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Sglt2 Inhibitors Diabetes Care

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ISCP web-seminar Cardiovascular risk management of diabetes and SGLT2 inhibitors Lecturer: Masayuki Yoshida, Professor of Medicine, Tokyo Medical and Dental University Interviewer Koji Hasegawa, Leader, Cardiovascular Clinical Research Network, National Hospital Organization

Practical Approach To Initiating Sglt2 Inhibitors In Type 2 Diabetes

, Volume 8, Issue5 , pp 953962 | Cite as Practical Approach to Initiating SGLT2 Inhibitors in Type 2 Diabetes Sodium-glucose co-transporter 2 (SGLT2) inhibitors are an attractive novel therapeutic option for the treatment of type 2 diabetes. They block the reabsorption of filtered glucose in kidneys, mainly in proximal renal tubules, resulting in increased urinary glucose excretion and correction of the diabetes-related hyperglycemia. Beyond improving glucose control, SGLT2 inhibitors offer potential benefits by reducing body weight and blood pressure. On the basis of the efficacy demonstrated in clinical trials, SGLT2 inhibitors are recommended as second- or third-line agents for the management of patients with type 2 diabetes. Beneficial effects on kidney disease progression, cardiovascular and all-cause mortality, and hospitalization for heart failure have also been demonstrated with one SGLT2 inhibitor (empagliflozin). Potential adverse events resulting from their mechanism of action or related to concomitant therapies are reviewed. A treatment algorithm for the adjustment of concomitant therapies after initiating SGLT2 inhibitors is also proposed. ConcomitantInitiationManagem Continue reading >>

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  1. dumblenetwork

    Anyway to get rid of bad breath in ketosis?

    Just broke my 3rd fast today (day 4) due to feeling constantly sick throughout the day and every 10 seconds nearly puking up but instead burping, stomach pains a lot - normally to do with needing to go for a sh*t - some reason unable to, have to properly force it out.
    Was wondering how I can get rid of the foul bad breath smell as it's a major put off and something that has bothered me A LOT along with the feeling sick constantly.
    I brush my teeth but it seems to come back after an hour, tried chewing a piece of gum or two and it can still be smelt after

  2. Rogue_Biscuit

    Have you been vigilant with brushing your TONGUE?
    I never realized before, but a lot of that icky taste in you mouth comes from a film that develops on your tongue. I brush my tongue like 4 times a day when in ketosis to avoid that gross taste, haha.

  3. dumblenetwork

    I've tried brushing it once or twice and it just comes back

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Dr. Dieuwke Broekstra presents "A systematic review and meta-analysis on the association between Dupuytren disease and diabetes" at the 2015 International Symposium on Dupuytren Disease in Groningen, The Netherlands.

The Efficacy And Safety Of Sglt2 Inhibitors For Adjunctive Treatment Of Type 1 Diabetes: A Systematic Review And Meta-analysis

The efficacy and safety of SGLT2 inhibitors for adjunctive treatment of type 1 diabetes: a systematic review and meta-analysis Scientific Reports volume 7, Articlenumber:44128 (2017) To assess the efficacy and safety of the SGLT-2 inhibitors as adjunct therapy to insulin in T1DM, clinical trials indexed in PubMed, Cochrane Library, EMbase from inception through April 5, 2016. A meta-analysis was conducted on trials of SGLT-2 inhibitors in patients with T1DM on insulin therapy using RevMan 5.3 software. Of the 371 articles identified, ten met eligibility criteria. Seven clinical trials including four randomized controlled trials and 581 patients were included. Compared with the control group, SGLT-2 inhibitors group had significantly reduced fasting plasma glucose by 0.69 mmol/L [1.32; 0.07], glycosylated hemoglobin A1C by 0.37% [0.54; 0.20], body weight by 2.54 kg [3.48; 1.60] and total daily insulin dose by 6.22 IU [8.04; 4.40]. The total incidence of adverse events (AEs), hypoglycemia, and genital and urinary infections were also similar to placebo, while an increased incidence of diabetic ketoacidosis (DKA) (n = 16) was seen in SGLT-2 inhibitors group. The present study demonst Continue reading >>

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  1. BigdogEMT

    Hello I'm new here, not new to low carb (but keto is a bit diff). I have been a type 2 diabetic for maybe 8 years diagnosed. And take metformin, glipizide, and januvia. My sugars stay high unless I'm low carbing it. Last a1c was 6.4 down from 7.4 3 months earlier.
    So I know it works but mu question is why I still have a 160-200 fasting blood sugar in the am? I haven't had over 10-15 gm of carbs for 4 days!
    It's just frustrating, my doctor tells me to not sweat it he just looks at the a1c!
    But I know what it's doing to my body while its high!

  2. Barbara_Greenwood

    Hi Bigdog, welcome.
    Let me guess.... if you test before lunch or dinner, your level is lower, yes? If so, you are experiencing Dawn Phenomenon, which is very common among T2's. Due to loads of hormone stuff which is to do with getting ready to wake up and take on the day, your liver dumps glucose into your blood. Actually, this always happens, but in people with T2 it really goes overboard.
    I have recently (3 days ago) started using the Freestyle Libre, which is a flash glucose monitoring system. I have a patch stuck on my arm, with a little filament sticking just under my skin. It measures glucose in interstitial fluid, which tracks blood glucose pretty well. It records it every 15 minutes, I scan it with a little reader device and then I can see exactly what has been going on.
    I've discovered that my BG is at a normal level right through the night, starts creeping up about 5am and rises inexorably till about 10am, after which it decreases slightly. And when the meals I eat are low carb, it barely rises at all after eating. However, the rise in the morning is so steep that, depending what time I tested my blood, it would be either a good or a bad day.
    So, your doctor has a point in that your A1C averages out what's going on across the day as a whole. But it is still important to get those morning readings down, because they do contribute to damage at the levels you mentioned.
    I would say give it more time - stick with the very low carb, and you will see your morning readings improve. But also - there are various things people suggest to blunt Dawn Phenomenon. Some swear by a protein snack before bed, or a fatty snack, or a small breakfast..... but what works for one apparently doesn't work for all.

    I've just set out on a programme of quantifying my Dawn Phenomenon when I try different food/drink options, both in the evening and at bedtime. Over time, I'll be able to track down what works for me - and the Libre will help a lot with that because I don't have to guess when is the best time to test, I get a pretty good picture each day of how much my BG has risen over the morning.

  3. BillJay

    BigdogEMT:


    My sugars stay high unless I'm low carbing it. Last a1c was 6.4 down from 7.4 3 months earlier.
    As @Barbara_Greenwood says, Dawn Phenomenon (DP) is probably why your fasting glucose is high.
    As I mentioned in another thread, I'm a recovered T2DM that had it pretty bad initially until I realized that I had a disease of blood glucose that was too high and it made no sense whatsoever to eat foods that turn into blood glucose, ever.
    The problem was that I struggled for years with the cognitive dissonance from what I had heard about carbs=good and fat=bad, but I remained aware that I have a disease of blood sugar regulation and if I ate something that raised it, it was bad.

    Finally, I gave in to keto and as far as I'm concerned, carbs are poison unless they come from non-starchy vegetables.

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Where Do Sglt2 Inhibitors Fit In Diabetes Care?

Where Do SGLT2 Inhibitors Fit in Diabetes Care? New Class of Drugs 'Turns Glucosuria on Its Head' This feature requires the newest version of Flash. You can download it here . Do We Need New Treatments for Type 2 Diabetes? Hello. I am Cliff Bailey, Professor of Clinical Science at Aston University in Birmingham, United Kingdom. It is my pleasure to be able to say a few words about sodium glucose co-transporter 2 (SGLT2) inhibitors as a new type of treatment for type 2 diabetes to control hyperglycemia. You might reasonably ask why we want new treatments for type 2 diabetes, bearing in mind the selection that we have already, so I would like to preface these words with some words about type 2 diabetes as a heterogeneous and progressive disease. It has a multivariable etiopathology, meaning that essentially there are many different factors that contribute to type 2 diabetes to different extents in different individuals, and these play out to a greater or lesser extent as the disease progresses. Therefore, we need different treatments and different combinations of treatments to focus on these different factors at different times as the disease progresses. Glycemic control is an impor Continue reading >>

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  1. Léo Léopold Hertz 준영

    Ketone bodies are water-soluble and should pose no problem to the kidneys because of solubility. If the kidneys are able to utilize ketone bodies for energy, then they must express the enzyme 3-ketoacyl-CoA transferase, correct?
    Do the kidneys express the enzyme 3-ketoacyl-CoA transferase?
    Can kidneys use ketone bodies as fuel?

  2. Léo Léopold Hertz 준영

    Alexandria's answer:
    This article's abstract says that 3-ketoacid-CoA transferase was found in the kidney: nature.com/pr/journal/v42/n4/abs/pr19972518a.html

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