Nowadays, diabetes type II therapy options are so much more then metformin or insulin.

More research is being done, more discovers are being found about diabetes type II and how this condition affects the human body.

The group of medications that combine Empagliflozin/Dapagliflozin/Canagliflozin is called SGLT-2 inhibitors (SGLT-2 in.) This group of medication is one of the best in the market and is getting more noticed and prescribed more frequently by healthcare professionals to patients with diabetes type II.

How does this group of tablets help to improve blood glucose levels?

In a very simple way, these tablets make your kidneys remove the excess of glucose through the urine.

Along the production of urine in the kidneys, there are several processes of reabsorption of, let’s call it “compounds”, such as potassium, sodium… and of course glucose. This reabsorption is performed to maintain the adequate levels of the above compounds within the normal levels in the body. Also, regarding glucose levels, it was discovered that individuals with diabetes type II reabsorbed more glucose via the kidneys then non-diabetic individuals. This means that there is another cause on blood glucose control increase in individuals with diabetes.

There are different mechanisms for this reabsorption and in the case of glucose, the mechanism that is in charge of its reabsorption is called SGLT-2. Now, as reported before, the group of medications this article is focused on get rid of the glucose excess by inhibiting the SGLT-2. If the glucose is not reabsorbed by the body, it’s going to be eliminated along with other urine compounds and water. This is why the generic name for this group of tablets is SGLT-2 inhibitors.

What brand names does this medication have?

Empagliflozin- Jardiance 10 mg/ Jardiance 25mg

Dapagliflozin- Forxiga 5mg/ Forxiga 10mg

Canagliflozin– Invokana 100mg/ Invokana 300mg

What side effects are expected when taking this medication?

Weight Loss

Because these tablets increase urine elimination so the body can get rid of the glucose excess, along with water, in the urine, there is the loss of calories as well. Also due to the increase of overall body fluid reduction and again, the calories loss, there is a considerably reduction of weight.

It is expected that weight loss can reach up to 6kg along the time.

Reduction of blood glucose control level

There is blood glucose reduction as a consequence of the excess of glucose being removed via the urine . Specifically HbA1c, is expected a reduction of close to 1%.

For more info on HbA1c, click here.

Increase risk of thrush and/or urinary infections

Usually human urine is an “acid” solution.

When glucose is added to an acid solution it gets less acid turning into a more basic/neutral/”sugary”.

Having in mind that micro-organism prefer a more sugary environment, individuals taking this medication are more prone to develop thrush and/or urinary infections. To prevent this situation, please see Care Plan below.

Slight drop of blood Pressure

Even being a very small/almost insignificant change, it is possible that this medication can improve your blood pressure as there is a fluid loss and consequently a blood pressure drop.

Risk of dehydration

As overall fluid is removed from the body, there is a higher risk for dehydration and this is why it is so important to keep hydrated at all times (see Care Plan below for more info on how to avoid dehydration).

Hypoglycaemia

Usually SGLT-2 in. therapy, on its own, doesn’t cause hypos. But it is important to inform that they can occur. There are some studies showing few cases of individuals that experienced hypo episodes when taking SGLT-2 in. alone. It is an unlikely event.

These tablets, along with other medication that cause hypos, can of course, increase hypo episodes.

Association of SGLT-2 in. with gliclazide, glimepiride or insulin can increase hypo episodes.

Care plan for more common side effects

Keep Hydrated

As explained above, because there is an increase fluid elimination, it is very important to keep hydrated.

An average of 1.5-2L or more of fluids per day will keep you hydrated.

Avoiding dehydration is one of the most important things to keep in mind when taking SGLT-2 in. medication.

Avoiding/ Treating Thrush or urinary infection

Keeping hydrated makes your urine less concentrated and reduces your probability of developing thrush and urinary infection.

Seek medical advice in case of experiment thrush or urinary infection. Anti-fungal creams or antibiotics may be prescribed by your doctor.

If these symptoms are too difficult to overcome and cope, hold this medication and seek medical advice for other Diabetes treatment plan.

Renal function

As this medication is focused on the kidneys, there is the need to monitor the kidney function from time to time. Reduced renal function won’t be suitable to start or continue this type of tablets. Some authors defend that this group of medication can be renal protective but no proper conclusions have been made just yet.

Sick day rules

It is very important that you hold this medication until you recover in the case you feel unwell – vomiting and/or diarrhoea. This is due fluids’ loss and unable to keep hydrated, taking a tablet that is removing water from your body will put you in a very risky situation that can lead to dehydration.

When to take this medication

This medication should be taken adjusted to your daily routine having in mind that from the moment you take it, you may have increase need to pass urine. Individuals that work from morning to afternoon should take this medication in the morning so the sleep is not interrupted. If individuals are night workers, the tablet should be taken in the afternoon.

These are the majority of the important information of this group of medication. Hope this article could help you to be more informed about your medication regimen and to know the importance of a good care plan when following this prescription