SGLT2 Inhibitors for Diabetes

 
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What are SGLT2 Inhibitors?

Sodium-Glucose Co-transporter 2 (SGLT2) inhibitors are diabetes medications that lower blood glucose. They work in the kidneys, directing excess glucose out of the blood and into your urine. The can be prescribed as a stand alone treatment or combined with other diabetes medication. Examples include:

  • Jardiance

  • Jardiamet

  • Glyxambi

  • Forxiga

  • Xigudo

  • Qtern

What are the benefits of taking SGLT2 Inhibitors?

  • Lower blood glucose level

  • Weight loss

  • Improved blood pressure

  • Reduces the risk of hospitalisation from cardiovascular disease

What are the possible side effects of taking SGLT2 Inhibitors?

  • Passing more urine that usual

  • Increased thirst

  • Nausea and constipation

  • Low blood pressure and dehydration

  • Genital or urinary tract infections

  • Diabetis Ketoacidosos (DKA); rare but requires urgent medical ttreatment.

What is Diabetis Ketoacidosos (DKA)?

Diabetic Ketoacidosos (DKA) is an emergency requiring urgent medical attention. It occurs when ketone bodies build up in the blood causing acidity of the blood.

It is usually associated with high glucose levels, however for people taking SGLT2 inhibitors, glucose levels may appear normal making the diagnosis more difficult.

Watch out for nausea and vomiting, abdominal pain, loss of appetite, rapid breathing and dehydration (dizziness, thirst, unusual fatigue and sleepiness).

It is most likely to happen during surgery, severe infection or illness.

If you experience any of these symptoms you should:

  • Go to the nearest hospital Emergency Department

  • Tell the emergency doctor that you are taking this medication.

When should I stop taking SGLT2 Inhibitors?

Be sure to stop taking your SGLT2 Inhibitor:

  • 2 days prior and day of surgery or procedure (including a colonoscopy)

  • If you have nausea or vomiting

  • If you are unwell or have and infection

  • During excessive alcohol consumption

  • If your diet is very low in carbohydrates or mainly a liquid diet (eg. Optifast)

  • If commencing the ketogenic diet

When should I restart using SGLT2 Inhibitors?

For day procedures, you can restart your SGLT2 Inhibitors when eating and drinking as usual. You may need to wait 24 hours and resume the next day if not eating and drinking normally.

For other surgery, you may need to wait 3-5 days post procedure before restarting SGLT2. Please check with your doctor before discharge.

Points to remember:

  • Anytime you see a doctor, tell them you are taking an SGLT2 inhibitor.

  • If you are unwell, ask the doctor to test your blood glucose and blood ketone levels

  • STOP SGLT2 Inhibitor medication if fasting.

 
Sydney Endocrinology, Diabetes EducationKatherine TonksSydney Endocrinology