SGLT2i - a traveller takes the first steps on a long journey - forxiga/dapagliflozin

[LittleGreyCat]

As mentioned elsewhere, I am now started on my next escalation of medication.

I am already on 4 * 500 mg Metformin a day.
Also on Vipidia/alogliptin 25 mg once a day.
I have not been able to get my HbA1c down below 7.5% and it seems to be around 7.8% to 7.9%.
This is partly due to poor self control, but also because I don't seem to be regulating my BG on a day to day basis being good (keto) or being bad (chips, chips, chips..)

The surgery know I have been doing low carb/keto for a long time and up until the last few years it has worked for me.
They were concerned about starting me on this new medication because LCHF/keto is considered a risk factor for diabetic ketoacidosis with no warning from high BG.
I agreed that I would up my carbohydrates. [].
You might guess that this wasn't a major hardship.

Anyway I am on my 3rd day of the pills.
forxiga 10 mg once a day.
They even have the days on the packaging.

Complicating factor - I have an infected sebaceous cyst on my back and am on Flucloxacillin 500 mg 4 times a day.
I don't often have to take antibiotics but when I do they knock me out.
This may be why my BG is worse than before I started the forxiga - antibiotics can upset BG control - but this isn't a good start to a new drug regime.

I will keep this thread updated as best I can, but I do hope that the full effect kicks in after a couple of weeks.
I had high hopes for this drug.

 

[EllieM]

I'll read your thread with interest. Thanks for sharing. Looks like it takes time for it to work?

Farxiga: Side Effects, Cost, Dosage, Uses, and More

Learn about side effects, cost, and more for Farxiga (dapagliflozin). It’s a prescription drug with many uses, including treating type 2 diabetes in certain adults.

www.healthline.com

How long does Farxiga take to work? Farxiga starts working when you take your first dose. But it might take a few weeks for your blood sugar level to improve. It’s not known how long it takes for Farxiga to help lower the risk of complications from heart failure or kidney disease.

I did some research on this when my T2 93 year old dad was offered it (mainly as a protection against heart attacks?). We decided against it because he both low carbs and drinks a lot of alcohol and we didn't think he would be willing to reduce his alcohol intake and drink water instead.)

Good luck.

 

[MissMuffett]

I’m on Forxiga 10mg and 2000mg metformine and it’s done wonders for my BG. My readings used to be in the teens regularly 15-17 mmol/l but now mostly 5s and 6s. I do low carb most of the time (usually less than 20g a day) and the Forxiga encourages me to eat that way because if I go higher carbs I would get thrush or UTI which I’ve had twice, not pleasant. I haven’t had any hypos or any threat of ketoacidosis and it’s working just fine with me. Everyone is different though obviously.

 

[TheSecretCarbAddict]

I've had to discontinue Forxiga (10g) when I doubled down on my low carb diet recently (<30g carbs a day) as in combination with gliclazide this was causing quite a few hypos. Came off gliclazide a couple of weeks ago and Forxiga earlier this week, as I was still having some low BG events. I've noticed that my overall BG levels have now gone up a little and will need to think how I spread my daily carb allowance across the day and perhaps tweak proteins as that is the next big impact on BG levels when it comes to food. I guess this is a longwinded way to say Forxiga seems to do its job when it kicks in.

One interesting comment my GP made when reviewing my meds earlier this week was that discontinuing Forxiga might mean my weight loss will slow or plateu as I'll be getting rid of less glucose through urine. I'm hoping that discontinuing gliclazide at the same time will balance things out as gliclazide can encourage weight gain.

I'll second the increased likelihood of developing thrush / UTIs when your BG levels are running high. Had to deal with thrush several times over the few years I was on Forxiga.

Edit: I had to go back and write the first part of the post again as it got wiped while I was tapping my acreen to click that Send button.

 

[LittleGreyCat]

Have added pee sticks (not the garden variety) to my shopping list.
Test for sugar in urine.
Test for ketones in urine.

Thanks for all the comments so far.
I am getting the picture that forxiga is not incompatible with low carbohydrate, despite the warnings on the patient leaflet, online, and from the surgery.

I am having a OMAD day (or intend to) as my BG hasn't been in the green on my Libre 2 since before I started the pills.
Down to 8.0 so I might go green later today!

Ordered some soft fruit sweets as the guidance on line says to be prepared for hypos, and my partner would like some emergency supplies in case I suddenly go hypo.
Very sensible.
I have no idea if I am hypo aware as I don't think that I have ever had a hypo.
Libre has shown some readings in the red overnight but (if I have noticed and checked) it is generally a dodgy sensor near end of life.

 

[TheSecretCarbAddict]

It was the Libre that flagged up my hypos. I used to feel shakes and fast heartbeat previously, but not this time around. My GP said that my body might have become adapted to low BG as I'm averaging just under 5 mmol/L. Having fast acting glucose tablets on my bedside table has been very handy - I like how each tablet represents a controlled portion of glucose and allows me not to overcompensate and push my BG too high (even if it is important to recover from hypos).

 

[LittleGreyCat]

Strange things going on.
I seem to be having a gout flare up despite the blood test just prior to starting my new medication showing that my urate levels were within range.
I wondered if the SGLT2i carried an extra gout risk but looking on line it seems to be a potential treatment for gout, and generally beneficial.
So I am baffled.
The only thought is that clearing sugar and urates at the same time is stretching my kidneys a little.
However the reports seem to feature people on gout medication already.

Anyway, just taken the last of my course of antibiotics.
The requirement for an empty stomach (take one hour before eating or two ours after eating) and taking 4 a day has really messed up my eating patterns.

 

[Max68]

I'm having a nightmare on Forxiga. My HBA1c had gone too high to 77 so was put on 5mg of Forxiga as well as slow release Metformin I've been on for years. Three months later it had dropped to 61. My mother then passed away and whilst no excuse I became silly with comfort eating and it jumped again to 69 so nurse increased the Forxiga to 10mg. I have had a weak/sensitive bladder for years, albeit 24 hr range of urine output was normal but going too often, but the mere jump to 10mg has made me extremely thirsty so drinking so much and I go to the loo so many times a day it's ridiculous and am passing double of what I usually do anything from 3,400ml to 4,100ml per day. I told my nurse but she said that was my diabetes not the medication, which whilst possibly partly true it wasn't like this before the Forxiga, I was rarely thirsty for a start and only outputting between 2,000 and 2,500ml. I've told her that I'm coming off it for my holiday because I won't be able to go anywhere! She did suggest something else, I think it might have been Gliflozin or sounding similar so wondering if that might be better because Forxiga and a sensitive bladder don't mix. I'm so miserable it's unbearable and exhausted because I'm getting up to go to the loo all through the night.

 

[LittleGreyCat]

@Max68 Forxiga is Dapagliflozin so perhaps they are suggesting an alternative "flozin"?
One from the same family of drugs which may not have quite the same side effects.

 

[LittleGreyCat]

I've finished my first two week pack and I don't know what is going on.
I don't really feel an increase in thirst but my thirst response isn't good. I only know if I am thirsty if I start to drink and then carry on glugging for a while.
Mainly I will start a pint (sometimes beer) and stall half way through.

After all the dire warnings abut hypos and concealed DKA and how LCHF and keto are not compatible with Forxiga I have upped my carbohydrates a bit, but no more than when I was off the wagon before I started the new drug.
I am seeing quite high BG and certainly no sign of low BG which could cause a hypo.

I am now trying to work out if the main effect is a delay in the onset of the BG rise after eating but I still usually get spikes even with relatively low carbohydrate meals.

I had a really weird one last night/this morning.
I had a carby pudding fairly late at night (around 21:00) with no obvious effect but about 02.00 (5 hours later?) I had a massive spike which kept going up till about 9 in the morning.
No idea why there was such a delay or such a spike.

In theory if I drink water then it should flush through my kidneys and take sugar out of my blood.
In fact the sugar should come out of the blood into my kidneys anyway, but flushing through makes it more effective.
I haven't been able to demonstrate this so far.

I think I will have to go back on the low carbohydrate diet and see what that leads to.

I have just ordered some ketositx and some sugar testing sticks so I should be able to check that I am not creeping into ketosis without warnings, and also confirm that I am chucking out sugar in my urine.
Routine tests in the past have shown no significant sugar in my urine.

Yet another pill which is not a miracle worker.

 

[LittleGreyCat]

Today I have had coffee, cream, butter for breakfast.
2 egg cheese omelette with tiny smear of tomato sauce for lunch/mid afternoon meal.
My BG has bottomed out at around 8.6 on the Libre 2.
I will check this in a bit with a finger prick.
I have no idea why I haven't gone down to "normal" BG.
Either I've stopped producing insulin for the moment, or my liver is dumping stored glucose.
Or for some reason there is gluconeogenesis going on with the protein and fats from the last meal.

What is not happening is my kidneys washing out sugar from my blood so that I go low.

Test sticks due to arrive this evening.

 

[LittleGreyCat]

Further note: BG steady(ish) around 8.5.
Had a small whisky and BG started to drop.
Alcohol takes precedence over glucose in the liver.
This suggests that my liver has been chucking out glucose to keep my BG over 8.
Problems with the control mechanism, in that insulin production has been throttled back but glucose production hasn't?
I am I headed for the single malt diet??

 

[LittleGreyCat]

Another update:

The "eat more carbs because hypos" seems to be not a good idea in my case.
My BG just seems to run constantly high if I eat any significant carbohydrates.
I am now back on the low carbohydrate wagon, and my BG seems to be mainly in the green on the Libre 2.
This is all very unsettling, though, because I have been warned to beware of hypos but I have no idea what a hypo might feel like, having never knowingly had one.
The Libre 2 did go down into the 3s last night, and I had a couple of precautionary soft jelly sweets, then warned my partner in case this was the dreaded hypo coming on, then went and tested with a finger prick which showed me up in the 6s so yet again a low reading Libre 2.

I've tried the pee sticks for glucose and ketones.
The glucose shows the maximum reading on the colour chart.
The ketones show the ""Medium" range which I think should be fine.
[Dangerous for T1s, probably, but not for low carb T2s.]

At the moment I think my control is very slightly better.
I can tolerate a baked potato as bulk in my meals, which I couldn't always very recently prior to the new medication.
I can't tolerate any major carbohydrates, though.

 

[LittleGreyCat]

Strange things are happening.
At the moment I seem to have a time delay (sometimes hours) before any food intake is seen on my Libre 2.
This isn't helped by the current sensor reading at least 2 full units low both high and low readings.
Changes are also dramatic - going from high glucose alarm to low glucose alarm (and vice versa) quite quickly at times.

I have increased my exercise levels so that might explain some of the low readings.

When the Libre 2 was showing very low 3s and dropping I took three fruit jellies as a precaution.
I then tested and was above 6!
Sensor was still showing around 3, though.
However I didn't see any spike from the fruit jellies so am wondering if they would have helped much in a real hypo.

I prefer logical responses to eating and drinking so it is all a bit confusing.

 

[MrsA2]

Strange things are happening.
At the moment I seem to have a time delay (sometimes hours) before any food intake is seen on my Libre 2.
This isn't helped by the current sensor reading at least 2 full units low both high and low readings.
Changes are also dramatic - going from high glucose alarm to low glucose alarm (and vice versa) quite quickly at times.

I have increased my exercise levels so that might explain some of the low readings.

When the Libre 2 was showing very low 3s and dropping I took three fruit jellies as a precaution.
I then tested and was above 6!
Sensor was still showing around 3, though.
However I didn't see any spike from the fruit jellies so am wondering if they would have helped much in a real hypo.

I prefer logical responses to eating and drinking so it is all a bit confusing.

I'm wondering if it's a faulty sensor...?

 

[imintroublenow]

I'm having a nightmare on Forxiga. My HBA1c had gone too high to 77 so was put on 5mg of Forxiga as well as slow release Metformin I've been on for years. Three months later it had dropped to 61. My mother then passed away and whilst no excuse I became silly with comfort eating and it jumped again to 69 so nurse increased the Forxiga to 10mg. I have had a weak/sensitive bladder for years, albeit 24 hr range of urine output was normal but going too often, but the mere jump to 10mg has made me extremely thirsty so drinking so much and I go to the loo so many times a day it's ridiculous and am passing double of what I usually do anything from 3,400ml to 4,100ml per day. I told my nurse but she said that was my diabetes not the medication, which whilst possibly partly true it wasn't like this before the Forxiga, I was rarely thirsty for a start and only outputting between 2,000 and 2,500ml. I've told her that I'm coming off it for my holiday because I won't be able to go anywhere! She did suggest something else, I think it might have been Gliflozin or sounding similar so wondering if that might be better because Forxiga and a sensitive bladder don't mix. I'm so miserable it's unbearable and exhausted because I'm getting up to go to the loo all through the night.

I have just had a consultation with my Cardilogist and he put me on this medication 10mg. I read the reports and I’m not taking it because I to have to get up at least 5 times a night due to an enlarged prostate and I’m not prepared to take this med as it would mean me urinating much more. I’m type 2 and have a 45%ev on my heart and that’s what the cardiologist prescribed it for . He also prescribed anther med which the Pharmacist said were water Pills. Good lord if I took those as well I’d need to know where the toilet was each time I went out so I’ve decided to go on a low carb low salt diet and lose weight instead

 

[Max68]

I have just had a consultation with my Cardilogist and he put me on this medication 10mg. I read the reports and I’m not taking it because I to have to get up at least 5 times a night due to an enlarged prostate and I’m not prepared to take this med as it would mean me urinating much more. I’m type 2 and have a 45%ev on my heart and that’s what the cardiologist prescribed it for . He also prescribed anther med which the Pharmacist said were water Pills. Good lord if I took those as well I’d need to know where the toilet was each time I went out so I’ve decided to go on a low carb low salt diet and lose weight instead

Apologies for late reply. Well despite what the nurse said about the thirst and excess urination being my diabetes and not the meds she dropped me to 5mg Forxiga and added 80mg Gliclazide for my holiday. The excessive thirst and urination dropped off dramatically so I'm only really having to get up once in the night now and not getting through large amounts of fluid in the evening. So it WAS the meds, does annoy me when they don't believe you. How it will have affected my HBA1c only time will tell as a couple of months away from the test but this combination is far more bearable. Funny how a mere 5mg of a drug can have such an impact.

 

[LittleGreyCat]

Update:

I have established that to keep my BG "in the green" or normal range on my Libre 2 I have to eat low carbohydrate.
However as always there is a complication.
If I eat very low carbohydrate, after a few days my BG starts to run very low overnight and my LibreLink App starts to give me Low BG warnings.
[This is complicated by the occasional "pressure low" when I roll over onto my sensor arm in the middle of the night.]
I feel nothing that suggests that I am going into a hypo.
However I have never, as far as I know, experienced a hypo.
So I don't know if I don't have hypo symptoms or if my body is quite happy with quite low BG levels.
Or if the sensor is just reading low.
I get readings of 3.0 mmol/L or slightly lower, but they soon bounce back into the 4s and sometimes 5s.
[I must grit my teeth and do some finger prick testing when the sensor is reading low, but I really hate the process of self harm and blood letting, however trivial.]

I have my annual review in about a month so my HbA1c will be interesting.
I have regained eating control over the last few weeks so hopefully my HbA1c will be a bit lower than last year, but for a true reading to reflect the new me (if I manage to maintain this) I would have to run for the full 90 days.

I have attached screenshots from LibreLink to show the difference over the last 30 days from the full 90 days.

I am currently starting to experiment with small carbohydrate snacks for late at night to tide me through until morning.
I will ask more about this in a diet Forum.