SGLT-2 Inhibitors explained

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Continuing with our medication series today we are discussing the class known as SGLT-2 inhibitors. This stands for sodium glucose co-transporter 2. As with all the posts in this series, this is not advice about whether you should or should not take them. Only how they work and the pros and cons of each medication.

SGLT-2 inhibitors are a diabetes medication used to treat high glucose levels. They work by making you excret excess glucose out in your urine.

What are SGLT-2 Inhibitors

They are also one of the newest classes of diabetes medications. SGLT-2 receptors are present in your kidney. Their job is to reabsorb glucose as it filtered by the kidneys. Normally, this is not a problem. However, glucose levels may be higher than usual when you have diabetes. Therefore, reabsorbing additional glucose can be problematic and can lead to hyperglycaemia.

SGLT-2 inhibitors block the SGLT-2 receptor preventing your kidneys from reabsorbing glucose. Instead, the kidneys make you pee out glucose helping to lower your glucose levels.

SGLT-2 inhibitors are mostly used in type 2 diabetes. However, there will be times when they are used in type 1 diabetes also.

Examples of these medications include:

  • Dapagliflozin (Forxiga)
  • Canagliflozin (Invokana)
  • Empagliflozin (Jardiance)
  • Ertugliflozin (Steglatro).

Benefits of using SGLT-2

SGLT-2 inhibitors are quite effective in lowering your glucose levels. However, they are not as effective as Sulphonylureas or GLP-1 therapy. You can expect your HbA1c to drop by approximately 0.5-1% (6.5-11mmol/mol) once starting this medication. This will vary depending on if they used as stand alone therapy or with other medications.

One surprising finding from research looking into SGLT-2 inhibitors is the cardiovascular benefits. SGLT-2 inhibitors are becoming more common in treating cardiovascular disease. The reason they are so effective remains unclear. However, one likely reason is because SGLT-2s make you urinate. Urinating more frequently lowers your blood pressure placing less stress on your circulation and heart.

Another great benefit is the weight loss effect. People lose between 3.5-7kg on average using SGLT-2 inhibitors. The reason for this is because glucose contains calories. As you pee out glucose you are also peeing out extra calories.

Finally, SGLT-2 slow the progression of renal disease. Therefore, you can see this medication class can be a very robust medication to have at your disposal.

SGLT -2 inhibitors

Negatives & Side effects of using SGLT-2 inhibitors

The most common side effect of SGLT-2 inhibitors is developing urinary tract infections and thrush. This is because bacteria likes sugar. As SGLT-2 inhibitors literally make you pee out sugar, you are at an increased risk of infection.

Also because you are peeing more it can put you at risk of dehydration. Particularly if you’re not someone who drinks lots of fluids.

SGLT-2 inhibitors can also put people at risk of developing diabetic ketones acidosis despite having normal glucose levels. This is due to the dehydrating effect of them.

When not to use SGLT-2 inhibitors

Caution should be practiced using SGLT-2 inhibitors in people with kidney disease . With a certain level of kidney disease, SGLT -2 inhibitors are no longer an option and should be stopped.

If you have vascular foot disease these medications will likely be stopped or not recommended in the first place.

If you are underweight these medications may not be appropriate either because they will further exacerbate weight loss.

SGLT-2 inhibitors should also be suspended if you are unwell and not eating or drinking. They should also be stopped if you develop symptoms of Covid 19.

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