SGLT-2 inhibitors are a class of medications commonly prescribed to individuals with diabetes. These drugs work by blocking the reabsorption of glucose in the kidneys, thereby promoting the excretion of glucose through urine.
While SGLT-2 inhibitors have proven to be effective in managing blood sugar levels, it is essential to be aware of the potential side effects that may arise from their use. This article aims to discuss some of the most common side effects associated with SGLT-2 inhibitors.
1. Genital Infections and Urinary Tract Infections (UTIs)
One of the most frequently reported adverse effects of SGLT-2 inhibitors is an increased risk of genital infections, such as yeast infections in women and balanitis in men.
It is believed that the increased glucose content in urine provides an ideal environment for the growth of microorganisms. Additionally, individuals using SGLT-2 inhibitors may also experience an increased incidence of urinary tract infections (UTIs). Symptoms may include frequent urination, painful urination, and urinary discomfort.
If any signs of infection are noticed, it is essential to seek medical attention promptly.
2. Dehydration
SGLT-2 inhibitors work by increasing the excretion of glucose in the urine. Consequently, this leads to an increased volume of urine production. As a result, individuals taking SGLT-2 inhibitors may experience a higher risk of dehydration.
Symptoms of dehydration can include dry mouth, increased thirst, lightheadedness, and decreased urine output. Patients are advised to consume an adequate amount of fluids while on these medications and promptly report any signs of dehydration to their healthcare provider.
3. Hypotension (Low Blood Pressure)
SGLT-2 inhibitors have been associated with a modest reduction in blood pressure.
While this effect can be beneficial for individuals with hypertension, those without preexisting low blood pressure may experience symptoms such as dizziness, lightheadedness, and even fainting. It is recommended to monitor blood pressure regularly while on these medications and adjust the dosage accordingly to prevent any complications.
4. Diabetic Ketoacidosis (DKA)
In some rare cases, SGLT-2 inhibitors have been linked to a potentially life-threatening condition called diabetic ketoacidosis (DKA). DKA occurs when the body is unable to use glucose for energy and starts breaking down fat instead.
This process leads to the production of ketones, which can accumulate in the blood and cause acidosis. Symptoms of DKA include frequent urination, excessive thirst, nausea, vomiting, abdominal pain, difficulty breathing, and confusion. If any of these symptoms occur, immediate medical attention should be sought.
5. Bone Fracture Risk
Recent studies have suggested a potential association between the use of SGLT-2 inhibitors and an increased risk of bone fractures.
While the underlying mechanisms are not yet fully understood, it is important for individuals at a higher risk of osteoporosis or those with a history of fractures to exercise caution while taking these medications. Regular bone density monitoring and appropriate supplementation should be considered for patients with increased fracture risk.
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6. Increased Risks During Surgery
When undergoing surgical procedures, individuals taking SGLT-2 inhibitors may face certain risks. Since these medications work by increasing urine output, patients should discuss temporarily discontinuing their use before any planned surgery.
This is to avoid potential complications like dehydration and fluctuations in blood glucose levels during the perioperative period.
7. Fungal Infections
In addition to genital infections, the use of SGLT-2 inhibitors has been associated with an increased risk of fungal infections in other areas of the body, including the mouth and skin folds.
These infections may manifest as oral thrush or skin rashes, and prompt treatment is necessary to prevent further complications.
8. Canagliflozin and Amputation Risk
A specific SGLT-2 inhibitor, canagliflozin, has been linked to an increased risk of lower limb amputations, particularly toe and mid-foot amputations.
Although the absolute risk is relatively low, individuals with a history of foot ulcers, peripheral vascular disease, or neuropathy should exercise caution while using canagliflozin and report any signs of foot or leg infections promptly.
9. Hypoglycemia (Low Blood Sugar)
SGLT-2 inhibitors are not typically associated with an increased risk of hypoglycemia when used as monotherapy.
However, when combined with other diabetes medications like insulin or sulfonylureas, the risk of experiencing low blood sugar levels may be higher. It is crucial for patients to be aware of the signs and symptoms of hypoglycemia and adjust their treatment regimen accordingly to maintain optimal blood sugar control.
10. Hyperkalemia (High Blood Potassium Levels)
In rare cases, SGLT-2 inhibitors may lead to an elevation in blood potassium levels, a condition known as hyperkalemia.
This can be particularly dangerous for individuals with preexisting kidney problems or those taking medications that can increase potassium levels. Routine monitoring of potassium levels is advised for patients at higher risk.
Conclusion
SGLT-2 inhibitors have emerged as an effective class of drugs for managing diabetes by promoting the excretion of glucose through urine. However, it is essential to be aware of the potential side effects associated with these medications.
Genital infections, dehydration, hypotension, diabetic ketoacidosis, bone fracture risk, surgical concerns, fungal infections, amputation risk with canagliflozin, hypoglycemia, and hyperkalemia are some of the possible adverse effects. Patients should always consult their healthcare provider and closely monitor their symptoms while on SGLT-2 inhibitors to ensure safe and effective diabetes management.
