Meal planning and physical activity are always at the forefront of diabetes management. But when diet and exercise alone are not enough to keep your blood glucose – also called blood sugar, levels on target, it’s comforting to know effective medications are available. Since diabetes was identified as a disease, researchers continue to discover new medications to effectively manage diabetes.
On December 21, 2017, the U.S. Food and Drug Administration (FDA) approved ertugliflozin – a new medication for use with diet and exercise to lower blood sugar in adults with type 2 diabetes. Ertugliflozin belongs to a relatively new class of medication called sodium-glucose cotransporter 2 (SGLT2) inhibitors.
It might surprise you to know that SGLT2 inhibitors lower blood sugar by causing the kidneys to remove sugar from the body through the urine. Each day the kidneys filter approximately 45 gallons of blood, and virtually all of the glucose in this blood is reabsorbed into the bloodstream. Glucose reabsorption takes place in the kidneys by a protein called SGLT2.
In people with type 2 diabetes, the ability of the kidney to filter glucose increases, causing more glucose to be reabsorbed before glucose is eliminated in the urine. This is where ertugliflozin comes in.
Ertugliflozin
Ertugliflozin reduces blood glucose by blocking the action of the SGLT2 protein, preventing the kidney from reabsorbing glucose back into the bloodstream. The result is that the kidneys are able to eliminate more glucose through the urine, thus lowering blood glucose levels. So, what historically has been viewed as a sign of poorly controlled diabetes—glucose in the urine—is now the desired outcome of ertugliflozin and an actual indicator that the medication is working.
All diabetes medications have a generic and brand name. It is important for you to know both names of your medication. Ertugliflozin, available under the brand name Steglatro is the fourth SGLT2 inhibitor approved for use in the United States. The others are canagliflozin (Invokana), dapagliflozin (Farxiga), and empagliflozin (Jardiance).
Side Effects
A Common side effect of SGLT2 inhibitors including Steglatro is frequent urination which can lead to dehydration. Likewise, dehydration may lead to orthostatic hypotension – a sudden drop in blood pressure on standing. Symptoms of dehydration include dizziness or fainting. You may be at risk for dehydration if you have low blood pressure; take medicines to lower your blood pressure, including water pills (diuretics); have kidney problems; are on a low sodium (salt) diet, or are 65 years of age or older.
Men and women taking Steglatro also have an increased risk for yeast infections and urinary tract infections – although women experience infection at a higher rate. As glucose leaves the body through urine, it increases bacterial growth which can lead to genital infection.
Steglatro may cause ketoacidosis, a potentially dangerous condition usually seen only with very high blood glucose levels. However, ketoacidosis has been reported to occur with only mild or moderately increased glucose in people taking SGLT2 inhibitors. Symptoms of ketoacidosis are nausea, vomiting, stomach-area pain, tiredness and difficulty breathing. If you experience any of these symptoms, you should stop taking Steglatro and call your doctor immediately or get emergency medical treatment. If possible, check for ketones in your urine if you have symptoms, even if your blood sugar is less than 250 mg/dl.
You should not take Steglatro if you have severe liver or kidney disease or you are on dialysis.
A positive side effect of Steglatro is weight loss. Glucose is a source of calories. As your kidneys eliminate glucose through urine, you are losing calories at the same time, which may lead to weight loss.
Meal Planning Consideration
The recommended starting dose of Steglatro is 5 mg once daily, taken in the morning, with or without food.
Be sure to follow all exercise and dietary recommendations made by your doctor or dietitian. It is important to eat a healthful diet and exercise regularly. Also, follow your doctor’s instructions about proper hygiene and drinking enough fluids throughout the day while you are on Steglatro.
Dietitians and diabetes educators play a significant role in educating patients about when and how to take their diabetes medications. They also provide guidance on how to prevent or minimize adverse effects of medications. Click here to find a diabetes educator in your area.
Constance Brown-Riggs, MSED, RD, CDE, CDN is a registered dietitian, certified diabetes educator, national speaker and author of The African American Guide to Living Well with Diabetes. Her new book “Diabetes Guide to Enjoying Foods of the World” will be released in January 2018. She is a spokesperson for OneTouch.