Navigating Health Together: A Doctor's Consultation on Diabetes Management

Key Takeaways

Farxiga^® (dapagliflozin) effectively lowers HbA1c and reduces glucose reabsorption.
Farxiga helps with diabetes management and may decrease the risk of hospitalization for heart failure.
Farxiga increases the risk of urinary tract infections, dehydration, and ketoacidosis.
The best results occur when Farxiga is combined with exercise, a balanced diet, and regular check-ups.
Farxiga is generally well-tolerated, but patients should be monitored for potential side effects and kidney function.

Author’s Note: ‘Bill’ is an actual patient; however, the details of his history have been changed enough to preserve his privacy. Nevertheless, Bill’s successful management of his type 2 diabetes is real. If you or someone you love might have type 2 diabetes, please consult a licensed medical provider.

Bill was 66 years old when he came to the office for an annual physical examination. He is a retired civil engineer with a history of type 2 diabetes treated with metformin, high blood pressure treated with amlodipine, and high cholesterol treated with atorvastatin.

Bill came in for a routine follow-up regarding his diabetes and to review his recent blood glucose levels. He mentioned that he had gradually gained weight over the past few years and expressed concern about his fluctuating blood sugar readings, which had not been well-controlled despite adhering to his current medication regimen.

I diagnosed Bill with type 2 diabetes 12 years prior to this visit. Initially, his blood glucose was well-managed through lifestyle changes and metformin. However, over the past three years, he has increasingly struggled to maintain target HbA1c levels, despite medication adjustments and dietary efforts. His most recent HbA1c was 8.4%, which exceeds the recommended target of 7%.

Bill reported experiencing episodes of polyuria (excessive urination), mild fatigue, and thirst, particularly in the afternoons. He denied any recent infections or hospitalizations. Over the past year, he has gained approximately 10 pounds, which he attributes to decreased physical activity following a knee injury.

During his physical examination, Bill weighed 240 lbs and stood five feet, ten inches tall, resulting in a body mass index (BMI) of 34.4, categorizing him as obese. His blood pressure was recorded at 138/82 mmHg. The remainder of his physical examination was unremarkable.

Bill’s blood tests revealed an HbA1c of 8.4%. His fasting blood sugar level was 165 mg/dL (elevated). His LDL (bad cholesterol) was 105 mg/dL, HDL (good cholesterol) was 38 mg/dL, and his triglycerides (blood fats) were 180 mg/dL.

Based on his physical examination and laboratory findings, my impressions of Bill were that his type 2 diabetes was poorly controlled, he was obese (BMI > 30), and he had high blood pressure and elevated blood lipids (currently under treatment).

Treating Bill’s Uncontrolled Diabetes With Farxiga

Given Bill’s uncontrolled diabetes despite metformin therapy and the need for additional glycemic control, I added Farxiga (dapagliflozin) 10 mg once daily to his treatment plan. Farxiga is a sodium-glucose co-transporter 2 (SGLT2) inhibitor. I selected it to help lower blood glucose, promote weight loss, and reduce the risk of heart failure, especially because the patient has underlying cardiovascular risks (hypertension and dyslipidemia).

The Rationale for Farxiga

Farxiga offers several benefits. It effectively lowers HbA1c and reduces glucose reabsorption in the kidneys, improving blood sugar control. Additionally, Farxiga has been shown to promote weight reduction, which can enhance overall diabetes management and lower cardiovascular risk. Importantly, it may also decrease the risk of hospitalization for heart failure, a critical consideration given Bill’s age and cardiovascular risk profile.

However, Farxiga can increase the likelihood of urinary tract infections and genital yeast infections due to higher glucose excretion in the urine. There is also a risk of dehydration, particularly in patients with low fluid intake, which may lead to dizziness or fainting. Furthermore, Farxiga can cause ketoacidosis, even in patients with normal blood glucose levels. Lastly, it may impair kidney function, especially in those with pre-existing kidney issues, and has been associated with an increased risk of lower limb amputations in some individuals.

Follow-up

I advised Bill to continue monitoring his blood sugar levels at home and return for a follow-up in three months to evaluate his response to Farxiga with a repeat HbA1c test.

I also encouraged him to increase his physical activity as tolerated, aiming for low-impact exercises like swimming or cycling to reduce strain on his knees, while adhering to a balanced diet with reduced carbohydrate intake. I counseled Bill about the potential side effects of Farxiga, including the risk of urinary tract infections and dehydration, and emphasized the importance of maintaining adequate hydration.

Bill’s diabetes is now much better controlled, with his HbA1c reduced to 7.1%, just above the target of 7%. His weight loss and improved physical activity have contributed to this success. There have been no severe side effects from Farxiga, and he tolerates the medication well.

With the addition of Farxiga to his treatment regimen and continued adherence to lifestyle modifications, Bill is expected to achieve better glycemic control, improve his cardiovascular health, and reduce his risk of diabetes-related complications. Regular follow-up will be essential to monitor his progress and adjust treatment as needed.

If You Are Concerned About Type 2 Diabetes

Seeking medical advice for type 2 diabetes is crucial for diagnosing and managing this chronic condition. If left uncontrolled, diabetes can lead to severe complications such as heart disease, kidney damage, nerve issues, and vision problems. Early detection enables prompt treatment, which is essential for preventing these complications. Regular medical consultations ensure that blood glucose levels are monitored and that medications—such as insulin or oral drugs like Farxiga—are adjusted as needed. Healthcare providers can also assess risk factors for complications and recommend individualized treatment plans, which are vital for preventing long-term damage.

In addition to medical treatment, lifestyle changes play a critical role in managing type 2 diabetes. Diet, physical activity, and weight management are essential for maintaining stable blood sugar levels. A balanced, low-carbohydrate diet helps prevent blood sugar spikes, while regular exercise enhances the body’s ability to use insulin and lowers glucose levels. Even modest weight loss can significantly improve insulin sensitivity and reduce the severity of diabetes. Smoking cessation and limiting alcohol intake further contribute to better health outcomes. By combining medical treatment with these lifestyle modifications, individuals can greatly improve their quality of life and reduce the risk of diabetes-related complications over time.

Rely on PlanetDrugsDirect.com to Buy Prescription Discount Farxiga

As a trusted prescription referral service, we offer important benefits whenever you order online. Each of our partner pharmacies and/or government-approved dispensaries is committed to providing the best experience possible of any online prescription referral service on the internet. We offer:

Low prices
Quick turn-around times
Generic and brand-name medications
Unparalleled customer service

Sources

Farxiga (dapagliflozin). Prescribing information. Astra Zeneca. https://www.farxiga.com/. Accessed October 25, 2024.
Dhillon S. Dapagliflozin: A Review in Type 2 Diabetes. Drugs. 2019 Jul;79(10):1135-1146. doi: 10.1007/s40265-019-01148-3. Erratum in: Drugs. 2019;79(18):2013. doi: 10.1007/s40265-019-01239-1.
Tingen J, Gazewood JD. Dapagliflozin (Farxiga) for Preventing Hospitalization for Heart Failure. Am Fam Physician. 2020;102(2):115-116.