Farxiga?

Hey Everyone,
My doctor add a new med last week (as I transitioned insurance companies) by adding Farxiga (in combination with the existing regimen of Metformin & Glipizde) as she wanted to see if my A1C of 7.2 would drop due to this relatively new drug that I had not previously been on. What I've noticed already in just a few short days is that what I used to think was comfortable temperature wise (76°F-78°F) is now too warm and what I used to think was chilly (72°F-74°F) is now just right. Has anyone else experienced this?
Thanks!
Adam

I'm not T2 and know little about those drugs. This is not to your question and is none of my business, but I have to ask. Doesn't a cocktail of three meds every day worry you? Have you noticed any other side effects? Is it your fasting BG or your post meal BGs, or both, that are driving the A1c?

I have to be honest, I usually decline to accept a new drug and I don't want to be a medical experiment. Farxiga (Dapagliflozin) was only approved by the FDA in January. Faxiga is a member of the new class of drugs called a SGLT2 inhibitors (like the earlier drug Invokana (Canagliflozin)). They work by lowering your renal threshold and essentially having you pee away high blood sugars. I am not against these drugs, at first glance they appear fairly safe, but I do not trust the FDA and big pharma to properly vet drugs anymore. Only after some time on the market do we really find out if these drugs are safe. And the idea that your doctor prescribed it to you to just see what happens I don't really like. That being said, I did discuss Invokana with my doctor and might consider trying it after a year or so when I know it isn't immediately toxic and my insurance covers it. Typically insurance plans will not pay for newer drugs as a preferred brand.

Despite all this bad mouthing the SGLT has been found to have some side effects which might explain your observations. The prescribing information notes that it may cause hypotension (low blood pressure) which could result in changes in circulation in your extremities and how you sense temperatures. You should also monitor your blood sugar and work with your doctor to make any necessary adjustments to your medications. The Glipizide may end up being too strong combined with the Faxiga and cause hypos, another side effect listed in the prescribing information. Hope that helps.

Hey Adam, fellow T2 here.

Managing diabetes is hard. In some ways, the fact that we T2's don't need exogenous insulin to simply stay alive actually makes it harder, in some ways, because it makes treating T2 look like there's an easy way out.

But there's not. The psychology is very much like smokers: Nothing particularly wrong now, what I'm doing must be working. The problem is, the damage accumulates slowly and silently, until it's not silent any more, and by then it's too late.

I treat with insulin, as you'll find many active, vocal T2's here do. In many cases (me) we do not because we have become absolutely insulin dependent like a T1 -- I could manage my D with diet+excercise+pills -- but we want to live as normal and free a life as we can.

Also, I'm not too keen on stressing out my pancreas with glipizide and/or other secretatory stimulants, or messing with kidney function, as this new drug apparently does. My approach is it's simply better to take firm control of BG, and make it operate as it does in a non-diabetic individual.

There's only one way to do that when you're diabetic, regardless of "type": Exogenous insulin.

So, It's something to consider, and to discuss with your doctor. It's not for everyone. Injections introduce a different set of "life-interfering" issues, but many of us find them far less bothersome than the diet and activity constraints/schedules that must be kept otherwise.

A pump and CGM (my treatment approach) makes it a breeze.

Finally, you'd be amazed how physically good, energetic, mentally sharp, etc. you would feel after just 1-2 days of keep your BG in line with some bolus insulin. That A1c you've got says you're probably making some big excursions postprandial -- probably over 200. Keeping your BG under 140-160 all the time, and getting your fasting BG under 120 all the time will make you feel great.

And, you get off all the drugs (except perhaps metformin -- I still take it -- it helps and has a long record of safety).

Just found this, which adds to my caution (similar to Brian's) in trying out new stuff like this:

SGLT2 Inhibitors May Up Glucose Production (MedPageToday)

Hi Terry,
It definitely does give me pause. It didn't happen overnight that I ended up on a three drug cocktail plan. It started out with metformin initially, then the addition of glipizide, and now we're trying Farxiga for 3 months. We do quarterly lab workups (blood and urinalysis) to help monitor for unintended consequences. I really haven't noticed any other side effects. I have even wondered with this latest cold snap if it's just that time of year when my body is readjusting to our more tropical like weather. Both fasting and post meal BG's I believe are driving my A1C.

Hey Brian,
I had a similar reaction when the suggestion was made. My hesitation went away once hearing about Invokana and her experience with that on other patients. I definitely have hesitation with FDA and big pharma vetting drugs fully. We're doing three months of it to see how it affects not only my A1C, but other functions. I'm using samples so no insurance to worry about at this point while we try it out. (FYI, I looked up both Invokana and Farxiga and both are in the same non-preferred tier and price with BCBS/FL.)

I hadn't thought of hypotension, but that does make a lot of sense. I haven't been watching my blood pressure as it's normally fine, but I will start watching that. I am testing more than normal to be ready for the hypo moments. So far I've not had more than normal, but with the lower readings, I would suspect that they will happen more. It would be nice if I could drop or lower the glipizide. Thanks for thinking about it so much.

Thanks! More reading :)