Empaglilozin and low carbing

lucylocket61 said:

My question is: in the leaflet it says not to low carb without my GP's permission. Any ideas why the leaflet says this?

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It seems to be associated with a slightly increased risk of ketoacidosis.
Apart from this (I can't find by how much the risk is increased), ketoacidosis will be more difficult to quickly diagnose if you're low carb, because you'll have ketones anyway from eating very few carbs. And testing for ketones is the quickest way to find out if you're heading for a possible DKA.

In T1's, it's recommended to test for ketones when having prolonged high BG's (higher 10's) as DKA only comes with high BG's usually.
So no high BG, no risk of DKA for us.

But on flozins, like empagliflozin, you can go into DKA without having high BG (euglyceamic ketoacidosis), which on its own increases the risk a diagnosis will be missed or written of as food poisoning or such. Alarm signals can be missed when not being high.
If you produce ketones because of your diet, this takes away the second easy diagnostic tool. No sense in testing for ketones if you already know they are there.

lucylocket61 said:

Also, it says to drink plenty, with no indication of what plenty means.

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This is because it works by making you pee out glucose, so you might be peeing more often, and your body prefers the glucose to be as diluted as possible when it gets rid of it.
It might also help in preventing yeast infections and UTI's, as yeasts and bacteria love a sweet environment.

Here's the link to the NHS site about it. Read right through to the bits about t2.
I think the dka can occur if someone on the drug goes very low carb very suddenly, so low carbing is best done very gradually. I know you @lucylocket61 are already low carb so I personally don't know if the risk still applies.
https://www.nhs.uk/medicines/dapagliflozin/
Keep testing and ge aware and keep safe

lucylocket61 said:

Now my levels are regularly in double figures, despite no change in my eating pattern or food choices, I think the time has come to try empaglilozin.

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I’m sorry things haven’t improved. I guess I’m curious why that particular choice of medication? If you want to maintain a lower carb way of eating would you consider others that don’t carry the eDKA risks? I’m assuming you’ve already made all the changes to eating patterns and choices you feel appropriate for your lifestyle and that road is maxed out?

lucylocket61 said:

That was the only choice given, except ozempic. I am not aware of others which dont carry the dka risk. I cant take metformin. What others are there?

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https://www.diabetes.co.uk/diabetes-medication/ There’s a lot more than 3 options. There might be genuine reasons why they only offered that those but it’s worth a good read and a conversation with your nurse before making a choice I’d say.

They probably wouldn’t be very keen on offering Gliclazide to someone eating low carb, as Gliclazide can cause hypos (and weight gain, and IIRC Lucy is somewhat overweight? Forgive me if I’m mixing up with someone else).

Empaglifozin, on the other hand, can promote weight loss, in addition to losing BG. If it helps at all, I take it, I eat low carb. I suggested it to my GP myself, when I asked to come off Gliclazide because of frequent hypos and a weight gain of 10kg in a month.

I don't know if this helps Lucy. I found the attached link. The guy in it was having a very low carb level of around 25g. Maybe ask your doctor if there is still a risk with the level of carbs you normally have?

https://pubmed.ncbi.nlm.nih.gov/31685745/

I'm on Dapagliflozin amongst other things and my DN okayed LC but advised to avoid keto.(she's come along way since I was 1st diagnosed and told me to switch the dried fruit in my porridge for honey as it was a natural sugar ,I still miss porridge )