Farxiga for Type 1

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1

My doctor wants me to try a new drug that was made for Type II diabetics because she has had good results with Type I patients. I wanted to share what happens.

I am a Type I diabetic, diagnosed at the age of 9 in 1993. My control is good, but my A1C is now 7.2. I use a Medtronic insulin pump, but I don't use glucose sensors.

2/19/2015 I went to see my endocrinologist, and she told me about a new drug: Farxiga (dapagliflozin) is an oral diabetes medicine that helps control blood sugar levels. Dapagliflozin works by helping the kidneys get rid of glucose from your bloodstream.

It’s for Type II diabetics, but she is giving it to some of her Type I’s that have problems with high blood sugars or spikes like me.

She showed me the results for a few patients. One was a woman that refuses to take more insulin because she is afraid of hypoglycemia. Her average sugar was 333. The drug got in her system within a day and leveled her out.

Farxiga spills sugar out in the urine, actually spilling about 250 calories per day. One man lost 28 pounds (she said he really needed to lose some weight though). You also use about 20% less insulin.

Right now, the drug companies are in so much competition that the drug is free with a card. My doctor said if the card doesn’t work, to have the pharmacy call her, and she can have her drug reps work it out for me.

2/25/2015 This morning I woke up with a blood sugar of 177 and took the normal correction. I adjusted my pump settings to 20% less basal, smaller correction and higher carbs ratio.

I took the first Farxiga pill and felt slightly low while I was getting ready for work, so I drank my breakfast shake (25 carbs), and I didn’t take a bolus.

I have a headache and kind of a queasy stomach, and my “slowness” matches my blood sugar which has been a level 69 the two times I tested before 11am.

11:00am I just ate a yogurt, and I’m not taking a bolus.

1:32pm My blood sugar is now 121 which is interesting because I decreased my basal, and I didn't bolus for the yogurt. I haven't been moving around because I am working at a desk from 9-5.

I can't wait to tell you about it as it really gets into my system (that should be within one day).

Bonnie

2

Wow! You didn't eat much for breakfast and lunch. Did you have to "pee" often? Keep us posted...

3

Haha, I expected I would have to pee more often than usual, but not so far. I always have the same food during the work week, two diet shakes and a yogurt. I sit at a desk for hours, so it helps maintain my weight. The weekends are different story though. I like to cook :)

4

Very interesting, I can't wait to see how it affects Type 1's long term.
I've never heard of Farxiga. I am also a type 1 on a medtronic pump.

5

My endo appointment was the first time I heard of it too. My doctor said there is no long term study on the effect it has on the kidneys, and she didn't let me start on the drug until she got my labs back.

6

Some of you might want to look at the review on Diabetes Mine by Gary Scheiner

http://www.healthline.com/diabetesmine/t2-diabetes-pee-drug-for-type-1
How is it going? Less spikes? Still nauseous?

7

My blood sugar was really stable until after dinner and through the night. Maybe I need to raise my basal, but it's most likely that I didn't bolus correctly for the food I was eating. I was about 200 this morning, but everything is back to normal now. Bg was 75 at 11:45. Stomach feels a little queasy, but not too bad. I really want to find a balance for the highs at night!

8

Any updates/feedback on Farxiga for Type 1?? My A1C=6.7 but high variability with glucose swinging high and low. My Endo gave me 5mg samples to take 1/2 tablet (2.5mg) per day and drop my Lantus from 25 to 18.
Can I expect Farxiga to help flatten out the swings, especially the highs?
Does Farxiga really cause weight loss? A concern because I am already 10 to 20 pounds under my desired and previously normal weight. Attempting to find safe weight gain methods for a T1D.

9

Hi! I still take the 10mg every morning, and I’m very happy with it. Before taking it, I would often wake up very low, sometimes unknowingly turning off my alarm clock and getting to work late. Now I rarely wake up low. Farxiga has eliminated the swings for me. I stay pretty stable. I can’t remember the last time I had a number above 300. I only see a number in the 200s if I don’t manage my food and exercise balance correctly. My A1C has been going down since I started taking it. Most recent numbers were 6.1 in March 2016 and then 6.0 in September 2016. I started at 7.2 in Feb. 2015. Farxiga hasn’t caused weight loss for me. I’ve stayed the same, but my doctor said it can go either way depending on the patient.

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10

I’ve been taking Forxiga (same as US Farxiga) 5 mg for three weeks now. I have noticed that it has lowered my standard deviation considerably. It also lowered my basal rates and ratios by about 30%. With Forxiga it seems that highs are often somewhat easier to bring down, they will “turn around” more promptly more often than in the past. It has not eliminated spikes entirely, however. I can still easily provoke a spike to 14-18 mmol/L (250-300 mg/dl), but so far I have not been above that level. I still have rollercoaster days where I swing from high to low and back again. But it does seem that, when I’m steady, I’m very steady. I haven’t experienced any weight loss thus far (I am hoping to).

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11

I went to a drug rep conference dinner where my doctor was the speaker. He did a really in depth presentation on farxiga and did discuss it’s off label use in type 1s a fair bit. A lot of the discussion was over my head because I was like the only one there who wasn’t a doctor but it was enough to definitely interest me.

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12

I have been a type 1 diabetic for 53 years. My doctor wants me to try farxiga. I am on Humalin N. I take 30 units a day. My A1C is at 7.9 it is usualy at 6.5. I lost my husband on Feb.1st of this year so needless to say I have been out of control. I can get my numbers back so do not know why I should try this Farxiga? I am hearing a lot about it still being in trial stage, so what can any one tell me about my risks?

13

I am truly sorry to hear about your husband. It is hard enough keeping your head on straight with diabetes but double hard when dealing with the loss of your partner.

But wow, 53 years. You are a hero.

I have to ask you a few questions if you don’t mind. Are only taking NPH? Have you ever taken a rapid insulin or use Regular (R)? Do you think you have problems with fasting blood sugars or after meals?

I have lots of information on Farxiga and other drugs in this class (SGLT2) as I have taken them and read up a bit on them. These SGLT2 drugs are only FDA approved for Type 2, but studies are slowly being done for Type 1. Despite that, doctors are prescribing them and they do work. But that doesn’t necessarily make them a good choice for you.

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14

Thank you. I did use R years ago for a short time. They took me off of it because it dropped my sugars to low. I do get spikes after I eat but usually because I ate some thing I should not Have…lol but yes I do get spikes. I have used N most of my life and seem to do well on it. My eyesight is retinopathy and glaucoma. Both sides of my neck I have had carotid artry surgery. Do to 2 strokes. I was very active until my husband’s passing and I plan on getting back to my active life soon. So if you can let me know more on farxiga I would be gratful. Thank you.

15

Ok, I don’t know the details, but I will tell you your current regime is far short of current standards of care. Maybe you are struggling to afford medications or have gotten poor medical advice or maybe your doctor just thinks you are doing fine. But currently, someone with T1 is advised to use a basal/bolus regime with modern insulin (not R or NPH). And you should self adjust your mealtime basal bolus to match your meal. That isn’t what you are doing and it apparently isn’t what you have been advised. So first I would encourage you to ask for a modern insulin regime such as Tresiba for basal and Humalog for bolus. And ask for a referral to a diabetes educator so that you learn about carb counting and how to do a basal/bolus regime. That would be what I recommend you do.

That being said, you asked about Farxiga. Farxiga is an SGLT2 drug which increases the amount of glucose that you excrete in your urine. It doe this by shifting the renal threshold from a normal 160-180 mg/dl to a markedly lower value. Usually when you blood sugar goes up over 200 mg/dl during a meal you will starting dumping glucose. With an SGLT2 you will start dumping glucose at a lower number, perhaps 140 mg/dl. The end result will be that your mealtime spikes will be “blunted.” You will still have spikes, just not as a high or as long. But note that the effect of an SGLT2 is far less effective than a proper mealtime bolus dose of insulin.

There are some possible adverse effects from SGLT2 drugs. First, you need to be careful about becoming dehydrated. Not just water, but you will go to the bathroom more and you can use vital electrolytes. Becoming severely dehydrated can put you at risk of DKA, so always be diligent. There is also an increased risk of UTIs and yeast infections, particularly for women. And SGTL2 drugs are contraindicated if you have any renal impairment.

ps. If you would consider a basal/bolus regime with modern insulins I am sure that many of our members here would help you with advice on how to do that successfully.

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16

Nice response. I know you meant bolus, not basal, when talking about adjusting mealtime doses, but you may want to clarify it for others.

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17

Thanks I corrected it. And if anyone can deduce the special code I used for the “strikethrough” you win the sleuth of the day award.

18

What do I get?

19

I thank you for the information. I have tried 70/30 in 2007 and again had very low blood sugars. Doctor decided for me to stick with what has worked fine for years. I have already (without farxiga) droped my blood sugars. With farxiga not being aproved for type one diabetes, I think I will stick with what I am on. Thank you.

20

A free subscription to bbcode BBCode magazine.

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