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

When you’re managing type 2 diabetes, taking a medication like Jardiance, Farxiga, or Invokana can feel like a win. These drugs help lower blood sugar, protect your heart, and slow kidney damage. But there’s a rare, terrifying side effect tied to them that most people never hear about until it’s too late: Fournier’s gangrene.

This isn’t a common reaction. But when it happens, it moves fast - and it kills. Fournier’s gangrene is a necrotizing infection that eats away at the skin and tissue around your genitals and anus. It starts with pain, swelling, or redness. Within hours, it can turn deadly. And it’s linked directly to a class of diabetes drugs called SGLT-2 inhibitors.

What Is Fournier’s Gangrene?

Fournier’s gangrene is a bacterial infection that destroys soft tissue. It’s not a typical skin infection. It spreads through the fascia - the layer of connective tissue under your skin - and cuts off blood flow. The tissue dies. Bacteria multiply. Gas forms. The smell is often described as rotten or foul. Fever, chills, and extreme pain follow.

It was once thought to affect mostly older men with diabetes or poor hygiene. But since 2018, cases have popped up in women, younger people, and those with no obvious risk factors - all while taking SGLT-2 inhibitors. The FDA confirmed this shift after reviewing 12 cases between 2013 and 2018. By 2022, New Zealand’s drug safety agency reported multiple cases tied to empagliflozin and dapagliflozin. One-third of these cases were in women. That’s a major departure from the past.

How Do Diabetes Medications Cause This?

SGLT-2 inhibitors work by making your kidneys flush out extra sugar through urine. That’s great for lowering blood sugar. But it also means your genital area is constantly exposed to glucose-rich fluid. Bacteria and yeast love sugar. So, infections like yeast infections and urinary tract infections become more common.

In rare cases, these infections don’t stay local. They spread deeper. A small cut, a pimple, or even friction from clothing can let bacteria breach the skin. Once they get under the surface, they spread rapidly. The body’s immune system, already weakened by diabetes, can’t keep up.

It’s not the drug itself that’s toxic. It’s the environment it creates. And that’s why this risk is unique to this class of drugs. Other diabetes medications - like metformin, sulfonylureas, or insulin - don’t cause this kind of sugar leakage in the genital area. That’s why Fournier’s gangrene isn’t linked to them.

The Emergency Signs: Don’t Wait

If you’re on an SGLT-2 inhibitor, you need to know the warning signs - and act within hours, not days.

• Severe pain in the genitals or around the anus - even if the area doesn’t look bad yet
• Redness, swelling, or warmth that spreads quickly
• Fever or chills that come on suddenly
• Foul-smelling discharge from the genital or anal area
• Dark or black patches of skin - a sign tissue is dying
• Pain out of proportion to what you see - this is a classic red flag
• Malaise - feeling extremely unwell, like you’re coming down with the flu

One patient, a 71-year-old woman on dapagliflozin, showed up with a large abscess and foul-smelling fluid. She didn’t have a history of trauma. No open wounds. Just diabetes and her medication. By the time she got to the hospital, the infection had already spread. She needed multiple surgeries and weeks in intensive care.

Don’t wait for the skin to turn black. Don’t assume it’s just a yeast infection. If you’re on one of these drugs and feel any of these symptoms, go to the ER immediately. Tell them you’re taking an SGLT-2 inhibitor. Say: “I’m worried about Fournier’s gangrene.”

What Happens When You Get Diagnosed?

There’s no gentle treatment for Fournier’s gangrene. It’s a medical emergency that demands immediate action.

First, your doctor will stop your SGLT-2 inhibitor. Right away. No delay.

Then, you’ll get high-dose intravenous antibiotics - often a mix of drugs to fight multiple types of bacteria. But antibiotics alone won’t save you. The dead tissue has to be cut out. That’s surgical debridement. Some patients need one surgery. Others need five or six. In the study of 19 cases, 63% required multiple operations.

Most patients end up in the ICU. 79% of those in the 2019 study were admitted there. Some die despite aggressive care. 16% of those cases were fatal.

Recovery is long. Scarring is common. Sexual function and urinary control can be permanently affected. The physical and emotional toll is huge.

Are These Drugs Still Safe?

Yes - but only if you know the risks.

The FDA, EMA, and Medsafe all agree: the benefits of SGLT-2 inhibitors still outweigh the risks for most people. These drugs reduce heart failure hospitalizations. They lower the risk of kidney failure. They help people live longer. That’s powerful.

But “rare” doesn’t mean “impossible.” And “benefits outweigh risks” doesn’t mean “no one should worry.”

These drugs are not for everyone. If you have a history of recurrent yeast infections, urinary tract infections, or skin infections in the genital area, talk to your doctor. If you’re overweight, have poor circulation, or are over 65, your risk may be higher.

And if you’re a woman - especially under 50 - you need to be extra aware. Fournier’s gangrene used to be called a “man’s disease.” Now, it’s not.

What Should You Do Now?

If you’re currently taking Invokana, Farxiga, Jardiance, or Steglatro:

• Don’t stop the medication on your own. Talk to your doctor first.
• Know the emergency signs. Write them down. Keep them on your phone.
• Check your genital area daily - especially if you’ve had infections before.
• Report any unusual symptoms to your doctor immediately - even if you think it’s “just a rash.”
• Ask your doctor if you’re a good candidate for this drug. Are there safer alternatives?

If you’re thinking about starting one of these drugs:

• Ask: “What’s my risk for genital infections? What’s my risk for Fournier’s gangrene?”
• Ask: “What are the alternatives? How do they compare?”
• Ask: “Will you monitor me for signs of infection?”

These aren’t just questions. They’re life-saving conversations.

What If You’ve Already Had an Infection?

If you’ve had a severe genital infection while on an SGLT-2 inhibitor - even if it didn’t turn into Fournier’s gangrene - you’re at higher risk for it happening again.

Your doctor should consider switching you to a different diabetes medication. Metformin, GLP-1 agonists like semaglutide, or insulin may be safer options depending on your health goals.

Don’t brush off a yeast infection as “just a side effect.” That’s how these cases start. One infection leads to another. One small tear becomes a gateway. And then - it’s too late.

There’s no shame in asking for a change. Your life matters more than sticking with a drug because it’s “working.”

Final Thought: Awareness Saves Lives

Fournier’s gangrene is rare. But when it strikes, it doesn’t care if you’re young or old, male or female, healthy or diabetic. It moves faster than fear.

The good news? You can prevent it - if you know what to look for. If you’re on one of these medications, you’re not just managing diabetes. You’re managing a hidden risk. And that means being alert, informed, and ready to act.

Don’t wait for the pain to get worse. Don’t wait for the skin to turn black. If you feel something wrong - go. Now. Tell them you’re on an SGLT-2 inhibitor. Your life might depend on it.