Fournier’s Gangrene and Diabetes Medications: Emergency Signs You Can’t Ignore

When you’re managing type 2 diabetes, the last thing you want is for your medication to put you in the hospital-let alone risk your life. But between 2013 and 2018, the FDA documented 12 cases of a rare, deadly infection called Fournier’s gangrene linked to a common class of diabetes drugs: SGLT-2 inhibitors. These include Invokana, Farxiga, Jardiance, and Steglatro. The infection doesn’t just appear out of nowhere. It builds silently, then explodes-often in people who thought they were doing everything right.

What Is Fournier’s Gangrene?

Fournier’s gangrene is a fast-moving bacterial infection that eats away at skin, fat, and muscle tissue in the genitals, perineum, or around the anus. It’s not a common condition-fewer than 1 in 10,000 people with diabetes will get it. But when it happens, it’s a medical emergency. Without surgery and strong antibiotics within hours, it can kill.

Before SGLT-2 inhibitors became popular, this condition mostly affected older men with diabetes, obesity, or weakened immune systems. But since 2018, cases have popped up in women, younger patients, and people with no obvious risk factors-except one: they were taking an SGLT-2 inhibitor.

How Do Diabetes Medications Cause This?

SGLT-2 inhibitors work by making your kidneys flush out extra sugar through urine. That lowers blood sugar-which is good. But that sugar doesn’t just disappear. It stays in your genital area, creating a sweet, moist environment where bacteria and yeast thrive. This is why so many people on these drugs get yeast infections or urinary tract infections. For most, it’s annoying but harmless.

But in rare cases, those infections don’t stay local. Bacteria can sneak through tiny tears in the skin or mucous membranes, then spread rapidly under the surface. Once they hit the fascia-the connective tissue beneath the skin-they start destroying everything in their path. The infection spreads faster than antibiotics can reach it. That’s why pain, swelling, and fever are warning signs you can’t ignore.

The Red Flags: Emergency Signs You Must Act On

If you’re taking one of these diabetes medications, know these symptoms. They’re not suggestions-they’re alarms.

• Severe pain or tenderness in your genitals, anus, or inner thighs-even if the area doesn’t look badly swollen yet
• Redness or swelling that spreads quickly, sometimes overnight
• Fever over 101°F (38.3°C) with chills or feeling extremely unwell
• Foul-smelling discharge from the genital or anal area
• Skin that feels warm, spongy, or crackles when touched (a sign of gas-producing bacteria)
• Pain that feels worse than it looks-this is a classic red flag in necrotizing infections

One woman, 71, on dapagliflozin, noticed a large abscess and foul odor near her anus. By the time she got to the ER, the infection had already eaten through layers of tissue. She needed multiple surgeries and weeks in the ICU. She survived. Others didn’t.

Who’s at Risk?

It’s not just men. The FDA and European regulators confirmed that about one-third of reported cases are in women. That’s a huge shift from the past, when Fournier’s gangrene was almost exclusively a male condition.

High-risk groups include:

• People with diabetes (especially if blood sugar is poorly controlled)
• Those who are overweight or obese (BMI over 30)
• Patients over 65
• Anyone with a history of genital infections while on SGLT-2 inhibitors
• People with weakened immune systems or recent trauma to the genital area

Even if you’re young and healthy, if you’re on one of these drugs and you notice any of the symptoms above-don’t wait. Don’t assume it’s just a yeast infection. Don’t wait until morning. Go to the ER now.

What Happens If You’re Diagnosed?

If a doctor suspects Fournier’s gangrene, they won’t wait for test results. They’ll start treatment immediately:

• Stop the SGLT-2 inhibitor-right away. No exceptions.
• IV antibiotics-usually a mix of drugs to cover multiple types of bacteria
• Emergency surgery to cut out dead tissue. Many patients need multiple surgeries over days or weeks
• ICU care-over 78% of reported cases required intensive care

According to a 2019 study of 19 cases, 15 patients needed ICU care. Twelve needed more than one surgery. Three died. Even with the best care, this infection kills up to 20% of the time.

Are These Drugs Still Safe to Use?

Yes-but with serious caveats.

The FDA, Health Canada, the European Medicines Agency, and Medsafe in New Zealand all agree: the benefits of SGLT-2 inhibitors still outweigh the risks-for most people. These drugs don’t just lower blood sugar. They reduce heart failure hospitalizations, lower the risk of kidney failure, and even cut the chance of dying from heart disease.

But that doesn’t mean they’re risk-free. If you’ve had recurrent yeast infections or UTIs while on these drugs, talk to your doctor. There are other diabetes medications without this risk. Metformin, GLP-1 agonists like semaglutide, and insulin don’t carry the same danger.

The key is awareness. If you’re on an SGLT-2 inhibitor, your doctor should have warned you about these signs. If they didn’t, ask. And if you’re experiencing any of the symptoms listed above-go to the ER. Don’t call your doctor first. Don’t wait. This isn’t something you can treat at home.

What Should You Do Now?

If you’re taking one of these medications:

1. Know the symptoms. Print them out. Put them on your fridge.
2. Check your genital area daily, especially if you’re prone to infections.
3. If you notice swelling, pain, or odor-go to the ER immediately. Tell them you’re on an SGLT-2 inhibitor.
4. Ask your doctor if you’re a good candidate to switch to a different diabetes drug.
5. Don’t stop the medication on your own. But don’t ignore symptoms either.

Diabetes management is a balancing act. You need to control your blood sugar without trading one danger for another. Fournier’s gangrene is rare-but when it strikes, it doesn’t give you time to think. Your best defense is knowing what to look for-and acting before it’s too late.