Low carb with Jardiance & metformin

I haven’t been through this but wanted to wish you all the best. Sounds like a tough situation. Hopefully some other Jardiance users will be along soon to give some guidance.

We are all different so my advice is try it and see how it works for you. Testing regularly as you go.
Even on metformin you can get a hypo but not as common or regular than if you were on insulin.
Keep us updated as you may need to tweek. Loads of advice on here to help out.
Myself I have to low cal and low carb to keep sugars good and lose all the excess weight. My priority is weight loss as I reached 22st on insulin therapy. I still need insulin but hoping that may change. I'm still losing but near 15½st now. I had to have bariatric surgery to correct my weight problem. I wish i could hv had bariatric help sooner. In fact I wish I'd been diagnosed as a child but nowadays not in the nieve 1970s.
Welcome to improving your health!

lcarter said:

Hi all.

I'm a type 2 with insulin resistance, (misdiagnosed with type 1 for 11 years- but that's another story!) Spoke with DSN today and she recommended I now try a very low carb diet.

I'm familiar with Dr Jason Fung, so feel its probably the best decision as my levels are horrific after eating carbs.

Average glucose level is about 15mml.

Last hba1c was 81.

My query is this.

I'm on 10mg of Jardiance and 2mg of metformin a day. My nurse did say that Jardiance only gets rid of excess glucose, so if I'm low carbing there shouldn't be any, so no risk of hypos as I previously worried about. Then she said metformin doesn't cause hypos either, so I'm safe to start fasting and low carbing as long as I check for ketones if my levels go over 17 or I feel unwell.

They offered me trulicity once weekly injection and possibly upping jardiance to 25mg a day...but I wanted to try this first.

I'm not asking for medical advice but more experience, has anyone been through this?

Any advice or thoughts welcome.

Click to expand...

Hi and welcome to T2 club..

Do you know what carb consumption you are going to aim for as it could be quite important?
"Low carb" can cover a multitude of ways of eating and if you include fasting (the ultimate zero carb) then that will have an impact too.

Watch out for UTI's with the Jardiance too.

Hmmm... to only get rid of “excess” glucose, it would have to be a smart drug and sense glucose levels in the body. That would be a miracle drug indeed. But it’s not, It removes glucose, what ever is there, at the rate that dose works in you body. I was started on Metformin and Jardiance 10mg at diagnosis. I also immediately changed my diet and was eating around 80-90 carbs at that time.

I started getting lows with Jardiance after exercise. BG was fine at the start, then exercise would drop it and Jardiance would keep dropping it for a few hours after. So, I stopped it after 5 weeks of having to needlessly eat sugar when I wasn’t even hungry. On the upside, it was the only new drug I started that gave me zero side effects. I hope your experience with it is good, mine was not horrible, just not ideal.

Oh, and @lcarter you should probably be aware of this. I would think shooting for ketones from a ketogenic diet at the carb levels you are planning would make it harder to determine if it’s the diet, or the Jardiance?

https://www.pharmacytimes.com/contr...g-sglt2-inhibitors-diabetic-ketoacidosis-risk

lcarter said:

Hi,

I'm aiming for under 30gs a day, if not 20gs.

Really not sure whether to continue with the jardiance my Dsn said it won't cause hypos but I'm just worried.

Thanks

Click to expand...

To be honest I'd monitor bloods and if they start to go too low then .. well you know I can't say but I know what I'd do...

If you are aiming for 20g of carbs then you should start to see far better numbers pretty soon. Especially if combined with some intermittent fasting.

Walking Girl said:

Oh, and @lcarter you should probably be aware of this. I would think shooting for ketones from a ketogenic diet at the carb levels you are planning would make it harder to determine if it’s the diet, or the Jardiance?

https://www.pharmacytimes.com/contr...g-sglt2-inhibitors-diabetic-ketoacidosis-risk

Click to expand...

There is a discussion together with personal experiences here
https://www.diabetes.co.uk/forum/th...-on-the-risk-of-diabetic-ketoacidosis.104325/

lcarter said:

Hi all.

I'm a type 2 with insulin resistance, (misdiagnosed with type 1 for 11 years- but that's another story!) Spoke with DSN today and she recommended I now try a very low carb diet.

I'm familiar with Dr Jason Fung, so feel its probably the best decision as my levels are horrific after eating carbs.

Average glucose level is about 15mml.

Last hba1c was 81.

My query is this.

I'm on 10mg of Jardiance and 2mg of metformin a day. My nurse did say that Jardiance only gets rid of excess glucose, so if I'm low carbing there shouldn't be any, so no risk of hypos as I previously worried about. Then she said metformin doesn't cause hypos either, so I'm safe to start fasting and low carbing as long as I check for ketones if my levels go over 17 or I feel unwell.

They offered me trulicity once weekly injection and possibly upping jardiance to 25mg a day...but I wanted to try this first.

I'm not asking for medical advice but more experience, has anyone been through this?

Any advice or thoughts welcome.

Click to expand...

Jardiance has some side effects for many people. UTI and yeast infection can be an issue with Jardiance. Something that helps me with UTI is taking a pre and probiotic specifically for the urinary tract. Also I use a bidet or you can fill a squeeze bottle each time you use the toilet. It rinses the glucose that causes the UTI or yeast infection. Also, I drink 3-5 liters of water daily. I am on 10mg Jardiance daily, and a low carb diet. For me, I do have issues with hypoglycemia, but I keep a snack with me at all times. And act at the first sign of having low glucose. My understanding is jardiance removes glucose from the body, not excess glucose. It also puts you into ketosis, which is why I check my ketones every 6 hours, ketoacidosis, although rare, does happen and can happen quickly. I wouldn't advise extreme low carbohydrates at first, try to adjust what suits you. I seem to have found a balance for me after a few weeks. I dont have the the addition of metformin, it raised my fasting blood glucose and gave me terrible abdominal pain. Good luck, I hope this helps.

lcarter said:

Hi all.

I'm a type 2 with insulin resistance, (misdiagnosed with type 1 for 11 years- but that's another story!) Spoke with DSN today and she recommended I now try a very low carb diet.

I'm familiar with Dr Jason Fung, so feel its probably the best decision as my levels are horrific after eating carbs.

Average glucose level is about 15mml.

Last hba1c was 81.

My query is this.

I'm on 10mg of Jardiance and 2mg of metformin a day. My nurse did say that Jardiance only gets rid of excess glucose, so if I'm low carbing there shouldn't be any, so no risk of hypos as I previously worried about. Then she said metformin doesn't cause hypos either, so I'm safe to start fasting and low carbing as long as I check for ketones if my levels go over 17 or I feel unwell.

They offered me trulicity once weekly injection and possibly upping jardiance to 25mg a day...but I wanted to try this first.

I'm not asking for medical advice but more experience, has anyone been through this?

Any advice or thoughts welcome.

Click to expand...

Hi Im on 1000g of metformin twice a day and just started Forxiga 10mg which is similar to Jardiance. I try and stick to 20g of carbs maximum a day and fast from 6pm until 12:30pm the following day. I do have coffee with cream at 8am but don’t count that as breaking my fast as it doesn’t interfere with my insulin level. I have considered longer fasts and cut out the coffee but wanted to make sure I was tolerating the Forxiga first.

For anyone reading this on Jardiance. Just be aware that a rare side effect is that you can go in to Diabetic Ketoacidosis without showing high bg levels.

Be aware of the symptoms of DKA so you can check Ketone levels / seek medical help.

I believe it can be made more likely on a low carb diet.

I ended up in hospital because of this (and had just switched to low carb). But again - it is a rare side effect.

DKA is not so rare it seems I am on 5 mg of Forxiga, and I had urine ketones of 4 mmol/l which rose to 8mmol/l during an episode where I felt ******. A blood test for ketones measured 4,2 mmol/l. I am a medium carber, and I was no where near dietary ketosis so the kertones were definitely being caused by the med making me burn lipids for energy. My bgl at the time I had the 8 mmol reading was 6.4 mmol/l so not at all high.

We have had others report ketones being measured when on this med, but so far no A&E visits being reported (i.e full blown DKA). My situation resolved itself without intervention too. I still get urine samples of around 4. I suspect I was dehydrated when I had my wobbup so you need to keep hydrated because of the extra weeing. Also may be a problem if on any diuretics.

lcarter said:

Hi all.

I'm a type 2 with insulin resistance, (misdiagnosed with type 1 for 11 years- but that's another story!) Spoke with DSN today and she recommended I now try a very low carb diet.

I'm familiar with Dr Jason Fung, so feel its probably the best decision as my levels are horrific after eating carbs.

Average glucose level is about 15mml.

Last hba1c was 81.

My query is this.

I'm on 10mg of Jardiance and 2mg of metformin a day.

Click to expand...

Hi, I wonder why you’re on such a low dose of metformin? Do you mean 2000mg? If you are on such a low dose maybe ask your diabetes nurse if you can try a higher dose and drop the Jardiance? Metformin is one of the safest diabetic drug out there and it’s been around for a very long time

MissMuffett said:

Hi, I wonder why you’re on such a low dose of metformin? Do you mean 2000mg? If you are on such a low dose maybe ask your diabetes nurse if you can try a higher dose and drop the Jardiance? Metformin is one of the safest diabetic drug out there and it’s been around for a very long time

Click to expand...

Althouh Metformin is a useful drug for diabetes, its effect on blood glucose levels is very small.and will do little to reduce the levels declared in the OP. Metformin is a protection medication for the heart and cardiovascular system as a whole, but its glucose lowering properties are in the order of just a couple of mmol/l even at max dose.

I think the original aim of going Low Carb possibly with some fasting should produce improvement for the OP, but Trulicity is for weight loss by inducing ketosis, and is contraindicated with low carb diet. There is a small risk of euDKA with the Glutide family of meds as we have had reports on this Forum.

Edit correction for Trulicity family name.