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Diabetes medications – SGLT 2 inhibitors

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Diabetes medications – SGLT 2 inhibitors

Hello today we look at sglt2 inhibitors sgf22 is an abbreviation of sodium glucose called transporter 2 and this molecule is found on the proximal tubule of the kidneys which usually reabsorbs about 90 percent of the filtered glucose and this s2 molecule is blocked by inhibitors and thereby the urinary glucose excretion is increased and we have four types of

Sgl2 inhibitors namely er2 glyphosate the plaque glyphosate empire glyphosine and canagliflozin all are ending with glyph flows in and let’s create now a mnemonic from the first letters of these sglt2 inhibitors let’s use edec the reason why i’m choosing this addict is because this is the order of decreasing kidney insufficiency values what i mean now is that

Elto glyphosene cannot be used by patients having a gfr of less than 60 milliliters per minute so one contraindication as against s282 inhibitors is kidney sufficiency as we saw it depends on which type of sglt2 inhibitor we are talking about f2 glyphosene is less than 60 milliliters per minute that pacclip flows in and impactly frozen is less than 45 milliliters

Per minute canada glyphosate is less than 30 ml so let’s name some other contraindications contraindication just mean cases where we are not allowed to start medication or procedure so we are not allowed to start h2 inhibitors in patients with type 1 diabetes or prior diabetic ketoacidosis or predisposing factors like pancreatic insufficiency or drug or alcohol

Abuse or we can have frequent bacterial urinary tract infections or low bone mineral density with high risk of fractures foot ulcers severe dehydration so the reason why we cannot start sgf2 inhibitors in these cases is because sglt2 inhibitors can aggravate and make these kind of symptoms worse so to understand contraindications it is very important to understand

Side effects so before listing all side effects i want you to understand that side effects are very rare and you should not panic due to the side effects there are side effects of anything in life and if you would not proceed with these type of medications due to fear of side effects you could not take any medication in life and you could not eat any food and you

Could not even breathe in your life okay so side effects of sgt2 inhibitors are for example urinary tract infections bladder cancer with hypotension acute kidney injury bone fractures diabetic ketoacidosis with symptoms of for example nausea or vomiting or malaise and an important lamb value that has to be taken by patients taking s22 inhibitors with symptoms of

Diabetic ketoacidosis like malaise nausea or vomiting is serum ketones so if serum ketones are increased in the blood then we know that the patient developed diabetic cataractuses due to these sgl2 inhibitors and then we need to stop the medication and then the last side effect of sgl2 inhibitors that is the most serious but very very rare so namely amputations

And due to these contraindications it is very important that we check some things before starting any type of sgt2 inhibitors like for example we check the kidney function by taking a blood sample also liver function by also taking a blood sample we check hypovolemia by measuring the blood pressure of the patient or in severe cases we can even use an inferior

Vena cava elasticity test with an ultrasound probe bone density with a dexa sex scan can be used it is also very important that we reduce insulin or sulfonylurea before starting sj2 inhibitors because otherwise the risk of hypoglycemia which is a sugar level of less than 60 milligram per deciliter is very high and we said that kidney function has to be checked

Before starting sglt2 inhibitors but it is equally important that we measure the kidney function every three months so in the beginning every three months and if the kidney function remains stable with a gfr of let’s say more than 60 milliliters per minute then we can can control this kidney function every year and if the kidney function is below 60 milliliter

Per minute of gfr then please continue measure this kidney function every three months hemoglobin a1c is a value that we measure also for all patients with diabetes and this should also be measured every three months in the beginning and then we can increase the interval for for example let’s say every six months in very stable patients and we said that insulin

Or sulfonylurea or glinids have to be reduced when we start s2l2 inhibitors but and this is due to the risk of hypoglycemia but the amount of reduction which should be done is around 20 for insulin and fifty percent for sulfonylurea or clinics and for patients taking insulin together with sgl2 inhibitors it is also very important that we measure fasting and

Premium fingerstick glucose measurement for the first two weeks following this initiation of sgl2 inhibitors or after any type of dose escalation we said that s22 numbers can cause hypovolemia and this is the same as saying that it can cause hypotension which is a low blood pressure and the risk of hypotension increases further when h2 inhibitors are given at

The same time as with diuretics or angiotensin converting enzymes or angular tensile receptor blockers and the reason why s22 inhibitors can cause hypotension is because they can cause osmotic derisis which simply means that we have a lot of sugar secreted from the urine and thereby the water flows with it and as we know blood pressure is dependent on water and

Therefore if we have less water we have then less blood pressure and that is the whole mechanism of this we said that s22 inhibitors can cause acute kidney injury also as a side effect and the risk of this can also be further increased by almost the same medications which increase the risk of hypotension namely theoretics angular tension converting enzyme

Inhibitors angular tensile receptor blockers and the one last one non-steroidal anti-inflammatory drugs so if the patient is taking non-steroidal anti-inflammatory drugs due to for example pain anywhere in the body then please stop that stop that type of medication when starting sglt2 inhibitors it is equally important to look at diseases that can predispose to

Accurate kidney injury for example heart failure for example hypovolemia and elderly patients with dehydration these are all predisposing factors for acute kidney injury and if you add stlt2 on top of that then the risk gets even higher and if you add non-steroidal anti-inflammatory drugs or also on top of that then the risk is even higher and we do not want

Accurate kidney injury we want to treat diabetes but it is important that we use medications in the proper manner meaning in the proper combination with each other so you cannot combine any medication as you want until now we have talked about a lot of negative aspects of exterior tutoring inhibitors meaning side effects and contraindications so before we start

To talk about the indications of s2l2 inhibitors meaning they’re positive aspects of s282 inhibitors i need to tell you uh one more disadvantage for instituting inhibitors compared to the other type of anti-diabetic medications and the first and most important disadvantage is the glycemic effect efficacy and sgf2 inhibitors has only moderate glycemic efficacy

Compared to the other anti-diabetic medications and this means that other anti-diabetic medications are reducing glucose more efficiently than sgf2 inhibitors the second disadvantage is that it costs more it’s more expensive than many other better anti-diabetic medications like for example metformin third disadvantage is that it is a relatively new medication

And everything that is new means that we don’t know the long-term safety for example prolonged glucosuria glucosuria means glucose in the urine and as we have seen with s22 inhibitors this increases the glucose in the urine and we don’t know if that is good for a longer period of time let us now look at indications of sglt2 inhibitors for which diseases are sg42

Inhibitors good for so we have atherosclerotic cardiovascular disease with heart failure diabetic kidney disease with a urine to alba mean creatine ratio of more than 300 milligram per gram and a gfr of less than 90 milliliters per minute and obesity the other benefit of these inhibitors can be combined with that it can be combined with many other medications

Like for example metformin sulfur luria pioglitazone cetacliptin and insulin so sgl22numerators can be combined as a second agent with metformin in patients who are for example obese and has high risk of hypoglycemia it can it is also having a very low risk of hypoglycemia and therefore it is in many cases better than sulfonylurea which has for example a very

High risk of hypoglycemia h22 inhibitors can also be used as a third engine meaning a triple therapy with metformin and sulfur nulluria for example so before finishing my presentation i want to emphasize the four types of h32 inhibitors namely er2 glyphosin the paclyflusine and as we remember the mnemonic headache edec and this is in decreasing order of kidney

Insufficiency values it means eptoglyclus in less than 60 milliliters per minute double glyphosate in an empirical glyphosate in less than 45 and canada glyphosate less than 30 milliliters per minute s2 inhibitors are very good for obese patients we said with atherosclerosis for heart failure patients and for diabetic kidney disease patients and we will deal

With these specifics in different uh separate lectures so we will deal with separately all the s 282 inhibitors so i thank you very much for listening and take care have a nice day bye bye

Transcribed from video
Diabetes medications – SGLT 2 inhibitors By Dr. Andras Fazakas