Today we are going to talk about some medications that make you urinate the extra glucose, the ones that we call SGLT2 inhibitors. These medications are being used a lot for type 2 diabetes lately. There are a few of these SGLT2 inhibitors. They are Canagliflozin (Invokana®), Dapagliflozin (Farxiga®), Empagliflozin (Jardiance®), and some others.
Hi welcome to type 2 where we discuss everything about type 2 diabetes in a way that everyone can understand now today we’re going to talk about a class of medications that make you urinate the extra glucose in the urine i mean in the toilet now these medications have been used a lot lately for type 2 diabetes on my last video i told you that there are different
Kinds of medications used for type 2 diabetes and on this channel we’re going to talk about all of them but today we will look at these ones that we call sglt2 inhibitors now i chose these ones first because we already have a video on why high blood sugar cause frequent urination and these medications do just that so it’s easy for you to understand now if you should
Take medications is between you and your doctor but my goal is to explain to you clearly how they work so that you can understand some of the pros and cons of taking medications now there are many of these sdlt2 inhibitors we have canon glyphlosins uh ampergliclosins deportable frozens and you know whenever you see some random letters followed by glyphlosins you
Know that we’re talking about sglt2 inhibitors now how do they work in my video about why high blood sugar cause frequent urination i told you that your blood including the glucose in it has to pass through the best filter in the world your kidneys more than 20 times a day right and i told you that everything in the blood except some big molecules like proteins
And some cells and things like that everything else has to pass inside this long tube that will make urine now you have two kidneys and inside of each one you have about a million of these small filters now the blood with all the waste products and other things including glucose will come inside your kidneys then let’s zoom one of these it will come inside and on
The way to make urine i told you that everything that is important to the body will be taken back at the end only the waste will come here you know and i also told you that glucose is on the vip list all of the glucose that will pass here will be taken back because there are transporters of glucose called sodium glucose link transporters or co-transporters these
Are sglg2 and sglt1 this one whenever glucose is passing by these transporters will take the glucose back to the blood and i told you that if your blood sugar is not too high that you know these transporters are overworking or something you cannot find glucose in the urine because there are transporters of glucose that will take all these glucose back to the
Blood and there will be no glucose here going to the toilet now someone said wait if you have high blood sugar the sugar is not always in your blood it’s actually going outside and then coming back so why don’t we just close the door and this is exactly what they did so when we talk about medications you know if you don’t study medicine you think that medications
Are some uh crazy things you know people invented but they’re not they’re just some easy manipulation or i don’t know how you call it in this case we know that glucose is leaving the blood more than 20 times a day so someone said why don’t we just close the door and that is exactly what they did they made some things that we call medications that when you take
When you eat them they will go all the way to your kidneys and these medications will come all the way here and block these transporters that are supposed to take the glucose back to the blood now we have transporters one and two but most of them are transporters too about 90 of them are transported to so that’s why we block this one now what happens when we
Block these transporters the glucose will come normal they’re going to the urine and there are doors for glucose to come back but the doors are closed so the glucose will keep going and will start to appear in the urine very easy to understand do you think this is a good or a bad idea you know every day your blood glucose is high you have high blood sugar and
You take these medications they block the transporters that are taking the glucose back to the blood so whenever the glucose comes out then the temperature nope can’t get intented no no and they will go to the urine some of them will take this one of course transporters one but they’re not many so at the end of the day you will have a lot of glucose going to
The toilet so do you think this is a good or a bad idea i know maybe some of you will say good some will say bad but at least with this understanding you will know some of the pros and cons of these medications the first good thing about these medications is that as i told you the glucose sugar is leaving your blood now that’s important because if you have high
Blood sugar and you take these medications you are wasting this sugar you are wasting glucose you are throwing it away for example when we compare that with something like insulin you know that insulin will make the glucose leave your blood to enter into different cells right and the glucose will be used for energy or be stored as glycogen and fat so when you
Take insulin you are feeding your cells right but when you take these medications you are feeding the toilet i mean not feeding but you are you are wasting the glucose here you are feeding your cells and you know people who take a lot of insulin tend to gain weight but with these medications because you’re wasting glucose you will tend to lose weight so patients
They take these medications their body weight tend to go down not up like insulin now i think it’s a good thing now you might say that financially speaking this is a disaster because you’re buying food and then you’re buying medications to get rid of the food that you buy but you know this channel is not for financial advice we physiologically speaking this is
A good thing it’s better than insulin in this aspect now another thing about these medications is that well i don’t need to tell you that they reduce your a1c right because you know you’re losing glucose and your a1c is the average blood glucose for you know two to three months which means that with these medications you will reduce a1c your a1c will go down
Even your fasting blood glucose will go down your post meal blood glucose will go down now what do you think that will happen to your blood volume if you’re urinating all the time now i told you that glucose will more glucose will come here and know that water in your body can freely move from lower concentration of solute to higher concentration of solid if
There there’s higher concentration of solute like glucose and sodium and you know other things outside water will come to balance the concentration of things in your body so more glucose here means more water will come and more urine will come so with these medications your blood volume will tend to go lower to reduce now is that a good or a bad thing for people
With type 2 diabetes we think it’s a good thing because a lot of people with type 2 diabetes also have high blood pressure so with these medications your blood pressure will go down lower blood volume means lower blood pressure let’s say your heart had this amount of blood to deal with now it has this amount of blood to deal with that will put less stress on
Your heart or your blood vessels on you know so you will have lower blood pressure and your heart will also have to work less that’s why patients who take these medications they tend to have less heart problems because of these medications and you know even reducing a1c and weight and other things can also help your heart but these medications can help your
Heart better than a lot of other uh medications for type 2 diabetes now there’s one more thing that we can say that is positive or negative depending on how you take it the chance of having hypoglycemia with these medications the chance of having low blood sugar with this medication is low because as i told you you only block sglt2 right you only block these
Ones but there’s still 10 percent of sdlt ones that can still take glucose so which means that when your blood sugar is low these ones are still taking it and if the blood sugar is slow even some of these sglt2 will still work will take some of the glucose and then another thing is that when your blood glucose goes down your pancreas will release glucagon and
Glucagon will tell your liver to make some glucose so it’s not likely to cause hypoglycemia like some of the other medications but this can be good or bad because it doesn’t reduce your blood sugar too much you know so when you talk about a1c reduction we expect a mild a1c reduction so most patients will not take only these medications they will have something
Else or they will have diet and exercise include or insulin or some other things but not just this sglt2 inhibitors but some people especially people that were taking too much glucose back to the blood these medications can do wonders like they will take them and it works fine for a long time now what are some of the real cause of these medications the first
One is that they cause infections in your urinary tract and your genital area and the reason why that happens is that first you’re urinating all the time which means it’s harder to keep that area clean and the second one is that glucose is energy glucose is food for the things that cause infection even when you know we try to grow cells in the lab we give
Them glucose so that they can grow faster so you know these medications increase infections especially for women men too but more women than men in this case another problem with these medications is that they can cause ketoacidosis now the risk is actually not that high the risk of getting ketosis is not that high but this condition is serious enough so i think
You should know because when you throw all these glucose away and let’s say you are someone who had ketoacidosis before or you are on a very low carb diet the very few glucose you’re putting in you’re throwing it away or someone who’s fasting or doing some ketogenic diet or someone or you’re under severe metabolic stress like if you just had a major surgery or
Something like that you should talk to your doctor about these things before you take these medications and for some people some of the advantages of these medications can be disadvantaged for example i told you that your body weight will go down right but if you are someone who is underweight and does not want to lose weight this can be a problem for you and
The same can happen with blood pressure if your blood pressure was already low uh before these medications it can be a problem so it depends now before you go after understanding how these these medications work when you compare them with something like diet which one do you think is better for example let’s say you cut all the refined carbohydrates from your
Diet now your blood sugar doesn’t go as high as before maybe before you used to go like this now maybe it’s here right or you’re someone who doesn’t want to change the diet and keeps the blood sugar high but buy these medications to throw them into the toilet which one do you think is better for me diet comes first and exercise second and all these medications
Including this one that gets rid of the glucose even though it’s an expensive way to deal with it but at least they don’t cause more problems to your diabetes they come third and then some other medications that cause problems to your diabetes that make you gain weight and other stuff that we’ll talk about later and then the last one is those that do nothing
And just wait for complications so you know you you have choices i hope this gave you a good idea of how these medications work have a blessed week bye
Transcribed from video
How SGLT-2 Inhibitors Work: with Pros and Cons – Jardiance, Farxiga, Invokana -Type 2 Diabetes#15 By Type 2 Diabetes – Dr. Vladmir Carvalho
