Oral antidiabetic medications - Sodium-glucose co-transporter-2 (SGLT-2) inhibitors: Nursing pharmacology

Sodium glucose transporter 2 or SGLT2 inhibitors are medications used to treat type 2 diabetes mellitus, which is characterized by insulin resistance.

This is when tissue cells have trouble responding to insulin in order to use glucose from the blood. As a result, tissue cells starve for energy despite having high blood glucose levels, which is called hyperglycemia.

Now, SGLT-2 inhibitors include canagliflozin, dapagliflozin, ampagliflozin, and ertliflozin. All SGLT-2 inhibitors end in gliflozin, and they are taken orally.

Once administered, SGLT-2 inhibitors travel to the proximal convoluted tubules in the kidneys, where they block the sodium glucose transporter or SGLT-2, which facilitates the reabsorption of 90% of glucose from renal tubules.

As a result, SGLT-2 inhibitors lead to an increased excretion of glucose in urine, known as glycosuria, which ultimately lowers blood glucose levels.

Now, all this glucose in the urine may favor microbial growth. For that reason, the most common side effects of SGLT-2 inhibitors are urinary tract infections, particularly yeast infections.

In addition, the decreased reabsorption of glucose in the renal tubules leads to an increase in the urine osmality, causing more water to be lost in urine too.

This can result in urinary frequency and polyuria, as well as renal impairment or even failure. This is especially likely to affect clients who also take medications like diuretics, ACE inhibitors, ARBs or NSAIDs, and could result in dehydration and orthostatic hypotension.

Other dangerous side effects of SGLT-2 inhibitors include hyperkalemia and euglycemic ketoacidosis. Some clients on SGLT-2 inhibitors may also present with reduced bone density, which increases the risk of fractures.

Finally, canagliflozin can increase the risk of lower limb amputation, while dabiggliflozin and ertugliflozin may increase the risk of necrotizing fasciitis of the perineum.

Now, SGLT2 inhibitors are contraindicated in clients with renal failure or those undergoing dialysis, as well as in clients with a history of diabetic ketoacidosis.

SGLT2 inhibitors should also be avoided while breastfeeding and should be used with caution during pregnancy. Caution should also be taken in clients with hypotension, dehydration, as well as in children and elderly clients.

Additional precautions should be taken in clients with adrenal, renal, or hepatic disease. Now, if your client with type 2 diabetes is prescribed the SGLT2 inhibitor like canagliflozin, be sure to review their most recent laboratory test results, including blood glucose, hemoglobin A1C, electrolytes, as well as their renal and hepatic function.

Also review the results of their most recent urinalysis. Next, explain how the medication works in their kidneys to lower their blood glucose level.

Be sure to remind them that the medication is most effective when combined with an anti-diabetic regimen, which includes following a low-carbohydrate and high fiber diet, regular physical activity, and frequent blood glucose monitoring.

Next, teach your client to take their medication once daily with the first meal of the day. Review with your client the symptoms of hyperglycemia, such as fatigue, blurred vision, increased thirst, appetite, and urination, and advise them to check their blood glucose level and contact their healthcare provider immediately.

In addition, teach your client how to decrease the risk of urinary tract infections by drinking plenty of fluids and to maintain scrupulous perineal hygiene.

Also advise them to notify their healthcare provider if they develop symptoms like fever, painful urination, and lower abdominal pain, as well as vaginal or penile discharge, itching or swelling.

Teach them to recognize signs of renal impairment, such as weight gain, swelling, blood in the urine, or changes in the amount of urine they are producing.

Stress the importance of monitoring daily their lower legs, feet, and toes, to always wear clean, dry socks, and to protect their feet from injury by never going barefoot and wearing well-fitting shoes.

In addition, caution them to immediately report any numbness or tingling in their feet, or changes like a blister, sore, ulcer, infection, or ingrown toenail.

Lastly, instruct them to promote bone health and decrease the risk of fractures by including calcium-rich foods in their diet, such as low-fat dairy products, dark green leafy vegetables, and legumes.

Finally, during treatment with the SGLT2 inhibitor, be sure to monitor for side effects and the therapeutic response to the medication by regularly checking your client's blood glucose levels, hemoglobin A1C, and renal function tests.

Alright, as a quick recap, SGLT2 inhibitors are medications used to treat type 2 diabetes mellitus. They lower glucose levels by acting on the kidneys.

Where they block the action of SGLT2, causing an increased excretion of glucose in the urine. Important side effects include genitourinary infections, renal impairment, decreased bone density, and an increased risk of lower limb amputation.

Nursing considerations for clients taking SGLT2 inhibitors include performing a baseline assessment, as well as monitoring for side effects and for the therapeutic effect of improved glucose control.

Client teaching is focused on safe self-administration, as well as preventing side effects and recognizing them when they occur.