Hi, welcome to type 2 where we discuss everything about type 2 diabetes in a way that everyone
can understand. Today we're gonna talk about a class of medications that make you urinate
the extra glucose in the urine. I mean, in the toilet. These medications are being used
a lot lately for type 2 diabetes. On my last video, I told you that there are different
kinds of medications used for type 2 diabetes. And on this channel we're going to talk about
all of them. But today we will look at these one that we call SGLT-2 inhibitors. I chose
these ones because we already have a video on why high blood sugar cause frequent urination,
and these medications do just that. So, it's easy for you to understand. If you should
take medications is between you and your doctor, but my goal is to explain to you clearly how
they work, so that you can understand some of the pros and cons of taking medications.
Now there are many of these SGLT-2 inhibitors. We have Canagliflozins, Empagliflozins, Dapagliflozins,
and you know, whenever you see some random letters followed by gliflozins you know that
we are talking about SGLT-2 inhibitors. How do they work? In my video about why high blood
sugar cause frequent urination, I told you that your blood, including the glucose in
it, has to pass through the best filter in the world, your kidney, more than 20 time
a day, right? And I told you that everything in the blood, except some big molecules like
proteins and some cells, and things like that...Everything else has to pass inside this long tube that
will make urine. You have two kidneys, and inside of each one you have about a million
of these small filters. The blood, with all the waste products and other things, including
glucose, will come inside your kidneys...Let's zoom on one of these. It will come inside,
and on the way to make urine, I told you that everything that is important to the body will
be taken back. At the end, only the waste will come here. And I also told you that glucose
in on the VIP list. All of the glucose that will pass here will be taken back, because
there are transporters of glucose called sodium glucose linked transporters or co-transporters...These
are SGLT-2 and SGLT-1. These ones, whenever glucose is passing by, these transporters
will take the glucose back to the blood. And I told you that if your blood sugar is not
too high that, you know, these transporters are overworking or something, you cannot find
glucose in the urine because there are transporters of glucose that will take all this glucose
back to the blood. And there will be no glucose here, going to the toilet. Now, someone said,
wait! If you have high blood sugar, the sugar is not always in your blood. It's actually
going outside and then coming back, so why don't we just close the doors? And this is
exactly what they did. So, when we talk about medications, you know, if you don't study
medicine, you will think that medications are some crazy things that people invent.
But they are not. They are just some easy manipulations...or, I don't know how you call
it. In this case we know that glucose is leaving the blood more than 20 times a day, so someone
said why don't we just close the doors? And that is exactly what they did. They made some
things, that we call medications...that when you take, when you eat them, they will go
all the way to kidneys. And these medications will come all the way here, and block these
transporters that are supposed to take the glucose back to the blood. Now, we have transporters
1 and 2, but most of them are transporters 2. About 90% of them are transporters 2, so
that's why we block these one. Now, what happens when we block these transporters? The glucose
will come, as normal, they are going to the urine...and there are doors for the glucose
to come back, but the doors are closed. So, the glucose will keep going, and will start
to appear in the urine. Very easy to understand! Do you think this is a good or a bad idea?
You know, everyday your blood glucose is high, you have high blood sugar, and you take these
medications...they block the transporters that are taking the glucose back to the blood,
so whenever the glucose comes out... tang tadand tadang, nope, can't get in...tang tang,
no...humm, no. And they will go to the urine. Some of them will take these one, of course,
transporters 1. But they are not many, so at the end of the day you will have a lot
of glucose going to the toilet. So, do you think this is a good or a bad idea? I know,
maybe some of you will say good, some will say bad, but at least with this understanding,
you will know some of the pros and cons of taking these medications. The first good thing
about these medications is that, as I told you, the glucose (sugar) is leaving your blood.
Now, that's important because if you have high blood sugar, and you take these medications,
you are wasting this sugar, you are wasting glucose, You are throwing it away. For example:
when we compare that with something like insulin, you know that insulin will make the glucose
leave your blood to enter into different cells, right? And the glucose will be used for energy
or be stored as glycogen and fat. So, when you take insulin, you are feeding your cells,
right? But when you take these medications you are feeding the toilet... I mean, not
feeding, but you are wasting the glucose. Here, you are feeding your cells, and you
know, people who take a lot of insulin tend to gain weight. But with these medications,
because you are wasting glucose, you will tend to lose weight. So, patients that take
these medications, their body weight tend to go down, not up like insulin. Now, I think
it's a good thing...You might say that financially speaking, this is a disaster, because you
are buying food, and then you are buying medications to get rid of the food that you're buying.
But this, you know, this channel is not for financial advise. Physiologically speaking,
this is a good thing. It's better than insulin in this aspect. Now, another thing about these
medications is that, well I don't need to tell you that they reduce your A1C, right?
Because, you know, you are losing glucose. And your A1C is the average blood glucose
for, you know, 2 to 3 months. Which means that with these medications, you will reduce
A1C. Your A1C will go down. Even your fasting blood glucose will go down...your post meal
blood glucose will go down. Now, what do you think that will happen to your blood volume
if you are urinating all the time? Now, I told you that more glucose will come here...and
know that water in your body can freely move from lower concentration of solute to higher
concentration of solute. If there's higher concentration of solute like glucose and sodium
and other things outside, water will come to balance the concentration of things in
your body. So, more glucose here means more water will come, and more urine will come.
So, with these medications, your blood volume will tend to go lower, to reduce. Now, is
that a good or a bad thing for people with type 2 diabetes? We think it's a good thing
because a lot of people with type 2 diabetes also have high blood pressure, so with these
medications your blood pressure will go down. Lower blood volume means lower blood pressure.
Let's say your heart had this amount of blood to deal with, now it has this amount of blood
to deal with, that will put less stress on your heart or your blood vessels, you know.
So, you will have lower blood pressure. And your heart will also have to work less. That's
why patients who take these medications...they tend to have less heart problems, because
of these medications. And you know, even reducing your A1C or weight and other thing can also
help your heart, but these medications can help your heart better than a lot of other
medications for type 2 diabetes. Now there's 1 more thing that we can say that is positive
or negative, depending on how you take it. The chance of having Hypoglycemia with these
medications... The chance of having low blood sugar with these medications is low. Because
as I told you, you only block SGLT-2, right? You only block these one. But there are still
10% of SGLT-1 that can still take glucose. :Which means that when your blood sugar is
low these ones are still taking it. And if the blood sugar is too low, even some of these
SGLT-2 will still work...will take some of the glucose. And then, another thing is that
when your blood glucose goes down, your pancreas will release Glucagon￼. And glucagon will
tell your liver to make some glucose, so it's not likely to cause hypoglycemia like some
of the other medications. But this can be good or bad, because it doesn't reduce your
blood sugar too much, you know. So, when you talk about A1C reduction, we expect a mild
A1C reduction. So, most patients will not take only these medications. They will have
something else, or they will have diet and exercise included, or insulin, or some other
thing. But not just these SGLT-2 inhibitors. But some people, especially people that were
taking too much glucose back to the blood, these medications can do wonders. They will
take them and it works fine for a long time. Now, what are some of the real cons of these
medications? The first one is that they cause infections in you urinary track and your genital
area. And the reason why that happens is that first, you're urinating all the time, which
means it's harder to keep that area clean. And the second one is that glucose is energy.
Glucose is food for the things that cause infections. Even when, you know, we try to
grow cells in the lab we give them glucose so that they can grow faster. So, you know
these medications increase infections, especially for women. Men too, but more women than men
in this case. Another problem with these medications is that they can cause ketoacidosis. Now,
the risk is actually not that high, the risk of getting ketoacidosis is not that high,
but this conditions is serious enough that I think you should know. Because when you
throw all these glucose away, and let's say you are some one who had ketoacidosis before,
or you are on a very low carb diet... the very few glucose you're putting in, you're
throwing it away...or someone who is fasting, or doing some ketogenic diet, or you are under
severe metabolic stress like if you just had a major surgery or something like that, you
should talk to your doctor about these things before you take these medications. And for
some people, some of the advantages of these medications can be disadvantages. For example,
I told you that your body weight will go down, right? But if you are someone who is underweight
and does not want to lose weight, this can be a problem for you. And the same can happen
with blood pressure. If your blood pressure was already low before these medications,
it can be a problem. So, it depends. Now, before you go...after understanding how these
medications work...when you compare them with something like diet, which one do you think
is better? For example, let's say you cut all the refined carbohydrates from your diet,
and your blood sugar doesn't go as high as before. Maybe before it used to go like this,
but now, maybe it's here, right... or you're someone who doesn't want to change the diet.
And keeps the blood sugar high, but buys these medications to throw them into the toilet.
Which one do you think is better? For me diet come first, and exercise second, and all these
medications, including this one that gets rid of the glucose, even thought it's an expensive
way to deal with it, but at least they don't cause more problems to your diabetes. They
come third. And them some other medications that cause problems to your diabetes, that
make you gain weight and other stuff that we will talk about later. And then the last
one is "those that do nothing and just wait for complications". So, you know, you have
choices. I hope this gave you a good idea about how these medications work. Have a blessed
week. Bye