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SGLT2 inhibitors are a form of diabetes medication that prevent the kidneys from reabsorbing glucose.
In the guide below, we take a look at SGLT2 inhibitors in greater detail.
What are SGLT2 inhibitors?
Sodium-glucose transport protein 2 inhibitors (SGLT2 inhibitors) are a group of diabetes medications that work in the kidneys.
Usually, the kidneys reabsorb glucose that has been filtered out of the blood to be used in the body for energy. SGLT2 inhibitors stop the body from reabsorbing this excess glucose; instead, it is forced into the urine and out of the body.
SGLT2s are beneficial for people living with diabetes because:
- They help reduce the amount of glucose in the blood
- Usually lead to some weight loss
- Can lower blood pressure and protect against other diabetes-related complications.
SGLT2 inhibitors are increasingly used in combination with insulin and other therapies to manage type 1 and type 2 diabetes.
Types of SGLT2 inhibitors
SGLT2s were initially used for people with type 2 diabetes. The first drug licenced was Dapagliflozin or Forxiga®, which is now also approved for people living with type 1 diabetes.
The medication is taken as a tablet at the same time every morning. If you are on insulin or oral hypoglycaemic medications like metformin, you should continue this as usual, although you will generally need a lower dose as a result of the improved blood glucose management.
Other SGLT2s can be identified because they all end in -gliflozin:
- Canagliflozin or Invokana® – this can also be prescribed in combination with metformin which is known as Vokanamet®
- Empagliflozin or Jardiance® – this is also available as a combination medication with metformin called Synjardy®
- Ertugliflozin or Steglatro®
SGLT2 inhibitors side effects
All drugs have side effects, and SGLT2 inhibitors are no different. Although the medication can be beneficial when you are living with diabetes, it can also cause complications that you should be aware of:
Diabetic ketoacidosis (DKA)
Diabetic ketoacidosis has been identified in people with both Type 1 and Type 2 diabetes, linked to SGLT2 inhibitors.
DKA can develop even with optimal or near-optimal blood glucose levels, so it’s essential to be aware of the symptoms and get urgent medical support.
Anyone that has raised blood ketones should stop taking SGLT2s immediately because there’s a risk of DKA. However, it’s vital to get medical help and continue insulin or other medication.
During the COVID19 crisis, clinicians have seen higher rates of ketosis and therefore advised people living with Type 1 diabetes to stop taking SGLT2 inhibitors during the pandemic. People living with Type 2 diabetes should stop taking them if they become unwell or develop COVID symptoms.
Your blood glucose levels can drop too low, hypoglycaemia, particularly if you are using SGLTs in combination with insulin or a sulfonylurea.
Genital and urinary tract infections
The higher glucose levels in urine can increase the risk of UTIs and genital infections, especially in women.
You will pass more urine; this can lead to increased urinary frequency, dry mouth, more thirst and sometimes dehydration and dizziness on standing due to postural hypotension.
SGLT2 inhibitors can reduce blood pressure, which can be a positive result of treatment. However, it can also drop the blood pressure too low.
- If you are suffering from dizziness, you may need to speak to your doctor about changing your dose or altering other hypertension medication.
Patients might find increased levels of constipation. Speak to your doctor if this is the case. They will be able to advise the best course of action to relieve symptoms.
SGLT2 inhibitors and heart failure
SGLT2 inhibitors have been shown to reduce the risk of cardiovascular death and prevent hospitalizations and urgent appointments in patients living with heart failure.
The National Institute for Clinical Excellence (NICE) recommends prescribing Dapagliflozin as an option for treating symptomatic chronic heart failure in adults with a low ejection fraction.
The ejection fraction is the percentage of blood that leaves your heart when it contracts; the fraction goes down if the heart is weakened by disease. An SGLT2 inhibitor can be added to standard care, which includes one of the following regimes:
- ACE inhibitor or angiotensin‑2 receptor blocker (ARB) with a beta-blocker and mineralocorticoid receptor antagonists (MRA) if tolerated
- Sacubitril valsartan with a beta-blocker and MRA if tolerated
SGLT2 inhibitors and kidney disease
SGLT2 inhibitors are often not recommended for people with nephropathy because kidney disease can prevent the drug from working effectively.
However, Dapagliflozin has recently been approved to treat or reduce the risk of kidney disease. It’s only just been approved for this use in the middle of 2021 and is the first drug to support people with chronic kidney disease for 20 years, so it is a promising development.
If you or a loved one suffers from diabetes and are looking for advice or treatment, please do get in touch today. Our team of highly trained specialists are on hand to answer any questions that you might have.
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