SLG2 Inhibitors for Diabetes Treatment - Doctabet®

SGLT2 Inhibitors for Diabetes Treatment

Doctablet Diabetes, Medications for Diabetes 1 Comment

SGLT2 (sodium-glucose co-transporter-2) is a receptor located primarily in the kidney.

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SGLT2 (sodium-glucose co-transporter-2) is a receptor located primarily in the kidney. SGLT2 acts to reabsorb glucose (sugar) filtered by the kidney into the urine. With the help of SGLT2 receptors, very specialized cells in the kidney (proximal tubular cells) are able to draw sugar out of the urine and back into the bloodstream to be used for energy.

Sugar in the urine (Glucosuria)


Believe it or not, sugar (or glucose) normally enters the urine through the kidneys every day. Approximately 162 grams of sugar are filtered into the urine daily (similar to the amount of sugar in four soda cans). But this does not mean the urine of healthy patients contains sugar. In fact, the body is happiest when all of this sugar is reabsorbed back into the bloodstream. As mentioned above, sugar is reabsorbed and pulled out of the urine with the help of the SGLT receptors.

Approximately 162 grams of sugar are filtered into the urine daily (similar to the amount of sugar in four soda cans).

SGLT2 inhibitors

SGLT2 inhibitors are a class of prescription, oral anti-diabetic medications that that are also called Gliflozins. Inhibitors of SGLT2 bind this receptor and block a portion of sugar reabsorption, causing sugar to spill out into the urine even at normal blood sugar levels. When on an SGLT2 receptor inhibitor, an adult patient will urinate out approximately 70 grams of glucose per day, as compared to non-diabetics who have no sugar in their urine under normal circumstances.

Inhibitors of the sodium-glucose co-transporter 2 bind this receptor and block a portion of sugar reabsorption, causing sugar to spill out into the urine even at normal blood sugar levels.
Blood sugar levels and SGLT2 inhibitors

As a result of inhibiting the SGLT2 receptor, the urine sugar increases and blood sugars decrease (both before and after meals). This class of medication is usually associated with a 1% reduction in HbA1c levels.

What are side effects of SGLT2 inhibitors

Humans are not the only organisms that like sugar. When sugar is present in the urine, it is likely to promote the growth of unwanted bacteria and fungus. For this reason, when someone is on an SGLT2 inhibitor, the risk of developing a urinary tract infection or yeast infection increases by about 10%.  As sugar and water increase in the urine, patients typically experience an increase in the volume of urination with the potential of lower blood pressure (by about 5 mmHg systolic). If the blood pressure drops too low, this can cause dizziness, especially when standing or getting out of bed.  In those patients already on a diuretic or ‘water pill,’ the dose of that medication will likely be decreased or held prior to starting an SGLT2 inhibitor to decrease abnormally low blood pressure (hypotension).

The risk of developing a urinary tract infection or yeast infection increases by about 10% when someone is on an SGLT2 inhibitor.

Dosing must be chosen carefully in those patients with kidney problems due to the fact that the SGLT2 inhibitor medications require an intact filtration rate to work properly. Despite what is conveyed on commercials, the risk of diabetic ketoacidosis on an SGLT2 inhibitor is quite low in those with type 2 diabetes: less than 0.1%. These cases were mostly described in patients on SGLT2 inhibitors in the hospital under large amounts of stress, such as going for surgery or a systemic infection called sepsis.

The SGLT2 inhibitors that are currently available in the market are: Invokana® (Canagliflozin), Jardince® (Empagliflozin), and Farxiga® (Dapagliflozin)

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Last Modified: Apr 2, 2021 @ 9:10 pm
About the Author
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Chris Palmeiro D.O. M.Sc.

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Dr. Christopher Palmeiro serves as the Medical Director of Telehealth for Moonlighting Solutions.  He is also the Medical Director of the Inpatient Endocrinology Telemedicine Program at Atlanticare Regional Medical Center in Southern New Jersey.  Additionally, Dr. Palmeiro serves Native American patients, in the Midwestern United States, via the Avera E-Care Specialty Telemedicine platform. Prior to his current positions, Dr. Palmeiro completed his fellowship in endocrinology, diabetes, and metabolism at Westchester Medical Center. He completed both his residency and chief residency in internal medicine at St. Vincent’s Catholic Medical Center in Manhattan. He is a diplomate of the American Board of Internal Medicine.  Dr. Palmeiro completed a Master of Science degree in clinical nutrition while in medical school at New York Institute of Technology College of Osteopathic Medicine and was the first graduate of an innovative program that incorporated this degree into the medical school curriculum, earning him the John J. Theobald Graduate Achievement award.  

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Admin
5 years ago

From the perspective of the cardiologist, this new class of diabetes medications offers never-before-seen benefits to patients taking them. The most recent studies published show that patients on these drugs had a significant reduction in the number of cardiovascular events they experienced; becuase of their effects in the body these drugs have the potential to enhace blood pressure control, help loose weight and reduce the chances of a heart failure exacerbation. These are not just impressive but also timely, as diabetes rages on as one of the most important health crisis of our time.