FUDiabetes

What is your experience with SGLT2 inhibitors?

@JessicaD, I think there are quite a few threads on that! I am on my phone so linking is hard, but if you search FUD (the search feature works really well) I think you’ll find quite a few.

For instance, I am pretty sure I remember @docslotnick starting several threads on SGLT2 inhibitors.

[EDIT] OK, I was wrong :slight_smile: There are many references to SGLT2 but there aren’t really good threads for it. We should start a few! @doclsotnick, you mentioned your good experience on SGLT2 before you had to stop them due to contraindications. Would you be willing to you discuss your experience on a new thread?

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@JessicaD I took an SGLT2 for about 1 1/2 years concurrently with a lower dose of metformin.

It worked magically. Bg was never over 225, and I didn’t suffer any of the urinary tract problems. But I had to stop due to my creatinine levels and potential for kidney damage. But I’m 67 years old and I don’t think that is unusual for a long term T1.

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@docslotnick, what specific one was it, if you don’t mind mentioning it?

@Michel It was Jardiance, but I think they all have the same warnings and contraindications.

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@JessicaD, @Michel: I took Forxiga (I think it’s Farxiga in the US) for six weeks and loved it. I only stopped due to intolerable side effects. It’s impact on my BG was great. Like @docslotnick said, it seemed to cap most highs at about 13 mmol/L and they were much easier to turn around. I could still get well above that 13 mmol/L if something went really wrong, but overall it helped my control greatly.

Jen, thank you so much for updating and wow on your results! That must feel great. Can I ask what your side effects were on Farxiga? (A friend is trying Jardiance and had high ketones with very slightly elevated blood sugar – alarming!) But I will evaluate further the option to try metformin – seems like a good one. Thanks again and I hope all of the good stuff continues! Jessica

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The side effect that made me stop taking it was two yeast infections within those six weeks after not having any for years.

I did also get ketones very easily, which according to my endocrinologist is normal with SGLT2 inhibitors. (I get ketones fairly easily as it is, compared to some people who rarely or never get them.) He was actually monitoring my ketones with lab draws every six weeks, and told me to monitor them twice a day and any time I felt unwell. I used urine ketone strips to monitor daily and tested blood ketones if the urine strips were highly positive or I felt unwell. Two times during that period I felt really crappy with somewhat high blood sugar, and both times I took insulin and drank a ton of water and they cleared.

My endocrinologist spent a long time talking to me about DKA risk and how to manage ketones, and he also said he was letting me try it in part because he knew I was very knowledgeable and on top of my diabetes. Like pumps, it’s a tool that comes with some risk, and I don’t think it’s a good match for people who don’t test often or don’t respond immediately to highs.

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Well, I am back two years later to ask if any other type 1s have tried any SGLT-2s? I just read an article (for type 2s) on Diatribe and it sounds like the proof for heart and kidney protection (in type 2s) continues to be made.

I haven’t made a move on trying this (hell, I don’t even have an endocrinologist to pester for it…), but with careful monitoring for DKA it seems like it could be a good complement to my diabetes regimen. I’m not on a pump (but do use a CGM) and have a crummy/very slow response to Humalog to bring down highs (like at least a few hours). I don’t seem to generate ketones easily. I am knocking on the door to treatable high blood pressure and it’s clearly transiently high.

Anyway. Anyone else out there who tried an SGLT-2 and can share their experience? Or anyone with insight into why it hasn’t been approved for type 1s yet? (I am guessing the DKA issue). Thanks! Jessica

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I tried Invokana. It was a miracle drug for the first few weeks—it was like I could barely break 180 if I tried, and was mostly in target range. I thought my diabetes control issues were solved. So excited. I had to drink even more than I already did at baseline, so constantly hydrating, and was peeing more. I also had to start taking one diflucan tablet a month preventatively, since increases risk of yeast infections. But over the next few months it stopped working as well, to the point where eventually I felt like my control was back to starting point. Sometime around then I had labs done, and for the first time ever had a very concerning kidney test. At that point, I said screw it, stopped the invokana. Follow up test within a month showed kidneys at their usual undetectable levels of protein, so I really don’t know if it was some kind of mistake on the test or if the meds did temporarily screw with my kidneys. All in all, I would say not in the slightest bit worth it the end, especially given the false hope at the beginning, sadly. Also on TuD, other accounts of people finding it miraculous at the beginning, then the effects wearing off and them eventually going off of it too.

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Are you up for trying IM injections?

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Oh, also, I would recommend Afrezza for faster acting blood glucose lowering ability before I would recommend an SGLT2 inhibitor, based on my personal experience with both. I also do find metformin ER to be an effective add-on that continues to be useful over time, unlike Invokana, though I don’t think it will address your issue with humalog. Have yet to try an IM injection, so can’t compare that myself, though obviously @Eric and many others on here can speak to that option.

The only other thing I’d suggest is that I do find that when my basal dose is running a little on the low side, it can look like my short acting/bolus insulin is inadequate. Increasing my basal slightly can have a dramatic, useful effect on that sometimes.

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@Eric - Ugh, I should be, but I just don’t think so. I have read about you guys doing them and I think it’s too intense for me. I hate that I’m such a wuss.

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I understand.

What @cardamom said about basal is very true. Basal is the foundation that you build your house on. Having a good solid strong foundation makes a lot of this stuff easier.

My basal is higher than it needs to be. I occasionally need to have a few nibbles during the day to keep from dropping. But what that higher basal does is make everything else work better. Most of my meal boluses are right at mealtime, not before.

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@cardamom - thank you for this info. Yikes on your Invokana experience. I had tried Symlin way back when it came out and it was helpful in tightening my range of BS, but I got scary lows from it and the constant extra injections associated with it ultimately put me off of it. Maybe I will start talking with my PCP about trying Afrezza and see if she will also prescribe metformin.

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@Eric - this is a really good point. I am on MDI, so my basal control is more “gross” than those of you with pumps, but I did just this week decide to split my Lantus dose into 2 x 12 hour doses, so am taking a lunch shot and bedtime shot b/c I think I was running out of Lantus at around 22 hours and trending high in the late evening hours because of it. I had been using 13u and am now doing 7u twice daily. We’ll see how it goes. Am also edging back toward considering a pump with control IQ-like features, but will need to think on that for some more months/years…! I am steering the topic off range so will quit for now!! :slight_smile: Jessica

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@JessicaD
Are your basal needs higher or lower during the day versus the night? Or are they relatively constant?

If they are higher at one time compared to another, and depending on how much insulin you take, then Levemir might be a good thing to look at.

Depending on how much you take, Levemir has a shorter duration than Lantus. For me it lasts about 12 hours, which makes it very good for splitting day and night (I need more at night than during the day).

If your basal needs are relatively constant, than splitting Lantus like you are doing is better.

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@Eric basal needs seem relatively constant through day/night, especially as I’ve recently learned that one little unit of Humalog extinguishes the feet-on-the-floor rise and insulin insensitivity that I thought were just new terrain for me along with middle aged lady hormones. (This is 90% good; the 10% bad is that my morning workout now often comes with my phone blaring low blood sugar alarms at me.)

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Morning workouts are tough, unless you wake up much earlier than the workout.

That’s why I generally run at night.

For races, which are generally held in the morning, I eat 2 hours before the gun. For a 7am race, that means eating at 5am. That’s just how it’s gotta be.

But if you want to discuss some of the scenarios for morning workouts, we can go through them. A lot of it depends on the type of workout and how hard your are working out and what your diet is like, etc.

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