Sodium-glucose cotransporter-2 (SGLT-2) inhibitors in type 2 diabetes

Common (may affect 1 in 10 people but is common in 1 in 100)

• Hypoglycaemia (low blood sugar) – the risk of low blood sugar is higher if you take an SGLT-2i with other medicines such as gliclazide, glimepiride, glibenclamide or insulin to treat your diabetes.You may need to reduce your other medications. Your doctor will advise you.
• Dehydration – this can be a result of the SGLT-2i increasing your urine output. You might notice that you are dizzy and/or thirsty. If you are on water tablets (diuretics), your doctor may advise reducing your dose of the diuretic.
• Fungal genital infections – Thrush – as SGLT-2i work by increasing the amount of glucose in your urine, this increases the risk of vaginal or penile thrush. Most cases are mild and can be treated with over-the-counter medicines. Personal hygiene is important in helping you lower your risk of developing thrush.
• Urinary tract infections – water infection – seek medical attention if you have symptoms of a water infection, for example burning sensation when passing urine, fever and/or your urine contains blood or appears cloudy.

Uncommon (1 in 1000 people)

• Diabetic ketoacidosis (DKA)
  DKA is an increase in acid in the blood, from ketones (chemicals that the body creates when it breaks down fat to use for energy). DKA is a rare but serious condition, which requires urgent medical treatment. It can happen with a normal blood sugar level.
  
  Symptoms and signs of DKA include nausea, vomiting, abdominal (stomach) pain, rapid breathing and dehydration. It can also cause drowsiness and confusion. It can cause a sweet smell on the breath, and/or a sweet or metallic taste in the mouth, which is sometimes described as similar to pear drops or nail varnish remover.
  
  If you experience any of these symptoms or signs, even if your blood glucose levels are normal, you should seek urgent medical advice, telling them you are taking an SGLT-2i.
  
  The risk of DKA is increased with:
  – prolonged fasting
  – very low carbohydrate diets (also called ketogenic diets), you should seek medical advice before starting any low carb diets
  – excessive alcohol consumption
  – dehydration
  – sudden reductions in insulin dose
  – a higher need of insulin due to major surgery
  – any illness including infections such as chest infection, flu, winter vomiting bug and COVID-19
  
• Necrotising fasciitis of the perineum or Fournier’s gangrene
  This is a rare but serious or even potentially life-threatening infection of the genitals and the area around the anus. If you develop pain, swelling, redness of the genital region and feel unwell with fever, you should seek medical advice urgently.