Author Topic: Jardiance / Forxiga and Ketones  (Read 463 times)

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Offline Lucy

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Jardiance / Forxiga and Ketones
« on: 20 June 2018, 09:58:16 PM »
Thought I’d pass this onto you as I hadn’t realised before starting taking Jardiance last week, but one of the possible side effects of this class of medication is DKA, even with normal blood sugar. Wasn’t mentioned to me at the hospital but I do have ketone urine strips (though very rare I ever use them normally) and tested them after a few days on the tablets. It turned straight to purple meaning high ketones, as did every test I did when I went to the toilet. Symptoms of DKA developed after that, but very mildly, I didn’t feel like I was that ill just a bit unwell with stomach ache, thirst, peeing, horrible taste in my mouth, and I had lost 5kg in a week which was maybe a bit more than expected.


Its very rare i have ketones and never usually more than low levels so after having them consistently at the highest level for 2-3 days and starting feeling ill i saw GP this morning. He suggested it did sound like the early stages of DKA developing and advised to stop the tablets and keep checking bg and ketones etc. Go to hospital if bg increased or felt more unwell as DKA can progress fast.


Moral of the story is... if someone takes these class of medications and feels any of the signs of DKA they need to test for ketones even if they have a normal blood sugar. Bit concerning that it seems people I’ve seen taking these tablets generally don’t have bg test strips or ketone strips though!
Type: Lucy.
Lantus and Apidra. Metformin XR, Propanolol

Offline nytquill17

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Re: Jardiance / Forxiga and Ketones
« Reply #1 on: 20 June 2018, 11:48:53 PM »
Saw your post on FB this morning. So glad you caught this early and are okay!
T1 DX 1995
Omnipod since 06/04/18 (Novorapid)
 
  ~-~-~-~
"If you can't ride, can you fall?"
"I suppose anyone can fall," said Shasta.
"I mean can you fall and get up again without crying, and mount again and fall again and yet not be afraid of falling?"
"I - I'll try," said Shasta.
  ~C.S. Lewis, The Horse and His Boy
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"There is no answer; seek it lovingly."

Offline Lisa65

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Re: Jardiance / Forxiga and Ketones
« Reply #2 on: 21 June 2018, 06:05:30 AM »
Ooh that's a bit scary Lucy! Glad you recognised the symptoms early!
T2, diagnosed June 2010 4x500mg Metformin
Oct 10 HbA1c 6.6 TC 5.59 Trigs 1.17 HDL 0.86
Jun 11 HbA1c 6.3 TC 4.26 Trigs 0.71 HDL 0.93
Feb 12 HbA1c 5.4 TC 4.14 Trigs 0.61 HDL 1.25
Sep 12 HbA1c 5.8 TC 5.08 Trigs 0.65 HDL 1.45
Sep 14 HbA1c 5.9 TC 5.1  Trigs 0.65 HDL 1.55

Offline Lucy

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Re: Jardiance / Forxiga and Ketones
« Reply #3 on: 21 June 2018, 07:38:59 AM »
Still have ketones of +++ but it’s been over 24 hrs since last taking the medication so should be on the way out now. Dr asked to see me again tomorrow to make sure all is okay.
Type: Lucy.
Lantus and Apidra. Metformin XR, Propanolol

Offline himtoo

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Re: Jardiance / Forxiga and Ketones
« Reply #4 on: 21 June 2018, 08:06:02 AM »
wow lucy............that is downright frightening........... as you say ...most peeps prescribed this med won't normally have access to BG or ketone strips.........

really glad you recognised , caught it , treated , stopped med !!!!
T1 Dia Aug 1972 -pumping omnipod since 29/09/15  Losartan 100mg , simvastatin 40mg,Furosemide 40mg, Omeprazole 80mg , Doxazosin 8mg
Hba1c - 06/2013 6.1 02/2014 43(6.1) 07/14 42(6.0) 08/14 40( 5.8 ) 12/14 39 (5.7) 08/15 41 ( 5.9) 10/15 44 ( 6.2 ) 03/16 49 (6.6)
cholesterol --nov 2011 4.3 june 2012 4.4 June 2013 4.1 Feb 2014 4.1 dec 14 4.5 oct 15 4.4
Dafne grad. necrobiosis lipoidica on legs
laser treatment on both eyes 2002 and 2012, injections left eye 3 , wearing Noctura mask since oct 2014

Offline Pattidevans

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Re: Jardiance / Forxiga and Ketones
« Reply #5 on: 21 June 2018, 09:49:43 AM »
That’s very scary Lucy.  Glad you are OK
Patti


Type 1.  Mis-diagnosed T2 May 2003, finally had CPeptide test 15/7/11 and proper diagnosis 1/9/11.  Now pumping Apidra with Roche Spirit Combo pump. Hba1c 6.1 Sept 2017.  45 (6.3) April 2018.


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Offline Liam

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Re: Jardiance / Forxiga and Ketones
« Reply #6 on: 21 June 2018, 04:08:54 PM »
I wonder if it is enough to cause full blown DKA? I know I've had fairly high urine ketone levels lately from weight loss. They aren't a danger for me as my Bags are normal and my blood beta ketone levels are low. The only thing I noticed was a bit of thirst (reason I tested)

Good you noticed and the doctor gave you the advice you needed. Helpful post for others and maybe we'll be able to point it out too others in the future.
DX Type I 1994.    Novorapid Animas Vibe pump
HbA1c 3/10 10.2%, 7/10 8.1%, 12/10 7.5%.
2/11 7.8%, 8/11 8.6% 9/11 8.3%.
3/12 62 (7.8%). 10/12 67 (8.3%)
4/13 63 (7.9%) 6/13 59 (7.5%)
1/14 71 (8.6%) 7/14 59 (7.5%) 11/14 (6.7%)
3/15 56 (7.3%) 12/15 49 (6.6%)
Ramipril: 10mg Quetiapine: 550mg Metformin: 2000mg

Offline Lucy

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Re: Jardiance / Forxiga and Ketones
« Reply #7 on: 21 June 2018, 04:38:51 PM »
I wonder if it is enough to cause full blown DKA?

Yep it can be, though this doesn’t necessarily mean it’s caused by the tablets. Enough evidence that it’s had to be included as a warning though on these types of medication. This is from the bnf:

MHRA/CHM advice (updated April 2016): Risk of diabetic ketoacidosis with sodium-glucose co-transporter 2 (SGLT2) inhibitors (canagliflozin, dapagliflozin or empagliflozin)

A review by the European Medicines Agency has concluded that serious, life-threatening, and fatal cases of diabetic ketoacidosis (DKA) have been reported rarely in patients taking an SGLT2 inhibitor. In several cases, the presentation of DKA was atypical with patients having only moderately elevated blood glucose levels, and some of them occurred during off-label use.

https://bnf.nice.org.uk/drug/empagliflozin.html
Type: Lucy.
Lantus and Apidra. Metformin XR, Propanolol

Offline Liam

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Re: Jardiance / Forxiga and Ketones
« Reply #8 on: 21 June 2018, 04:56:48 PM »
Good to know. I'm really bad for not remembering the type II pills but hopefully I'll remember if anyone else trying them has symptoms of DKA to post about it.
DX Type I 1994.    Novorapid Animas Vibe pump
HbA1c 3/10 10.2%, 7/10 8.1%, 12/10 7.5%.
2/11 7.8%, 8/11 8.6% 9/11 8.3%.
3/12 62 (7.8%). 10/12 67 (8.3%)
4/13 63 (7.9%) 6/13 59 (7.5%)
1/14 71 (8.6%) 7/14 59 (7.5%) 11/14 (6.7%)
3/15 56 (7.3%) 12/15 49 (6.6%)
Ramipril: 10mg Quetiapine: 550mg Metformin: 2000mg

Offline Lucy

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Re: Jardiance / Forxiga and Ketones
« Reply #9 on: 21 June 2018, 11:17:42 PM »
I took my last tablet at 7am Wednesday. Have had +++ ketones constantly, with last check showing +++ at 4-5pm today. At 11pm (so 40hrs post last tablet) I’ve tested twice now and had just traces. So it appears even once you stop taking them you could be at risk of having ketones, whilst they wear off.
Type: Lucy.
Lantus and Apidra. Metformin XR, Propanolol

Offline Liam

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Re: Jardiance / Forxiga and Ketones
« Reply #10 on: 22 June 2018, 10:41:20 AM »
Glad the ketones are finally starting to come down. Hope you are feeling better now?
DX Type I 1994.    Novorapid Animas Vibe pump
HbA1c 3/10 10.2%, 7/10 8.1%, 12/10 7.5%.
2/11 7.8%, 8/11 8.6% 9/11 8.3%.
3/12 62 (7.8%). 10/12 67 (8.3%)
4/13 63 (7.9%) 6/13 59 (7.5%)
1/14 71 (8.6%) 7/14 59 (7.5%) 11/14 (6.7%)
3/15 56 (7.3%) 12/15 49 (6.6%)
Ramipril: 10mg Quetiapine: 550mg Metformin: 2000mg

Offline himtoo

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Re: Jardiance / Forxiga and Ketones
« Reply #11 on: 22 June 2018, 08:24:55 PM »
glad you have weathered the ketone storm..............
T1 Dia Aug 1972 -pumping omnipod since 29/09/15  Losartan 100mg , simvastatin 40mg,Furosemide 40mg, Omeprazole 80mg , Doxazosin 8mg
Hba1c - 06/2013 6.1 02/2014 43(6.1) 07/14 42(6.0) 08/14 40( 5.8 ) 12/14 39 (5.7) 08/15 41 ( 5.9) 10/15 44 ( 6.2 ) 03/16 49 (6.6)
cholesterol --nov 2011 4.3 june 2012 4.4 June 2013 4.1 Feb 2014 4.1 dec 14 4.5 oct 15 4.4
Dafne grad. necrobiosis lipoidica on legs
laser treatment on both eyes 2002 and 2012, injections left eye 3 , wearing Noctura mask since oct 2014

Offline Pattidevans

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Re: Jardiance / Forxiga and Ketones
« Reply #12 on: 22 June 2018, 09:57:33 PM »
Personally I don't like the idea of those kind of tablets (the ones that make you pee glucose out) it seems very unnatural and totally against what diabetics should be aiming for.
Patti


Type 1.  Mis-diagnosed T2 May 2003, finally had CPeptide test 15/7/11 and proper diagnosis 1/9/11.  Now pumping Apidra with Roche Spirit Combo pump. Hba1c 6.1 Sept 2017.  45 (6.3) April 2018.


© 2015 Patti Evans

Offline Lucy

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Re: Jardiance / Forxiga and Ketones
« Reply #13 on: 22 June 2018, 10:29:28 PM »
Feeling better now, ketones at + each check today (guess that is a normal level?). Saw GP this morning and given I’ve recovered as soon as the tablet has worn off, and both the leaflet and his book of drugs warn of it as a possible side effect it does seem like it was a reaction to the tablet. It’s listed on my records now so I won’t be taking those again, to be honest I’m a little surprised that the consultant didn’t mention to watch out for it and check ketones if any signs? He did tell me about urine infections and peeing more, and I didn’t like the sound of the tablets then either Patti. But he suggested I could try this one instead of another drug in that class, since then I could take the starter dose instead of the full dose, and just see how the starter dose went. And also I’d have an appointment with the nurse so I could consider them just as a trial and talk to the nurse about them.  Well I’m glad I didn’t start on the normal dose!
Type: Lucy.
Lantus and Apidra. Metformin XR, Propanolol

Offline Lucy

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Re: Jardiance / Forxiga and Ketones
« Reply #14 on: 22 June 2018, 10:33:36 PM »
Oh, also the GP will write back to the consultant and let him know what happened, and ask the hospital to get in touch with me to see me again as I need a new plan. I expect in a few days I’ll also get a letter from the hospital summarising my appointment last week too, telling me to start taking these tablets I’ve just stopped and asking my GP to prescribe them 😂
Type: Lucy.
Lantus and Apidra. Metformin XR, Propanolol