Diabetic nephropathy as the leading cause for end stage renal disease and replacement therapy is increasing every year. Treatment of T2DM with the present oral blood glucose lowering drugs and insulin is challenging, with an enormous number of patients are able to achieve the target glycaemic control (HbA1C<6.5%). Despite the use of new Insulin compounds and different recommended combination of oral anti-diabetic drugs, the benefits of these recommendations are offset by side effects such as weight gain and recurrent hypoglycaemia. Therefore, the need for new agents that control blood glucose strictly and have other proactive cellular pathways is challenging. The sodium glucose transporter protein 2 (SGLT2) inhibitors, are recently being widely used.The main therapeutic effect of these new drugs, SGLT2 inhibitors (SGLT2-I), is lowering the blood glucose levels via inhibitory effect on the transport of glucose and sodium in the proximal tubular cells by sodium glucose transport 1. SGLT2-I reduce plasma sodium level by natriuretic and diuresis, with decreasing blood pressure and body weight. These new medications can be used as first and second lines of treatment especially in patients with normal glomerular filtration rate, with or without cardiovascular complications. The most effective combination of SGLT2I is Metformin especially in albuminuria and slowing the progression of diabetic nephropathy especially if initiated in early stages of DM. The new class of medication (SGLT2I) are less effective in patients with moderate CKD (eGFR<45 ml/min). This review will focus on the new pathways such autophagy as a new pathway where SGLT2 are involved with protective effects.

Small cell lung cancer (SCLC) is aggressive cancer with high mortality without appropriate early treatmenr. The patient can present with paraneoplastic syndromes, such as Cushing syndrome, because of an inappropriate secretion of ectopic adrenocorticotropic hormone (ACTH) with severe hypokalemic metabolic alkalosis, Parathyroid hormone with hypercalcemia, and hyponatremia due to inappropriate anti-diuretic hormone (ADH) secretion. Patients with SCLC and paraneoplastic syndrome, are with poor prognostic factor. Diagnosis must be made early with immediate treatment. We report a 57-year-old male patient who had severe refractory hypokalemia, metabolic alkalosis, and hypertension as manifestations of an inappropriate secretion of ACTH-secreting from small cell carcinoma of the lung. He was treated with high doses of spironolactone to control the symptomatic refractory hypokalemia, and Metyrapone to control the ectopic ACTH secretion. Aggressive chemotherapy was initiated soon after lung mass biopsy, with SCLC diagnosis.