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SLGT2 Inhibitors...Ketones...good for patients...

kokhongw

kokhongw

Well-Known Member
Messages
2,394
Location
Singapore
Type of diabetes
I reversed my Type 2
Treatment type
Diet only
It is rather clear that medical professionals do understand the value and mechanics of ketones...but only when it is drug induced?

For the Good of Your Patients, Continue Using SGLT2 Inhibitors
Per-Henrik Groop, MD, DMSc

DISCLOSURES
November 14, 2018

https://www.medscape.com/viewarticle/904397?src=soc_fb_181118_mscpedt_news_endo_sglt2i&faf=1
How do these medications lead to DKA? The SGLT2 inhibitor improves insulin secretion, but patients then have less absolute insulin in the circulation. They then produce free fatty acids and ketones. Because of the mode and mechanism of action, ketones are generated just by giving the drug to these patients.

In most cases, this is good for patients. However, if they run out of insulin, they may then develop ketoacidosis. In those cases, you must make sure that you are giving your patients enough insulin if they are on an SGLT2 inhibitor plus insulin.
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My dsn stopped my Jardiance because i was getting higher than liked keytones, 2.1 im pretty sad about this as the Jardiance was very helpful when I started it, I guess we will see how important it was, I was on that before I started insulin
 
Oh My Days! The list of disclosures is like a who's who of Big Pharma! No bias there then, Pfft.
 
I read the comments from the other Doctors and they sound just like us lot discussing carbs!
 
"Discuss with patient" Will a GP get many takers after disclosing the admittedly small but significant number of patients developing Fourniers Gangrene as a direct side effect of these drugs? And as one doctor put it, the growing number pf people with DM may flag up more side effects as the drugs are used long term.
 
I'm slightly confused. If higher levels of ketones is caused by eating a low carb diet and too high a level can lead to ketoacidosis, how do I know that my low carb diet isn't doing me more harm than good? I have used keto stix but to be honest they only confirm the presence of ketones.
 
DavidGrahamJones said:
I'm slightly confused. If higher levels of ketones is caused by eating a low carb diet and too high a level can lead to ketoacidosis, how do I know that my low carb diet isn't doing me more harm than good? I have used keto stix but to be honest they only confirm the presence of ketones.
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Ketoacidosis should only be a problem if blood sugar is very high too... as you have some endogenous insulin production then you should be fine with some ketones.
Unless of course you are taking SGLT-2 inhibtors
 
DavidGrahamJones said:
I'm slightly confused. If higher levels of ketones is caused by eating a low carb diet and too high a level can lead to ketoacidosis, how do I know that my low carb diet isn't doing me more harm than good? I have used keto stix but to be honest they only confirm the presence of ketones.
Click to expand...

This is a point that has been raised before. Patients should be advised that a ketogenic diet is contraindicated whilst using SGLT2s.
 
Exactly guzzler, my dn knew I was eating low carb, under 20g a day and still prescribed it!
 
No one knows if slgt2 are safe with a low carb diet, some doctors are advising against it, but the drug regulator has said nothing about it. We don't know if any of the people in the safety studies on sglt2 were eating a low carb diet.

As to DKA slgt2 will keep someone's BG looking OK even while they are having DKA hence the need to test ketones and then blood gas if keystones are very high. DKA is always due to very low (or no) inslin, high BG is not part of the biological process of DKA, but is normally also expected when inslin is very low.
 
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