Annual Review and starting Dapagliflozin

[Docb]

Annual review this morning and a great chat with a new nurse who has clearly had some training but was quite happy to listen and ask questions of me to find out more. All is well generally, but together we decided that there would be merit in trying to check my HbA1c. My current level (55 mmol/mol) is perfectly acceptable for somebody of my age but the upward trend of my blood glucose levels generally together with the possibility that worsening neurological symptoms may be blood glucose related, indicated adding some medication to try and halt the progression. An SGL-2 is suggested and Forxiga (Dapagliflozin) prescribed. The current approach apparently is to encourage your kidneys to excrete more glucose with an SGL-2 rather than beat up your pancreas further with a sulphonylura like gliclazide. They are reserved to deal with much higher glucose levels which need to be treated with a bit of urgency.

I shall monitor the effect of taking it on blood glucose both in the short and long term and report the results to you. With the caveat that whatever I find might be influenced by my system, my way of doing things and the quality of my analysis, it could be interesting to others.

One thing that came out of it is a message for those, like me, who are well past the first flush of youth. It is that as far as the pros are concerned HbA1c's in the 50's are perfectly acceptable and is nothing to panic about.

 

[Andy HB]

Fingers crossed for you with the dapagliflozin. I was put on that a couple of months ago, but after three weeks, I was displaying symptoms of DKA so had to stop taking it. My BG was starting to get back under control as well, so I was a little frustrated about that!

 

[Felinia]

I was switched to Dapagliflozin from Canagliflozin and have had no side effects at all, apart from the expected weeing a lot! My DN also said she would be happy if I could reduce my current HbA1c from 57 to below 56, preferably down to 53. I'm coming up to 74 so would agree with your comment about age related HbA1c and the medical profession.

 

[Anji53]

in Sept of 2022 I was diagnosed with an HbA1c of 117 and prescribed xigduo ( metformin and dapagliflozin)
With medication and a low carb diet I reduced it to 38
4 months ago I was taken off metformin but kept on dapagliflozin as told it had significant’ other‘ benefits My hba1c today was 40
ive had no side effects from the dapagliflozin
comments about age are interesting. I am almost 71 and this Hasn’t been mentioned.

 

[Docb]

It is now a week since I started dapagliflozin and first indications are interesting.

There is a suggestion that its main effect is to reduce the peaks of post meal rises. I have a pretty standard breakfast at a pretty standard time and tend to take a before and 1.5 hrs after eating reading. About as near as you can get to "controlled" conditions.

Before dapagliflozin, the after reading tended to be in the 10-13 range. Since starting dapagliflozin this reading has been in the 8-10 range. I'm reserving judgement on any other effects until I have got more data and can do some proper analysis but there is a suggestion that there is less variability in my waking reading.

Usual caveat - my readings with my way of doing things. Conclusions apply to me and are not necessarily universal.

 

[everydayupsanddowns]

An interesting early observation @Docb

Feels like that would be a clinically significant change if it continues, and extends similarly to other meals.

Have you had any negative effects since starting?

 

[Kopiert]

Very interesting thread. I am about to start with Canagliflozin (Invokana) this weekend. The nurse said to increase to 4 metformin per day before starting. I have been keeping track of my BG levels to make the comparison.

I am looking up the differences between Dapagliflozin and Canagliflozin. They appear to be similar but different.

 

[Kopiert]

It is now a week since I started dapagliflozin and first indications are interesting.

There is a suggestion that its main effect is to reduce the peaks of post meal rises. I have a pretty standard breakfast at a pretty standard time and tend to take a before and 1.5 hrs after eating reading. About as near as you can get to "controlled" conditions.

Before dapagliflozin, the after reading tended to be in the 10-13 range. Since starting dapagliflozin this reading has been in the 8-10 range. I'm reserving judgement on any other effects until I have got more data and can do some proper analysis but there is a suggestion that there is less variability in my waking reading.

Usual caveat - my readings with my way of doing things. Conclusions apply to me and are not necessarily universal.

Were you advised to increase your water intake?

 

[Kopiert]

I was switched to Dapagliflozin from Canagliflozin and have had no side effects at all, apart from the expected weeing a lot! My DN also said she would be happy if I could reduce my current HbA1c from 57 to below 56, preferably down to 53. I'm coming up to 74 so would agree with your comment about age related HbA1c and the medical profession.

Was there a reason for the switch?

 

[Docb]

Have you had any negative effects since starting?

No, although things are complicated by the experimentation with various medications to try and relieve ongoing neurological problems. They have had real problematic side effects for me and would mask anything the dapagliflozin might produce.

Were you advised to increase your water intake?

Yes, the DN was quite thorough in her briefing before I started it. I have a bit of a thirst most of the time and take that over drinking lots more. An elderly gentleman's urinary system can be a delicate thing and some, like mine, do not take to being overburdened with throughput.

 

[Kopiert]

No, although things are complicated by the experimentation with various medications to try and relieve ongoing neurological problems. They have had real problematic side effects for me and would mask anything the dapagliflozin might produce.

Yes, the DN was quite thorough in her briefing before I started it. I have a bit of a thirst most of the time and take that over drinking lots more. An elderly gentleman's urinary system can be a delicate thing and some, like mine, do not take to being overburdened with throughput.

My DN gave me a booklet to read and told me to increase metformin, and when I do start on Canagliflozin I must drink a lot of water. I was diagnosed via thrush, so I think I am susceptible to it, and I will need to be aware.

 

[Felinia]

Was there a reason for the switch?

My GP said they had been advised to switch by the NHS, as Dapagliflozin had other benefits

 

[Kopiert]

My GP said they had been advised to switch by the NHS, as Dapagliflozin had other benefits

Thank you. Trying to understand this category of drugs so that is interesting

 

[Docb]

I am guessing you have seen this.

About dapagliflozin

NHS medicines information on dapagliflozin – what it's used for and key facts.

www.nhs.uk

For what it is worth, since starting it my urinary system has become smoother (zero to desperation time much longer and less of a problem) suggesting it is doing more than just encouraging glucose extraction in and around the kidneys.

 

[Kopiert]

I am guessing you have seen this.

About dapagliflozin

NHS medicines information on dapagliflozin – what it's used for and key facts.

www.nhs.uk

For what it is worth, since starting it my urinary system has become smoother (zero to desperation time much longer and less of a problem) suggesting it is doing more than just encouraging glucose extraction in and around the kidneys.

Thank you - I will take a look. The reason I come here is I like to hear what they now call the lived experience. Real people's reactions. They are almost always interesting

 

[Docb]

An update.

It is now two weeks since I started on the dapagliflozin. The indications still are that its principal effect seems to be to truncate the post meal highs to below 10. Since starting it I have had only one post meal high above 10, whereas previously post meal highs were routinely between 10 and 12. There is no suggestion that my overall levels have dropped with waking readings still being between 7 and 9.

Give it a couple more weeks and I will have a months worth of data and can then poke around a bit and see if anything more can be seen in and amongst the noise. One of the things I will have to be careful of is to make sure things have not been influenced by the brain scrambling done whilst I was under the influence of the neuropathic "pain" killers.

 

[Docb]

An update.

I have now been taking dapagliflozin for a month and am in a position to present some conclusions on how effective it is.

To start with, the conclusions are about me, my diabetes and my way of doing things and some care needs to be taken in extrapolating the conclusions to anybody else. Some details of the experiment...I have attempted to control variables as best as can be done without being silly. I have taken tests morning and evening and then at random-ish times during the day. My diet has not significantly changed and neither has my weight during the period of the experiment which I have taken as the four weeks taking dapagliflozin and the four weeks prior to taking it. The only other point to note is that I have had a bad period with the neurological problems, which are now a feature of my life, over the last three months and have been taking various medications to try and counteract it. I am making a simple assumption that this has had no effect on blood glucose levels.

First a plot of blood glucose over time. I started the dapagliflozin on 19 Jan.


This graph rather illustrates the problem of making sense of finger prick testing. There is a sense that something has changed after 19 Jan but it is really hard to say what.

To find out if anything is going on you have to look at all the data and look at it statistically. My approach was to compare the data for the four weeks taking dapagliflozin with the four weeks prior to taking it. When looking at the whole data set, what I found was.

Mean blood glucose before was 8.25 mmol/l and the variance on 98 readings was 2.14
Mean blood glucose after was 7.71 mmol/l and the variance on 110 readings was 1.16

The results suggest that, based on overall means, blood glucose levels were lower with dapagliflozin and the spread of the results is lower. A students t test indicates a better than 99% significance for those differences.

Similar differences with similar levels of statistical significance were seen when comparing both waking and bedtime readings.

So to summarise, dapagliflozin does reduce blood glucose levels for this individual with small but statistically significant impacts on overall, waking and bedtime readings.

PS... I would defy anybody to see the difference without doing proper statistical sums on a reasonable amount of data.