SGLT2 in type 2 - friend or foe?

[pkitchen62]

Hi everyone I'm Paul, living with type 2 for 5 years now.

I've been doing well until the last year when my blood glucose crept up sufficiently for my healthcare professional to recommend adding an SGLT2 inhibitor to my regimen of 500g Metformin twice daily. So, I'd love to hear back from you especially if you can help me make my next decision.

Who among you is taking one of the SGLTs for type 2? Do the pros outweigh the cons (side effects). I need to decide by Monday for my follow up consultation.

My weight, kidney, liver, blood pressure and all other metrics are good when tested last week.

Thanks for caring.

 

[trophywench]

Sorry - a bit more detail first please! Are you already on the fullest possible dose of metformin which is no longer keeping your blood glucose in a good enough place? What adjustments have you already made to your diet? What exercise do you take? What was your HbA1c prior to this and what is it now?

 

[rebrascora]

Hi and welcome.
I am not familiar with that drug type but I would highly recommend following a low or very low carb diet rather than taking more medication. It can be a more powerful means of managing Type 2 diabetes than most drugs, but it does take more effort than swallowing tablets. It is however an enjoyable way to eat, one you get your head around it.
Do you have a blood glucose monitor, so that you can test your blood before and after meals to find which foods affect your levels most and tailor your diet to your own body's tolerances? This is the regime many Type 2s on the forum follow to successfully push their diabetes into remission even without medication and we have many inspiring stories on the forum. Even as a Type 1 I find that following a very low carb diet is helpful in managing my diabetes.

 

[ianf0ster]

Hi, Some of the side effects of SGLT2 meds are quite scary, so its best to just eat fewer carbs (which turn into glucose) rather than eat a lot and then take an SGLT2 med to make you pee some of it out again.
Still if you have to go on them remember that most side effects are quite rare and I will never forget the first time I read through all the side effects for Aspirin and found one which simply said Death.

 

[Oblivious]

Hi and welcome.
I am not familiar with that drug type but I would highly recommend following a low or very low carb diet rather than taking more medication. It can be a more powerful means of managing Type 2 diabetes than most drugs, but it does take more effort than swallowing tablets. It is however an enjoyable way to eat, one you get your head around it.
Do you have a blood glucose monitor, so that you can test your blood before and after meals to find which foods affect your levels most and tailor your diet to your own body's tolerances? This is the regime many Type 2s on the forum follow to successfully push their diabetes into remission even without medication and we have many inspiring stories on the forum. Even as a Type 1 I find that following a very low carb diet is helpful in managing my diabetes.

hi @rebrascora, what kind of levels would qualify as low/very low carb?

 

[pkitchen62]

Sorry - a bit more detail first please! Are you already on the fullest possible dose of metformin which is no longer keeping your blood glucose in a good enough place? What adjustments have you already made to your diet? What exercise do you take? What was your HbA1c prior to this and what is it now?

Hmm lots of questions you have there. I’m not seeking a diagnosis but some practical experience anyone has with the drugs I specified. My diet changed radically once diagnosed. Decaf coffee, unsweetened oatmilk, porridge or rye/sourdough breakfast, occasional poached egg. Avocado, tuna, nuts, leaves, soups for lunch and chicken or fish with whole grain rice or sweet potatoes and greens. Nuts are my snack and hummus with celery. Biscuits are my vice.
Blood sugar have risen from 8.2% to 10% YOY done next to no exercise this winter apart from walking average 5,000 steps a day. Recently got back to swimming. Weight is stable, 1kg change in the year. Room to lose about 7kg.

 

[rebrascora]

@Oblivious ..... Low carb would be under 130g of carbs a day. Very low, below 50g in my opinion.

 

[pkitchen62]

Hi and welcome.
I am not familiar with that drug type but I would highly recommend following a low or very low carb diet rather than taking more medication. It can be a more powerful means of managing Type 2 diabetes than most drugs, but it does take more effort than swallowing tablets. It is however an enjoyable way to eat, one you get your head around it.
Do you have a blood glucose monitor, so that you can test your blood before and after meals to find which foods affect your levels most and tailor your diet to your own body's tolerances? This is the regime many Type 2s on the forum follow to successfully push their diabetes into remission even without medication and we have many inspiring stories on the forum. Even as a Type 1 I find that following a very low carb diet is helpful in managing my diabetes.

Thank you Barbara. I have started to reduce my carbs except at breakfast where I’ll have oats or rye/sourdough toast, sometimes egg on toast. I do have a monitor unused at the moment. I will start a daily usage as you suggest.

I think lowering my carbs and monitoring plus swimming twice a week and increasing my steps will go some way to helping. Lockdown means no swimming for a while though. Thanks for your feedback. Good luck with your regime.

 

[pkitchen62]

Hi, Some of the side effects of SGLT2 meds are quite scary, so its best to just eat fewer carbs (which turn into glucose) rather than eat a lot and then take an SGLT2 med to make you pee some of it out again.
Still if you have to go on them remember that most side effects are quite rare and I will never forget the first time I read through all the side effects for Aspirin and found one which simply said Death.

Thanks Ian, lowering my carbs feels doable and increasing my exercise should help. I’m also going to ween myself off my one vice, biscuits. I think the additional drugs can wait so long as I monitor my blood sugars between check-ups.

 

[rebrascora]

Hi again. That sounds like a good plan although breakfast is probably the worst time to eat carby foods as the body often has more resistance to insulin in the morning....I know it takes an hour for my injected insulin to work on a morning whereas it takes 20 mins at lunchtime or evening, so you would be best having something low carb for breakfast if you could manage it. An omelette or fry up minus any bread or creamy Greek natural yoghurt with chopped nuts and seeds and berries
Whilst the carbs you are eating are what the NHS would recommend, some type 2s cannot tolerate even those healthy options like porridge and wholegrain and hummus... and sweet potato can be more carby than new potatoes.
There are low carb breads available to buy in the bigger supermarkets if you really need toast on a morning which would almost certainly be better than the sourdough. Learning to read nutritional labels on the back of food for carbohydrate content is key to going low carb. Porridge would put my levels into double figures for 8 hours, as would wholegrains and I just can't get away with bread now, but everyone is different which is why testing before eating and 2 hours after is so important.

 

[rebrascora]

As regards the biscuits, they will definitely not be helping at all. How about a chunk of really nice cheese instead or a chicken drumstick or a boiled egg with a good dollop of mayonnaise .... I see you already do nuts as a snack. Try a sour cream and chive dip instead of hummus with your celery sticks.

 

[BigPawsMaw]

Hi everyone I'm Paul, living with type 2 for 5 years now.

I've been doing well until the last year when my blood glucose crept up sufficiently for my healthcare professional to recommend adding an SGLT2 inhibitor to my regimen of 500g Metformin twice daily. So, I'd love to hear back from you especially if you can help me make my next decision.

Who among you is taking one of the SGLTs for type 2? Do the pros outweigh the cons (side effects). I need to decide by Monday for my follow up consultation.

My weight, kidney, liver, blood pressure and all other metrics are good when tested last week.

Thanks for caring.

Hi there
Ive just joined here. Am type 2 aswell about same time.
what are SGLT2? I might be on them but not know it. Whats the tablet name? Thx

 

[grovesy]

Hi there
Ive just joined here. Am type 2 aswell about same time.
what are SGLT2? I might be on them but not know it. Whats the tablet name? Thx

They are a group of Diabetic Drugs, there is more than.

 

[pkitchen62]

Hi again. That sounds like a good plan although breakfast is probably the worst time to eat carby foods as the body often has more resistance to insulin in the morning....I know it takes an hour for my injected insulin to work on a morning whereas it takes 20 mins at lunchtime or evening, so you would be best having something low carb for breakfast if you could manage it. An omelette or fry up minus any bread or creamy Greek natural yoghurt with chopped nuts and seeds and berries
Whilst the carbs you are eating are what the NHS would recommend, some type 2s cannot tolerate even those healthy options like porridge and wholegrain and hummus... and sweet potato can be more carby than new potatoes.
There are low carb breads available to buy in the bigger supermarkets if you really need toast on a morning which would almost certainly be better than the sourdough. Learning to read nutritional labels on the back of food for carbohydrate content is key to going low carb. Porridge would put my levels into double figures for 8 hours, as would wholegrains and I just can't get away with bread now, but everyone is different which is why testing before eating and 2 hours after is so important.

Thanks again Barbara. Will have to rethink breakfast. I did have a cooked bfast this morning black pudding, 1x poached egg, half large mushroom and beans, no toast. I've come to love porridge so will test the impact at lunchtime. I won't miss bread and your alternative suggestions will work for me, I don't like dairy on the whole but yoghurt is fine.

 

[pkitchen62]

Hi there
Ive just joined here. Am type 2 aswell about same time.
what are SGLT2? I might be on them but not know it. Whats the tablet name? Thx

Hi BigPawsMaw. They are glucose inhibitors, I can't recall the brand names. Google the SGLT2 and the names will come up, from memory I think there are 3 of them all doing pretty much the same thing, flushing out Glucose through urine. I'm going to avoid them for now, measure my blood sugars daily and make dietary and exercise adjustments as I'm still very active.

 

[everydayupsanddowns]

Welcome to the forum @pkitchen62

SGLT2 meds are effective and approved for use, but they do come within a degree of risk for a small number of patients (particularly people with T1 who use them)

Coincidentally I saw this tweet today from a highly respected diabetes consultant which stressed the need to be aware of ‘sick day rules’

https://twitter.com/x/status/1243844207787286530

 

[Steve75]

Hi pkitchen62

I used to have a sweet tooth manly for biscuits so when I was diagnosed with type 2 I reduced my carb intake from 260 -150 now down to 130 and by reducing carbs I found I didn’t crave biscuits.im not saying it was easy but I have stuck with it and by doing so have lost one stone nine lbs so that’s a bonus to keep me away from them.i wish I could eat porridge but it doesn’t agree with me and my go to snack is boiled eggs and mayo.i hope this may help you

 

[Ditto]

Hello and welcome to the forum @pkitchen62 🙂

 

[pkitchen62]

Hi pkitchen62

I used to have a sweet tooth manly for biscuits so when I was diagnosed with type 2 I reduced my carb intake from 260 -150 now down to 130 and by reducing carbs I found I didn’t crave biscuits.im not saying it was easy but I have stuck with it and by doing so have lost one stone nine lbs so that’s a bonus to keep me away from them.i wish I could eat porridge but it doesn’t agree with me and my go to snack is boiled eggs and mayo.i hope this may help you

Yes, helpful thanks, Steve. Weight not an issue but reducing carbs is already working, no longer crave the biscuits. Love porridge, like eggs, usually poached sometimes boiled. My go-to snack is celery and humous. I did 16K+ steps in one day, might have to reel that back a bit. I am partial to over-excitement🙂

 

[pkitchen62]

Welcome to the forum @pkitchen62

SGLT2 meds are effective and approved for use, but they do come within a degree of risk for a small number of patients (particularly people with T1 who use them)

Coincidentally I saw this tweet today from a highly respected diabetes consultant which stressed the need to be aware of ‘sick day rules’

https://twitter.com/x/status/1243844207787286530

Thanks for this, I'm sure it will help many facing the same dilemma. Decided to drop the carbs and increase the exercise instead of going SGLT2 route. Might have to subscribe to Peloton though with this virus hanging about.