Let Your Kidneys Help You Manage Type 2 Diabetes

New class of diabetes medications offers organ assistance

Joy Pape, diabetes medicationsBy Joy Pape, RN, BSN, CDE, WOCN, CFCN

March is National Kidney Month, a fitting time to talk about a new class of diabetes medications available for people who have type 2 diabetes (T2DM).  It has a totally different mechanism of action than has been available before.  It allows your kidneys to help you rid your body of excess glucose (sugar).

First, let's take a look at type 2 diabetes. We used to think for the most part, it had to do with the pancreas and it's inability to meet the insulin needs of the body. Well, now we know the pancreas is only part of the story. We now know there are at least eight organs or places in the body involved in T2DM. These have been named "The Ominous Octet" by Dr. Ralph DeFronzo, MD, Professor of Medicine and Chief of the Diabetes Division at the University of Texas Health Science Center and the Audie L. Murphy Memorial VA Hospital in San Antonio, TX.

These eight places in the body are:

1. Pancreas' beta cells, which don't produce enough insulin to meet the body's need. Sometimes there is high insulin production, but the body can't use it…so it's not enough.
2. Pancreas' alpha cells, which increase the production of glucagon. Glucagon raises blood sugar.
3. Liver, which increases it's production of glucose.
4. Brain, where there is neurotransmitter dysfunction.
5. Muscles, where there is decrease in the glucose they use.
6. Fat cells, where there is increased breakdown of fat.
7. Intestines, where there is a decrease in the incretin effect (hormones that help regulate blood sugar).
8. Kidney, where there is increased reabsorption of glucose and also production of glucose.

Focusing on the kidney, up until somewhat recently, we thought of the kidney as a victim in T2DM, meaning high blood sugars and high blood pressure cause kidney damage. That's still true, but now we also know that the kidney also plays a part in increasing blood sugar by reabsorbing glucose (sugar) into your bloodstream, which adds to high blood sugar.  

Think of the kidneys as a filter. When things are working right, they hold on to what your body needs, and filters out the wastes your body doesn't need, into your urine. In most people who do not have T2DM, the kidneys reabsorb the amount of glucose (sugar) your body needs and filters out excess glucose your body doesn't need, mostly by way of a protein called the sodium glucose transporter 2 (SGLT-2). This usually happens at a blood glucose level of 180mg/dL (10 mmol/l) or above. We have found that people who do have T2DM don't start losing the excess glucose until their blood glucose rises to about 240mg/dL (13.33 mmol/l) or above.

What the SGLT-2 inhibitors do is inhibit the reabsorption of glucose into the blood, at a blood glucose level of about 70-90mg/dL (3.88-5 mmol/l). Doing this allows the body to rid itself of the excess glucose in urine, therefore lowering blood glucose levels. Besides lowering blood glucose levels, this class of diabetes medications has also been shown in some to reduce weight. The main adverse effects of SGLT-2s are genital yeast infections, which may be prevented by cleaning well after each urinating, and if needed using an antifungal medicine to treat them.

If you are interested in trying a SGLT-2 inhibitor, talk with your health care provider to see if it's right for you.


Read Joy's bio here. 

Read more of Joy Pape's columns.

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.

Last Modified Date: March 21, 2014

All content on dLife.com is created and reviewed in compliance with our editorial policy.
  1. Diabetes. "From the Triumvirate to the Ominous Octet: A New Paradigm for the Treatment of Type 2 Diabetes Mellitus." 4/09. http://diabetes.diabetesjournals.org/content/58/4/773.full.pdf+html. (Accessed 3/14.)
  2. Diabetes in Control. "SGLT2 Inhibitors: A New Class of Diabetes Medications." 3/14/13. http://www.diabetesincontrol.com/articles/91-how-glp-1-works/14495-sglt2-inhibitors-a-new-class-of-diabetes-medications. (Accessed 3/14.)
  3. Invokana. "What Is Invokana?" 12/10/13. http://www.invokana.com/about_invokana/what_is_invokana?utm_source=google&utm_medium=cpc&utm_campaign=Branded&utm_term=sglt2%20inhibitors&utm_content=SGLT2|mkwid|sJQEuijte_dc|pcrid|29023106246. (Accessed 3/14.)
  4. Farxiga. "Farxiga is Now Approved: An Adult Type 2 Diabetes Treatment that When Used with Diet and Exercise May Help Lower Blood Sugar." 1/14. http://www.farxiga.com/index.aspx?TC=13055&utm_source=google&utm_medium=cpc&utm_campaign=brand&utm_term=sglt2&utm_content=farxigageneral_textad_Home_texttc13055. (Accessed 3/14.)

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