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SGLT2 inhibitors: updated advice on the risk of diabetic ketoacidosis
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<blockquote data-quote="Oldvatr" data-source="post: 2313150" data-attributes="member: 196898"><p>In the article you posted, the author is himself a T1D, and is writing it from the T1D aspect only. But it does raise a couple of new problems that I was only vaguely aware of. Firstly, it is fairly common for GP's to start a new diagnosis by assuming T2D and treat as such until it becomes more apparent from symptoms that the patient has a different form of diabetes or is becoming insulin dependent. This is how NICE guidelines progress in their flowchart. Since the drug companies are pushing this medication as a replacement for Metformin and as a 'cure' for many other common ailments, then they are becoming pressured to prescribe it from the getgo. NICE and the BFN do not carry any warning about mixing it with LC or Low Cal diets, and do not really give proper advice on the euDKA variant (which occurs with 'normal'' glucose levels) So the patients will largely be unaware of these risks, and the A&E staff may also miss the warning signs too.</p><p></p><p>Second problem is that SGLT2 inhibitors cause raised ketones in the blood but drop the levels in the urine so the wee sticks become useless at giving warnings or sugar levels. SGLT2 meds also apparently reduce sensitivity to hypo's which is also a worry for insulin users. Note: the SGLT2 actually stop the kidneys filtering out the ketones so they build up in the blood unless you burn them off - The dietary levels of ketones is low (less than 4 mmol/l even on full keto) But on an SGLT2 you will also be blocking the removal of ketones from exercise and other normal activities so unless your bgl is low enough for fat burning all the time, this buildup can occur at bgl levels around 10mmol/l rather than the usual >25mmol/l of a standard diabetic DKA</p><p></p><p>Personally if it was me I would want to avoid this family of medicines since I value my gonads and hate UTI but find low carb an easier alternative for both bgl, BP, and weight control.</p></blockquote><p></p>
[QUOTE="Oldvatr, post: 2313150, member: 196898"] In the article you posted, the author is himself a T1D, and is writing it from the T1D aspect only. But it does raise a couple of new problems that I was only vaguely aware of. Firstly, it is fairly common for GP's to start a new diagnosis by assuming T2D and treat as such until it becomes more apparent from symptoms that the patient has a different form of diabetes or is becoming insulin dependent. This is how NICE guidelines progress in their flowchart. Since the drug companies are pushing this medication as a replacement for Metformin and as a 'cure' for many other common ailments, then they are becoming pressured to prescribe it from the getgo. NICE and the BFN do not carry any warning about mixing it with LC or Low Cal diets, and do not really give proper advice on the euDKA variant (which occurs with 'normal'' glucose levels) So the patients will largely be unaware of these risks, and the A&E staff may also miss the warning signs too. Second problem is that SGLT2 inhibitors cause raised ketones in the blood but drop the levels in the urine so the wee sticks become useless at giving warnings or sugar levels. SGLT2 meds also apparently reduce sensitivity to hypo's which is also a worry for insulin users. Note: the SGLT2 actually stop the kidneys filtering out the ketones so they build up in the blood unless you burn them off - The dietary levels of ketones is low (less than 4 mmol/l even on full keto) But on an SGLT2 you will also be blocking the removal of ketones from exercise and other normal activities so unless your bgl is low enough for fat burning all the time, this buildup can occur at bgl levels around 10mmol/l rather than the usual >25mmol/l of a standard diabetic DKA Personally if it was me I would want to avoid this family of medicines since I value my gonads and hate UTI but find low carb an easier alternative for both bgl, BP, and weight control. [/QUOTE]
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