Taking Dapaglifloxin, last HbA1C test worse than usual, and other effects

[Babooshka59]

I'm Type 2 diabetic, and as I was finding it hard to tolerate Metformin due to digestive issues my GP prescribed Dapaglifloxin, which I have been taking since February. I've also managed to shed 20 pounds in weight this year, despite having a recognised eating disorder (binge eater) and Long COVID, which depletes my energy so I am eating more carbs than I ought just to get my energy levels up. I still need to lose another 20 pounds to get back to the weight I was before my health began to slide, and have been told by the GP practice's diabetic nurse that it is very possible I can still go into remission if I manage that. I therefore expected my HbA1c readings to improve when I had my last test a few weeks ago, but they have shot up since last time to the highest reading ever for me (76) despite the new meds and the weight loss, and also me taking more exercise (about an hour a day gentle walking, in spurts around a private dog walking field). So this increased HbA1c result is disappointing to say the least, and I'm also worried. Have others here experienced similar on this drug? I also seem to be constantly peeing, up to 4 times an hour during the day on occasion, and at least twice in the night. I also suspect I am dehydrated as I find it difficult to remember to take fluids (been like it since I was a kid, I just don't feel thirst) and can't drink much at a sitting. My skin has become very 'loose' and wrinkled looking, especially my hands and arms, and I sometimes wake in the night with a very dry mouth. I'm reluctant to keep drinking more and more (I drink mostly water) as it seems the moment I do I need to visit the loo. I've no idea how much extra fluid I ought to be taking on this drug as the leaflet doesn't say. I'm due a call from the practice diabetic nurse on 28th April, but not expecting much help as I don't feel they are particularly concerned about my situation, and I rarely seem to get any specific answers to questions I raise with them. I'm 65, and was diagnosed in 2018.

 

[Kiwigal]

I'm also Long Covid.
Before covid I'm diagnosed Type 2 Diabetes. (2021) BMI of 35

After Covid+ (Dec 2022) I have lost over 30 kg (66lbs) weight loss and haven't regained back the weight. I'm now BMI of 24.

I noticed when I reduce ozempic from 1mg to 0.50mg or 0.25mg - my glucose will rise up. This is sign of insulin deficiency.

Meanwhile as I'm on Ozempic and my last Hba1c was 5.3 in sept 2024. (My cgm average glucose is slowing creeping up for 90 days). I'm due for new Hba1c blood test.

I'm still using high dose of ozempic to manage my diabetes - which isn't typical Type 2 Diabetes - in Type 2 you are supposed to reduce the medication and your own producing insulin will works to manage your diabetes after weightloss.

Another clue - I'm not yet in remission for "Type 2 Diabetes" after more than 10 to 15% weightloss.

When I'm unwell or on prednisolone, I get high glucose 13 mmol and Ketones of 1.2 mmol - this is another clue - insulin deficiency.

I recently had HLA blood tests - got high risk for Type 1 Diabetes and other autoimmune diseases.

From Covid+ - my immune system started attacking. (I do have signs of autoimmune diseases symptoms that is overlapped.)

All those makes me suspect I'm not a typical Type 2 Diabetes but leaning toward to autoimmune Diabetes like LADA and very early Type 1 Diabetes.

So my next step is to build up timeline with evidences... and look into 2nd opinion for Endocrinologist who is LADA complex diabetes.

Esp there is a lot of research people who get covid+ ends up afterwards Type 2 Diabetes or Type 1 Diabetes.

I would suggest get tested for Type 1 diabetes - gad tests and antibodies, and your c-peptide checked out as well.

There is LADA/Type 1 Diabetes you can be negative for antibodies and got insulin deficiency. Esp of very very slow burning of beta cells.

 

[Babooshka59]

Wow, this is very interesting. Firstly thank you for rpelying at such length and in such detail. Secondly, I will ask for the tests when I speak to the Diabetes nurse next week, though not expecting her to agree - they are not very on the ball with diabetes here at my surgery and I've never felt my care was good. At one point I was left for best part of a year without any meds at all. I live rurally and care down here is pretty **** for just about any conditon you can name. Interestingly, my brother (who has never had COVID) was diagnosed as Type 2 in his early 30s. After years of illness and nothing working well (he lives alone and was having night hypos, very dangerous), he was finally tested 3 years ago and they realised he is Type 1. He's now totally insuLin dependent. He's younger than me by nearly 6 years. He also has other auto immune diseases that have developed since his initial T2 dianosis, we were only talking about this on the phone last week. He has osteo-arthritis, has several other conditions that he says are auro immune, and he is now being tested for MS. Scans do not show any changes in the brain or body but the hospital feel he has a fairly rare form of the conditon. He is awaiting further tests. I don;t have any other conditions, and last year was told after my diabetic eye screen that I don't need to have another for 2 years becaue my eyes are so good. I wonder at the wisdom of that but I belioeve it;s down to NHS beng so strapped for cash the yare cutting corners wherever they can. So armed with what you have told me, I'll be asking the Nurse next week abot those tests. I wish you all the best goign fiorward, especially with the Ozempic being prescribed for someone who actually needs it. I have a diagnosed binge eating disorder, but when I asked for Ozempic I was told the surgery needed written permission from the big hopsital in next door Devon, and I never heard any further. This was well over a year ago. I was told my BMI was high enough to warrant the drug, so I have a suspicion they refused me due to my mental health issues. So having lost the 20 pounds all by myself, which has been a full on struggle against the eating disorder, I am fortunate, even though it is tough, but I bet it is not even acknowledged by the Diabetes nurse.

 

[Kiwigal]

My family also got other autoimmune diseases of MS, B12 Deficiency, Psoriasis etc.

I'm not yet diagnosed for Autoimmune diseases but the blood test have picked up ANA - Negative but positive Cytoplasmic antibody speckled. I have signs of psoriasis/lupus symptoms it is overlapped - but a long waitlist for Rhuematologist of 1.5 year. This will buy me time for my antibody to build up over the time for Rhuematologist to narrow down which one of autoimmune diseases.

My mum got Psoriasis confirmed she also got B12 Deficiency for years. (we both caught covid same time and ended up Long covid.)

Only different I'm the one with massive weightloss for post covid. So possibility the covid triggered/supercharged the Type 1 Diabetes genes.

With your brother - he has got autoimmune diseases. So there is chance is you would got the autoimmune diseases genes as well that may not yet triggered or could be triggered by covid.

My own GP is happy to referral me to Endocrinologist for a 2nd opinion. As I did try public hospital to referral back to Endocrinologist but it got refused coz it was focus on well managed Type 2 Diabetes Hba1c.

So I will try private Endocrinologist with my evidences of list - so have to research for early LADA Endocrinologist who deal with those complex diabetes. To see if get the diagnoses of LADA.

I will wait for Covid specialist appointment next month - as they were so concerned of my weightloss which is not an typical Type 2 Diabetes when I had appointment last year.

It is going to be an journey to try get right diagnosis this time and right treatment esp I'm not on insulin injection either.

Yes esp I'm still med dependent for Ozempic to managed diabetes and it is matter of time esp insulin deficiency - as my own producing insulin is partly working.

Hopefully you will get the answers so keep logging up evidences of your diabetes... ie if Type 2 oral medications doesn't works, any unusual things ie with foods on protein or low carbs etc if you noticed the differences of pre and post covid with your diabetes.

Good luck and hope it helps a bit. Just hard when you have to advocate yourself to arm up with evidences.