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

[LittleGreyCat]

Further complications:
https://diabetesjournals.org/care/a...0400/SGLT2-Inhibitors-and-the-Diabetic-Kidney
This a paper from 2016.
"On the basis of the studies performed so far in patients with CKD, these drugs should not be started in patients with eGFR <60 mL/min/1.73 m2 and should be stopped when eGFR is <45 mL/min/1.73 m2."

Noting that my latest eGFR was 40 but was not even mentioned in the review.
I tracked this paper down in the references to
The “discordant doppelganger dilemma”: SGLT2i mimics therapeutic carbohydrate restriction - food choice first over pharma?
Which I found via Twitter/X because one author is Dr. David Unwin, who I follow.

I have no idea if this recommendation is still current, but it does raise concerns.

I think the main concern is not that it will damage the kidneys further, but that it will not be very effective as it relies on the kidneys to filter out glucose into the urine.

I will be interested in the response from the surgery!

 

[EllieM]

I will be interested in the response from the surgery!

The US kidney foundation article that I linked to earlier (and below) had a video which I believe mentioned using it for people with low egfrs?
https://www.kidney.org/atoz/content/sglt2-inhibitors

I think 2016 may be quite a long time ago as regards these drugs? (And interestingly, I have a T2 friend who I believe was on a study for this drug for about 7 years and has been happily taking it on prescription since the study ended. Not sure which SGLT2 he was taking though, maybe empagliflozin).

 

[LittleGreyCat]

From https://gpnotebook.com/en-GB/pages/...gy/nice-guidance-metformin-in-type-2-diabetes
"

• before starting an SGLT2 inhibitor, check whether the person may be at increased risk of diabetic ketoacidosis (DKA),for example if:
  • they have had a previous episode of DKA
  • they are unwell with intercurrent illness
  • they are following a very low carbohydrate or ketogenic diet
    
• address modifiable risks for DKA before starting an SGLT2 inhibitor. For example, for people who are following a very low carbohydrate or ketogenic diet, they may need to delay treatment until they have changed their diet
  
  
• advise adults with type 2 diabetes who are taking an SGLT2 inhibitor about the need to minimise their risk of DKA by not starting a very low carbohydrate or ketogenic diet without discussing it with their healthcare professional, because they may need to suspend SGLT2 inhibitor treatment

"

Life is never easy, is it?

 

[MissMuffett]

I’ve just skipped through the posts so not read any in detail yet. But just to add I take dapagliflozin and eat very low carb most of the time. In the beginning I thought taking this drug would give me a bit more carb freedom but ended up with a UTI that lasted 3 weeks - very unpleasant. So now I try and stick to 20g of carbs a day and I have no side effects, my BG has never gone lower than 5.3 mmols so I feel quite safe

 

[HSSS]

I’ve just skipped through the posts so not read any in detail yet. But just to add I take dapagliflozin and eat very low carb most of the time. In the beginning I thought taking this drug would give me a bit more carb freedom but ended up with a UTI that lasted 3 weeks - very unpleasant. So now I try and stick to 20g of carbs a day and I have no side effects, my BG has never gone lower than 5.3 mmols so I feel quite safe

Surely it was the dapagliflozin that caused the uti not the extra carbs though?

The issue with sglt2 and low carb or keto isn’t going low on blood glucose but going higher on ketones and having a dka without the typical high blood glucose which is often an early warning sign.

Obviously it doesn’t happen to everyone but for those that do have this side effect everything is fine, til it isn’t. If you want to stick with keto I’d chat with your DN and make sure you have ketone testing ability at the very least, particularly if you are sick in anyway at all. Possibly there are other medications that are better suited to you if you’re sticking with keto. Do you still even need it at all?

 

[LittleGreyCat]

I’ve just skipped through the posts so not read any in detail yet. But just to add I take dapagliflozin and eat very low carb most of the time. In the beginning I thought taking this drug would give me a bit more carb freedom but ended up with a UTI that lasted 3 weeks - very unpleasant. So now I try and stick to 20g of carbs a day and I have no side effects, my BG has never gone lower than 5.3 mmols so I feel quite safe

Back on this thread again.
I assume your UTI was linked to flushing extra glucose out of your system, which was linked to a higher carbohydrate intake.
This is disappointing for me because I am struggling to stick to very strict keto and was also hoping that an SGLT2i would allow me the occasional treat without sky high BG.

I have a blood test later today, so we shall see what the results are.
I am not very hopeful as I've just returned from a long holiday (harder to maintain control) with in flight catering being universally high carbohydrate.

Can I ask what other medications you take alongside your dapagliflozin?

 

[jpscloud]

I took dapagliflozin for a while before going back to working on my health - it reduced my BG and I lost a little weight (I'm morbidly obese even after losing a bit) but I wanted to do some fasting and try to reduce, then cut out, carbs to see if I still had a chance at health by diet alone so stopped taking it.

Since stopping it I've been doing intermittent fasting and gradually cut out carbs (low carb for a while, and nearly two weeks into carnivore now) and it does look like I might be lucky and regain health if I can sustain it (there will be some planned off-plan, sort of - very occasionally). BGs are very good, blood pressure reducing and weight coming off.

I do credit dapagliflozin with helping me come to the decision to try taking back control but that could just be a coincidence in that I am at a point in my life where decisions relating to mortality are suddenly much more important! I should be having a diabetic review soon so I hope then I will be officially ok'd to stop taking medications while I am consistent with avoiding carbs.

I think dapagliflozin might be unnecessary for me now that I'm not having carbs, however I do think everyone is different and as the drug's stated purpose is to reduce risk of/manage kidney disease and heart failure (and the all-cause mortality figure is good. i.e. it really seems to do that) then each person has to look at their own individual case.

One thing I noted was that I really craved salt when taking dapagliflozin. I believe it also makes the kidneys excrete sodium as well as glucose and I'm not sure that's always a good thing.

 

[MissMuffett]

Back on this thread again.
I assume your UTI was linked to flushing extra glucose out of your system, which was linked to a higher carbohydrate intake.
This is disappointing for me because I am struggling to stick to very strict keto and was also hoping that an SGLT2i would allow me the occasional treat without sky high BG.

I have a blood test later today, so we shall see what the results are.
I am not very hopeful as I've just returned from a long holiday (harder to maintain control) with in flight catering being universally high carbohydrate.

Can I ask what other medications you take alongside your dapagliflozin?

Yes I think it was because I had eaten too many carbs and now I keep them very low. I also take 2000mg of Metformin twice a day. I do have a ‘treat’ a couple of times a week but try and spread it out so as Not to load my blood stream with sugar

 

[LittleGreyCat]

Latest HbA1c is 7.8% despite my best efforts.
Looks like I am about to try out some new medication.