SGLT2 Inhibitors

SGLT2 inhibitors are a class of medications that treat Type 2 diabetes. SGLT2 stands for sodium-glucose transport protein 2. They manage your blood sugar by helping your kidneys remove extra glucose through your pee.

But the use of SGLT2 inhibitors goes beyond managing blood sugar. They also help improve kidney and heart health for people with chronic kidney disease (CKD) or heart failure. They can slow the progression of kidney disease and reduce the risk of needing dialysis. SGLT2 inhibitors also lower the risk of heart failure flare-ups.

How do SGLT2 inhibitors work?

SGLT2 is a protein in your kidneys that reabsorbs glucose. Typically, when glucose in your blood flows through your kidneys, some glucose goes back into your bloodstream. These medications block that process, so your kidneys don’t reabsorb glucose. Instead, it comes out in your pee. This means the glucose doesn’t get into your bloodstream and raise your blood sugar.

What drugs are SGLT2 inhibitors?

The most common examples of SGLT2 inhibitors are:

• Bexagliflozin (Brenzavvy®)
• Canagliflozin (Invokana®)
• Dapagliflozin (Farxiga®)
• Empagliflozin (Jardiance®)
• Ertugliflozin (Steglatro®)

How do you take SGLT2 inhibitors?

You take them once daily by mouth, usually in the morning.

Each medication comes in different dosages. Your healthcare provider often starts at a low dose, which they may increase over time. All SGLT2 inhibitors come in milligrams (mg). Examples include:

• Bexagliflozin: 20 mg
• Canagliflozin: 100 mg or 300 mg
• Dapagliflozin: 5 mg or 10 mg
• Empagliflozin: 10 mg or 25 mg
• Ertugliflozin: 5 mg or 15 mg

What if I miss a dose?

If you miss a dose, you should take it as soon as you remember. But it can’t be too close to your next dose. Generally, if your next dose is six hours or fewer away, skip the dose. Don’t take two pills to make up for a missed dose.

If you’re unsure, talk to your healthcare provider or pharmacist.

Can you overdose on this medication?

Yes, you can take too much. This is why providers don’t recommend doubling up on pills. It can increase your risk of complications.

Always take your medications as prescribed by your healthcare provider. If you’re unsure how much you’re supposed to take, contact your provider.

What other medications can interact with SGLT2 inhibitors?

SGLT2 inhibitors can interact with other medications and cause side effects. Some of these medications include:

• Diuretics (can cause dehydration and low blood pressure)
• Blood pressure medications (can lower blood pressure too much)

SGLT2 inhibitors can be used with other diabetes medications like metformin or GLP-1 agonists. But it can be unsafe to take SGLT2 inhibitors with insulin or sulfonylureas. Your healthcare provider will need to monitor you closely to make sure your blood sugar doesn’t get too low.

Always tell your provider about all the medications you take.

What are the benefits of SGLT2 inhibitors?

The main benefit is that they lower blood sugar levels in people with Type 2 diabetes. Other benefits could include:

• Reduce blood pressure
• Weight loss (because you’re peeing out sugars, which are calories)
• Improvement in Type 2 diabetes and kidney disease and/or heart failure

SGLT2 inhibitors aren’t a treatment option for Type 1 diabetes.

What are the side effects of SGLT2 inhibitors?

Side effects could include:

• Peeing more
• Dizziness
• Vaginal yeast infections

What are the risks of SGLT2 inhibitors?

One major risk of SGLT2 inhibitors is low blood sugar. If your dose is too high or you take too much, your blood sugar can get too low. This can be life-threatening.

Other risks of SGLT2 inhibitors include:

• Urinary tract infections (UTIs): Excess sugar in your pee can create an environment for bacteria to grow.
• Dehydration: The medication has a diuretic effect and can make you pee more. This can lead to dehydration.
• Diabetes-related ketoacidosis: Ketone levels can build up in your blood when your body breaks down fat (instead of sugar) for energy. If ketone levels get too high, it can cause ketoacidosis. This is a medical emergency. Symptoms include confusion, weakness, extreme thirst and very high blood sugar levels.
• Low blood pressure: Peeing more often could lead to low blood pressure.

Your healthcare provider can let you know more about the potential risks.

Can I drink alcohol with SGLT2 inhibitors?

You should be cautious if you drink alcohol while taking this medication. It can increase your risk of side effects like low blood sugar and dehydration. If you drink alcohol, drink only in moderation and monitor your blood sugar.

Can I take SGLT2 inhibitors if I’m pregnant?

No. You shouldn’t take this medication if you’re pregnant or thinking of becoming pregnant. Insulin or metformin may be an option for you during pregnancy. Talk to your healthcare provider about what they recommend.

When should I call my healthcare provider?

You should have regular appointments with your healthcare provider when taking SGLT2 inhibitors. They can make sure your treatment is working.

Call your provider if any of the following happen:

• You have concerning side effects.
• Your blood sugars are very high or low.
• You’re thinking of stopping the medication.
• You become pregnant or are thinking of becoming pregnant.