Concerns About Using Empagliflozin for Type 2 Diabetes Management

Regarding the use of the diabetes medication - Empagliflozin film-coated tablets?

Hello Dr.
Lin,
I have type 2 diabetes and have been taking the extended-release metformin prescribed by my endocrinologist for many years.
Earlier this year, my doctor recommended switching to empagliflozin.
Since starting this medication, I have noticed that my toilet bowl becomes moldy very easily after urination; if I don’t flush each time, it will mold within a day, and even flushing every time, it still molds every two to three days.
Additionally, I have observed a change in the odor of my urine, which has become stronger.
I understand that this medication works by excreting glucose through urine, but is this a normal phenomenon? It feels like pouring a sugary drink into the toilet without flushing.
Are there any specific precautions I should take while using this medication? Furthermore, the medication information mentions the possibility of urinary tract infections and genital yeast infections.
How high is the risk for these side effects, and what should I be aware of?
Since my follow-up appointment is not yet due, I am reaching out with these questions.
Thank you, doctor!

Yang, 30~39 year old female. Ask Date: 2020/02/21

Dr. Lin Jianliang reply Internal Medicine

Empagliflozin in Jardiance Duo causes glucose to be excreted in the urine, which is why there is sugar in the urine.
When taking this medication, it is important to be aware of potential side effects such as hypoglycemia, ketoacidosis, urinary tract infections, genital fungal infections, and necrotizing fasciitis of the perineum, among others.
It is recommended to drink plenty of water to avoid infections.
If any uncomfortable symptoms occur, it is advisable to consult a physician immediately.

Reply Date: 2020/02/21

More Info

Empagliflozin, a sodium-glucose co-transporter 2 (SGLT2) inhibitor, is commonly prescribed for managing type 2 diabetes. It works by preventing glucose reabsorption in the kidneys, leading to increased glucose excretion in urine. This mechanism can indeed lead to some noticeable changes in urine characteristics, as you have described.
The issues you are experiencing, such as the increased likelihood of mold growth in the toilet and changes in urine odor, are not uncommon among patients taking Empagliflozin. The increased glucose in the urine can create a more favorable environment for microbial growth, which can lead to the observations you’ve made. It is akin to pouring a sugary liquid into a container and leaving it uncleaned; the sugar provides a nutrient source for mold and bacteria.
While these changes can be concerning, they are generally not harmful in themselves. However, they do highlight the importance of maintaining good hygiene practices, especially when using medications that alter glucose excretion. Regular cleaning of the toilet and ensuring proper sanitation can help mitigate these issues.

Regarding the potential side effects of Empagliflozin, you are correct that there is an increased risk of urinary tract infections (UTIs) and genital fungal infections. The mechanism behind this is similar to the mold growth you’ve observed; the presence of excess glucose in urine can promote the growth of bacteria and fungi. Studies suggest that while the risk of these infections is elevated, it varies among individuals. Factors such as personal hygiene, pre-existing conditions, and overall health can influence the likelihood of developing these infections.
To minimize the risk of UTIs and fungal infections while on Empagliflozin, consider the following precautions:
1. Stay Hydrated: Drinking plenty of water can help dilute the urine and reduce the concentration of glucose, which may lower the risk of infections.

2. Maintain Good Hygiene: Proper genital hygiene is crucial. After urination, ensure that the area is clean and dry to prevent fungal growth.

3. Monitor Symptoms: Be vigilant for any signs of infection, such as burning during urination, increased frequency of urination, or unusual discharge. If you notice any of these symptoms, consult your healthcare provider promptly.

4. Regular Check-ups: Keep up with your scheduled appointments with your healthcare provider. They can monitor your kidney function and overall health, adjusting your treatment plan as necessary.

5. Diet and Lifestyle: A balanced diet and regular exercise can help manage your diabetes more effectively, potentially reducing the need for higher doses of medications like Empagliflozin.

In conclusion, while the changes you are experiencing are related to the mechanism of action of Empagliflozin, they warrant attention and proactive management. It’s essential to communicate these observations to your healthcare provider during your next visit, as they can provide personalized advice and may consider adjusting your treatment if necessary. Always remember that managing diabetes effectively involves a combination of medication, lifestyle changes, and regular monitoring.

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