Type 1 and new drug Jardiance

Hi folks! So today at my endo appt she wanted me to try a newly approved med for T2 called Jardiance. You can read about the announcement HERE.. In short, "Jardiance is a sodium glucose co-transporter 2 (SGLT2) inhibitor. It works by blocking the reabsorption of glucose (blood sugar) by the kidney, increasing glucose excretion, and lowering blood glucose levels in diabetics who have elevated blood glucose levels. The drug’s safety and effectiveness were evaluated in seven clinical trials with 4,480 patients with type 2 diabetes receiving Jardiance. The pivotal trials showed that Jardiance improved hemoglobin A1c levels (a measure of blood sugar control) compared to placebo."

She said she currently has 12 T1's on it, all have had great success. Essentially what it does is bind glucose in the bloodstream so it is not re-absorbed by the kidneys, and is filtered out unprocessed through the urine. What does this mean for T1's? Lower TDD, lower average BG's, and in many cases weight loss. The main side effect is due to the extra sugar in the urine, there is a higher chance of UTI.

Im interested if we have any other T1's on this med? How has it worked for you?

This drug sounds to me very similar to Invokana, which also inhibits the SGLT2 cotransporter. And as with Invokana, i would also expect heavy polyurea, since Sodium will be lost as well, and whenever less sodium is reabsorbed, water will go with it, which will lower BP as well.
I mean, I personally wouldn't fix unless it is broken, but if you end up trying it out, make sure to tell me how it went!

Has it been studied at all with T1s? I would think another side effect might be that there would be less sugar available for your cells or maybe you would have harder hitting lows? Is your A1C kind of high?

Well Swiss she did say Ill need to increase my water intake, but being in the desert I already drink a TO?N of water. We'll see.

Officially studied by the FDA no. But many endos have had luck with T1's. Have to remember its a new drug, so we'll see.

My A1C's for the last 10 years or so have been between 6.5 and 7.5 which Im OK with. My issue has always been post-meal spikes. We first tried adding Symlin to my regimen, but it didnt really help. Im pretty anal about my care, and have all sorts of bolusing tricks to eliminate or reduce post meal spikes to no avail. We're thinking by reducing them, it will lower my A1C's as well.

The added bonus of weight loss is nice too.

I also think it sounds like invokana. I wouldn't use any of these drugs due to their action on the kidneys. We are already at risk for kidney damage.

Understand I am T2. I have to tell you Jardiance is second of three currently approved SGLT-2 inhibitors. Invokana was the first approved in March 2013. Jardiance and then Faxiga were approved in Aug and Oct 2014 respectively. I have been taking Invokana going on 5 months. It appears to be significant benefit to patients on insulin by increasing excretion of glucose by between 70-90 g of glucose every day. This has enabled me to reduce my total daily dose by 30-40%. I appear to have lost a few points as well.

I was unwilling to take Invokana until it had been on the market about 18 months and was carried as a preferred medication by my insurance.

ps. No studies suggest that SGLT-2 inhibitors place you at risk of kidney damage. However if you already have existing kidney damage then you should be careful (the same can be said about insulin).

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Please note that I'm a Type Weird, and that my thoughts on the matter are purely speculative.

I was on Invokana for about a month. My biggest problem is post-prandial spikes, and on or off meds I've never had a problem with fastings. For fairly intuitive reasons, Invokana didn't work for me. (If my BG spikes that high that fast after eating, and the sugar in urine can only be so concentrated, then it stands to reason that it will not pull my BG down fast enough for me to avoid the high blood sugar induced exhaustion, headache, etc.)

However, my fastings went from the mid-80's to the low 70's. I didn't have a problem with this, but I think it makes sense that a drug that pulls sugar from your body will lower fasting numbers. Meaning, if it can pull X amount of sugar from your body, which depletes your glycogen stores and therefore lowers your BG because your body has less sugar to dump into your bloodstream, then your BG should drop by Y amount over a period of time.

Therefore, the utility of an SGLT2 inhibitor in a T1 would be to potentially lower basal insulin, but not to decrease bolus. It might also create difficult lows because the body will be less able to compensate for the low BG.

Also, as a side note, I wonder how fast this weight loss would happen, since I didn't lose an ounce while on Invokana. (This is especially weird because I had bronchitis during this time and I usually lose ~5 pounds when I get bronchitis.)

Based on the physioloigcal action of the SGLT-2 inhibitors you should see an effect not only on fasting blood sugars but an overall effect lowering your effective renal threshold and improving your response to meals. The SGLT-2 drugs essentially shift the curves by reducing absorption. The curve below explains the end effect. Usually between 6.1 mmol/L (110 mg/dl) and about 10 mmol/L (180 mg/dl) there is a modest proportional rise in glucose excretion form the kidneys that starts at the renal threshold (it various but is about 160 mg/dl). Then looking at the graph, the smaller red lines reflect the increasing effect of the SGLT-2 drug resulting in a final result that is the bold dashed red line. As you can see there is a fair amount of glucose excretion all the way down to 110 mg/dl which is consistent with what I have seen (I have actually measured excretion below 100 mg/dl). But it is also clear that you start to excrete glucose in proportion to plamsa glucose levels starting at 110 mg/dl as opposed to the normal renal threshold of about 160 mg/dl. This means that you should start to see increased glucose excretion in response to glucose rises from meals. For someone on insulin this would reduce the amount of insulin needed for mealtime boluses.

That being said we are all different and not everyone responds to various drugs.

oh, and regarding Victoza (which i still believe is kinda the same) and type 1 and the flu:

Thanks Brian for the excellent info.

I read the article and it didn't mention Victoza?
"The important message is that if you have type 1 diabetes and are taking Invokana or any other type of SGLT2-inhibitor such as Farxiga™ (dapagliflozin) or Jardiance® (empagliflozin) and have a cold, other illness or feel sick to your stomach (one of the key symptoms of high ketone levels), you should be aware that you may be at risk for DKA even with normal blood sugar levels".
Victoza, I was told, stimulates the pancreas to produce more insulin and helps the body use it better, so it sounds different. Also, maybe that applies to people who also take insulin with the drug. I have nausea with the med because its a side effect in the beginning. I hope this isn't true because it would be difficult to know if the symptoms were from DKA. I was thinking that my BS would slowly rise, if and when, my body isn't producing enough insulin anymore.

As folks have said above, it's the same class as Invokana, which I have been taking as a Type 1 for about 7 months now. I have done extremely well on this - no side effects except a few more trips to the bathroom (I already consumed a lot of water daily, so not much increase there). I have probably lost a few pounds, and dropped my I:C ratio and upped my SF. I rarely ever see 200 (used to see that quite regularly when I ate "normal" food) and if I do, my levels come down very quickly, usually without any extra insulin, which didn't tend to happen before.

All in all, I love it. My doctor only recommends it to her Type 1's who she knows can do the research and are very well managed. Just waiting for the Type 1 trials to start b/c I know that I can't get free refills forever.

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At least a little bit ironic: When I was diagnosed back in the days of stone knives and bearskins, there was no home bg testing, there was only home urine testing. And the goal was to NOT HAVE glucose in urine. Now there's a medicine that intentionally puts glucose in urine!

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Sorry bjm, i meant Invokana. messed those 2 up. :( my bad…

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Thanks..that's a relief!

As an update: All is great so far! Like Kimberly, I havent seen a 200 in a few days. My average for the last 3 days is 141. Also, as Kimberly experienced, a few more trips to the bathroom, and pee is darker, but living in the desert I drink alot of water anyway, so no side effects to speak of.

Im liking this stability thing!

DanP… how’s it working now further into the year? Are you experincing more low low blood sugars and more severe low blood sugars with Jardiance? I’m going to be volunteering for a trial on Jardiance as well and I’m Type 1 Diabetic. My first thought was how would it help the post meal spikes and if it helps too much and food out of the system in 2 hours but bolus insulin still working 2 to 6 hours, would cause low sugars. But if lowering the insulin doses, then maybe not. This is all theory on my part as I didn’t start it yet. Are you still taking it? Is you’ee blood sugar less volatile? A1C’s lower?

I was on Invokana for 8 months and I’m a T1. I went off of it because I became pregnant. Otherwise, I loved it and would have stayed on it for as long as I could. It helped me lower my alc from 7.5 to 7.0 in 3 months, I lost 25lbs total (dropped 3 pant sizes) while on Invokana, and I decreased my insulin amount both basal and carb ratios. I have no prior kidney issues, my doctor checked my kidney function like she always does with still no issues.
After my third child, I had major issues trying to lose weight and I love working out. I was killing myself and nothing was helping. I was working out 4 times a week, decreased diet, I tell you I would have stood on my head if it would have helped me lose 5lbs. Invokana was so helpful for me. I drink a lot of water to begin with, I just had to visit the bathroom a little more. I had one somewhat negative side affect. I have very low blood pressure and drinking and extrecting all that urine drove my blood pressure down more. To compensate for this, I drank a lot of sugar free poweraid and gaterade and ate more salt. I needed the eletrolyte balance thats all. That seemed to do the trick.

@RichardR Im doing well on Jardiance still. Im on a pretty low dose (10mg) but it has drastically lowered post meal spikes. and my last A1C was .4 lower (7.1 to 6.7). All in all its going pretty well.