SGLT 2 Inhibitors (sotagliflozin) on T1D trial

Have you heard about SGLT 2 Inhibitors to manage T1D / any or have any experience with below:

Boehringer Ingelheim’s Jardiance – are part of a new class of drugs known as SGLT-2 inhibitors. Instead of working through the pancreas and liver, as prior diabetes medications have, SGLT-2 inhibitors block the absorption of glucose in the kidneys, allowing patients to excrete excess glucose through their urine.

I tried an SLGT2 inhibitor for about six weeks, but had to stop due to side effects. It did have some positive impact on my blood sugar and lowered insulin doses as well as weight, but it wasn’t nearly as dramatic an effect as I’ve heard (my endocrinologist thinks because I already had good control prior to starting). It did cause me to have ketones even wehn not eating a low-carb diet, so that risk is something to be aware of.

While this is not an FDA approved the use of the medication some doctors and T! PWD’s really like using them. Others find that the medication has little impact or too many side effects to continue using them. Regardless insulin must still be used but insulin requirements are reduced.

Hello Jen, I am wondering if the increased Ketones are due to the fact that you were on the pump? In the trial study similiar results were reported by pump users. Did you adjust the insulin basal rate? Did you try Jardiance 10mg ? I am thinking of giving it a try …

I was taking Forxiga 5 mg. I am on a pump and had to adjust the basal rate and my ratios down, but my overall blood sugar control didn’t improve all that much, I just had the same control using less insulin (and I did find that highs were easier to “turn around”). My endocrinologist said that SGLT2 inhibitors cause raised ketones, he didn’t mention anything about it being due to the pump versus MDI. He did say that one risk with these medications in people with Type 1 is that the insulin will be lowered so much that it’s below the baseline of what the body needs, and this will trigger DKA (he said he’d seen some really nasty cases of severe DKA with normal blood sugar while on call at the hospital). Before prescribing it for me, he went over exactly what I should do if I had high ketones, and there was once or twice where I did have high ketones and followed those instructions (basically drink lots of water, give extra insulin, and eat extra carbohydrates to get rid of them). I was eating a low-carb diet at the time I started, but I didn’t feel comfortable having ketones from the low-carb diet plus the SGLT2 inhibitor plus the risk of a pump failure. I felt that combination was too high risk, so I temporarily ate more carbohydrates. I would be interested in trying this class of medication again, but with the side effects I had (two yeast infections in six weeks), I’m not sure it would turn out any differently. I have wondered if maybe eating a low-carb diet while on the medication would help, because you’d be peeing out less glucose overall which is what caused the infections.

That’s an interesting insight. Thanks for sharing. I might buy some ketone test strips, monitor Bs and start with half pill of the 10g min dose to test the reaction. Did you notice any weight reduction ?

I found an interesting comparison of Farxiga vs Jardiance .,Jardiance/?a=s

I did lose some weight, but then gained it back (it seems I can’t eat carbs without gaining weight). My endocrinoloigst had me monitoring ketones while I was taking Forxiga. First I did it about twice a day, but eventually moved to just doing it a couple times a week or when I felt off.

I have the same issues with Carbs. The less carbs I eat the better my BS is ; the less insulin I use , loose weight etc… can highly recommend Diabetes 101; Dr Bernstein Diabetes Solution etc

Just found another interesting article on this new type of drugs (SGLT 2 Inhibitors) :

This is the part of the SGLT 2 meds that has never made sense to me—how is releasing all the extra glucose through your urine NOT going to result in lots of yeast infections, UTIs, etc? What an intolerable side effect! One of the many benefits of being in tighter control for me (averages well below the threshold for urine spillover) has been less glucose excreted in urine, which has basically eliminated what used to be very regular YIs. Maybe it works better in men…

Info/summary on what I’ve read to date on sotagliflozin. It’s “new” dual SGLT 1 & 2 inhibitor, not just a SGLT 1 inhibitor. It’s documented “benefits” include what a few of prescriptions in the past have been shown to have, but not necessarily replace, similar effects as ACE inhibitors, Angiotensin II receptor blockers (ARBs), metformin and statins. It’s latest trials are being tested/sold to help keep the “peaks” in check/close to the non-diabetic range and help “enhance” the other drugs, thus reducing your bolus and potentially basal in addition to the usual additional benefits to the other drugs being prescribed. But as any other of these drugs, there are un/documented side effects.