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This past Friday the US Federal Drug Administration released a warning that some newer type 2 diabetes drugs, known as SGLT2 inhibitors, may cause ketoacidosis, or dangerously high levels of blood acids that could require hospitalization. The warning comes from the US, but what does this mean for Canada. Our Medical Director, Dr. Tom Elliott, lets us know.
“The SGLT2 inhibitor class of drugs is represented in Canada by canagliflozin (“Invokana”) and dapagliflozin (“Forxiga”). These drugs are used in Type 2 diabetes. They need to be used with caution in patients with impaired kidney & heart function and in those taking diuretics such as furosemide.
“They should not be used in patients with fasting blood sugar consistently above 12. The news wire report of 20 episodes of diabetic ketoacidosis (“DKA”) is unexpected. Given that DKA only occurs in patients with severe insulin deficiency (and sugar above 15) my interpretation of the finding is that it was used inadvertently in patients with Type 1 diabetes. Type 2 diabetes patients currently receiving an SGLT2 inhibitor medication need have no concern providing their fasting sugar is < 12 and if they have no impairment of kidney or heart function and are not taking another diuretic such as furosemide. Diuretics such as HCTZ are not a concern.”
-Dr. Tom Elliott, Medical Director at BC Diabetes
SGLT2 inhibitors reduce glucose in the bloodstream by essentially allowing patients to pee out sugar, which is a stark contrast to managing blood sugar through other means such as insulin, weight loss, or other oral medications.
Type 1 diabetes is often diagnosed after some significant event or test, but if symptoms do not have a rapid onset, people with Type 1 diabetes can sometimes be mis-diagnosed as Type 2.