Article about SGLT2i, possible actions, possible effects on kidneys. Reviews please!

LittleGreyCat

Moderator
Staff Member
Moderator
Messages
4,291
Type of diabetes
Type 2
Treatment type
Tablets (oral)
Dislikes
Diet drinks - the artificial sweeteners taste vile.
Having to forswear foods I have loved all my life.
Trying to find low carb meals when eating out.
SGLTi and hypertension

This talks about hypertension, and the use of SGLT2i and low carbohydrate diets with relation to hypertension.
However a lot of the article talks about diabetes (often linked with hypertension) and the effects of hyperglycaemia.

It seems to say that SGLT2i can have a very similar effect to carbohydrate restriction, because both reduce the amount of glucose in the blood and encourage the use of ketones and other fats for energy.
Therefor why use drugs if low carbohydrate can give the same results without the side effects of drugs?
[Noting Dr David Unwin:cool: as one of the authors.]

I've only read it once, but a couple of things struck me.

I think that it suggests that reducing the load on the kidneys by reducing the amount of glucose re-absorbed can improve kidney function.
I would appreciate a view on this.
I has assumed that using the kidneys to clear glucose would put an additional load on them.
I would be more than happy to be proved wrong.

It also says:
"So how can we get the drug-like outcomes, without financing or taking the drug? What is the right way to move forward when both can produce “mirror-like” results but they cannot therefore be combined? "
Is this poor wording for combining the two approaches provides no additional benefits, or is it suggesting that SGLT2i should not be combined with a restricted carbohydrate diet?
This could be a key issue.

Are there people here eating low carbohydrate and also taking SGLT2i drugs?

Reviews of this paper (especially on the points mentioned) would be very helpful, thanks.
 
  • Informative
Reactions: jpscloud and jjraak

Solaire

Member
Messages
23
Type of diabetes
Carer
I get quite confused by all the words which aren't explained ...SGLT2i ... ..LADA type 1.5 and many more .... is there a section on abbreviations anywhere as soo often I really don't know what folks are talking about .... probably a simple explanation, but not for me ‍♀️
 
  • Like
Reactions: jpscloud

lovinglife

Moderator
Staff Member
Moderator
Messages
4,858
Type of diabetes
Type 2
Treatment type
Diet only
I get quite confused by all the words which aren't explained ...SGLT2i ... ..LADA type 1.5 and many more .... is there a section on abbreviations anywhere as soo often I really don't know what folks are talking about .... probably a simple explanation, but not for me ‍♀️
I haven’t read the article through but you may find this page useful from our DCUK website

 

ianf0ster

Moderator
Staff Member
Moderator
Messages
2,522
Type of diabetes
Treatment type
Diet only
Dislikes
exercise, phone calls
SGLTi and hypertension

This talks about hypertension, and the use of SGLT2i and low carbohydrate diets with relation to hypertension.
However a lot of the article talks about diabetes (often linked with hypertension) and the effects of hyperglycaemia.

It seems to say that SGLT2i can have a very similar effect to carbohydrate restriction, because both reduce the amount of glucose in the blood and encourage the use of ketones and other fats for energy.
Therefor why use drugs if low carbohydrate can give the same results without the side effects of drugs?
[Noting Dr David Unwin:cool: as one of the authors.]

I've only read it once, but a couple of things struck me.

I think that it suggests that reducing the load on the kidneys by reducing the amount of glucose re-absorbed can improve kidney function.
I would appreciate a view on this.
I has assumed that using the kidneys to clear glucose would put an additional load on them.
I would be more than happy to be proved wrong.

It also says:
"So how can we get the drug-like outcomes, without financing or taking the drug? What is the right way to move forward when both can produce “mirror-like” results but they cannot therefore be combined? "
Is this poor wording for combining the two approaches provides no additional benefits, or is it suggesting that SGLT2i should not be combined with a restricted carbohydrate diet?
This could be a key issue.

Are there people here eating low carbohydrate and also taking SGLT2i drugs?

Reviews of this paper (especially on the points mentioned) would be very helpful, thanks.
I can't answer all your question since I'm not a medical scientist.

The paper says that a Therapeutic Carbohydrate Reduction (low carb/Keto to us) has an almost identical effect on both diabetes, blood pressure and LDL Cholesterol to that of SGLT2i drugs - the 'flozin s, but with less problematic side effects - no where near as nsty as those of SGLT2i drugs. So it questions why the medical profession chose to use the SGLT2I drugs rather than advising patients to eat low carb.

1700934427012.png



I don't understand why they add dizziness to the side effects for Low Carb, because that is just Hypotension caused by the combination of Low carb while remaining on the same dose of drugs to reduce blood pressure!

Which would you rather risk:
Geniturinary infections and increased risk of amputation
or Keto Flu and constipation (both of which are easily dealt with without need of anything more than some supplements.

I'm fairly confident that some members do both take SGLT2i's and reduce their carbs to some extent.
I believe that Oldvatr now deceased) was one of those.
 
Last edited:

LivingLightly

Well-Known Member
Messages
3,809
Type of diabetes
Type 2
Treatment type
Tablets (oral)
A useful list of abbreviations and jargon cited above, but SGLT2i, the subject of this thread, does not appear there.

SGLT2i is an abbreviation for sodium-glucose cotransporter protein 2 inhibitors, a class of drugs known as gliflozins.
Dapagliflozin, empagliflozin and canagliflozin are widely prescribed for type 2 diabetes.
 
Last edited:

ianf0ster

Moderator
Staff Member
Moderator
Messages
2,522
Type of diabetes
Treatment type
Diet only
Dislikes
exercise, phone calls
There is another paper about Dr Unwin's Type 2 patients on Low Carb and how their kidney function (which normally reduces with age) actually improved overall, or at worst stayed constant.
 

HSSS

Moderator
Staff Member
Moderator
Messages
7,582
Type of diabetes
Type 2
Treatment type
Diet only
Sglt2 are associated with euglycemic DKA. Ie dka without the typically high bgl. Taking them in association with a low carb or keto diet increases this risk. It’s low but it’s there. I understood this is why they shouldn’t be combined.
 

Lamont D

Oracle
Messages
16,481
Type of diabetes
Reactive hypoglycemia
Treatment type
I do not have diabetes
In my experience, and I've been around keto for a decade now.
My blood panel results always showed that I had fatty liver, higher than normal liver and kidney function results and of course hypertension. This was before diagnosis and misdiagnosis before that.
Subsequent weight loss, change to a restrictive diet and improving my lifestyle, has seen all my blood panel results improve. Of course I have other issues that have had an impact, but if I do the very low carb diet, my health improves. And even now, that my meds were stopped, because of my results, I now that my daily fasting readings are very good. (Ish)
 
  • Winner
Reactions: jjraak

MrsA2

Expert
Messages
5,941
Type of diabetes
Type 2
Treatment type
Diet only
Sglt2 are associated with euglycemic DKA. Ie dka without the typically high bgl. Taking them in association with a low carb or keto diet increases this risk. It’s low but it’s there. I understood this is why they shouldn’t be combined.
I thought (but can't link to proof or research because I'm not that technically adapt) that if someone on a 'flozin' went suddenly very low carb there was an increased but small risk of dka, but if carbs were reduced slowly, under medical supervision so the amount of the 'flozin' could be adjusted in line, then the risk virtually disappeared. I think its mentioned on the 'flozin' packet.
About 3 years ago on another low carb forum someone was ranting about the dangers of going low carb as they had had a dka and were hospitalised, but it turned out they were on a high doze of flozin, suddenly went keto overnight and within a week was in hospital . When she read the warnings in the flozin packet she understood she hahouldnt have done it that way.
Please note this is only my own interpretation and summary of many posts I've read. I'm not a medic nor profess to be one, and fully expect I'll be wrapped over the knuckles , again, for trying to help
 

HSSS

Moderator
Staff Member
Moderator
Messages
7,582
Type of diabetes
Type 2
Treatment type
Diet only
I thought (but can't link to proof or research because I'm not that technically adapt) that if someone on a 'flozin' went suddenly very low carb there was an increased but small risk of dka, but if carbs were reduced slowly, under medical supervision so the amount of the 'flozin' could be adjusted in line, then the risk virtually disappeared. I think its mentioned on the 'flozin' packet.
About 3 years ago on another low carb forum someone was ranting about the dangers of going low carb as they had had a dka and were hospitalised, but it turned out they were on a high doze of flozin, suddenly went keto overnight and within a week was in hospital . When she read the warnings in the flozin packet she understood she hahouldnt have done it that way.
Please note this is only my own interpretation and summary of many posts I've read. I'm not a medic nor profess to be one, and fully expect I'll be wrapped over the knuckles , again, for trying to help
Presumably going low carb would mean normalising the bgl levels therefore mean a smaller dose of flozins. So to me its the lower dose, rather than the gentle introduction of low carb, that matters. The slow intro is more about avoiding keto flu type reactions or sugar withdrawals as far as I’ve read.
 
  • Like
Reactions: jpscloud

LittleGreyCat

Moderator
Staff Member
Moderator
Messages
4,291
Type of diabetes
Type 2
Treatment type
Tablets (oral)
Dislikes
Diet drinks - the artificial sweeteners taste vile.
Having to forswear foods I have loved all my life.
Trying to find low carb meals when eating out.
Thanks to all the respondents so far.
I am relatively low carb and sometimes make it all the way into ketosis.
At the moment I am not doing well with my self control and my last HbA1c was 7.9%.
I am clinging onto the wagon at the moment but my Libre 2 is suggesting that my BG is still running higher than I would like.
The surgery has suggested an SGLT2 inhibitor and I've asked for another 3 months then a check to see how I am managing.
If my numbers are still high then I am likely to go for a "flozin".
I am now doing some research to see what the implications are.

I think my risk of DKA is low because my body has been in and out of ketosis for many years, and I think the ketone levels for DKA are way higher than even the most hardcore keto diet. I am thinking that the issue may be that people switch over to producing ketones before their bodies have adapted to using them effectively and so get overloaded with ketones. Something else to check.

Nobody so far has commented on the kidney function but perhaps nobody has combined SGLT2 inhibitors with a low eGFR.
My last eGFR was 40 which it is the lowest that it has ever been.
It has varied between the mid 50s and the mid 70s over the last few years.
If SGLT2i will take a load off the kidneys that may be a mark in its' favour.
 
  • Agree
  • Like
Reactions: jpscloud and RobynV

HSSS

Moderator
Staff Member
Moderator
Messages
7,582
Type of diabetes
Type 2
Treatment type
Diet only
I think my risk of DKA is low because my body has been in and out of ketosis for many years, and I think the ketone levels for DKA are way higher than even the most hardcore keto diet. I am thinking that the issue may be that people switch over to producing ketones before their bodies have adapted to using them effectively and so get overloaded with ketones. Something else to check.
I’m not so sure that it’s the switching that causes trouble, nor the degree to which you are adapted. More the fact the the flozins “need” some carbs to work against. I’m sure there’s been posts on this before (with links) you might be able to find with a good search on here.

Yes the levels created by a keto diet are quite different from DKA, but that’s not the issue here. The issue is why the DKA would occur in the first place, thus causing ketones to rise well above nutritional level.
 

LittleGreyCat

Moderator
Staff Member
Moderator
Messages
4,291
Type of diabetes
Type 2
Treatment type
Tablets (oral)
Dislikes
Diet drinks - the artificial sweeteners taste vile.
Having to forswear foods I have loved all my life.
Trying to find low carb meals when eating out.
  • Informative
  • Useful
Reactions: jpscloud and jjraak

HSSS

Moderator
Staff Member
Moderator
Messages
7,582
Type of diabetes
Type 2
Treatment type
Diet only

EllieM

Moderator
Staff Member
Moderator
Messages
9,597
Type of diabetes
Type 1
Treatment type
Pump
Dislikes
hypos and forum bugs
I hadn't realised.
When did this happen?
October, very sad news.

As for the flozins
I think that it suggests that reducing the load on the kidneys by reducing the amount of glucose re-absorbed can improve kidney function.
I would appreciate a view on this.
I has assumed that using the kidneys to clear glucose would put an additional load on them.
I would be more than happy to be proved wrong.
Interesting (very positive) article about flozins and kidney disease here

Not clear to me at all whether it's safe to combine them with a keto diet, not sure how much data is out there. Definitely something to discuss with your team, in my opinion.
 

LittleGreyCat

Moderator
Staff Member
Moderator
Messages
4,291
Type of diabetes
Type 2
Treatment type
Tablets (oral)
Dislikes
Diet drinks - the artificial sweeteners taste vile.
Having to forswear foods I have loved all my life.
Trying to find low carb meals when eating out.
<snip>

Interesting (very positive) article about flozins and kidney disease here

Not clear to me at all whether it's safe to combine them with a keto diet, not sure how much data is out there. Definitely something to discuss with your team, in my opinion.

That is a very useful thread.
I am seriously contemplating an SGLT2i now purely for my kidneys.
I hope there is someone at the surgery who is aware of this.
 
  • Like
Reactions: jpscloud

LittleGreyCat

Moderator
Staff Member
Moderator
Messages
4,291
Type of diabetes
Type 2
Treatment type
Tablets (oral)
Dislikes
Diet drinks - the artificial sweeteners taste vile.
Having to forswear foods I have loved all my life.
Trying to find low carb meals when eating out.
For reference, this is the query I have submitted to the surgery via AskMyGP:

"
I would like to speak to someone with in depth knowledge of SGLT2 inhibitors in relation to both T2 diabetes and CKD.
I have been recommended SGLT2 inhibitors as a next step and researched them. This has left me with some questions.
(1) https://bnf.nice.org.uk/interactions/dapagliflozin/ lists an interaction with Aloglyptin. Is this likely to be an issue for me?
(2) https://www.gov.uk/drug-safety-upda...d-advice-on-the-risk-of-diabetic-ketoacidosis lists risk factors including:
a low beta cell function reserve - should I be tested for this? (C-peptide)
(3) My last eGFR was 40, which is the lowest it has ever been. Could this be due to the Allopurinol? If so is it safe to continue? Would an SGLT2 inhibitor improve my kidney function?
(4) I currently eat a low(ish) carbohydrate diet to try and control my blood glucose levels. How is this likely to react with an SGLT2 inhibitor?
"

I will report back, hopefully with detailed information.