Starting SGLT2 inhibitors for patients

When starting SGLT2 inhibitors, you should be aware of a few key things:

Potential benefits: SGLT2 inhibitors can reduce the risk of angina, heart attacks, strokes, peripheral vascular disease and improve diabetes control.

Genital yeast infections: There’s a risk of genital yeast infections (thrush), particularly in women. You should maintain good hygiene and promptly report any symptoms to your doctor, nurse, physician associate or pharmacist.

Risk of dehydration and low blood pressure: SGLT2 inhibitors can cause increased urination, which may lead to dehydration and low blood pressure, especially in elderly patients or those taking diuretics (water tablets). If you become unwell or develop diarrhoea or vomiting then stop the medication and do not restart until you have started eating and drinking for at least 24 hours.

Fournier’s gangrene: There’s a very rare risk of developing a serious bacterial infection affecting the genitals and perineum. If you develop pain, swelling, ulcers or redness in the genital or perineal area, seek medical attention immediately

Ketoacidosis: Although rare, SGLT2 inhibitors can increase the risk of diabetic ketoacidosis (DKA), a serious condition where the body produces high levels of blood acids (ketones). You should look out for symptoms like nausea, vomiting, a loss of appetite, tummy pain, excessive thirst, difficulty breathing, confusion, unusual tiredness or sleepiness.

Kidney function: SGLT2 inhibitors can affect kidney function, so you should have your kidney function monitored annually via a blood test, especially if you have pre-existing kidney issues.

Medication interactions: You should inform your clinician about all medications, supplements, and herbal remedies you are taking, as some drugs may interact with SGLT2 inhibitors.

Lifestyle modifications: Along with taking medication, you should maintain a healthy lifestyle, including a balanced diet, regular exercise, and avoiding smoking and excessive alcohol consumption, to optimise your diabetes management.

Medical emergencies: You should know what to do in case of a medical emergency, such as severe hypoglycemia (low blood glucose levels) or ketoacidosis, and seek immediate medical attention.

Always consult with a healthcare professional for personalised advice before starting or changing any medication regimen.