By Dr. Moxit Shah, DM Endocrinologist
Vishuddha Endocrine Clinic, Ahmedabad
Dapagliflozin and Empagliflozin are now among the most commonly prescribed Diabetes medicines in India.
They belong to a group called SGLT2 inhibitors, and their benefits go well beyond blood sugar.
Certain SGLT2 inhibitors have been shown to reduce hospitalisation for Heart Failure and slow the progression of Chronic Kidney Disease. But they also have specific side effects and safety rules that every patient should know.
What are SGLT2 inhibitors?
SGLT2 inhibitors are tablets that help the kidneys remove extra glucose through the urine. Examples include:
- Dapagliflozin
- Empagliflozin
- Canagliflozin
- Ertugliflozin
- Remogliflozin, available in India
Because they work through the kidneys rather than by increasing Insulin, they rarely cause Hypoglycemia on their own.
What are the benefits of SGLT2 inhibitors?
- Lower HbA1c
- Modest weight loss
- Modest reduction in blood pressure
- Reduced risk of hospitalisation for Heart Failure with certain agents
- Slower progression of Chronic Kidney Disease with certain agents
The ADA Standards of Care recommend SGLT2 inhibitors with proven benefit for people with Type 2 Diabetes who have Heart Failure or Chronic Kidney Disease, largely independent of HbA1c.
Some are also used in Heart Failure and Chronic Kidney Disease in people without Diabetes.
What are the common side effects?
Genital fungal infections
This is the most common side effect, because glucose in the urine encourages yeast growth. It causes itching, redness or discharge.
- Keep the genital area clean and dry
- Wash after passing urine, if practical
- Wear cotton underwear
- Seek treatment early. Most infections respond well
Urinary tract infections
Slightly more common. See your doctor for burning urine or fever.
More urination and dehydration
You may pass more urine. In hot weather, with diuretics or in older adults, this can cause dehydration or dizziness. Drink adequate water.
What is euglycemic ketoacidosis?
This is a rare but serious complication. Ketones build up in the blood even when blood sugar is not very high, so it can be missed.
Risk increases with:
- Acute illness, vomiting or not eating
- Surgery
- Prolonged fasting
- Very low-carbohydrate or keto diets
- Heavy alcohol use
- Large reductions in Insulin dose
Symptoms: nausea, vomiting, abdominal pain, unusual tiredness, fast breathing. Seek urgent care and mention that you take an SGLT2 inhibitor.
Read more about Diabetic Ketoacidosis.
When should SGLT2 inhibitors be paused?
- During illness with vomiting, diarrhea or inability to eat and drink (“sick-day rules”)
- Before planned surgery, usually a few days beforehand, as your doctor advises
- During prolonged fasting, after discussion with your doctor
Restart only when you are eating and drinking normally.
Are SGLT2 inhibitors safe for the kidneys?
Yes, and in suitable patients they protect them.
A small, early dip in kidney function tests after starting is expected and usually not harmful. Your doctor will monitor it. See Diabetes and kidney health.
Who should not take SGLT2 inhibitors?
- People with Type 1 Diabetes, in general
- People with a history of ketoacidosis
- People with frequent genital or urinary infections
- Pregnant or breastfeeding women
- People with very severe kidney impairment or on dialysis, depending on the agent
Can SGLT2 inhibitors be combined with other medicines?
Yes. They are commonly combined:
Metformin → liver glucose production
SGLT2 inhibitor → glucose loss in urine, heart and kidney protection
GLP-1 medicine → appetite, weight and glucose regulation
Read about Metformin and our complete guide to Diabetes medicines.
Diabetes treatment in Ahmedabad
At Vishuddha Endocrine Clinic, Dr. Moxit Shah selects Diabetes medicines based on heart and kidney health, weight, side-effect risk and cost, not blood sugar alone.
Frequently Asked Questions About SGLT2 Inhibitors
Why is there sugar in my urine test after starting Dapagliflozin?
That is how the medicine works. Urine glucose is expected and is not a sign of worsening Diabetes.
Is Empagliflozin better than Dapagliflozin?
Both have strong evidence. The choice depends on your conditions, availability and cost.
Can I take SGLT2 inhibitors while fasting?
Discuss it with your doctor before any fast, because of the risks of dehydration and ketoacidosis.
Do SGLT2 inhibitors cause weight loss?
Usually modest weight loss of a few kilograms.
Can people without Diabetes take Dapagliflozin?
Some SGLT2 inhibitors are used for Heart Failure and Chronic Kidney Disease without Diabetes, when prescribed by a doctor.
Final Takeaway
SGLT2 inhibitors are valuable medicines, particularly for people with heart or kidney disease.
The right patient + genital hygiene + adequate water + sick-day rules + pause before surgery + awareness of ketoacidosis symptoms.
If you have been prescribed Dapagliflozin or Empagliflozin and have questions, consult an endocrinologist.
Dr. Moxit Shah
DM Endocrinologist
Vishuddha Endocrine Clinic, Ahmedabad
📞 +91 99799 92797
📍 Elite Magnum, Bhuyangdev Cross Road, Ahmedabad
🌐 endocrinologistinahmedabad.com
This article is for educational purposes only and does not replace an individual medical consultation. Prescription medicines should be started, adjusted or stopped only under the supervision of a qualified healthcare professional.
