Canagliflozin (Invokana®), Dapagliflozin (Forxiga ®), Empagliflozin (Jardiance®), Ertugliflozin (Steglatro®)
You have been prescribed a medication called a SGLT2 inhibitor (SGLT2i) by your diabetes team. This medication helps to lower your blood sugar levels and can also help you to lose weight. We also know that these medicines can help to prevent some heart and kidney problems in the long term.
The information in this leaflet will help you to get the best out of your medication. More information is available in the manufacturer’s leaflet dispensed in the box with your medication.
How do they work?
SGLT2 inhibitors act in the kidneys to stop glucose being absorbed back into the bloodstream. This glucose is passed out in the urine instead.
Passing out this excess sugar in the urine can help you to lose weight. However, as with all treatments for diabetes, it is also important to eat a healthy, balanced diet. We have printed some advice about this on the other side of this leaflet.
What are the common side effects?
Common side effects of these medicines include urine infections and infections in the genital area due to the increased amount of sugar in the urine. These are usually mild and can be treated – ask your GP or pharmacist for advice if you develop any discomfort in this area. There are things you can do to reduce infections:
• Wear loose-fitting underwear
• Wash regularly with unperfumed soap
It is important to keep well hydrated (drink at least 6-8 glasses of fluid per day, unless advised otherwise by your healthcare professional) whilst taking these medicines. If you become unwell with an illness that means you are at risk of dehydration (e.g. diarrhoea or vomiting) it is best to stop your SGLT2i until you are eating and drinking normally again. If you are unsure, contact your GP for advice.
Rare side effects
Very rarely, these medicines can cause an increase of acid in the blood called ‘diabetic ketoacidosis’. Symptoms of this can include nausea and vomiting, abdominal (central tummy) pain, rapid breathing and dehydration. If you experience these symptoms, seek immediate medical help from your GP or NHS 111. The risk of this side effect is increased if you follow a very low carbohydrate (ketogenic) diet; please seek advice from a health professional before starting any new diet. It is also important to keep alcohol intake within the recommended limit of 14 units per week.
There is an extremely low risk (1 in 100,000) that these medicines can cause a severe spreading skin infection in the genital or groin area called Fournier’s gangrene. If you develop severe pain, redness or swelling in this area, seek medical help immediately.
Foot Care
It is always important to check your feet regularly when you have diabetes. More information about foot care is available on the Diabetes UK website: https://www.diabetes.org.uk/guide-todiabetes/complications/feet/taking-care-of-your-feet If you develop a foot ulcer your diabetes team may advise you to stop your SGLT2i medication.
Monitoring
You do not usually need to check your blood sugars at home whilst on these medicines. However, if you are on other diabetes medicines that can cause low sugars (e.g. gliclazide, insulin), your diabetes team may recommend you check your sugars regularly, particularly when you first start the SGLT2i.
You will need a blood test to check your HbA1c (average blood sugar) and a weight check 3 months after starting this medication.
For more support and information about your new medication, ask your Community Pharmacist about the New Medicines Service.
Diabetes: How to take control
Remember – You can make a big difference to your diabetes and health. Learn more and take control. Aim to
change habits so that this becomes a different way of living.
Lose weight.
Aim to shift your energy balance by reducing your calorie intake and increasing your physical activity.
Food and drink provide calories or “fuel” for the body. If you take in less fuel than your body needs each day,
your body will start to use up fat stores.
Try to:
• Reduce your portion sizes, try using a smaller plate. Eat slowly, and stop eating as soon as you are satisfied,
rather than continuing until the plate is empty.
• Avoid foods high in fat or sugar, or have only occasionally e.g. fried foods, pastry, chocolate, non-diet fizzy
drinks, cakes and sweets.
• Include more vegetables or salad at mealtimes. These are low in calories, and contain plenty of vitamins &
minerals, with fibre to fill you up. Aim for ½ of your plate to be vegetables or salad, with about 1/4 protein,
and 1/4 carbohydrate.
• Choose lean sources of protein e.g. chicken, fish, eggs, pulses. Avoid adding extra fat or oil, and grill, boil, or steam rather than fry.
• Try to pause before you have a snack, and think “Am I hungry?” If not, then try to do something else to distract yourself. If you are hungry, choose a healthy snack.
• Reduce your alcohol intake – a pint of beer or glass of wine contains about 170-250 calories, so these can soon add up.
Reduce carbohydrate intake.
All carbohydrate foods break down into glucose in your blood: having less of these will reduce the amount of
glucose going into your bloodstream.
There are two main types of carbohydrate foods: sweet, and starchy.
Starchy carbohydrates include potatoes, bread, rice, pasta, breakfast cereal, chapattis, plantain, yam, maize or
corn meal, and cassava. Try to reduce your portions of these foods. For example, aim for just ¼ of your plate to
be starchy carbohydrate, and limit bread to just 1-2 slices per meal.
Sweet carbohydrates include those foods with added sugar, and those containing natural sugars such as fruit,
fruit juices, and honey.
Try to limit your intake of foods with added sugar:
• Choose diet or sugar free alternatives, water, tea or coffee, rather than full sugar fizzy drinks and squashes, fruit juices and smoothies.
• Try to avoid snacks such as cakes, biscuits, chocolate, or have only occasionally.
• Choose a diet or natural yogurt, or sugar-free jelly for a sweet treat.
• Have a portion of fruit (one handful) as a healthy snack. Increase activity.
Increasing activity burns more calories, helps reduce your blood glucose, and can also help to keep your joints healthy and improve your mood. Build up your activity gradually, and limit sitting down time.
Take medication.
Take medication if prescribed by your doctor – but remember that changes to your diet and activity levels will help you to control your blood glucose alongside the medication.
Useful sources of information. NHS Choices (www.nhs.uk/conditions/diabetes) Diabetes UK (www.diabetes.org.uk)