I wonder how big this risk truly is (of hypoglycemia) for healthy people. I thought that one of the primary effects of this class of drugs (as with acarbose) is the just flatten the curve, thus reducing the blood sugar spike we get after consuming food / carbs., but with no change in the AUC. At the same time I wouldn’t recommend SGLT2 inhibitors to anyone on a Keto diet, due to the risk of ketoacidosis as identified in posts above in this thread.
“The risk of hypoglycemia associated with SGLT2 inhibitors is low, unless co-administered with insulin or an insulin secretagogue”. From the source above by @tongMD
Also, as a circumcised male, the risk of genital infections (especially for those of us who have never had such an infection ever before) seems extremely low (and this is the highest risk side effect I believe) and easily treatable in the low chance it does happen.
SGLT2 inhibitors are associated with an increased risk of genital mycotic infection, 5,6 particularly in patients with a history of genital mycotic infection and in uncircumcised males.1, 2,3, 4Genital mycotic infections occur more frequently in females than males receiving treatment with SGLT2 inhibitors, are generally mild or moderate in severity, and respond to standard antifungal therapy.
The other risk are UTIs. Again - in healthy, non diabetic males, with no previous history of UTI, it seems like a low risk:
Data on the potential SGLT2 inhibitor-associated risk of urinary tract infection (UTI) are less consistent, and published reports have provided conflicting conclusions. Some SGLT2 inhibitor studies suggested an increased associated risk of UTI, whereas others did not.
Its unclear to me why exactly anyone would think that the risk of serious side effects with SGLT2 inhibitors is unacceptably high for healthy, younger males with a low to moderate carb diet. I don’t see the specific risk factors that are high - especially when using SGLT2 inhibitors in a pulsed dosing fashion (My default right now is 5 days out of 7, so a two day “off” period each week.