Fournier Gangrene

What are SGLT2 inhibitors?

• How do SGLT2 inhibitors work?

• How are SGLT2 inhibitors taken?

• What other side effects do SGLT2 inhibitors cause?

• SGLT2 inhibitors and driving

• Who should not take SGLT2 inhibitors?

• What if I forget to take my medication?

• Getting the most from your SGLT2 inhibitor medication

Sodium-glucose co-transporter-2 or SGLT2 inhibitors as they are more commonly known are a class of medications that are commonly used to treat type 2 diabetes. You may be prescribed it to take on its own, or with other diabetes medicines. It can also be used for the treatment of heart failure and chronic kidney disease to help protect the heart and the kidneys.

There are a few different tablets in the SGLT2 inhibitor family, these include:

How do SGLT2 inhibitors work?

They work by stopping the kidneys from reabsorbing glucose back into the blood. This allows the kidneys to reduce blood glucose levels as the remaining glucose is removed from the body in your urine. As you are losing glucose from your body, you are effectively losing calories so SGLT2 inhibitors can help some people lose weight.

SGLT2 inhibitors reduce the symptoms of the high blood glucose levels (such as feeling thirsty). In the long-term, good control of blood glucose levels reduces the risk of developing problems with your eyes, kidneys and feet.

They have also been shown to lower the risk of heart attacks, help people with heart failure and slow the progression of kidney disease. This class of medication may be beneficial if you already have these conditions or are at high risk of developing these in the future.

How are SGLT2 inhibitors taken?

SGLT2 inhibitors are given in a tablet form and can be taken at any time of the day, usually accompanied by a glass of water. It is important to take your medication at the same time each day and you don’t need to take them with food.

Because of the way that SGLT2 inhibitors work, your urine will test positive for glucose while you are on this medication.

What other side effects do SGLT2 inhibitors cause?

Most people can take SGLT2 inhibitors without experiencing many other side effects. However, like all medications, SGLT2 inhibitors can cause side effects in some people and, very rarely, these can be serious.

Some of the side effects include:

• Higher risk of developing genital and urinary tract infections

• Urinating more frequently

• Flu like symptoms

• Nausea

• Joint pain

Germs (bacteria and fungus) like to grow in body fluids with a high sugar content. Because SGLT2 inhibitors increase the amount of glucose in your urine, they do increase the chance of urine infection and/or genital (vaginal or penile) thrush infection (sometimes known as Candida).

The risk of infection can be reduced by increasing the amount of non-sugary fluids you are drinking when you start the medication. Severe urine infection is rare, but you should see your doctor or nurse if you have any signs of infection, such as burning pain or discomfort when passing urine, obvious blood in the urine or a discharge from the penis or vagina.

There have been recent reports linking a serious genital infection called Fournier’s Gangrene to SGLT2 inhibitors, although the risk is extremely low. Affected individuals usually have other severe medical conditions.

Fournier’s Gangrene usually starts with an area of redness or a sore in the genital/groin area that spreads quickly. People also usually feel very unwell. You must report any such symptoms urgently to your doctor or nurse.

People with diabetes are at increased risk of getting sores or ulcers on the feet and legs. SGLT2 inhibitors can reduce the circulation to the fingers and toes and so increase the chance of a sore or ulcer developing. It can also make the fingers and toes feel colder. This can in theory increase the risk of amputation and so you should speak to your doctor or nurse if you develop a new sore or ulcer or feel that the circulation to your fingers and toes is less good.

SGLT2 inhibitors can raise the blood levels of chemicals called ketones. Very rarely, this can lead to a condition called ‘diabetic ketoacidosis’, which is more usually seen in people with type 1 diabetes but can occur in people with type 2 diabetes. Contact your doctor or nurse straight away if you notice a sweet smell on your breath, sweat or urine, or if you have symptoms such as: feeling sick, tummy pains, losing weight quickly, feeling very thirsty, breathing unusually quickly, confusion, tiredness or sleepiness.

You should stop taking SGLT2 inhibitors if you become very unwell, especially if you have vomiting and/or diarrhoea or are not eating and drinking. You can start taking them again once you are back to normal health. You should inform your

doctor or nurse at the earliest opportunity that you have stopped your SGLT2 medication.

SGLT2 Inhibitors and Driving

SGLT2 inhibitors should not affect your ability to drive, cycle or use machinery or tools as long as your blood glucose levels are stable.

On their own they will not cause you blood glucose level to go too low (i.e. cause hypoglycaemia, which is classed as a blood glucose level less than 4 mmol/L,) but they may increase the risk of this happening if you also take insulin or drugs called sulphonylureas (e.g. gliclazide).

If you are in any doubt about driving whilst taking SGLT2 inhibitors, then speak to your diabetes care team or have a look at the national guidelines about driving when you have diabetes.

Who should not take SGLT2 inhibitors?

SGLT2 inhibitors are usually prescribed to adults who have type 2 diabetes. They may not be suitable for some people. You should tell your doctor before starting any of this medication if you:

• Have problems with your kidneys

• You are easily hydrated or take a high dose of diuretics (water tablets)

• Are pregnant, planning a pregnancy or breastfeeding

• Have problems with repeated urine infections

• Are taking any other medicines, this includes any herbal or prescribed

• Have had an allergic reaction to a medicine

What if I forget to take my medication?

If you forget to take a dose, then take it as soon as you remember unless it’s nearly time for your next dose. In this case, skip the missed dose and just take your next one as normal.

Do not take a double dose to make up for a missed one.

Getting the most from your SGLT2 inhibitor medication

Continue to take your medication regularly unless your doctor tells you otherwise. It is important that you keep your regular clinic appointments.

If you have been advised by your doctor or nurse about changes to your diet, stopping smoking or taking regular exercise, it is important that you follow this advice.

It is important for you to take care of the skin on your lower limbs and to report any sores or signs of infection to your doctor or nurse.

We will always respect your privacy, dignity and your religious and cultural beliefs particularly when intimate examinations are advisable – these will only be carried out with your express agreement and you will be offered a chaperone to attend the examination if you so wish.

You may also request a chaperone when making the appointment or on arrival at the surgery (please let the receptionist know) or at any time during the consultation.

You can be assured that anything you discuss with any member of the surgery staff, whether doctor, nurse or receptionist, will remain confidential. Even if you are under 16, nothing will be said to anyone, including parents, other family members, care workers or teachers, without your permission. The only reason why we might want to consider passing on confidential information without your permission would be to protect either you or someone else from serious harm. In this situation, we would always try to discuss this with you first.

If you have any worries or queries about confidentiality, please ask a member of staff.

If you would like to discuss matters of a confidential nature, either with our receptionists or a member of the dispensary team, we have a side room available in reception for this purpose.

We need to hold personal information about you on our computer systems and in paper records to help us to look after your health needs, and your doctor is responsible for their accuracy and safe-keeping. Please help to keep your record up to date by informing us of any changes to your circumstances.

Doctors and staff in the practice have access to your medical records to enable them to do their jobs. From time to time information may be shared with others involved in your care if it is necessary. Anyone with access to your record is properly trained in confidentiality issues and is governed by both legal and contractual duty to keep your details private.

All information about you is held securely and appropriate safeguards are in place to prevent accidental loss.

In some circumstances we may be required by law to release your details to statutory or other official bodies, for example if a court order is presented, or in the case of public health issues. In other circumstance you may be required to give written consent before information is released – such as for medical reports for insurance, solicitors etc.

To ensure your privacy, we will not disclose information over the telephone or fax unless we are sure that we are talking to you. Information will not be disclosed to family, friends or spouses unless we have prior written consent, and we do not, leave messages with others.

You have a right to see your records if you wish. Please ask at reception if you would like further details about our patient information leaflet. An appointment may be required. In some circumstances a fee may be payable.

All GP Practices are required to declare mean earnings (i.e. average pay) for GPs working to deliver NHS services to patients at each practice.

The average pay for GPs working in the practice of Brunswick Surgery in the last financial year was £65,287 before tax and National Insurance.

This is for 2 full time GPs and 4 part time GPs who worked in the practice for more than six months.

This practice is committed to preserving, as far as is practical, the security of data used by our information systems. This means that we will take all reasonable actions to;

Maintain the Confidentiality of all data within the practice by:

• Ensuring that only authorised persons can gain access to our systems
• Not disclosing information to anyone who has no right to see it

Maintain the integrity of all data within the practice by:

• Taking care over input
• Ensuring that all changes are reported and monitored
• Checking that the correct record is on the screen before updating
• Reporting all apparent errors and ensuring that they are resolved

Maintain the availability of all data by:

• Ensuring that all equipment is protected from intruders
• Ensuring that backups are taken at regular, predetermined intervals
• Ensuring that contingency is provided for possible failure or equipment theft and that any such contingency plans are tested and kept up to date

Additionally we will take all reasonable measures to comply with our legal responsibilities under:

• The Data Protection Act (2018)
• The Health and Safety at Work Act (1992)
• The Access to Health Records Act (1990)

Increasingly, patient medical data is shared e.g. between GP surgeries and District Nursing, in order to give clinicians access to the most up to date information when attending patients.

The systems we operate require that any sharing of medical information is consented to by patients beforehand. Patients must consent to sharing of the data held by a health provider out to other health providers and must also consent to which of the other providers can access their data.

e.g. it may be necessary to share data held in GP practices with district nurses but the local podiatry department would not need to see it to undertake their work. In this case, patients would allow the surgery to share their data, they would allow the district nurses to access it but they would not allow access by the podiatry department. In this way access to patient data is under patients’ control and can be shared on a ‘need to know’ basis.

Your patient record is held securely and confidentially on the electronic system at your GP practice. If you require treatment in another NHS healthcare setting such as an Emergency Department or Minor Injury Unit, those treating you would be better able to give you appropriate care if some of the information from the GP practice were available to them.

This information can now be shared electronically via: The Summary Care Record, used nationally across England

The information will be used only by authorised health care professionals directly involved in your care. Your permission will be asked before the information is accessed, unless the clinician is unable to ask you and there is a clinical reason for access.

If you would like to opt out, please ask reception for our opt out form.

A parent or guardian can request to opt out children under 16 but ultimately it is the GP’s decision whether to create the records or not, because of their duty of care to the child. If you are the parent or guardian of a child under 16 and feel that they are able to understand, then you should make this information available to them.

Who Has Access?

Across all health care settings, including urgent care, community care and outpatient departments in England.

Information Source

GP record

Content

• Your current medications
• Any allergies you have
• Any bad reactions you have had to medicines
• Additional information (upon request to your GP)

For more information visit:

www.digital.nhs.uk

Your patient record is held securely and confidentially on the electronic system at your GP practice. If you require treatment in another NHS healthcare setting such as an Emergency Department or Minor Injury Unit, those treating you would be better able to give you appropriate care if some of the information from the GP practice were available to them.

This information can now be shared electronically via: The Summary Care Record, used nationally across England

The information will be used only by authorised health care professionals directly involved in your care. Your permission will be asked before the information is accessed, unless the clinician is unable to ask you and there is a clinical reason for access.

If you would like to opt out, please ask reception for our opt out form.

A parent or guardian can request to opt out children under 16 but ultimately it is the GP’s decision whether to create the records or not, because of their duty of care to the child. If you are the parent or guardian of a child under 16 and feel that they are able to understand, then you should make this information available to them.

Who Has Access?

Across all health care settings, including urgent care, community care and outpatient departments in England.

Information Source

GP record

Content

Your current medications
Any allergies you have
Any bad reactions you have had to medicines
Additional information (upon request to your GP)
For more information visit:

www.digital.nhs.uk

The NHS operate a zero tolerance policy with regard to violence and abuse and the practice has the right to remove violent patients from the list with immediate effect in order to safeguard practice staff, patients and other persons. Violence in this context includes actual or threatened physical violence or verbal abuse which leads to fear for a person’s safety. In this situation we will notify the patient in writing of their removal from the list and record in the patient’s medical records the fact of the removal and the circumstances leading to it.