Allen and I were talking to a person
with type 1 diabetes this last weekend and he was bragging about
being on an oral medication for type 2 people with diabetes. I said
that the doctor was prescribing it “off label” and there were
some serious side effects to the SGLT2 medication. He asked what the
side effects could be. Allen said that DKA (diabetic ketoacidosis)
was the side effect and that it was not the same as that experienced
generally by people with type 1 diabetes.
The person laughed and said he was not
aware of any problems. Fortunately, I had just read this and had my
wife's laptop with me. I pulled up the article and the definition
for euglycemic, which is a condition or state in which the blood
glucose level is within the normal range. See also glycemia. As
reported…the presence of euglycemia appeared to delay correct
diagnosis in some of the patients in their series.
- Euglycemic DKA may be associated with the use of a SGLT2-inhibitor in type 1's.
- Volume depletion associated with SGLT2-inhibitor use could exacerbate the problem by further increasing glucagon, cortisol, and epinephrine.
- If insulin levels are low and glucagon and other counterregulatory hormones are high, a perfect storm exists.
Now we had his attention and he asked
to read the article. When he finished, he said that then he could be
in trouble as he was scheduled to a surgery on Monday, June 29. He
said that it is recommended that he be off the medication for three
days before any surgery.
Then I opened the Medscape article and
had him read that article. His first question was how he could get
access to either article, as he was not aware of either source. I
said he would have to join both sites to have access to them and that
they were free. Allen said it would be good to be a journalist when
applying, but that there was good information, he would email him
some of the links for diabetes and other information, and then he
could explore for his favorite topics.
He called his doctor at his home and
informed the doctor of what he had read and that he needed to
postpone this surgery at least two days if possible. He asked the
doctor for his email address and sent the doctor the two links and
his phone number and then the doctor called him and said he would see
that the surgery was set back for at least two days. He went back to
talking with us.
Next, he thanked both of us and said he
was sorry he had acted so badly when we started the conversation. He
explained that he had always felt that people type 2 diabetes had no
interest in helping people with type 1 diabetes. I said that type 1
takes enough grief from people ignorant of the difference and accused
them of many of the problems that type 2 people face on a regular
basis. I said we need to work together to end the ignorance and help
each other at every opportunity. He agreed and thanked us again.
I said that I had sent him the links
for the two articles and would send him any more that I found. I
said I was aware of at least one more, but I would need to get on my
home computer to find it.
Then he asked to read the first article
again. He said that he had not been counseled by his doctor when he
started the medication as was recommended and was happy we could show
him information. He was going to have a long discussion with his
doctor and consider not taking the medication. He said that it was
helping in the management of his daily blood glucose levels so the
decision would be difficult without the doctor understanding what
could happen.
He asked if anyone we knew was using
the SGLT2 medication. Allen said no, as the members of our support
group only used metformin or insulin. I added that we have a few
members that have been able to stop all medications after lifestyle
changes. They continue the monitor their blood glucose levels and
have been successful so far.
He said he needed to head home and
repeated his thanks and said he would stay in touch.
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