If you have Type 2 diabetes, you're probably already taking medications like Metformin. But your doctor may have told you about a new class of medications called SGLT2 inhibitors. Or you may have heard about them. So, what are SGLT2 inhibitors? How do they actually work? In this article, we'll talk about them simply and precisely.
What are these SGLT2 Inhibitors?
Simply put, SGLT2 inhibitors are a type of oral pill that helps control your blood sugar levels. The thing about them is that they work a little differently than other diabetes medications.
Think about it, our kidneys are an amazing filtering system. When cleaning our blood, the kidneys filter out some of the sugar (glucose) in our blood into our urine. However, our kidneys have a protein called Sodium-glucose cotransporter 2 , or SGLT2 for short. Like a gatekeeper, this SGLT2 protein captures most of the sugar that goes into the urine and puts it back into the blood.
Now do you understand? A person with diabetes already has high blood sugar. So what these SGLT2 inhibitors do is they turn off that gatekeeper, the SGLT2 protein, a little bit. Then it can't take the sugar back and add it to the blood. As a result, the excess sugar is excreted from the body in the urine . This is how these medications lower your blood sugar levels.
This type of medication is unique because it lowers blood sugar in a different way, without directly affecting the hormone insulin.
What are the most common SGLT2 Inhibitors in Sri Lanka and abroad?
There are several types of medications in this group. They all do the same thing. They are usually taken once a day, before the first meal of the day. Your doctor will assess your condition and prescribe the most appropriate medication.
| Generic name of the drug | Most commonly used brand name |
|---|---|
| Canagliflozin | Invokana |
| Dapagliflozin | Farxiga |
| Empagliflozin | Jardiance |
| Ertugliflozin | Steglatro |
| Bexagliflozin | Brenzavvy |
Who is suitable to use this medicine?
This is a very important question. SGLT2 inhibitors are not the first drug a doctor would prescribe for Type 2 diabetes.
Usually, a doctor will first advise lifestyle changes , such as diet control and exercise, and then start a medication like Metformin.
Your doctor may consider an SGLT2 inhibitor in the following situations:
- You are already taking several medications, but your blood sugar is still not well controlled .
- If you have a medical reason why you cannot take other diabetes medications.
- If you are at risk of dangerously low blood sugar (hypoglycemia).
- If you need to lose weight or lower your blood pressure.
Who should not take this medicine?
This type of medication is not suitable for everyone.
- This medication is not approved for people with type 1 diabetes .
- These are not recommended for people who have previously developed a severe complication of diabetes called diabetic ketoacidosis .
- This medicine will not be of much benefit to someone who already has severe kidney disease .
- If you are pregnant, trying to become pregnant, or breastfeeding, you should definitely talk to your doctor about using this medicine. There is not enough data on its safety at this time. Therefore, do not start or stop taking this medicine without consulting a doctor.
What are the possible side effects?
Like any medicine, this medicine can cause some side effects. However, not everyone gets them. And most of them can be managed.
| Side effect | Description and what to know |
|---|---|
| Frequent urination and thirst | Because sugar is excreted in the urine, you may need to urinate frequently throughout the day and night. This may also increase your thirst. Drink plenty of water. |
| Urinary tract and genital infections | The sugar in urine increases the risk of yeast and bacterial infections. Tell your doctor if you experience symptoms such as itching, swelling, or pain in the genital area. |
| Weight loss | You may lose some weight because sugar (calories) are excreted in the urine. This is an advantage for some people. |
| Low blood pressure and dehydration | Sometimes, as fluid is released from the body, blood pressure can drop, which can make you feel tired and dizzy. |
| A serious side effect that requires immediate attention | |
| Diabetic Ketoacidosis (DKA) | This is a rare but very dangerous condition. The body burns fat instead of sugar, producing acids called ketones. If you experience symptoms such as nausea, vomiting, severe stomach pain, extreme fatigue, and difficulty breathing, tell your doctor immediately or go to the nearest hospital emergency room (ETU). |
Not just for diabetes, there are other benefits!
Although this medicine was originally developed to treat diabetes, research has found it to have several other amazing benefits.
1. Protecting the kidneys: These medications can reduce damage to the kidneys caused by diabetes and control the progression of chronic kidney disease.
2. Reducing the risk of heart attacks and death from heart attacks: Some SGLT2 inhibitors have been shown to reduce the risk of hospitalizations and death, especially when given to patients with heart failure.
3. Reducing the risk of heart attack and stroke: Some studies have shown that these also contribute to reducing the risk of heart attack and stroke.
For these reasons, doctors may sometimes prescribe this medication to people who do not have diabetes but have kidney disease or heart disease.
Take-Home Message
- SGLT2 inhibitors are a new class of oral medications that treat type 2 diabetes.
- These work by stopping the kidneys from reabsorbing sugar back into the blood and excreting it in the urine.
- These are not usually the first medications given for diabetes. Your doctor may recommend these when your blood sugar is not controlled with other treatments.
- In addition to controlling diabetes, they also have the amazing ability to protect the kidneys and reduce the risk of heart disease.
- As with any medication, there can be side effects. Talk to your doctor about any changes you experience.
- Only your doctor can decide whether this medication is right for you, so be sure to discuss this with him or her.
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