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Empagliflozin

Blackwater5

Well-Known Member
Messages
46
As I'm a newbie, if this is in the wrong place please can admins move it.

I was diagnosed with T2, hnA1c of 47 rising to 55 by early autumn and was prescribed lipigliptin whish caused bullus perigould (autoimmune blistering) and was taken off it., last August and was told to try and reduce it by diet *NHS one) but given no other info.
I was put on steroids for that which I stopped after 2 weeks. Given a meter for a short time and recording bg I managed to get my bg down to between 6.5 and 8 mmol/L yesterday.
I also am being prescribed the SGLT-2 inhibitor Empagliflozin although my bul;bullus is not completely healed. I was told that there have been no cases of ketoacidosis caused by this drug although the Forum posts say that it exists but doesn't show in standard blood tests. I was also told that as I can't take gliptins the only alternative was insulin.
The reason for this was that I had two positive hepatitis tests 15 years ago, although the PCR for it showed no virus and the consultant I saw back then couldn't understand why so said he thought I mussed have cleared it naturally. My liver tests have always been very good although the hospital has me recorded as never seeing a consultant so invited me for treatment 3 years ago. When I saw the liver consultant he apologised that he couldn't treat me because no virus was found!.
I'm now following a fairly low carb diet but my body objects to too much fat and my weight has dropped to 52 kg (2 or 3 points off an underweight BMI.
I'm thinking of trying the SGLT-2, certainly don't want insulin if I can avoid it, but know that my body reacts to a number of drugs.

I've been told that it's impossible to get hypos on this inhibitor aqs it cuts the glucose excreted from the liver. That may be why ketoacidosis tests don't work. I've also been told it will make me smell 'sweet' and I'll lose weight. Right now I could stay as I am now at the expense of new clothes. I think the weight loss is caused by diabetes complications, that I was hyper for over a year and have also been pr4escribed pirindipal to protect my kidneys..
 
Hi @Blackwater5 I don't have any knowledge of your autoimune problem.
An HbA1C of 47 is below the threshold for Type 2 diabetes (which is only diagnosed at a reading of 48 or more). Even now at 55 you are only a little way into the T2 Diabetic range unlike other members who are diagnose with HbA1C's of 100 or more!

Since you are currently still needing/taking the steroids, they may well be raising your Blood Glucose at present.
The main things you can't control which raise Blood Glucose are: Infection, Injury, medication such as Statins and Steroids, Stress, Lack of Sleep.

I have read a fair bit about SGLT-2 inhibitors including reports from other members who have taken them.
They are usually prescribed for obese/overweight people who can't control their Blood Glucose by lifestyle and/or by Metformin.
I don't understand why you/your Doctor are talking about SGLT-2 meds and Insulin if your HbA1C is only 55 and your BMI is low.

It also seems unlikely that diabetes complications ( in this case just plain old ultra high Blood Glucose) could have caused your weight loss when (if the HbA1C of 55 is to be believed) yours has never been nearly high enough to suffer that symptom.

Ketoacidosis is where you are unable to properly use the energy in your blood stream (both Glucose and Ketones. It's rare in Type 2's, much more common in previously undiagnosed Type 1's. I agree that ketoacidosis is listed on the risks and side effects, but logically I don't understand how an SGLT-2 inhibitor could cause ketoacidosis.
SGLT-2's in general don't affect the liver, they affect the kidneys, preventing them re-absorbing glucose from the blood stream with the effect that instead you just pee it out in your urine. Thus the most common side effects complained of (especially by women) are Urinary Tract Infections and yeast infection.
It's strange that you were told that Hypo's are impossible due to SGLT-2's since hypoglycemia is one of the main listed potential risks, though it isn't a common problem.
https://www.healthline.com/health/type-2-diabetes/sglt2-inhibitors


Low Carb does tend to have the effect of weight loss, but not usually to the point of being actually underweight. Usually when people want to stop losing weight on low carb they A). Eat more protein and more fat e.g. nuts provide both as do eggs and cheese. Or if their BG is low enough to support it, they add back a little more carbs into their diet. Subject to no meal spiking their BG by more than 2.0 mmol at 2hrs after the 1st bite

Is it gallbladder or bile problems that mean you think your body can't handle fat? Some members with no gallbladder find they can handle fat fine so long as they don't eat too much of it at the same time.
 
I don’t have much to say just that I’m on empaglaflozin and I haven’t lost any weight.
 


I was given lipigliptin when my hbA1c went from 50 to 55in a couple of months. I was given no diet advice, no advice really, just told to eat a balanced diet. Then the hives and blisters caused by the lipigliptin, was given a powerful steroid cream and next test I was up to 56. My last hbA1c was 67, I'd been taken off diabetic meds, but still knew nothing about diet, just that exercise was good. But by then it was too painful to even walk. I've now been off oral steroids fpor 10 days and my figures are improving, which may be connected with my avoiding sugary and high carb foods.
I've recently been diagnosed with proteinuria although my GP says my kidneys are 'good' so he's prescribed pirindipil.
He won't consider metformin because of positive liver antibody tests years ago, but my liver numbers have always been good and the last test for viruses I had didn't find any, which the consultant couldn't understand the reason for. But both the GP and hospital seem to have records saying I never saw a consultant.

I think that I was given the gliptin because my bg is low compared to most and then they were planning on a a gliclazide, but changed their minds after high sugar spikes stopped when I stopped oral steroids and went more low carb. I have the lowest dose of a beta blocker and that group of drugs can make you unaware of hypos. Now I've been prescribed the SGLT-2 inhibitor, but I've read up on it and it seems that there are contraindications as well as weight loss (BMI of 21 now).

Because of my experience with gliptins and my reading about SGLT-2 inhibitors I'm afraid to take them, and that alone could cause problems.

Regarding fats, I had a meal of 3 boiled eggs, salad and lots of olive oil. After eating it I felt nauseous.

Thanks for the info about SGLT-2 inhibitors making your body get rid of glucose in urine..
 
Sarah69 said:
I don’t have much to say just that I’m on empaglaflozin and I haven’t lost any weight.
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Thanks for letting me know. According to MHRA studies it should be used as part of a soluble or triple therapy.
Everyone is different and gliptins causing me to be covered in painful blisters is a very rare side-effect to that group of drugs..
 
@Blackwater5 I don't know how much olive oil you put on the eggs, but I found I was nauseous when eating lots of according to the Dave Feldman protocol (for temporarily lowering LDL Cholesterol i.e. fooling your doctor). But the same food without oall the olive oil was OK for me.
So I suggest you try eggs with little /no olive oil and see how you get on with them.
 
Sarah69 said:
I don’t have much to say just that I’m on empaglaflozin and I haven’t lost any weight.
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Ditto - I also have not lost any weight due to Jardiance - I am also using insulin that seems to counteract weight loss. However, a friend of mine has lost weight on Jardiance - problem is he is already as thin as a pencil - he is not on insulin.

I do know though that it is working because my urine is laced with sugar, when my BG ocasionally goes out of whack.
 
Blackwater5 said:
.... Regarding fats, I had a meal of 3 boiled eggs, salad and lots of olive oil. After eating it I felt nauseous.....
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To be honest, I couldn't have lots of olive oil on its own, or just with boiled eggs.

If I wanted a similar meal to yours I would have had the eggs, and some cheese.

I'm a slight female who tends to skirt the very bottom of the healthy BMI ranges, at under 50kg. I have a reduced carb lifestyle, but to be honest, I don't care to eat lots of fat on its own. My preference would be to have fattier cuts of meat, like lamb, or cheaper options would be belly port, or mince. Mince cab become so many things from chilli, to curry to burgers, to sausages. I also have cheese, and add cream to berries.

Perhaps have a bit of a wider think about your diet, and it could maybe be (bearing in mind your steroids will be out of your system by then, hopefully) you could get away without medications for your diabetes.

To be clear, there is absolutely nothing wrong with taking meds to support your health, but it is liberating to know you are controlling your condition without any pharmaceutical help.
 

I'm not on insulin but have early signs of kidney problems plus NP that varies between high and lopw. My bg does the same although it's a lot lower than when I was on steroids.

My DBN said this med will make me lose weight *monotherapy) and if I lose much more I'll be underweight. Trouble is I can't eat big meals and only like small amounts of meat or fish.
 
Re: the olive oil - you can scramble or fry eggs in it, make an omelette,dress your salads, add a small amount to soups and a little more to stews, and not notice it. Careful if using it to fry as it needs a lower temperature than butter.
 
Although I was told empagliflozin could cause weight loss it hasn't touched me as far as I can see. My clothes all fit the same as ever. I'm on the maximum dose. I think weight loss is a 'may' not a definite side effect.
 
Is this a GP or endocrinologist? If GP I would insist on seeing an endocrinologist or diabetologist - there’s a lot of gps who believe they are more expert than is born out by evidence. Good luck
 
sunspots said:
Although I was told empagliflozin could cause weight loss it hasn't touched me as far as I can see. My clothes all fit the same as ever. I'm on the maximum dose. I think weight loss is a 'may' not a definite side effect.
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I'd lost a lot of weight before diagnosis. I was also told that my hbA1c and finger-prick tests wouldn't give me symptoms, but I got them. I also have high blood pressure and albuminuria . It seems tht can be reversed with good bp and bg control, but I'm told I shouldn't eat a lot of protein.
 
johnme said:
Is this a GP or endocrinologist? If GP I would insist on seeing an endocrinologist or diabetologist - there’s a lot of gps who believe they are more expert than is born out by evidence. Good luck
Click to expand...

It was a gp. I've never seen an endocrinologist and I get the feeling that it won't be suggested or offered.
 

My nephrologist originally suggested Invokana, but my endocrinologist preferred Jardiance, as apparently it has less side-effects.
 
jape said:
My nephrologist originally suggested Invokana, but my endocrinologist preferred Jardiance, as apparently it has less side-effects.
Click to expand...

Jardiance has less side-effects although some of those you can get are nasty. It is also a drug that helps obese patients (non-diabetic) to lose weight although it's not licensed for that. But insulin can cause people to put weight on.
According to my reading of trials it starts to work within 1 to 2 weeks but takes 24 weeks to be fully effective.
I've been on it for 2 days, but it took at least 2 weeks for me to get rare side effects from lipigliptin.
 
Hello!
I was recently put onto Empagliflozin in February this year, the weight started to drop quickly, yet i thought nothing of this. I was urinating every hour, and constantly intaking fluids due to this. I was also prescribed Ozempic at the same time; this could make me feel like i did not want to eat. Start of April, i was constantly vomitting, therefore went to the GP, who checked my urine and rushed me straight to hospital. There, they told me my ketone levels were 5.6, yet a normal range was 0.3; i was diagnosed with diabetic ketoacidosis. I was in hospital for 2 full days, and on 3 constant drips which were fluids, insulin and glucose. Upon speaking to the doctors and diabetic nurses it was found that the cause was the empagliflozin and ozempic, which have now been discontinued and i now continue with my 1g of metformin twice a day, and 16 units of insulin in a morning.
 
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