Question for those who are now taking dapaglifozin & your carb intake

[lovinglife]

Just asking for personal experience of those who now take dapagliflozin and were low carb or Keto before taking it, how much did you find you had to or could increase your carbs?

I been low carb & then Keto with normal fats & protein for about 17 years, but I’ve recently been diagnosed with a rare autoimmune liver condition that isn’t related to diabetes Primary Biliary Cholangitis (PBC) I have to now eat low fat because of the damage that can be caused to the liver, because the bile cannot get into the liver to process fats.

Primary biliary cholangitis

Find out about primary biliary cholangitis (primary biliary cirrhosis), which is a type of long-term liver disease where the bile ducts in the liver become damaged.

www.nhs.uk

I have my annual diabetes check coming up and I think I will have to consider meds for diabetes as I’m expecting my HbA1c to have gone up as I’ve been adding a few more carbs to replace the fat, which is why I’m wondering if the dapa may be an option. I have already been offered the dapa a few weeks ago under the new N.I.C.E. guidelines, but declined. I also had to stop the metformin that I tolerated really well because the meds for the PBC has similar side effects and the two together were the “perfect storm” shall we say lol. I must take the meds for the PBC

 

[Rachox]

I’ll tag in @Resurgam who I think started Dapagliflozin recently and has previously been an advocate of low carbing. Resurgam please correct me if I’m wrong.

 

[Resurgam]

@Rachox correct - I had to take a break after a month as I started with a heavy cold and cough and was not eating, but I have not found it necessary to eat very much more. I do need to move when I consume carbs, so milk in coffee in the mornings, remembering to eat a first meal, then a few more carbs with an evening meal and then something before bed if my glucose levels are low.

I've bought some strips so I can check glucose levels now, and have put up a reminder to visit the loo - important particularly as I am still coughing, but I am pleased that the tablets seem to have no dire consequences.
Just how effective they are remains to be seen.

 

[lovinglife]

Thanks @Resurgam, It may not be for me then as I’m finding I can’t cope with much fat at all and protein is a bit hit & miss, also I see it’s processed by the liver so will need to speak to my hepatology consultant to see if I can take it. It’s all very new to me so still trying to juggle both conditions, there’s not much I can do about the PBC other than take the medication (that doesn’t always work, I have to take it for at least 12 months to see if I’m a responder) & eat low fat, there’s hopefully more options diabetes wise. The PBC has been a bit of a curve ball and turning the way I’ve been able to control my diabetes for the last 17 years on its head

 

[Resurgam]

Thanks @Resurgam, It may not be for me then as I’m finding I can’t cope with much fat at all and protein is a bit hit & miss, also I see it’s processed by the liver so will need to speak to my hepatology consultant to see if I can take it. It’s all very new to me so still trying to juggle both conditions, there’s not much I can do about the PBC other than take the medication (that doesn’t always work, I have to take it for at least 12 months to see if I’m a responder) & eat low fat, there’s hopefully more options diabetes wise. The PBC has been a bit of a curve ball and turning the way I’ve been able to control my diabetes for the last 17 years on its head

When I swapped to low carb my nurse was concerned about it being high fat, but I analysed my previous diet and what I had changed to and the amount of fat I ate was at least 1/3rd lower after diagnosis as I removed seed oils from the kitchen and cut out things which were considered healthy as they were made with oils not solid fats.

If your gall bladder doesn't collect bile from the liver to release into the gut then the food you eat will probably not be emulsified and will be shielded from digestive enzymes - also as the bile is the end product of cholesterol and red blood corpuscle breakdown, also phospholipids and various salts you could - I suspect experience those things becoming out of balance. I do hope that the medication improves things for you.

 

[lovinglife]

It’s not that the gall bladder doesn’t collect bile - it’s an autoimmune disease where your body attacks the bile ducts and damages them so the bile can’t get to the liver to process anything and it causes damage to the liver which can quite quickly, if you don’t look after yourself, or any of the few meds that help don’t work, lead to needing a liver transplant. I’ve never been high fat either, even on Keto, just normal fat but I have to have minimum fat now & to keep it to unsaturated fat. Minimum red meat. It’s all about protecting the liver and giving it as minimum work as possible- no alcohol or one unit now & then.

People with PBC their cholesterol naturally runs higher. I’m now in prescribed fat soluble vitamins as you can become deficient in those.

Some people in a support group I’m in on Facebook are on their 3rd liver transplant!

 

[Antje77]

@lovinglife , this sounds like a very complex (and unwelcome!) puzzle.

The liver is involved in processing flozins so that option would need to be talked through with both the diabetes provider and the nephrologist.
With low fat and not too much protein, you seem to be left relying on carbs for a significant portion of your fuel.

Maybe a wild thought, but insulin may be something to consider again if you need to increase your carbs. As far as I understand, it puts a much lower burden on the liver than almost all other diabetes medications.

From a quick google search, PBC and diabetes are often linked, without insight in the direction of causality (if any). Which is a completely useless tidbit of information, sorry.

 

[lovinglife]

@lovinglife , this sounds like a very complex (and unwelcome!) puzzle.

The liver is involved in processing flozins so that option would need to be talked through with both the diabetes provider and the nephrologist.
With low fat and not too much protein, you seem to be left relying on carbs for a significant portion of your fuel.

Maybe a wild thought, but insulin may be something to consider again if you need to increase your carbs. As far as I understand, it puts a much lower burden on the liver than almost all other diabetes medications.

From a quick google search, PBC and diabetes are often linked, without insight in the direction of causality (if any). Which is a completely useless tidbit of information, sorry.

Thanks @Antje77 - yes it’s a conundrum, PBC is linked to a lot of auto immune conditions - osteoarthritis, Sjorgens Syndrome, which I’ve just been diagnosed with in the last couple of weeks, a few others, I also have had for a very long time PCOS which has now been recategorised as autoimmune & Psoriasis. But the PBC is the most difficult and the symptoms can be quite debilitating- and strangely symptoms don’t correlate with how good or bad your liver is. It’s a silent condition. No symptoms could still have bad liver, lots of symptoms liver could be doing ok

I haven’t ruled out insulin and I welcome your suggestion I’m just hoping my GP can do joined up work with the hepatologist lol