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As SGLT2i reduce endogenous insulin, using with exogenous insulin actually reduces the risks of DKA. I also do not understand the new indication of SGLT2i for kidney disease, when that is a contraindication for SGLT2i.

Maybe a change in terminology from over the pond. Many T2D users here (US) use exogenous insulin and Farxiga is approved in this setting. In my case, I am an exogenous insulin user and see a rise in ketones with this drug, so perhaps not perfectly safe for us either. So far my ketone levels...

It makes sense that ketone formation would be higher with low glucose or low insulin levels. These are the classical cases of ketone formation. It's interesting to me that these drugs seem to promote ketone formation regardless of glucose or insulin levels.

The reason for asking in this thread is, the drugs seems to be able to elevate ketones WITHOUT having low blood sugars. The proposed mechanisms above are direct glucagon release from the liver and a reduction of ketone clearance in the kidneys. These mechanisms can work regardless of blood...

It has actually been a good drug for me for about 5 years. The long acting insulin I am on, cannot react to mealtime and so this drug helped shave off the spikes. It also allowed for lower doses of insulin, a med which for me packs on the pounds. Nonetheless, even though my ketones are not...

I am quite diabetic, and I think there would be ethics violations if it was threatened to withhold my insulin. In my case, I would LIKE to take the drug, but am worried about a similar runaway ketones case. I am peaking daily around 2.0mmol/L. For all its detractors and woes, this might be...

Thanks. Yes it is interesting. A few mechanisms there besides simply reducing glucose. Direct glucagon secretion and reduced ketone clearance, Am having some elevated ketones now and may have to give up the Farxiga. Not looking forward to that as it just means MORE insulin and MORE weight...

Traditionally, ketones are thought to be created in any quantity from only 2 conditions. 1. Lack of glucose. 2. Lack of insulin. SGLT2 inhibitors seem to have a third mechanism that promotes ketone formation even when more than adequate levels of blood glucose and insulin exist. (I'm not...

My anti-GAD antibodies were found 8 years ago, yet still over 8x normal C-peptide today with a lot of insulin resistance. This favors that I am Type 2 even if I also become Type 1.

I am not on a low carb diet. My body has sufficient carbs and insulin.

Hello, new user here. I am a T2D with anti-GAD antibodies, so likely will be Type 1 someday, but still measuring high C-peptide levels. I have mitochondrial disease, so even with high insulin levels, I do not really use carbs very well. My current meds are Glipizide, Lantus (insulin...