SGLT2 Inhibitors: Everything You Need to Know

Medically Reviewed by Michael Dansinger, MD on March 16, 2023
6 min read

SGLT2 inhibitors are a type of medicine you might take to lower your blood sugar when you have type 2 diabetes. They increase the amount of blood sugar (or glucose) you get rid of when you pee.

If you have type 2 diabetes and you've already tried other treatments, your doctor may suggest you take SGLT2 inhibitors. They keep your kidneys from absorbing as much blood sugar to help you get rid of it.

SGLT2 inhibitors vs. other diabetes medicines

The goal in managing your type 2 diabetes is to make a hormone called insulin more available in your body to keep your blood sugar at a healthy level. Treatments can do that in a number of ways.

The most straightforward treatment is to get a shot of insulin to raise the amount that's in your body. You may also take drugs that trigger your body to release more insulin. Other medications make your body more sensitive to insulin or slow down how fast carbohydrates get absorbed into your bloodstream.

SGLT2 inhibitors work in a different way to lower your blood sugar. They curb the action of proteins called "sodium-glucose cotransporter 2" that help your kidneys reabsorb glucose (sugar) from your blood. After you take SGLT2 inhibitors, less of your blood sugar ends up in your kidneys and more of it leaves your body in your urine.

SGLT2 inhibitors all do about the same thing. They're all taken by mouth. You generally take once a day before your first meal.

Your doctor might suggest you try one of these SGLT2 inhibitors:

If you're thinking about taking an SGLT2 inhibitor to treat your diabetes, ask your doctor which one you should try first and why. 

SGLT2 inhibitors aren't usually the first medicine your doctor will suggest for type 2 diabetes. 

Before you try an SGLT2 inhibitor, your doctor will likely suggest you make changes in your lifestyle -- like diet and exercise -- as well as take a medication such as metformin.

Because SGLT2 inhibitors are a newer medication, there is limited information about their long-term safety. And they're only able to lower blood sugar by a small amount, compared with other medications.

Your doctor might consider an SGLT2 inhibitor if:

  • You already take several medications and your blood sugar is still not well-controlled.
  • There's a medical reason you can't take other diabetes medications.
  • You're at risk for getting dangerously low blood sugar .

The drugs can be an option if you're uncomfortable with giving yourself insulin shots. Your doctor might also suggest them if you need to lose weight or lower your blood pressure.

These drugs might be an option if you don't want to start insulin to treat your diabetes. They are unique in lowering glucose without affecting insulin levels. SGLT2 inhibitors can help to protect your kidneys. They can slow down kidney disease and may make heart failure less likely when you have type 2 diabetes. 

The FDA hasn't approved these medications to treat type 1 diabetes. They're not recommended for anyone who has had diabetic ketoacidosis, a serious complication of diabetes.

SGLT2 inhibitors also aren't that helpful for someone who already has severe kidney disease.

Before prescribing an SGLT2 inhibitor, your doctor will think about any other health conditions you have. They'll also watch your blood sugar levels and kidney function at every visit. The goal is to limit the risks that come with this new class of medicine and make sure you're getting as much benefit from your treatment as possible.

If you are pregnant or want to get pregnant, ask your doctor if you should stop taking SGLT2 inhibitors. There hasn't been a lot of information about whether they are OK to take when you're pregnant or breastfeeding. One recent review of all the studies available found some evidence that these medicines aren't safe to take during pregnancy or breastfeeding. 

They concluded that it's a good idea to stop taking them when you're pregnant or want to get pregnant. You should always talk to your doctor before stopping your medicines. More data is needed to know how these medicines affect pregnancies.

These medications may make you:

  • Pee more often, both during the day and at night
  • Thirsty
  • More likely to get yeast or urinary tract infections
  • Have pain in your pelvis or back
  • Have itchiness, discomfort, or swelling in your vagina or penis
  • Feel tired or weak
  • Have a fever
  • Have symptoms similar to the flu
  • Swell in your legs or feet
  • Have blood pressure that is too low
  • Lose bone density
  • Be more likely to get broken bones
  • Get dehydrated

The most serious side effect of SGLT2 inhibitors is a greater chance that you could get diabetic ketoacidosis, a condition that happens when your body makes too many acids called ketones. If you notice changes or side effects you think are related to your SGLT2 inhibitors, let your doctor know. 

SGLT2 inhibitors and weight loss

SGLT2 inhibitors can make you lose weight. The reason is that you're peeing out blood sugar (glucose), which means that you are losing calories. You'll pee out about 60-100 grams of glucose every day. But you may not lose as much weight as you'd expect. That's because you're likely to make up for the lost calories by eating more. If you're taking SGLT2 inhibitors for your diabetes and are trying to lose weight, ask your doctor about other things you can do to help you reach your health goals.

SGLT2 inhibitors were developed to lower blood sugar in type 2 diabetes. But they do have other uses. Some of them are approved for chronic kidney disease. They also can treat heart failure. They can reduce the risk of:

  • Heart attack
  • Stroke
  • Heart failure flares

SGLT2 inhibitors are used for type 2 diabetes. They aren't usually the first choice, but they can help to lower your blood sugar in a different way than other medicines by making you lose more glucose in your pee. They also have some other benefits for protecting kidneys and treating heart failure. If you have type 2 diabetes, kidney disease, or heart failure, ask your doctor if SGLT2 inhibitors are worth a try.

  • What is the most popular SGLT2 inhibitor?

Empagliflozin (Jardiance) is the most popular drug in this class, but you can't get a generic version. Compared to other drugs in this class, it is more selective. That means that it does the best job of targeting sodium-glucose cotransporter 2 and not a similar protein called sodium-glucose cotransporter 1 (SGLT1).

  • Is Ozempic an SGLT2 inhibitor?

Ozempic (semaglutide) is another drug for type 2 diabetes, but it isn't an SGLT2 inhibitor. It works in a different way to help your pancreas release more insulin. The medicine does this by acting like another hormone your body has called GLP-1.

  • Are SGLT2 inhibitors good or bad?

SGLT2 inhibitors aren't inherently good or bad. They probably won't be the first medicine you'll try for type 2 diabetes. Like any medicine, they can have side effects. But they may be a good option to consider in consultation with your doctor. Along with lowering glucose, they can slow down kidney disease and make kidney failure less likely. They also can help with heart failure.