SGLT2 inhibitors: updated advice on the risk of diabetic ketoacidosis

Brunneria said:

Here is a link to the DCUK webpage giving info about these drugs, including the common brand names.
(it occurred to me that people may not realise that the drug they are taking is an SGLT2 inhibitor [Gliflozins])

https://www.diabetes.co.uk/diabetes-medication/sglt2-inhibitors.html

Also worth noticing that as I post this, the side effects listed on that page do not include ketoacidosis, although they list genital and UT infections, hypos, liver damage, breast and bladder cancers and increased cholesterol.

Maybe @Administrator may ask someone on the team to update the info to include ketoacidosis? Thank you in advance, Administrator.

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Risk of increasing breast and bladder cancer remains a safety issue of SGLT2 (sodium glucose cotransporter type 2) inhibitors, a novel class of antidiabetic agent. We reviewed related papers published before January 29, 2014, through Pubmed search. Dapagliflozin and canagliflozin are the first two approved SGLT2 inhibitors for diabetes therapy. Although preclinical animal toxicology did not suggest a cancer risk of dapagliflozin and overall tumor did not increase, excess numbers of female breast cancer and male bladder cancer were noted in preclinical trials (without statistical significance). This concern of cancer risk hindered its approval by the US FDA in January, 2012. New clinical data suggested that the imbalance of bladder and breast cancer might be due to early diagnosis rather than a real increase of cancer incidence. No increased risk of overall bladder or breast cancer was noted for canagliflozin. Therefore, the imbalance observed with dapagliflozin treatment should not be considered as a class effect of SGLT2 inhibitors and the relationship with cancer for each specific SGLT2 inhibitor should be examined individually. Relationship between SGLT2 inhibition and cancer formation is still inconclusive and studies with larger sample size, longer exposure duration, and different ethnicities are warranted.

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Contralto said:

I don't care how many times people reintroduce this data. Docs (5 of mine for example) are still heavily pushing this drug

If I had not had a documented adverse reaction to one of them, I probably would have been declared non compliant as a patient by docs without a clue who wanted me to get better control:

https://www.fda.gov/Drugs/DrugSafety/ucm617360.htm

I am sure I am not the only person not to realize that a whole class of diabetic drugs is downright dangerous

The connection between this kind of gangrene and the common women's curse candida also needs reiteration

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Oldvatr said:

I have on several occasions asked forum posters who are using this family of diabetes medication if their prescriber has discussed the symptoms of DKA with them in regard to this family of medications. So far none has replied that this happened, so I am starting this thread with the current Government advisory from both the UK and USA. I cannot find any NICE guidelines to GP's covering this aspect but there was an internal assessment report I found that discusses this topic. The report is not for public release. It discusses the reported incidence rates for DKA and acute pancreatis but has no recommendations other than wait for more FDA investigation studies to complete.
The following advisories are released and updated by the regulatory authorities:
https://www.gov.uk/drug-safety-upda...d-advice-on-the-risk-of-diabetic-ketoacidosis

http://www.fda.gov/Drugs/DrugSafety/ucm446845.htm

I really think this should be made into a sticky so it does not get lost. DKA is a potentially life threatening condition that can apparently be triggered by these meds even on lowish bgl levels (10 mmol/l) so is not the same as the classic DKA symptoms where there is very high bgl with it.
@Giverny

The report that the NICE comittee used to base their decision on is available on the web
https://www.nice.org.uk/guidance/ta336/chapter/4-Consideration-of-the-evidence

It is interesting that the Company ran all the tests and presented the findings. The tests were short duration and the only side effect noted in the summary was UTI. The incidence of bone thickening and fracture was not reported, and DKA was not considered. There was no seperate chapter on SAFETY at all, and long term safety did not seem to be a consideration.

The current guidelines for prescription do not mention either of these 'side effects either.
https://www.nice.org.uk/guidance/ta390/chapter/3-Evidence

Edit to add a couple of related topics:
Sglt2 Inhibitors Continue To Be Linked With Amputation Risk In Type 2 Diabetes
https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2696726

And another related study on mortality associated with this medication:
https://jamanetwork.com/journals/ja...t=personalizedcontent&previousarticle=2696726

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carina62 said:

This is scary reading! I think I’ve made up my mind and am going to refuse this drug and try and continue to lower my levels with diet & exercise.

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ickihun said:

I don't mind being the alarmist on this occasion. Its so damaging to diabetics who rely on their mobility to maintain their diabetes. Mobility is a huge part of maintenance.
I feel like a fish with one fin

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Indy51 said:

And apparently the class action suits in the USA are starting. Just saw this posted on Twitter:

View attachment 28559

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DaveXF said:

So..after reading this ( genital gangrene, *****) , I won't be taking up the kind offer from my DN to have this muck inside me
Now..let's have a look at sitagliptin

Edited by mod for language

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magicmoose2 said:

Just posted this on the thread "Dapaglifloxin - anyone had any experience with this?" but figured I would cross post it here as well.

Hello, magicmoose here - for some reason I am unable to log in with my real account so have created magicmoose2 until I can rectify the issue with the forum team.

An update on my experiences with Dapagliflozin! Commenced on 29/12/18 and reduced carb intake on 02/01/19 gradually saw numbers come tumbling down in the right direction. Started to feel unwell light headed / headache a week in so as advised here got my blood pressure checked and was deemed ok. Also purchased a BP monitor to check at home and BP was perfect, not too low or too high.

Headache passed, but then I started to feel ill - I'm not normally physically ill so I knew something was not right. Four days in after abdominal pain, lower back ache, cramps in legs, headache and general feeling of confusion I checked for ketones with a ketone stick, was at ++++ next day checked again when up and same ++++ BP fine and BG in 10's.

Decided to speak to duty DN who initially thought I had a virus and advised me to stop Dapagliflozin, if symptoms continued then it was a virus, if they disappeared then blame the drug. I then mentioned the ketones and she asked me to check again and she would call back. I checked still at ++++ and so given my symptoms she sent me to A&E. I fear had I not mentioned the ketones she would have just gone with the virus idea.

Triaged in A&E blood ketones at 3.6 of course doctors were confused as BG's fairly normal, at this point reading on BG monitor was 9.2. That morning I was struggling to eat, felt sick and was nodding off in the chair - not like me. I was also incredibly thirsty and was drinking loads of water, mouth was extremely dry. When I mentioned the drug and the connection to DKA the doctor did his research and started to treat me for that. Fluids administered, bloods taken, chest x-ray (breathing was a little fast) ECG done. Spent 5 hours in A&E before being moved to ward. Spent three hours on the ward and stayed for two nights until bloods improved.

Ketones continued to increase over the next few hours, but eventually started to go down. Back home, all symptoms gone within 24 hours, Dapagliflozin stopped. No ketones showing now on stick.

I'll be honest had I not used this forum to learn of DKA with Dapagliflozin, I might have dismissed it as a virus given the time of year.

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magicmoose2 said:

Just posted this on the thread "Dapaglifloxin - anyone had any experience with this?" but figured I would cross post it here as well.

Hello, magicmoose here - for some reason I am unable to log in with my real account so have created magicmoose2 until I can rectify the issue with the forum team.

An update on my experiences with Dapagliflozin! Commenced on 29/12/18 and reduced carb intake on 02/01/19 gradually saw numbers come tumbling down in the right direction. Started to feel unwell light headed / headache a week in so as advised here got my blood pressure checked and was deemed ok. Also purchased a BP monitor to check at home and BP was perfect, not too low or too high.

Headache passed, but then I started to feel ill - I'm not normally physically ill so I knew something was not right. Four days in after abdominal pain, lower back ache, cramps in legs, headache and general feeling of confusion I checked for ketones with a ketone stick, was at ++++ next day checked again when up and same ++++ BP fine and BG in 10's.

Decided to speak to duty DN who initially thought I had a virus and advised me to stop Dapagliflozin, if symptoms continued then it was a virus, if they disappeared then blame the drug. I then mentioned the ketones and she asked me to check again and she would call back. I checked still at ++++ and so given my symptoms she sent me to A&E. I fear had I not mentioned the ketones she would have just gone with the virus idea.

Triaged in A&E blood ketones at 3.6 of course doctors were confused as BG's fairly normal, at this point reading on BG monitor was 9.2. That morning I was struggling to eat, felt sick and was nodding off in the chair - not like me. I was also incredibly thirsty and was drinking loads of water, mouth was extremely dry. When I mentioned the drug and the connection to DKA the doctor did his research and started to treat me for that. Fluids administered, bloods taken, chest x-ray (breathing was a little fast) ECG done. Spent 5 hours in A&E before being moved to ward. Spent three hours on the ward and stayed for two nights until bloods improved.

Ketones continued to increase over the next few hours, but eventually started to go down. Back home, all symptoms gone within 24 hours, Dapagliflozin stopped. No ketones showing now on stick.

I'll be honest had I not used this forum to learn of DKA with Dapagliflozin, I might have dismissed it as a virus given the time of year.

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Dollylolly said:

I’ve only been told to test if I feel a hypo is coming on and my GP states that I’m safe doing moderate low carb not Keto so this is wrong then and I should be wary doing so?

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