SGLT2

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EMcKT

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Morning all,
Does anyone have any experience of this type of medication? DN has suggested that I consider changing my Metformin and Bendro to either Empaglyflozin or Depa....... Been on Bendro for years and on Metformin x four a day. Newish diabetic on low carb. BG down from 94 to 52, so on right track, but open to suggestions. Done a bit of research so see what they are but just asking for opinions.
 
EMcKT said:
Morning all,
Does anyone have any experience of this type of medication? DN has suggested that I consider changing my Metformin and Bendro to either Empaglyflozin or Depa....... Been on Bendro for years and on Metformin x four a day. Newish diabetic on low carb. BG down from 94 to 52, so on right track, but open to suggestions. Done a bit of research so see what they are but just asking for opinions.
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You sound to have been doing well on the current medications so did they explain why the change unless you were getting some side effects.
The flozin medications encourage the kidneys to excrete excess glucose via urine so it is recommended that people drink plenty which usually results in more loo visits, also a small risk of UTIs as the more glucose in the urine can 'feed' the bacteria in your system.
The other thing is it is not recommended that people go too low carb as there can be a risk of eugenic DKA but there is not much agreement about what is a safe level of carbs, but around the 130g per day rather than less but some do go lower without problem. It can depend on what other meds you are taking.
There are a people who take it and get on well but it is often in addition to metformin if people tolerate that OK rather than instead of.
 
Sglt2 medications are not recommended with very low carb or keto diets. There is a small but real risk of euglycemic diabetic ketoacidosis when used together. Ie a DKA without the usual high blood glucose warnings. Your nurse should be aware of this and discuss the risks with you. Obviously that doesn’t mean eating high carb on them but nothing more than moderate reductions and an ability to test for ketones if unwell just in case.

cks.nice.org.uk

SGLT-2 inhibitors | Prescribing information | Diabetes - type 2 | CKS | NICE

SGLT-2 inhibitors, Prescribing information, Diabetes - type 2, CKS
cks.nice.org.uk cks.nice.org.uk

As a firm advocate of low carb for removing the problem (excess glucose in the body) as close to the source as possible I’d rather keep up and possibly intensify the low carb and not put it in there in the first place rather than take the sglt2 and probably need to actually increase my carbs from where I am now but that’s my personal view not a medical one.
 
Thats very interesting. She said that it was deemed ' unethical ' not to inform me of alternatives, she was not pushing, just giving my a choice. I am not no carb and have actually increased my carbs but still under 100g per day. No further weight loss which did not seem to worry her. I have to have my B12. checked again in three months, it's dropped on the Metformin, so will ask for BG to be done as well to see where I am with that. I would really like to diet control this but am open to medication if needs be.
Thank you .
 
I had to look up "Bendro" as I didn't know what it was and as it is a diuretic (for anyone eles like me who didn't know) I can kind of see how the Flozin might do both jobs of treating diabetes and hypertension/fluid retention and remove the Metformin which may be causing the B12 to be deficient.
How well does the Bendro work for you? If you can manage the diabetes just through diet and perhaps increased activity and it looks like you have been doing well with that very significant drop (many congratulations on that by the way) and the Bendro works well for you with none or minimal side effects, then I might be inclined to negotiate to either drop or reduce the Metformin but stay on the Bendro as there are potential side effects with a Flozin particularly if you are low carb and to me it seems wrong to eat more carbs and then take a medication to remove the glucose from them, rather than eat less and perhaps not need the medication.
It may depend on how sustainable you feel your current diet is in the long term, but you should always have the option to add that Flozin in at a later date if you can't maintain the diet or your levels start to rise for some other reason.
If your HbA1c hadn't dropped so much then I think the Flozin would have been a reasonable option, but it looks like your dietary changes are making a real difference (the Metformin alone would not drop your levels by that much) An HbA1c of 52 is not putting you at serious risk and depending upon how long you have been diagnosed and how long you have been doing low carb, I think in your situation I would be asking for another 3 months hiatus, perhaps with reduced Metformin to see how I got on with mostly just dietary control. If levels stay the same or go up, then consider the Flozin in 3 months time. I think that is a reasonable compromise. .
 
Wow, what great responses people!!!!! Thank you. Bendro is what I call it as I cannot get my tongue around the name and I have been on it for years with no problems. Water pill 2.5 mg, atenolol 25mg , candesartan 8 mg, and simvastatin just been raised to 40 mg. I have been on those doses for a long time and am ok with them. Now that the BG and Vit D levels have improved greatly I feel very well and am loath to meddle. The decision is mine but it has been very useful to have experienced input. I think I shall carry on as I am and see how I go.

May I ask, without insulting anyone, is it a necessity to test???? Wording this carefully as DN did not suggest it and I did not ask and I do see that lots of people do. I understand that T1 need to and there must be people with T2 who need to but does it help??? I think I would be interested but worry about getting too fixated. Apologies but I'm only asking so please nobody take offence.!!!!!!
 
Ps my dietary changes have helped but so too has the huge reduction in Mr Booze. No sherry since February, gins that have not gin, I drink diet tonic anyway, and The Jam Shed ( red wine I like) has been vastly cut. Water water and more water.....
 
With alcohol, the two things to consider are.... will it increase your BG levels and if you need to lose weight, will drinking it impact that because it is after all empty additional calories. If you are at a normal BMI, then you just need to look at alcoholic drinks which don't contain carbs. Gin and other spirits and red wine or dry while wine should be fine. Sherry or port being sweet wines are obviously less good and beer, cider and lager also contain carbs. You could therefore treat yourself to an occasional G & slimline T (beware of Fevertree which is sweetened with fructose and catches some people out who are fooled by the advertising, especially as it tastes nice) or a glass or two of dry red but obviously within sensible limits. Alcohol itself actually lowers BG levels because it causes the liver to stop releasing glucose which is one of it's main functions and work on removing that toxin from the blood as a priority instead.

As regards testing, it can be an invaluable tool in adjusting your diet with Type 2 as it shows which foods you eat which you are particularly susceptible to raising your BG levels and which foods you can get away with. You could test your response to having that occasional glass of wine or two and see what happens. It can also motivate you when you see progress and deter you from eating "naughty treats" when you see the effect they have on your levels/. I once hit 27mmols/l (healthy range is 4-10mmols) after eating a whole bag of Jacobs salt and balsamic vinegar crackers and thought I was going to have to go to hospital as that is really dangerously high..... I have never touched them since! I was torn between staying at home and risking dying rather than dealing with the shame of having to admit my gluttony to hospital staff. 🙄.

It is however important to understand that some people cope better with testing than others and it is also important to know that, unlike many things which are measured with the body, BG levels naturally go up and down day and night within that 4-10 range, so you have to learn what the readings should be between at different points in the day and what will push them up and what will bring them down. We often liken managing diabetes without testing to driving without a speedometer. If you are not comfortable and confident driving then you are best sitting in the passenger seat and allowing the medical professionals to advise you but if you are a person that likes to be in control and have your independence, then that speedometer will help you and keep you safe and providing you keep an eye on it and adjust your speed(diet) to what it tells you, you should be safe from getting any speeding tickets (high HbA1c result at your next appointment). It simply takes a lot of guesswork out of the situation and gives you more control.

Generally diabetes can be managed best by the patient if they have the right support and information and they become the expert in their own body and lifestyle and diet and what works for them. If you rely on a nurse or GP who you see once or twice or even 4 times a year to take tests and make adjustments to your medication, they really can't know what your true lifestyle and diet is like, just a rough guess, so they are making a rough guess about medication too.
 
Thanks, that's what I thought. I wrote it all down at the start but ......... Had a banana for breakfast and have just had a sliced ostrich steak with hard boiled egg and salad for lunch. Have had a litre of water this morning. Dinner might be salmon and stir fry cabbage. Will have more water , and possibly tonic later. Away this weekend so will be good.....ISH and I can resurrect the notebook on Monday. I love salt and vinegar things, dont have a sweet tooth at all but kicked the crisps too. Thanks .
 
Bananas are probably the highest carb fruit there is so many of us rarely have them and when we do, it's just half at a time. They release their glucose quite quickly which is why you sometimes see tennis players eating them between games. You can sometimes slow the release of their glucose by having them with a fatty food like cream or creamy Greek style natural yoghurt or peanut butter.

It is also worth knowing that most of us are more resistant to insulin in the morning, than at any other time of day, so eating banana might be better later in the day than for breakfast. Many of us have a few berries like rasps or strawberries which are much lower carb than banana, with mixed seeds or nuts and creamy natural Greek style yoghurt. I usually add some cinnamon and chopped lemon balm from the garden to mine to give it extra flavour and occasionally a dessert spoon of a lower carb granola just to give it a bit more crunch. Your other meals sound great. Testing would show you whether your body can cope with a whole banana for breakfast of course.
 
People tend to do a fair bit of testing initially so they can find out what meals are not too good a choice but also ones that are perfectly fine which you may have rejected. As time goes on you will have a good idea of what is OK so don't need to test those meals again.
You may then only test to check progress and make sure you are on track by testing in the morning to get a fasting reading, it would be up to you whether you did it every day as some people do or whatever you want.
Testing means you are not 'flying blind', it takes some of the guesswork out of making dietary changes.
 
I may well look into this, there is so much advice here that it's a lot to take in at one sitting, I keep dipping in and out as I originally posted.
Dinner was not what I intended.......spent afternoon with husband at the local Respiratory clinic for his regular appointment, took ages and the quick trip to Costco on way home.......through M4 tea time traffic. I was driving, I don't do tea time traffic. So. I'm afraid that tea was two slices of white toast and expensive peanut butter. I rarely ate bread anyway and stopped it completely when I started this malarkey. Oh it was good won't do it again though.......
 
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