I still believe my question is valid. 70mg of glucose per minute is huge given that the whole blood has 5g of glucose! This means that every 1 hour, empagliflozin removes from the circulation the total amount of glucose in blood! This is in addition to the glucose consumed by the tissues! This means that this glucose must be replenished internally (excluding food ingestion empagliflosin would still need to remove 60g of glucose as I explain below). This is very aggressive glucose removal and maybe that's the reason behind empagliflosin's unique ability to decrease morbidity and mortality.
We normally eat 3x100g of sugar per day in three meals. After 90min from ingestion, the blood glucose tops at around 250mg/dL. This means that from the 100g of sugar ingested, only the 12.5g ended up in blood as excess. The rest have been absorbed.
During these 90min, empagliflozin would have removed 6.3g of sugar. In every meal, empagliflosin would remove 6.3x3= 19g of sugar.
Unless it removes more during high blood glucose period which is understandable if its removal is related to the blood glucose levels. Let's say it is proportional. So if at 100mg/dL, empaglifrozin removes 19g of sugar per 4.5h, then for 175mg/dL it would remove 19x1.75 = 33g of glucose per 4.5h. I take 175mg/dL and not 250mg/dL because I take the average as the postprandial glucose rises gradually.
This means that Empagliflozin will need to remove a whopping 60g of sugar in the rest day that there is supposedly normoglycemia!
I suspect that this may be the reason for empagliflosin's success in decreasing mortality and morbidity. It must remove significant glucose from the blood during the whole day. This would mean that the therapeutic target for diabetes should not be normoglycemia but severe and constant glucose restriction!
What do you think?
EDIT: Actually, I think to be more accurate, this would be the equation of empagliflosin glucose removal with R=glucose removal rate per hour:
15xR +9xRx1.75 = 90
15h times the R during normoglycemia
plus
9h times R during feeding period times 1.75 as the average factor of blood glucose increase (I took 3h per meal to double the 90min as I assume normoglycemia to return after 3h)
the above sum equals the 90g of glucose removed per 24h
This means x = 2.92g of glucose per hour which means that every two hours of normoglycemia, empagliflosin removes the whole glucose in the blood!