Back before we had any idea about how to control diabetes, we did notice that with diabetics, they urinated a lot more and also had sugar in their urine. This is where the term "sugar diabetes" comes from.
By the way at one time they gave diabetics more sugar when they saw this, thinking that it might be causing a sugar deficiency, and this in fact did end up prolonging the lives of some type 1 diabetics that were treated this way, but only marginally, but since you go from wasting when this disease is completely uncontrolled, that actually makes sense, and if was only later that we figured out that this was from insulin deficiency and the fatally low glucose uptake by the cells that this results in.
We now also know that what happens is that the kidneys will excrete excessively high glucose in the blood to a certain degree, over a certain level, which does differ in individuals and this is what we call the renal threshold.
So if your blood sugar is above this threshold then this will cause you to both urinate more and also urinate glucose, and this is a mechanism that helps the body deal with too high blood sugar, although it only works to a certain degree and the kidneys can only eliminate so much glucose over a given period of time.
This by the way isn't a good condition to be in, the body has decided though in its wisdom that whatever the renal threshold is set at, and it's generally in the range of 250 or higher, this is where the complications of urinating glucose and urinating more become worth it. If it would need to be set lower, the body would have done so.
We often think we are smarter than Mother Nature though, especially people who sell drugs, and they came up with an idea to make a drug that lowers this threshold. There is an enzyme that regulates this, called SGLT2, so the new class of drugs became known as SGLT2 inhibitors, because they inhibit this enzyme to some degree.
So not surprisingly, these drugs do lower blood sugar, but they do so at a price, and all drugs do so at a price in fact, as they look to override natural processes rather than compliment them. This is what you get when you focus on the symptoms, in this case higher blood sugar, rather than looking to address the causes of it.
Lowering blood sugar is still a good thing though, but the question becomes, are the risks or costs worth the benefits this provides? Often times we just focus on the result, it lowered your blood sugar, be happy, but this drug does more than that to be sure.
One of the effects of it is to cause urinary tract infections, sugar is not supposed to be in the urine, parasites such as bacteria and yeast feed on this, and they have a non stop feast when you take this. They can give you antibiotics and antifungals for this though so they aren't too worried, but antibiotics in particular can change your intestinal flora significantly in a bad way, and this is a lot bigger deal than some think. It's especially a bad idea if you have candida, and not only an infection with this yeast in the urinary tract, it can infect all parts of your body and antibiotics is the worst thing for it.
This also causes dehydration, and we know or should know how important proper hydration is, and this can be a concern for diabetics in particular. People also often report sleep disturbances, having to get up several times a night to urinate, and quality sleep is very important, especially for diabetics.
That would be more than enough to scare me away from it actually, but that's not even the scary part. The FDA is concerned about this causing acidosis, and you can die from that, and the jury is still out on that one. At worst though, the risk for this would be very low, but if you die from the stuff that's little consolation, so this is something to keep an eye on, and they are.
There may also be an increased risk of certain cancers with this, particularly bladder cancer, and the bladder takes the brunt of the dirty work here, it's not supposed to be a sweet environment but these drugs certainly sweeten it up, and sweet here isn't so sweet.
A new paper just came out that is reporting loss of bone density in users which leads to a higher risk of fracture, like postmenopausal women. This may be a particular problem with those who already have lost bone density or are at risk of this, and can't afford to have this made worse. We're seeing fractures in as little as 12 weeks on the drug with some patients. They also show loss of bone density in only a short period of time on it.
One of the things that concerns me that you don't hear talked about is the effect of the diuretic effect on levels of certain nutrients, especially electrolytes. Some do deplete potassium, but SGLT2 inhibitors don't seem to do this, and they actually can elevate potassium levels to dangerous levels. It may cause magnesium deficiency though, diuretics tend to do this generally, and most people are deficient in this already, especially diabetics.
I'm not even sure that this drug will be allowed to stay on the market long term though and there are ads by legal firms looking to recruit people for class action suits already. I don't think that there is anywhere near enough on this yet but they are certainly preparing for it, and you don't see this happen with a lot of drugs, and when it does, this usually spells bad news for the drug makers at some point anyway.
Given the overall profile of side effects on this, as is often the case with diabetic meds generally, the risks may indeed outweigh the benefits, and that's something we always need to look at, the benefits versus the costs or potential costs of the thing. The increased risk for infection and the increased urination with the dehydration that results, along with disturbances in the sleep cycle, would be enough for me even without peeking to see what bigger monsters may be behind the curtain.
There are certainly safer ways to achieve the same objective, and we're not even sure what the long term effects of this will be, especially with kidney health, so this is far from a great treatment and may indeed be a foolish one.