Diabetes Support Forum

Living with diabetes => Insulin and medication => Topic started by: Lucy on 20 June 2018, 09:58:16 PM

Title: Jardiance / Forxiga and Ketones
Post by: Lucy 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!
Title: Re: Jardiance / Forxiga and Ketones
Post by: nytquill17 on 20 June 2018, 11:48:53 PM
Saw your post on FB this morning. So glad you caught this early and are okay!
Title: Re: Jardiance / Forxiga and Ketones
Post by: Lisa65 on 21 June 2018, 06:05:30 AM
Ooh that's a bit scary Lucy! Glad you recognised the symptoms early!
Title: Re: Jardiance / Forxiga and Ketones
Post by: Lucy 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.
Title: Re: Jardiance / Forxiga and Ketones
Post by: himtoo 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 !!!!
Title: Re: Jardiance / Forxiga and Ketones
Post by: Pattidevans on 21 June 2018, 09:49:43 AM
That’s very scary Lucy.  Glad you are OK
Title: Re: Jardiance / Forxiga and Ketones
Post by: Liam 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.
Title: Re: Jardiance / Forxiga and Ketones
Post by: Lucy 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 (https://bnf.nice.org.uk/drug/empagliflozin.html)
Title: Re: Jardiance / Forxiga and Ketones
Post by: Liam 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.
Title: Re: Jardiance / Forxiga and Ketones
Post by: Lucy 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.
Title: Re: Jardiance / Forxiga and Ketones
Post by: Liam on 22 June 2018, 10:41:20 AM
Glad the ketones are finally starting to come down. Hope you are feeling better now?
Title: Re: Jardiance / Forxiga and Ketones
Post by: himtoo on 22 June 2018, 08:24:55 PM
glad you have weathered the ketone storm..............
Title: Re: Jardiance / Forxiga and Ketones
Post by: Pattidevans 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.
Title: Re: Jardiance / Forxiga and Ketones
Post by: Lucy 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!
Title: Re: Jardiance / Forxiga and Ketones
Post by: Lucy 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 😂
Title: Re: Jardiance / Forxiga and Ketones
Post by: nytquill17 on 23 June 2018, 12:41:54 AM
In blood tests, 0.0-0.6 is normal, 0.6-1.5 is "concern" and 1.5-3.0 is "danger". I dunno recall how the blood scale and the urine scale relate, like if 0-0.6 is the same as "+", but definitely you can have a little ketones just from normal fat burning and stuff, it doesn't always have to be at zero.
Title: Re: Jardiance / Forxiga and Ketones
Post by: Lucy on 23 June 2018, 07:44:05 AM
The words on the urine strips are
+/- is traces
+ is faible
++ is moyen
+++ and ++++ are fort

So I think that means probably up to + is normal, ++ is medium and +++ is high. And if they’re high and you don’t know why, or feel ill, or have high bg, then you need to keep checking / seek help? Not sure about if it’s a concern if they’re ++, imagine need to at least keep an eye on which way it’s going.


Having barely ever used ketone strips before, I also noticed that the pack says you must throw away after 6 months of opening. I have used quite a lot this week but doubt I’d ever get through a whole pot of 50 in 6 months!
Title: Re: Jardiance / Forxiga and Ketones
Post by: Lisa65 on 23 June 2018, 11:26:36 AM
I was reading through some old posts last night trying to catch up on three years of absence  and I noticed that Kat's T2 husband had the same thing on canafligozin which is another drug in the same class. So it can't be that rare given that there's not exactly thousands of active members on this forum.
I'm glad you managed to spot the symptoms and avert a hospital visit Lucy. I had thought I might ask for Forxiga if metformin alone doesn't cut it for me anymore, but that's another class of meds of my list now!
Title: Re: Jardiance / Forxiga and Ketones
Post by: Lucy on 23 June 2018, 09:51:13 PM
I was reading through some old posts last night trying to catch up on three years of absence  and I noticed that Kat's T2 husband had the same thing on canafligozin which is another drug in the same class. So it can't be that rare given that there's not exactly thousands of active members on this forum.
I'm glad you managed to spot the symptoms and avert a hospital visit Lucy. I had thought I might ask for Forxiga if metformin alone doesn't cut it for me anymore, but that's another class of meds of my list now!

Oh really, that’s interesting. The letter arrived telling me and GP the plan that i would start taking these tablets and mentioned DKA as a “very rare” side effect, as well as the more common urine infections etc. My ketones were none this morning, not even traces. So going to stop checking them now, unless feel ill or high etc.
Title: Re: Jardiance / Forxiga and Ketones
Post by: Pattidevans on 24 June 2018, 11:24:14 AM
Actually ISTR reading an article about this class of drugs causing DKA about the time Moby started on them.  I think I alerted him to the article. 


I mean honestly.... “here, take this drug which may give you urine infections and.. oh... the odd person may get a life threatening condition which they won’t recognise and nor will their Dr, but it will help control your BG”. Who even thought this drug was a good idea?
Title: Re: Jardiance / Forxiga and Ketones
Post by: sedge on 29 June 2018, 02:29:22 PM
Have you yellow carded them, Lucy?  You should if not - it's OK the mfrs saying 'very rare' so neither the GP nor the patient reports the adverse effect on this person or that, so the original 'very rare' finding remains.

BUT - what if it isn't actually 'very rare' at all?
Title: Re: Jardiance / Forxiga and Ketones
Post by: Lucy on 29 June 2018, 09:19:16 PM
Have you yellow carded them, Lucy?  You should if not - it's OK the mfrs saying 'very rare' so neither the GP nor the patient reports the adverse effect on this person or that, so the original 'very rare' finding remains.

BUT - what if it isn't actually 'very rare' at all?

The GP does this sedge
Title: Re: Jardiance / Forxiga and Ketones
Post by: lozzark on 01 July 2018, 01:55:04 AM
Hi All,
I've been on Jardiance for over a year.  At first I was started on 10mg twice/day.  During this period I lost 1/2 stone in maybe a month.  The diabetic nurse then switched me to 25mg once per day (it's cheaper) and weight loss stopped.
I now use the triple therapy metformin, gliclazide and Jardiance (an approved NICE therapy).  It works OK but no weight loss.
Jardiance inhibits a protein in your kidneys so that they do not reabsorb glucose. Therefore glucose is eliminated.  Personally I cannot see anything wrong with is type of drug because basically it just reduces your renal threshold.
Title: Re: Jardiance / Forxiga and Ketones
Post by: Pattidevans on 01 July 2018, 01:24:09 PM
Edited by admin to remove all those pesky size tags that get transferred over when you edit/copy/paste stuff.
Title: Re: Jardiance / Forxiga and Ketones
Post by: Lucy on 02 July 2018, 10:36:14 PM
im sure they work great for those who don’t get side effects, I felt too unwell to continue with them. My next consultant appointment has been brought forward from December to September and I’ve got a dietician appointment in August. I think I’ve exhausted every T2 med now and can just stick to metformin, insulin and lifestyle changes, and my beta blockers, which is great by me. Think I’d prefer to stick to things without weird side effects.