Why a new class of diabetes drug got an FDA warning


The FDA recently issued a warning of a risk of ketoacidosis from a new class of type 2 diabetes drugs.  The drugs, called Farxiga, Invokana, and  Jardiance are SGLT2 inhibitors.  They make it easier for sugar to get through the kidneys so it can be removed in urine.  These drugs are used to help lower blood sugar and support weight loss.  I’ll explain why these drugs are risky, especially if you’re on a low-carb diet.


First:  What is ketosis and is it safe?

Ketosis, or nutritional ketosis, or keto-adaptation, is a normal, healthy adaptation mechanism.  Our brains can use either glucose or ketones as fuel.  If we eat a restricted amount of carbohydrates, usually less than 50 grams per day, our fat is broken down to make ketones.  This process is ongoing but controlled and is designed to keep our brains well-nourished.  As soon as we add back carbohydrates, ketosis stops.  The insulin in our bodies gets the sugar into our cells, signaling the body to stop making ketones.

Many of my patients find they lose weight and fat faster when they are in ketosis.  I have been in and out of ketosis and find I feel leaner in ketosis.  If you are interested in spending more time in ketosis, contact the office.  We will map out a safe path for you.

So what’s ketoacidosis?

Unlike ketosis, ketoacidosis reflects an uncontrolled breakdown of fat and protein to make ketones.  Type 1 (insulin-dependent) diabetics are most at risk.  Without insulin, the body will keep creating ketones, raising the level in the blood.  Once the levels get above 20 mmol/L the lungs and kidneys are overstressed trying to remove the acid from the blood.  Coma and death are possible outcomes if the condition is untreated.  Insulin infusion will stop the creation of ketones and allow the level to return to normal.


Why would these drugs cause ketoacidosis?

We don’t know exactly how these drugs have brought on these cases of ketoacidosis.  One possibility is that they block the release of ketones from the body.  For this reason, IF YOU ARE TAKING ONE OF THESE MEDICINES, DO NOT GO ON A LOW CARB OR KETOGENIC DIET.  These diets will raise ketone levels, as mentioned before.


Why should anyone even take these drugs?

Good question.  Metformin and insulin are generally safe and effective treatments.  Safer and even more effective is lifestyle change.  Hopefully these drugs will fade from use.ketosis