own advocate.

Some clinics now use checklists before prescribing: “Have you had genital infections in the past year?” “Is your HbA1c under 8%?” “Do you have any immune issues?” If your doctor doesn’t ask, ask them.

Regulators are still tracking cases. The FDA’s FAERS system and the EU’s EudraVigilance database are collecting reports. So far, no new drugs in this class have been pulled. But the warning is clear: this is real. And it’s preventable-with knowledge.

Bottom Line: Stay Informed, Not Afraid

SGLT2 inhibitors are powerful tools. But like any tool, they come with risks. Fournier’s gangrene is rare. But it’s terrifying. And it doesn’t care if you’re young, old, male, or female. It only cares if you’re unaware.

If you’re on one of these drugs, keep your blood sugar under control. Practice good hygiene. Don’t ignore genital pain. And if something feels wrong-go to the ER. Don’t wait. Don’t call your doctor first. Go. Because in this case, seconds matter more than schedules.

You didn’t start this medication to risk your life. You started it to live better. Stay informed. Stay alert. And don’t let silence kill what you’re trying to protect.

Tags: SGLT2 inhibitors Fournier's gangrene diabetes drugs early warning signs diabetic complications

Comments:

  • Meghan Hammack

    Meghan Hammack

    January 9, 2026 AT 01:55

    OMG I just read this and my heart dropped. My dad’s on Farxiga and he’s had three yeast infections in six months. I’m printing this out and handing it to him right now. Don’t wait for it to get bad - go to the ER if something feels off. Seriously.

  • RAJAT KD

    RAJAT KD

    January 9, 2026 AT 03:10

    High HbA1c + SGLT2i = perfect storm. The data is clear. Prevention is simple: control glucose, monitor hygiene, act fast. No excuses.

  • Jacob Paterson

    Jacob Paterson

    January 9, 2026 AT 07:18

    Of course the FDA didn’t pull these drugs. Pharma makes billions. Meanwhile, people are dying in pain because no one told them to check their crotch for black spots. Thanks, capitalism.

  • Angela Stanton

    Angela Stanton

    January 11, 2026 AT 03:42

    So… sugar in urine = bacterial buffet? 🤔 That’s like leaving a candy bar in your underwear for E. coli to throw a rave. Not rocket science. But apparently, it’s too much for most patients to connect the dots. 😒

  • Catherine Scutt

    Catherine Scutt

    January 11, 2026 AT 19:02

    I’ve been on Jardiance for two years. Never had an issue. But now I’m paranoid every time I pee. Thanks for that.

  • Darren McGuff

    Darren McGuff

    January 12, 2026 AT 17:54

    As a GP in the UK, I’ve seen two cases in five years. Both were men over 60 with HbA1c >10%. They survived because they came in within 6 hours. The key isn’t fear - it’s awareness. Tell your patients. Print this. Share it.

  • Johanna Baxter

    Johanna Baxter

    January 13, 2026 AT 16:59

    I’m a woman and I just Googled ‘Fournier’s gangrene’ and now I’m crying in my car. I’m on Invokana. I’m scared. I’m mad. I don’t even know who to talk to.

  • Chris Kauwe

    Chris Kauwe

    January 14, 2026 AT 12:58

    The real issue isn’t the drug - it’s the systemic failure of medical education. Why are patients only learning about this after a CT scan shows gas in their scrotum? The FDA warning is a Band-Aid on a hemorrhage. We need mandatory pre-prescription counseling, not just a footnote in a 50-page label. This is negligence dressed as pharmacology.


    Let’s be honest: if this were a cancer drug causing 1.9 cases per 100k, the media would be screaming. But because it’s a diabetic drug affecting ‘private areas,’ it’s treated like a shameful secret. That’s the real disease here.


    And don’t get me started on the ‘good hygiene’ advice. You think I’m not washing? You think I’m not changing my underwear? This isn’t about being dirty - it’s about biology meeting bureaucracy. We need better screening tools, not shame.


    Stop telling people to ‘just go to the ER.’ What if they can’t afford it? What if they don’t have transportation? What if they’re undocumented? The system fails them long before the infection starts.


    And yes - I know the benefits outweigh the risks. But that’s not the point. The point is: we could do better. We have the data. We have the tools. We just don’t have the will.


    Next time you write a drug label, ask yourself: who’s this for? The insurance company? Or the person whose life depends on you not being lazy?

  • Pooja Kumari

    Pooja Kumari

    January 16, 2026 AT 05:25

    I just got off the phone with my endo and she said ‘it’s rare’ and ‘don’t worry’ and I just started crying. I’ve had three UTIs this year. I’m 42. I’m a single mom. I can’t afford to get sick. I can’t miss work. I can’t go to the ER and get a $15k bill and then lose my job because I’m too weak to come back. I just wanted to control my sugar. Why does everything have to be so dangerous? Why can’t medicine just be simple? I feel like I’m being punished for being diabetic. I didn’t ask for this. I didn’t choose this. And now I’m scared to take my medicine. And I don’t know what to do.


    My daughter asked me today why I cry so much. I told her I’m just tired. But I’m not tired of the sugar. I’m tired of the fear. I’m tired of being told to ‘stay positive’ while my body feels like a warzone. I don’t want to be brave. I just want to be safe.


    Can someone please tell me what to do? Not ‘go to the ER’ - I know that. Not ‘talk to your doctor’ - I did. I need someone to hold my hand and say ‘you’re not alone.’ Because right now, I feel like I’m the only one who sees this.

  • Matthew Maxwell

    Matthew Maxwell

    January 17, 2026 AT 03:55

    It is a moral failing of the highest order to prescribe SGLT2 inhibitors without first ensuring the patient has achieved glycemic control via diet and exercise. To treat diabetes with pharmaceuticals while ignoring foundational lifestyle interventions is not medicine - it is complicity in self-destruction. The patient who permits HbA1c to rise above 9% is not a victim; they are an active participant in their own demise.


    Furthermore, the normalization of ‘go to the ER’ as a default response reflects a collapse of personal responsibility. If you cannot manage your blood sugar, you should not be given drugs that amplify biological risk. The solution is not more warnings - it is stricter prescribing criteria. This is not a drug problem. It is a character problem.

  • Drew Pearlman

    Drew Pearlman

    January 17, 2026 AT 22:14

    I’m not scared of the drug. I’m scared of how little we talk about this. My cousin died from this in 2021. He was 54. He had type 2 for 12 years. He never told anyone he was in pain because he thought it was ‘just a yeast infection.’ He waited three days. By the time he got to the hospital, they had to remove his entire genital area. He didn’t make it. He left behind two kids. His wife still sleeps with his pill bottle on her nightstand. I don’t want anyone else to go through that. Please - if you’re on one of these, check yourself. Don’t wait. Don’t be embarrassed. Your life is worth more than your pride.

  • Maggie Noe

    Maggie Noe

    January 19, 2026 AT 00:30

    It’s fascinating how we treat medical risk like a math problem - ‘1.9 per 100k’ - as if that number absolves us of moral responsibility. But risk isn’t abstract. It’s a man screaming in a hospital bed. It’s a woman Googling ‘black skin on penis’ at 2 a.m. It’s a child asking why their parent doesn’t come home. Numbers don’t cry. People do.


    Maybe the real question isn’t ‘how rare is this?’ but ‘how much suffering are we willing to tolerate for a 30% reduction in hospitalizations?’


    And why is it that when the risk is in the genitals, we whisper. When it’s in the heart, we scream?


    Maybe it’s not the drug that’s dangerous. Maybe it’s the silence.

  • Heather Wilson

    Heather Wilson

    January 19, 2026 AT 06:35

    Another ‘awareness’ post. Where’s the data on incidence rates before SGLT2 inhibitors? Was Fournier’s gangrene nonexistent? Or did we just not look? The risk may be higher now - but is it because of the drug, or because we’re diagnosing it better? The FDA’s database is full of noise. Correlation ≠ causation. Let’s not panic because someone wrote a blog post.

  • Jerian Lewis

    Jerian Lewis

    January 19, 2026 AT 22:02

    I’ve been on Stelatra for a year. No issues. But I’m not going to lie - I checked my groin in the mirror this morning. I’m not ashamed. I’m careful. That’s all.

  • Meghan Hammack

    Meghan Hammack

    January 20, 2026 AT 09:14

    Thank you for sharing this. My dad’s HbA1c is 8.2 now - he’s been eating better and walking every day. He said he’s not taking any chances anymore. He’s alive because he listened.

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