If you have Type 2 Diabetes, your doctor may have prescribed a medication called Canagliflozin (often known as Invokana in our country) to help control your blood sugar levels. This medication works best when used in conjunction with a healthy diet and daily exercise. So, let's talk about some of the most important things you need to know about this medication.
1. What conditions does Canagliflozin treat?
Diabetes and heart disease often go hand in hand. In fact, research has found that people with diabetes are twice as likely to develop heart disease or heart failure than people without diabetes.
Canagliflozin belongs to a class of drugs called sodium-glucose co-transporter 2 (SGLT2) inhibitors. Simply put, it works by reducing the amount of sugar your body excretes in your urine, which lowers your blood sugar levels.
Another special benefit of this is that this drug has been approved to reduce the risk of death from serious conditions such as heart attacks and strokes in adults with type 2 diabetes who have cardiovascular disease, or who are at high risk of developing such diseases.
In addition, this medicine also helps reduce the following risk factors:
- End-stage kidney disease
- Impaired kidney function
- Hospitalization due to heart failure
- Hospitalization due to kidney damage caused by diabetes (Diabetic Nephropathy)
Most importantly, this medicine is not suitable for people with Type 1 Diabetes. Also, people with severe kidney disease cannot take this medicine.
2. How to use this medicine?
This is a medicine that comes in the form of a pill. You have to take it once a day, usually before your first meal of the day.
This medicine can be taken with other diabetes medicines, such as metformin. However, sometimes these medicines can interact with each other. If this happens, their effectiveness may be reduced or side effects may occur. Therefore, it is essential to tell your doctor about all the medicines, vitamins, and nutritional supplements you are taking.
Your doctor will adjust the dose if necessary. Store this medicine at room temperature, in a closed container. Keep away from excessive heat, moisture, and direct sunlight. Dispose of expired medicine safely.
How is the medication dose?
Your doctor will probably start you on a 100 milligram (100mg) tablet. If you need more control over your blood sugar levels, your dose may be increased to 300 milligrams (300mg) per day. If you miss a dose, take it as soon as you remember. But if it is almost time for your next dose, do not take two doses at once. Skip the missed dose and take your next dose as usual.
3. What are the possible side effects?
Some people may experience mild, moderate, or severe side effects from this medication. Let's be aware of them.
| Type of side effect | Features to watch out for |
|---|---|
| Commonly seen side effects | |
| Urinary Tract Infections | Burning when urinating, lower abdominal pain, frequent need to urinate, blood in the urine. |
| Low blood sugar (Hypoglycemia) | This can happen when taken with other diabetes medications. Symptoms include dizziness, headache, sweating, tremors, and rapid heartbeat. |
| Severe/immediate medical attention-seeking side effects | |
| A rare bacterial infection (Necrotizing Fasciitis) | A dangerous infection that destroys the tissue under the skin around the genital area and anus. Seek medical advice immediately if you experience symptoms such as pain, swelling, and redness. |
| Severe allergic reaction | Skin rash, swelling, hives, or severe itching. These are also conditions that require immediate medical attention . |
| Bone Fractures | Research has shown that this medication may slightly increase the risk of bone fractures. |
| Other severe symptoms | Loss of vision, blurred vision, eye pain, difficulty breathing, irregular heartbeat, fainting, difficulty speaking, difficulty walking, excessive sweating, or fever. |
If you experience any of these severe side effects , do not delay and immediately call the 1990 ambulance service or go to the Emergency Treatment Unit (ETU) of the nearest hospital.
4. Special warnings and safety (Warnings)
Risk of foot removal
There is some debate about whether this medication increases the risk of amputations, especially of the feet and lower legs. This is very rare. However, if you have had such surgeries before, or if you have frequent foot ulcers or infections, it is important to be aware of this and take special care of your feet.
Diabetic ketoacidosis (DKA) condition
This is the most important thing to know about this medication. This medication can cause a very dangerous condition called Diabetic Ketoacidosis (DKA) in some Type 2 diabetics.
Simply put, DKA occurs when your body doesn't have enough insulin to turn the sugar in your blood into energy. Your body then starts burning fat for energy. During this process, chemicals called ketones build up in your blood. When these ketones build up in excess, your blood becomes acidic, which can poison your body and make you very sick. In severe cases, you can go into a diabetic coma or even die.
The first signs of DKA are excessive thirst and frequent urination. This is a warning sign that your diabetes is out of control. Talk to your doctor about how to prevent DKA and keep your insulin and blood sugar levels at a healthy level.
5. What precautions should be taken before surgery?
Yes. If you have a scheduled surgery, you should stop taking this medicine 3 days before the surgery to reduce the risk of DKA. It is important to inform your surgeon and your diabetes doctor about this. During this time, your doctor will closely monitor your blood sugar levels and use other methods to control them.
6. Who should not use Canagliflozin?
Doctors do not recommend this medicine if you have the following conditions:
- If you have severe hepatic impairment
- If you are pregnant or hoping to become pregnant
- If you are a breastfeeding mother
- If you are under 18 years of age
- If you have had a severe allergic reaction (e.g., anaphylaxis or swelling such as angioedema) to this medicine
- If you are undergoing kidney dialysis
Before using this medication, it is very important to talk to your doctor to make sure this is the right medication for you to manage your diabetes.
Take-Home Message
- Canagliflozin is a medication used to treat type 2 diabetes. It also helps reduce the risk of heart disease and kidney disease.
- This pill should be taken once a day, before the first meal.
- Don't forget to tell your doctor about all other medications you are taking.
- Be aware of side effects such as urinary tract infections, low blood sugar (hypoglycemia), and rare genital infections.
- Be aware of the symptoms of a dangerous condition called Diabetic Ketoacidosis (DKA) (excessive thirst, frequent urination).
- This medication should be discontinued 3 days before any surgery, as directed by your doctor.
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