I am not sure where to post this, but I want to highlight a rare but potentially lethal side effect of taking Forxiga a SGLT2 inhibitor. Sorry for the long post, but I want to explain the background to alert others to the risk.
My husband was diagnosed 17 years ago and was successfully controlled by tablet for 16 of them. A year ago he was put on Forxiga 5mg plus metformin. All seemed ok for 6 months, but his control was not so good, so the dose was upped to 10mg. He was ecstatic to find the weight dropped off him, 16kg in less than 6 months, but his glucose levels were rising(10 - 11) morning fasting. I have eaten reasonably lc since being diagnosed, but was also put on Forxiga 10 mg straight away. No dramatic weight loss, but glucose levels consistently between 5 and 6.
After being warned his next step was insulin, he decided to eat the same as me, but we both reduced calories to 1000 to see if he could get levels down and keep them steady when he increased calories. After 2 days his levels were between 4 and 5 consistently before meals and 2 hours after. However, on day 3, levels were at 6, he was a bit breathless with a stinking headache. He then had an episode of projectile vomiting in the evening, not even making it out of the armchair. Despite my concerns I allowed him to reassure me (tbh, felt rather rough myself having had surgery on a broken wrist the day before, so probably was easier to convince).
The next morning, breathing was significantly worse, several episodes of vomiting, and a raging thirst. Blood glucose had risen to 10.6. I called 999, a car with 2 paramedics arrived to assess him, then an ambulance with 3 more. Admitted to the acute medical unit, treatment for ketoacidosis. The diabetic registrar said she would have expected to see glucose levels in excess of 40, but the highest his got was 15.8. The consultant accused him of starving himself, but he had only had 2 days at 1000kcal, not complete fasting or even the Newcastle diet. Another side effect is however, anorexia.
They said it was an a-typical reaction to the forxiga, and had been documented as less than 1 in 1000. If I had not been at home, he would have gone to bed to sleep it off, with disastrous consequences. If the lc days triggered it, I can only be glad, because I am convinced he was already suffering side effects. However I knew the symptoms of ketoacidosis, having done extensive research before changing to lc, many may not, as even the doctors on duty in a&e kept saying it wasn't possible in a non- insulin dependant type 2 with his glucose levels. Luckily though they still started treatment immediately rather than wait for the diabetic specialists.
3 days later, he is home, now under the hospital consultant rather than our practice nurse, and on insulin. He isn't finding it half as frightening as he thought, and is already losing a lot of the general malaise he had been progressively complaining about. He will be disappointed if he puts weight on, he is the lightest for 30 years, but it went too quick to be healthy, and tbh I began to worry what else might be going on.
Side effects are listed in the packet inserts, but how many of us read them when first prescribed, then if all seems well, don't bother afterwards? All I remember the nurse actually telling me was there an increased risk of thrush. No mention at all of any of the more serious potential issues. If you are on these, read that insert over again, and make sure your family are also aware. It might be rare, but it also might be you.
My husband was diagnosed 17 years ago and was successfully controlled by tablet for 16 of them. A year ago he was put on Forxiga 5mg plus metformin. All seemed ok for 6 months, but his control was not so good, so the dose was upped to 10mg. He was ecstatic to find the weight dropped off him, 16kg in less than 6 months, but his glucose levels were rising(10 - 11) morning fasting. I have eaten reasonably lc since being diagnosed, but was also put on Forxiga 10 mg straight away. No dramatic weight loss, but glucose levels consistently between 5 and 6.
After being warned his next step was insulin, he decided to eat the same as me, but we both reduced calories to 1000 to see if he could get levels down and keep them steady when he increased calories. After 2 days his levels were between 4 and 5 consistently before meals and 2 hours after. However, on day 3, levels were at 6, he was a bit breathless with a stinking headache. He then had an episode of projectile vomiting in the evening, not even making it out of the armchair. Despite my concerns I allowed him to reassure me (tbh, felt rather rough myself having had surgery on a broken wrist the day before, so probably was easier to convince).
The next morning, breathing was significantly worse, several episodes of vomiting, and a raging thirst. Blood glucose had risen to 10.6. I called 999, a car with 2 paramedics arrived to assess him, then an ambulance with 3 more. Admitted to the acute medical unit, treatment for ketoacidosis. The diabetic registrar said she would have expected to see glucose levels in excess of 40, but the highest his got was 15.8. The consultant accused him of starving himself, but he had only had 2 days at 1000kcal, not complete fasting or even the Newcastle diet. Another side effect is however, anorexia.
They said it was an a-typical reaction to the forxiga, and had been documented as less than 1 in 1000. If I had not been at home, he would have gone to bed to sleep it off, with disastrous consequences. If the lc days triggered it, I can only be glad, because I am convinced he was already suffering side effects. However I knew the symptoms of ketoacidosis, having done extensive research before changing to lc, many may not, as even the doctors on duty in a&e kept saying it wasn't possible in a non- insulin dependant type 2 with his glucose levels. Luckily though they still started treatment immediately rather than wait for the diabetic specialists.
3 days later, he is home, now under the hospital consultant rather than our practice nurse, and on insulin. He isn't finding it half as frightening as he thought, and is already losing a lot of the general malaise he had been progressively complaining about. He will be disappointed if he puts weight on, he is the lightest for 30 years, but it went too quick to be healthy, and tbh I began to worry what else might be going on.
Side effects are listed in the packet inserts, but how many of us read them when first prescribed, then if all seems well, don't bother afterwards? All I remember the nurse actually telling me was there an increased risk of thrush. No mention at all of any of the more serious potential issues. If you are on these, read that insert over again, and make sure your family are also aware. It might be rare, but it also might be you.
