Please be aware, the information on this page relates to Luton & Dunstable University Hospital

SGLT-2 inhibitors

A guide on the use of the SGLT2 inhibitor class of medications in diabetes

SGLT-2 inhibitors – what you need to know

You have been prescribed a tablet that belongs to a class of medications called SGLT-2 (sodium-glucose co-transporter-2) inhibitors. These are used in Type 2 Diabetes and have been prescribed to help improve your blood glucose levels.

The three different SGLT-2 inhibitors currently in use are:

Canagliflozin (Invokana)

Dapagliflozin (Forxiga)

Empagliflozin (Jardiance)

How do they work?

SGLT-2 inhibitors work by stopping your kidneys from reabsorbing glucose (sugar) into the bloodstream. Instead, this glucose is excreted in your urine. This helps reduce the circulating glucose in your blood and improve your diabetes control.

How else could I benefit from taking this medication?

Taking an SGLT-2 inhibitor could be beneficial to you in other ways. It may help to

  • lower your blood pressure
  • protect your kidneys
  • protect your cardiovascular system (your heart and blood vessels)
  • reduce your weight (average 2-3 kg over 6-12 months)

What about side effects?

Because this tablet allows you to pass sugar in your urine, it can be associated with side effects. Most commonly these are:

  • needing to pass water more
  • dehydration
  • low blood pressure
  • increased risk of urinary tract infections and thrush
  • low blood glucose (hypoglycaemia) if you are also taking either insulin or a sulphonylurea (eg gliclazide)

We advise all people taking these tablets to drink plenty of sugar free fluids throughout the day to assist the action of the tablet.

You may need to increase the amount of fluid you drink to avoid dehydration. Other less common side effects to be aware of are:

  • digestive problems such as nausea and constipation
  • back pain

You should STOP taking your SGLT-2 inhibitor if you:

  • are about to have an operation
  • are sick with diarrhoea or vomiting
  • develop any circulatory problems with your feet
  • develop sudden symptoms of vomiting, no appetite, abdominal pain, excessive thirst, difficulty breathing, confusion or excessive fatigue. This is because very rarely, SGLT-2 inhibitors have been found to cause ‘Euglycaemic Diabetic Ketoacidosis’ (DKA)

What is Diabetic Ketoacidosis (DKA)?

This is an unusual complication of Type 2 diabetes. DKA develops when there is too much acid in your blood and it can happen even when your blood glucose concentration is normal. If not identified early, this can be very dangerous. However, DKA is a VERY RARE complication.

What should I look out for?

If you are taking an SGLT-2 inhibitor, please look out for these symptoms of DKA:

  • nausea
  • vomiting
  • fast breathing
  • abdominal pains

If you have any of these symptoms, please see a medical professional, such as a doctor or nurse, even if your blood sugars are near normal. If your GP practice is closed, please phone 111.

What may increase the risks of developing Diabetic Ketoacidosis?

DKA can develop at any time but usually it is associated with illness or infection, therefore you need to be especially careful if you develop an infection (like a chest or urine infection).

If you need to have an operation, please discuss your SGLT-2 inhibitor with your doctor or nurse. You may need to temporarily stop your tablets and restart when you’ve recovered from your surgery and can eat and drink normally.

However, do not stop your SGLT-2 inhibitor without discussing this with your doctor or nurse first.

Do I need to be monitored while on an SGLT-2 inhibitor?

your doctor will check your kidney function before you start this medication, and then every year afterwards.

your blood pressure may need to be monitored if you are being treated for high blood pressure. The doses of your tablets might need to be adjusted. Talk to your doctor if you have concerns.

Do I need to lose weight?

Your BMI (body mass index) will indicate if you need to lose weight. This measurement uses weight and height to allow you to see if you are underweight, an ideal weight, overweight or obese.

A healthy BMI is 18.5-25.0 kg/m2

Weight loss and a healthy weight

  • weight loss is important to reduce the fat in your liver
  • studies show that reducing your total weight by 7-10% can help reduce the fat and inflammation in your liver
  • aim for slow, gradual weight loss, avoiding rapid reductions in your weight and ‘crash diets’
  • aim to lose approximately 0.5 to1kg (1-2lbs) per week
  • monitor for low blood glucose levels if you also take either insulin or a sulphonylurea (eg Gliclazide)