Some think you can’t be too rich or too thin. A stylish female, type 2 diabetes, 46 years of age came into the office (a weight loss clinic) for a follow up. Everyone was telling her how great she looked. She said she was feeling great and excited because she could fit into clothes she couldn’t fit in the past few years. She lost 9 pounds in three months. She had not been self monitoring her glucose. She was thrilled, but her doctor wasn’t so thrilled, at least not yet. He was concerned her glucose was elevated.
Hemoglobin A1C came back elevated as was her potassium. She was taking her basal insulin as prescribed, a SGLT-2 inhibitor and an ARB. We called her immediately, increased her basal insulin and asked her to stop her SGLT-2, we need to see her more often, come in to recheck her labs in one week.
- Although basic, HCPs need to always remember: no matter how much weight a patient wants or needs to lose, weight loss is not always a positive outcome.
- ACE-I and ARBs, recommended for people who have diabetes, can increase potassium levels.
- SGLT-2s, indicated for people who have type 2 diabetes, can increase potassium levels.
- People who have type 2 often don’t have symptoms of hyperglycemia, even though their glucose levels are increased.
- When patients are taking both ACE-1 and/or ARB and SGLT-2, and potassium is elevated, choose, depending on patient history, which to stop. If blood pressure is managed and the patient is on insulin, one choice is to stop the SGLT-2, and increase insulin to help manage hyperglycemia.
- Check labs often, and teach your patients the importance of self-glucose monitoring between visits. Teach levels to report, make necessary changes rather than wait 3 to 6 months for office visits.
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