Newbie with Questions !

[Vikki88]

Hi everyone, I'm Vikki and I was diagnosed with type 2 diabetes approx 8 weeks ago.
I'm on Metformin and they've now added dapagliflozin 10mg. I started this a week ago but ever since, my appetite had basically disappeared and I'm wondering if anyone else has experienced this. It's all so confusing! Thank you

 

[Leadinglights]

Hi everyone, I'm Vikki and I was diagnosed with type 2 diabetes approx 8 weeks ago.
I'm on Metformin and they've now added dapagliflozin 10mg. I started this a week ago but ever since, my appetite had basically disappeared and I'm wondering if anyone else has experienced this. It's all so confusing! Thank you

Welcome to the forum.
It does seem a bit odd to add another medication before 3 months has gone by and you have had another HbA1C test to assess whether the metformin and dietary changes have been working.
What was your HbA1C when diagnosed as that will usually indicate how much work you need to do and what medications may be prescribed.
Metformin helps the body use the insulin it produces more effectively and reduces the output of glucose by the liver and the dapagliflozin encourages the kidneys to excrete excess glucose via urine so it is important to drink plenty otherwise people can become dehydrated but also it is not advised to reduce carbs too much as there is a risk of a form of DKA but around 130g carbs per day is usually OK for most people.
Were you advised on diet and that is the most important thing that people can do in managing their condition.
It perhaps sounds a bit hasty to add more meds.
I should ask your GP if it is really needed at this stage.

 

[Alan44]

Hi @Vikki88 and welcome to the forum.

It may help members to advise if you are happy to share a little more information such as your HBA1c score and what advice your health care team have offered or given you.

Alan 😉

 

[mashedupmatt]

Hi @Vikki88 and welcome to the forum - any diabetes diagnosis is very daunting and confusing at the start, but you have found the right place here for support - glad you have found us 🙂

 

[everydayupsanddowns]

Welcome to the forum @Vikki88

There are some diabetes medications that are specifically designed to reduce appetite, but generally it’s not an effect that is expected with ‘flozins like Forxiga - though I think some people can experience a slight degree of appetite reduction because of changes to metabolism to encourage more glucose to be excreted in urine with Dapagliflozin.

Are you looking to lose weight as part of your diabetes management? Or is the loss of appetite an unwelcome side effect?

There are some FAQs about dapagliflozin here which may help

Common questions about dapagliflozin

NHS medicines information on common questions about dapagliflozin.

www.nhs.uk

 

[HayleyR]

Hi @Vikki88 and a warm welcome from me 🙂. Glad you decided to join us as I'm sure you'll find the help and support from our members really useful. Just ask away with any questions.....

 

[rebrascora]

Hi and welcome from me too.

I am guessing you were started on a low dose of Metformin and gradually built it up over a period of a few weeks so it may well be the Metformin now it is (I assume) at full strength, which is affecting your appetite rather than the new "flozin" medication. I am sure I have read somewhere that Metformin was initially developed as an appetite suppressant/diet drug. I don't think it has that effect on everyone but I am pretty sure it will be that, rather than the "flozin". Metformin takes time to build up in your system to an effective level, so you likely would not feel that effect until several weeks after starting taking it.

 

[NearlyWellBeing]

Wish my appetite would go away, especially the snacking appetite, but to some extent it has. I don't bother much with breakfast and lunch except to have a cup of something, but after tea I am a dustbin. No idea if it was the Metaformin that did it though it just seems the natural thing to do.

 

[Leadinglights]

Wish my appetite would go away, especially the snacking appetite, but to some extent it has. I don't bother much with breakfast and lunch except to have a cup of something, but after tea I am a dustbin. No idea if it was the Metaformin that did it though it just seems the natural thing to do.

The idea of having proper meals with protein and healthy fats which are low carb will be fulfilling and then snacking is less likely and not a good habit as they are often high carb foods.
Metformin is not normally regarded as having that effect.

 

[Vikki88]

Hi everyone. Thanks so much for reading, to addd some further information - my HbA1C at diagnosis was 94. Post 8ish weeks, it was 59. But it was once it was 59 she decided to add this extra medicine. I've questioned it but she's adamant that it's the best thing since sliced bread. I have to wonder about targets to get people on this drug (I work in medicine myself but know very little about diabetes). The appetite loss concerns me as my sugars tend to run low now, yesterday for example 3.2 before tea. I had eaten a little for breakfast and a little for lunch. I do need to lose some weight, but for some perspective, since February, I'm down 2 stone 2lbs and so whilst the appetite suppression doesn't concern me for that reason, it does for getting enough nutrients and keeping my sugar at a sensible level. I have worked so hard, and have changed my entire life since diagnosis. The diabetic nurse has agreed to me dropping one metformin in the morning and then taking 2 at night. So right now I take 1 metformin AM and 1 dapgliflozin. Then pm 2 metformin. Everyone is saying its not really a side effect, but it seems a major coincidence that its happened within days of taking this drug!

 

[Leadinglights]

Hi everyone. Thanks so much for reading, to addd some further information - my HbA1C at diagnosis was 94. Post 8ish weeks, it was 59. But it was once it was 59 she decided to add this extra medicine. I've questioned it but she's adamant that it's the best thing since sliced bread. I have to wonder about targets to get people on this drug (I work in medicine myself but know very little about diabetes). The appetite loss concerns me as my sugars tend to run low now, yesterday for example 3.2 before tea. I had eaten a little for breakfast and a little for lunch. I do need to lose some weight, but for some perspective, since February, I'm down 2 stone 2lbs and so whilst the appetite suppression doesn't concern me for that reason, it does for getting enough nutrients and keeping my sugar at a sensible level. I have worked so hard, and have changed my entire life since diagnosis. The diabetic nurse has agreed to me dropping one metformin in the morning and then taking 2 at night. So right now I take 1 metformin AM and 1 dapgliflozin. Then pm 2 metformin. Everyone is saying its not really a side effect, but it seems a major coincidence that its happened within days of taking this drug!

I think I would tell your nurse exactly what you have said here, loss of appetite, and now a bit low blood glucose and can you drop the dapagliflozin and see how your blood glucose is when you have your next HbA1C as you had done very well with the regime you had.

 

[rebrascora]

What are you using to test your BG levels? If a Blood Glucose meter, which one? Some give a false low reading if you don't get enough blood on the test strip rather than showing an error. And if using Libre or other CGM they often over exaggerate drops and rises, so I would be a little hesitant to accept that low reading at face value.

As regards adding extra medication when you had already reduced your HbA1c quite dramatically in only 8 of the roughly 12 weeks an HbA1c measures, it sounds like your nurse has railroaded you which is not supposed to be how it works. If you didn't want to add any extra medication then you should have been given time to continue as you were for a set period of say 3 months to see if your lifestyle changes had managed to reduce you further.

The only thing I would say is that your nurse/GP can prescribe you meds but they can't make you take them, so it is up to you whether you do. If your low reading was a genuine low, then that would suggest you are overmedicated, so it would be reasonable to stop taking them although it would be advisable to discuss it with your nurse or at least let them know of your decision. I am not specifically encouraging you to go against your nurse's advice, but just saying that your action plan to manage your diabetes should reflect your views too and ultimately you have a choice if you are not happy with an action plan that doesn't reflect your views.

The good thing is that you have a means of keeping an eye on your levels and if you do decide not to take the medication you can assess what if any effect that has and always restart it if levels start to noticeably rise.

Those are my thoughts anyway.

 

[saffron15]

I tested at 69 in June and 64 in July when I had cut cake pastry etc ( before I found the forum) I saw the DN mid August by which time I had lost a stone ( needed) she discussed metformin with me but said the HCP i had seen had written down SGLT2. She didn't know whether to give me metformin or SGLT2. She said she'd check with him then phone me. I started on metformin but knew SGLT2 would be added. I did find metformin initially blunted my appetite and so I would take it with breakfast and lunch as I sometimes got to the evening and didn't want more to eat. The week after I'd reached 4 metformin I was put on dapaglifozin the same dose as you and metformin was reduced to two tablets. I was told dapaglifozin was good for cardiovascular health and as I had high blood pressure I thought it was sensible. My hba1c was 51 by end of September.
I don't know how helpful I can be as I am a lot older than you and have high blood pressure.The hcp I saw who was a pharmacist was a huge fan of dapaglifozin. I had tummy upsets and a seven week cold at this stage plus a cataract op and two weeks of steroids. The DN told me not to test my BG ( but I did) My appetite did return but I also had statins added and I felt knocked off course on my eating habits as I had been eating between 80 and 120 gms of carbs but thought I had to increase carbs a little and of course was tempted to eat too many carbs sometimes.
I'm not aware of serious side effects for me. It's important to stay hydrated and you may pee more. I was given ketostix to use if I felt unwell. I tested a few weeks ago when I felt slightly under the weather but my urine was fine.

If I were you I would definitely contact the surgery. I don't know if you need to lose some tummy fat. It seems a good idea for them to check if the dose and medication is appropriate. My metformin dose was reduced when I started on dapaglifozin.

 

[JimG]

What are you using to test your BG levels? If a Blood Glucose meter, which one? Some give a false low reading if you don't get enough blood on the test strip rather than showing an error. And if using Libre or other CGM they often over exaggerate drops and rises, so I would be a little hesitant to accept that low reading at face value.

As regards adding extra medication when you had already reduced your HbA1c quite dramatically in only 8 of the roughly 12 weeks an HbA1c measures, it sounds like your nurse has railroaded you which is not supposed to be how it works. If you didn't want to add any extra medication then you should have been given time to continue as you were for a set period of say 3 months to see if your lifestyle changes had managed to reduce you further.

The only thing I would say is that your nurse/GP can prescribe you meds but they can't make you take them, so it is up to you whether you do. If your low reading was a genuine low, then that would suggest you are overmedicated, so it would be reasonable to stop taking them although it would be advisable to discuss it with your nurse or at least let them know of your decision. I am not specifically encouraging you to go against your nurse's advice, but just saying that your action plan to manage your diabetes should reflect your views too and ultimately you have a choice if you are not happy with an action plan that doesn't reflect your views.

The good thing is that you have a means of keeping an eye on your levels and if you do decide not to take the medication you can assess what if any effect that has and always restart it if levels start to noticeably rise.

Those are my thoughts anyway.

I echo the comments about being railroaded. I am fortunate that most of my interactions have been very much a two way interaction. The healthcare professionals recommend and advise but, except in emergencies, the ultimate decision is down to the patient what they do. In fact, I find that most professionals will say, "In my opinion...", "it seems as if...", "we could try..." "but the decision is yours". I do not go against the ultimate advice but then I feel that we have jointly arrived at the result through a discussion and I have had all my questions answered before the prescription is made or procedure recommended. If something does not feel right, you do need to go back to the nurse. I find it useful to do a bit of research and write down my symptoms and questions before a meeting in a notebook and will check the notebook to make sure that I have asked and said all that I want to ask and say. I have not encountered a medical practitioner that has been unhappy that I am taking ownership of my condition and medication in this way.

 

[NearlyWellBeing]

I don't know what dapagliflozin is or what it does.
That's why the first thing I would do next is . . . read the instruction leaflet that came with the medicine.