Dapagliflozin and low carb diet

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Noggin11

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Hi,
I've been reading loads of threads and picked up that you have to be carefull of being on a low carb diet and dapagliflozin which I am on. Can anyone tell me why this is the case. I'm new to all this so hope it's not a silly question. Thanks.
 
Welcome to the forum @Noggin11 - the forum where there is no such thing as a silly question. Sadly I can't answer yours though as I'm a plain old metformin girl, but someone should be along soon to answer it 🙂
 
@Noggin11 thank you for asking this question. I was diagnosed type 2 with a second blood test at end of July of 64. I started on metformin in August then in September I was put on forxiga a brand of dapaglifozen. It gets rid of sugar from the liver into your pee. After a month of unbroken sleep as I was no longer peeing so much it is a nuisance. I was told of potential side effects of thrush etc but none yet. I was given keto sticks in case I had ketoacidosis. It is a rare complication but worried me. There is a warning not to go on a keto or low carb diet without medical advice. At first I was unbothered as I was eating between 80 and 120 grams of carbs and sometimes a bit more. I sort advice from the pharmacist and she wasn't sure and on this forum many people said don't go below 130. I have found it dispiriting and difficult. I have dealt with it by adding carbs I don't want eg a chocolate biscuits 10 carbs or a slice of bread. I even had a piece of banana bread today. I also have had a lot of stress and a two week course of oral steroids. Thanks to your question I have done a further Google search and found an American study of obese people on the drug who had their carbs restricted to 100 grams though it indicated they found it difficult. The cohort they used seemed well into the obese category. When diagnosed I had a bmi of 32 but am now 28 which is overweight.

I am going to take the study as permission for me to stop worrying if my carbs are between 120 to 130. If i eat in a cafe which i do a few times a week I usually have bread which increases my carb count above this.


I have also relooked at side effects and see a runny or blocked nose. I have had a cold since the end of September which was slowly getting better but my nose is running again and it may be a side effect rather than an incredibly long cold
 
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This is the study I saw. I'm conscious that participants would have been carefully monitored and I don't think I should go as low as 100 grams but I think i can stop worrying.

The DAPA‐DIET study: Metabolic response to Dapagliflozin combined with dietary carbohydrate restriction in patients with Type 2 Diabetes Mellitus and Obesity—A longitudinal cohort study - PMC

The cardio‐renal benefits of sodium glucose‐like transporter 2 inhibitor (SGLT2i) therapies have been demonstrated in patients with and without type 2 diabetes. However, no studies have explored the long‐term metabolic effects of SGLT2i, combined ...
pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov
 
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Noggin11 said:
I've been reading loads of threads and picked up that you have to be carefull of being on a low carb diet and dapagliflozin which I am on. Can anyone tell me why this is the case.
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You shouldn’t eat a low carb diet on dapagliflozin because it can cause DKA with normal blood sugars. I’ve certainly had that side effect and there was a post recently that had resulted in the person sadly dying from the DKA on this class of medication.

If you’re keen to low carb you’d be best considering discussing a change in medication with your doctor, or at a minimum having a means of testing ketones.
 
@Lucyr I thought the reported death was someone who was on Semaglutide (Ozempic) not a flozin unless you are referring to another story.
 
rebrascora said:
@Lucyr I thought the reported death was someone who was on Semaglutide (Ozempic) not a flozin unless you are referring to another story.
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No it wasn’t ozempic it was an SGLT2, like dapagliflozin.

Lucyr

Post in thread 'Ketones - help !'

tiptoptapper said:
I know how serious DKA is - my brother in law died of it in the summer - he was type 2 and lived alone, but he was taking an SGLT2 inhibitor which we understand can cause DKA even with BG in the normal range. Sorry if this triggers anyone. We're still coming to terms with it.
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I’m so sorry to read this, it’s a risk that GPs don’t explain enough I feel. I really would increase your carbs in the circumstances so that you just don’t need to think about the ketones. You won’t have to increase them that much to shake them off I expect, and you have the gliclazide if your Bgs look like...
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Ah, different story, I was thinking of the nurse who died in Scotland and made national news. Both very sad stories.
 
Thankyou everybody for your replies. I had no idea, the doctor never warned me of the side effects. So I'm going to have to be carefull. A Ketone monitor seems like a good idea, so back to the doctors.
 
@Noggin11 I haven't seen a Doctor about this. I saw an hcp who is a qualified pharmacist. He prescribed keto sticks which I haven't used yet. They are for dipping in urine. I was going to try one but then saw once opened should use within 6 months so have left it unopened. The impression I get is you only need to test if you feel unwell.
Please post if your doctor gives useful info.
 
As a matter of interest can you get the Keto sticks from a pharmacy without a presciption or do I need to go and see my doctor. Thanks for your help, you guy's are great.
 
You can buy KetoStix (brand name) over the counter at a pharmacy or online without a prescription and they should be about £5 for a pot of 60 strips.
 
I’m not sure whether degrees of low carb have really been assessed on these meds, but they are explicitly said not to be used in T1

www.gov.uk

SGLT2 inhibitors (canagliflozin, dapagliflozin, empagliflozin): risk of diabetic ketoacidosis

Test for raised ketones in patients with acidosis symptoms, even if plasma glucose levels are near-normal.
www.gov.uk www.gov.uk

There are also mentions in the follow-up information about conditions involving “reduced food intake”, and reduced circulating insulin - which I suppose could be the effect of a lower carb diet (particularly very low carb / keto).
 
The ones I was prescribed were called ketostix in a yellow box. I now see they are not very expensive so may try using one. I would be happy to pay for another box and a prescription is not necessary. As they came as part of my prescription I did not pay.
The impression I got is it is an unusual side effect. What concerned me is the suggestion it could happen even if your blood sugars were in a normal range. I assumed that you would still get an element of warning by feeling unwell.
 
saffron15 said:
What concerned me is the suggestion it could happen even if your blood sugars were in a normal range. I assumed that you would still get an element of warning by feeling unwell.
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DKA can progress very quickly, by the time you feel unwell from it you may already have it. Whilst it is an uncommon side effect it isn’t unheard of, there are people we know on the forum have had it. Many people recover from DKA, especially if caught early, but it can result in death as has been demonstrated upthread.

If you’re prescribed them then take them but be careful with going too low carb and be careful about ketones if you feel unwell. If you have ketones seek medical advice.
 
Thankyou for all of the replies.
 
@everydayupsanddowns thank you for flagging up the government advice. I read it and the update, when I was worried when first prescribed in September. Against the grief of my diagnosis which I should have had some warning of if they had bothered to test I was bouyed by a consistant weight loss and forsaw increasing carbs would stop it, which it has. I have reread it and I am not in the at risk categories. Additionally the " normal" BG they refer to is 14. When I was on oral steroids I twice hit 13 but that is the highest I've ever been. It also stresses the symptoms which amount to feeling ill. I will now try to destress! I suspect my bout of uveitis and eyedrops are the main stress!
 
Hello @Noggin11 sorry to jump on your thread however, wanted to ask my DN told me in my first telephone appointment on Friday that ketones only possibly happen when double figures readings with monitor and very unlikely when get readings in single figures. Anyone else know if this is correct?
 
Zaraah said:
Hello @Noggin11 sorry to jump on your thread however, wanted to ask my DN told me in my first telephone appointment on Friday that ketones only possibly happen when double figures readings with monitor and very unlikely when get readings in single figures. Anyone else know if this is correct?
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What is being referred to is euglycemic DKA which can rarely occur in people taking that particular medication at only slightly raised blood glucose levels.
 
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