Weight Loss:
SGLT2 Inhibitors (by mechanism of action) may cause weight loss. This is because an individual will excrete glucose (calories) through their urine. However, SGLT2 inhibitors should NOT be promoted as weight loss products. The mechanism of action occurs ONLY in the presence of excess glucose (diabetes). Care should be taken to ensure an individual understands how this medicine works.
Interventions:
- Diabetes MedsCheck with counselling regarding mechanism of action.
Genital Infections:
Possible increase in genital infections (thrush) and urinary tract infections: SGLT2 Inhibitors (by mechanism of action) will increase the amount of glucose being excreted through the kidneys. This may increase the risk of urinary tract infections and genital thrush (in both men and women).
Interventions:
- Counselling should occur at the start of the medicine to ensure the person understands the mechanism by which this occurs and what to do if this were to happen.
- Diabetes MedsCheck with education on side effect profile and referral to health care team for treatment where required.
Surgery:
SGLT2 Inhibitors should be ceased prior to major surgery.
Interventions:
- SGLT2 should be ceased prior to major surgery (48-72 hrs before surgery depending on the healthcare team). Treatment with SGLT2 may be restarted once oral intake is normal
- Those scheduled for non-urgent surgery who are yet to have ceased SGLT2 Inhibitor should be assessed, and consideration should be given to postponing the procedure.
- Diabetes MedsCheck at start of medicine to ensure all individuals understand that if they are having surgery or are unwell, they need to cease SGLT2 inhibitors under the guidance of their healthcare team..
Ketoacidosis:
There have been reports of ketoacidosis.
Interventions:
- Diabetes MedsCheck at start of medicine to ensure all individuals understand ketoacidosis including the signs and symptoms. Consider ketone and glucose monitoring with referral pathways to credentialled diabetes educator for training on monitoring and sick day management.
Changes to complete blood examination (CBE) over time:
SGLT2 Inhibitors (by mechanism of action) may change potassium, magnesium, calcium levels over time. Consideration should occur to have regular complete blood examination of salts.
Interventions:
- Diabetes MedsCheck with referral to appropriate health care professional to ensure salt depletion does not occur.
Loop Diuretics:
Care should be taken when using loop diuretics and SGLT2 inhibitors at the same time due to the potentiation effects. Individualised care should be introduced at this time.
Interventions:
- Diabetes MedsCheck for medicine interaction, consult relevant health care professional and refer if needed.
Sulfonylureas & Insulin:
Care should be taken when initiating SGLT2 Inhibitors with insulin or sulfonylurea.
Interventions:
- Counsel to watch for lower blood glucose levels and hypoglycaemia symptoms. Extra blood glucose monitoring is warranted.
- Diabetes MedsCheck with counselling on hypoglycaemia.
- Referral to health care professional especially credentialled diabetes educator for managing hypoglycaemia and blood glucose monitoring.