Invokana: A New Option for Type 2
SGLT-2s lower blood glucose, add risk of urinary infections
By Bennet Dunlap
What is the newest medical treatment for type 2 diabetes? InvokanaTM (previously know as canagliflozin). Introduced by Johnson and Johnson's Janssen Pharmaceuticals, Inc., InvokanaTM was approved by the FDA for prescription in the United Stated on March 29, 2013. It is the first drug approved in a new class of treatment options for type 2 diabetes known as "SGLT-2 inhibitors." While InvokanaTM is the first SGLT approved by the FDA, there are other treatment options for type 2 diabetes in development.
InvokanaTM works differently than other type 2 drugs to help people self-manage their blood sugar. To understand what a SGLT-2 inhibitor does, a small explanation of the kidneys is in order.
The kidneys filter blood. In the beginning of that process, they filter out glucose with waste products. Glucose is the energy that powers cells in the body. Rather than allowing that energy to be lost, the kidneys continue the urinary process and recover glucose through a step called the sodium glucose co-transporter 2, or SGLT-2 for short. Probably for most of the millenniums that humans have been around, this conservation of energy has been an important evolutionary advantage.
As a diabetes drug, SGLT-2 inhibitors slow down this glucose recovery. As a result, there is more sugar in urine. The sugar is passed when the patient urinates thereby reducing blood sugar. This is different way of lowering sugar than other medications that influence insulin production or insulin sensitivity. Invokana'sTM lowering of blood glucose happens more when glucose levels rise, not when sugars are near normal levels. As a result, low blood sugars are a less likely side effect of this approach to managing blood glucose.
Clinical trials found that by removing sugar, InvokanaTM helped patients lose and keep off weight. Patients saw improvements in blood glucose, blood pressure and reductions in weight. While urinating out a few hundred calories a day can add up to lower blood sugars and weight reduction, there are issues to be considered. Most notably, urine with higher sugar concentration can cause urinary tract infections. An unpleasant side effect for anyone, certainly.
The press release announcing drug approval also introduced "InvokanaTM CarePath," an effort to support patients and caregivers by supplying "information regarding affordable access, adherence and education, thereby helping patients to start and appropriately manage their disease and therapy over time."
InvokanaTM is a once a day tablet and will be available by prescription only. Patients should consult with their physicians to consider their diabetes, lifestyles, the possible benefits and risks of any medication, including InvokanaTM.
For more information, check out:
- Kelly Close's dLife article, "An Interview with Dr. Sanjay Kaul."
- The Janssen press release announcing the FDA approval, including indications and other details
NOTE: The information is not intended to be a replacement or substitute for consultation with a qualified medical professional or for professional medical advice related to diabetes or another medical condition. Please contact your physician or medical professional with any questions and concerns about your medical condition.
Kidney Bean, Barley, and Sweet Potato Stew Fat-Free Plum Sauce Thyme and Garlic Roasted Turkey Breast Homeade Tomato Sauce with Ravioli Graham-Cracker Pie Crust Bruschetta Bread Firecracker Barbecue Pork One Bowl Banana Bread Glazed Pork Tenderloins Vegetable Citrus Salad
I no longer wear an insulin pump. Nor do I wear a CGM. I wish the latter were different, as I think a CGM would be quite useful, but the welts that it leaves on my skin - in spite of multiple efforts to fight that welts - are just unacceptable. I am, however, still interested in when people remove their pumps and why. I've seen some recent discussion around folks being asked to remove their pump for mammogram procedure, so I figured I'd ask around the hospital I work to...