SGLT2 inhibitors — what they do and who should consider them

SGLT2 inhibitors are a group of pills that lower blood sugar by making your kidneys remove more glucose in urine. Big trials showed they also cut heart-failure hospitalizations and slow kidney decline — benefits that go beyond diabetes control. Common names you’ll see: empagliflozin, dapagliflozin, and canagliflozin.

What they help with

These drugs are mainly for people with type 2 diabetes, but doctors now prescribe them for heart failure and chronic kidney disease even when blood sugar is normal. You can expect lower A1c by about 0.5–1% on average, a small drop in blood pressure, and modest weight loss. For people with heart failure, the real win is fewer hospital stays; for kidney disease, they slow loss of kidney function.

How to use them and what to watch for

Most SGLT2 inhibitors are taken once daily, usually in the morning. Some starting doses are empagliflozin 10 mg or dapagliflozin 10 mg, but your doctor will pick the exact dose for you. Before starting, your provider should check your kidney function (eGFR) because dosing and safety depend on it.

Watch for these common side effects: genital yeast infections (more common in women), urinary tract infections, and dizziness from lower blood pressure. A rarer but serious issue is euglycemic diabetic ketoacidosis (DKA) — it can happen with only modestly raised blood sugars. Call your doctor if you have severe nausea, vomiting, belly pain, fast breathing, or feel unusually weak.

Stop these meds before major surgery (usually 2–3 days prior) and tell your care team you’re on one. Also pause them if you have a severe infection, heavy vomiting, or anything causing major dehydration.

Be careful if you take strong diuretics or already have low blood pressure — combining them can cause dizziness or fainting. People with type 1 diabetes generally should not use SGLT2 inhibitors because the risk of DKA is higher. Pregnant or breastfeeding people should avoid them.

Monitoring is simple: check kidney function before starting, recheck within a few weeks, and then periodically. If creatinine rises a bit right after starting, that can be expected, but big drops in kidney function or persistent problems need a review. Also monitor electrolytes and blood pressure if you are on other drugs that affect fluids.

If you get recurrent yeast infections or UTIs, talk to your provider — there are ways to treat and sometimes switch medications. Don’t stop an SGLT2 inhibitor suddenly without discussing it, especially if it’s protecting your heart or kidneys.

Bottom line: SGLT2 inhibitors can do more than lower glucose. They help the heart and kidneys but come with specific risks to watch for. Ask your doctor if they fit your health needs, and keep an eye on dehydration, infections, and symptoms of DKA.