This blog tracks updates to the Blood Sugar 101 Web site.

Friday, May 15, 2015

FDA Issues Letter Warning of Ketoacidosis Associated with Whole Class of SGLT-2 Inhibitor Drugs

Page Changed: SGLT2 Inhibitors, Farxiga, Invokana, Jardiance. Questionable New Drugs

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(Note: The text below was slightly modified on 5/16 after this post was originally posted.)

Serious Side Effects of This Entire Class of Drugs

The FDA issued a warning on 5/15/2015 stating that it had received a significant number of aftermarket reports linking this class of drugs to ketoacidosis. Ketoacidosis is a very serious, potentially fatal condition where the acid level in the blood rises dangerously high. Ketoacidosis makes people very sick and if untreated can be fatal. It requries a trip to the emergency room. Symptoms of ketoacidosis include: difficulty breathing, nausea, vomiting, abdominal pain, confusion, and unusual fatigue or sleepiness.

What is particularly worrisome here is that ketoacidosis usually ONLY occurs in people with Type 1 diabetes who have very high blood sugars--those above 300 mg/dl. However, in these cases the ketoacidosis was occuring in people with Type 2 diabetes who had only modestly elevated blood sugars. It is likely that these drugs are promoting ketoacidosis because of the way they affect the kidneys, which may make it harder for the body to eliminate ketones as they build up.

Typically, people eating very low carb diets are told that as long as their blood sugar isn't high, it's perfectly safe to have raised ketone levels in blood and/or urine. But this may NOT be the case if you are taking one of these drugs because they may block the normal processes that keep ketone levels within a safe range. Until it is 100% clear what is leading to ketoacidosis in people taking these drugs it is not a good idea not to take them if you are eating a ketogenic low carb diet. You can read the entire FDA warning at:

FDA Drug Safety Communication: FDA warns that SGLT2 inhibitors for diabetes may result in a serious condition of too much acid in the blood

Sunday, May 3, 2015

We've Consolidated our Diabetes and Low Carb Web Sites

As part of our efforts to re-do our site to placate Google, which sends us most of our traffic and who has decreed that all sites must be mobile friendly, we have moved most of the content that used to appear on our standalone "What They Don't Tell You About Low Carb Diets" web site to the Diet tab of the Blood Sugar 101 web site. The

The home page for the Low Carb site now redirects to a page on the diabetes site too,

This will make it a lot easier for us to keep the site updated and mobile friendly.

Do let us know if you run into problems with any of these pages. We've tried to make sure all the links still work, but there are always little things we miss.

Tuesday, April 21, 2015

We're Changing the Look of our Site to Make it More Mobile Friendly

Google has announced that it will be lowering the search ranking of sites that it doesn't consider to me "mobile friendly." Unfortunately, that includes Blood Sugar 101 and its Low Carb sister site.

So we have been changing the layout of the site to make it possible to easily convert it to mobile format.  The content has not changed, other than a few editorial tweaks. The process will take a few days to complete.

We hope you like the new layout!

Friday, April 17, 2015

FDA to add warning to Onglyza label warning of greatly increased risk of heart failure

Page Changed: DPP-4 Inhibitors: Januvia, Onglyza, Trajenta, Combiglyze, Janumet, and Jentadueto

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In April of 2015, the data was made public that the SAVOR study showed that people taking Onglyza were 27% more likely to be hospitalized for heart failure. As a result, the FDA decided to add warning information about heart failure to the Onglyza label. (Details HERE.) However, few doctors keep up with changes to the labels of the drugs they prescribe. And as the FDA still considers this to be an acceptable drug, it will continue to be prescribed. This kind of FDA response is in line with its policy of putting the interests drug companies above those of drug users.

Friday, April 3, 2015

Several New GLP-1 Agonists Added to the Web Page. All Are Potentially Cancer-provoking.

Page Changed: GLP-1 Agonists: Byetta, Lyxumia, Bydureon, Victoza, Trulicity and Tanzeum Text Added:

Byetta, Lyxumia, Bydureon, Victoza, Trulicity and Tanzeum

These drugs are all members of the incretin drug family. Byetta (exenatide) is injected several times a day, Victoza (liraglutide) and Lyxumia (lixisenatide) once a day. Saxenda is the same drug as Victoza, but it has been approved for people without diabetes who need to achieve weight loss. Bydureon is a long lasting version of exenatide. It, Trulicity, (dulaglutide) and Tanzeum (albiglutide) are injected once and last a full week.

Thursday, March 26, 2015

Cipro and Other Common Antibiotics can Cause Permanent Neuropathy and Hypos

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Certain Commonly Prescribed Antibiotics Can Also Cause Neuropathy So Avoid Them

The fluoroquinolone family of antibiotics, which includes  ciprofloxacin (Cipro), gemifloxacin (Factive), levofloxacin (Levaquin), moxifloxacin (Avelox), norfloxacin (Noroxin), and ofloxacin (Floxin) have been found to cause a form of neuropathy which can be irreversible. These drugs can also cause hypoglycemia in people with diabetes. They are commonly prescribed for urinary tract infections, but there are other drugs that are a better choice for poeple with diabetes. If you are battling with neuropathy, ask your doctor to prescribe one of the other, safer, drugs.

Diabetes Self-Management:Nerve Damage and Fluoroquinolone Antibiotics.

Tuesday, March 24, 2015

Early Reports on Afrezza Lead to Cautious Optimism

Page Changed: Inhaled Insulin - Afrezza

Early reports posted on diabetes social media sites are encouraging. Most of those reporting are people with Type 1. They report being able to tolerate a higher dose than the corresponding amount of injected insulin they usually use. Most are finding they need to use correction doses after meals because of Afrezza's very short activity curve. They are also finding that they need to adjust their basal insulin after a week or so on Afrezza. For some it works extremely well. However, others are reporting that it is possible to experience hypos while using Afrezza, contrary to claims of some investors who have also been posting to diabetes social media. There aren't enough people with advanced Type 2 using it yet to determine how it will work for its target market--people with Type 2 who have put off using insulin out of a fear of needles.

Because it is inhaled, Afrezza can not be taken by people who have lung problems or by smokers. Because the long-term impact of exposing lung tissue to a growth-promoting hormone is unknown, the FDA insisted on much longer, more rigorous testing for Afrezza. I had originally thought that the testing for Afrezza had gone on longer than that for Exubera, which did eventually appear to cause some excess lung cancer, but that does not appear to be true, so a certain amount of caution would be advisable. I would personally be willing to give it a try, but I would not use it for every meal. If you do experience prolonged bouts of coughing after using it that don't go away after a week it's probably a good idea to avoid it.

For now there is no reason for people who are comfortable using fast acting injected insulin who are getting great control with it to switch to Afrezza. But for people who have been putting off moving to meal-time insulin out of a fear of needles, and for those who don't have the necessary skill to work out insulin/carb ratios and carefully dose injected insulin to the carbs in their food, and who are having too many hypo, Afrezza may be very helpful. If your doctor does prescribe it, be sure that he or she follows the instructions on the Prescribing Information and sends you for a lung function test before you start Afrezza and then follows up with one six months later. Also make sure that he gives you enough to cover snacks and occasional corrections at the dose you will need. A single box may not be enough. Most people reporting on early experiences with Afrezza are using two or even three boxes.

If that activity curve really works out that way in real life and for people with Type 2 diabetes, and the drug turns out to be safe over the longer term, Afrezza might provide a way for people who were just diagnosed with Type 2 to normalize their blood sugar because it restores their lost first phase insulin.