Empagliflozin actually raised my glucose levels, slightly. I’m 46, relatively lean (14-15% body fat), and already have pretty low fasting glucose. My fasting glucose taken from blood panels has ranged from 67 to 83 mg/dL since 2023, my A1c has ranged from 5.4 to 5.1 during this time as well. My A1c goes up or down primarily depending on how much I eat and how many carbs I eat; same for my fasting insulin levels, which go low the less carbs I eat. So, I decided to experiment taking 10mg of empagliflozin daily, typically at night for about 90 days. During the last two weeks I put on a Stelo CGM and recorded my glucose values, then stopped taking it, and put on another CGM. I suspected that the empagliflozin was raising my glucose levels already, because when I used a finger prick in the mornings while on it, it was always in the 90s whereas usually its in the 80s.
The results were that empagliflozin did raise my average glucose by about ~4mg/dL, mostly by raising the low end/floor: my average on empagliflozin was 95.76 versus off at 91.95. Comparing the medians gave similar results, and as you might suspect, though, empagliflozin lowered the standard deviation a little bit, 9.70 compared to 11.27 normally. Interestingly, the highs, maximums and upper percentiles were almost identical. So it didn’t do anything to reduce spikes. So it seems to have prevented really low dips overnight, where most of my lower readings (in the 60s and 70s) occur.
To be thorough, I then performed a regression, adjusting for total daily calories and total daily carbohydrates (taken from my Chronometer app), just in case I was eating more while on empagliflozin. To my surprise, I was actually eating slightly more carbs off of it. The nutrition-adjusted efect was slightly larger than the unadjusted effect, about 4.65 mg/dL. Presumably this is due to a counteracting homeostatic effect, where my liver produces more glucose in response.
So for background, at the time I had been on 500mcg of semaglutide weekly and had been taking emiglimin daily, 1,000 mg, once at night also, about half the prescribed dose. These were unchanged though.
My question: are there any plausible benefits to taking something like SGLT2 inhibitors (or other drugs like imeglimin or acarbose) when your blood sugar is already really low? Another question is might these drugs be more effective for people on high carb diets? Right now, I am on a very high protein diet, 150mg to 200g daily out of my 3,000 calories, and usually about 100 grams of carbs. I realize this isn’t recommended by a lot of people, like Valter Longo, etc. But when I used to eat a lot of fruit and breads, my A1c would go up higher, albeit in ‘normal’ range, up to 5.4 for example. So now I’m thinking, perhaps you could get the best of both worlds, by eating healthy complex carbs, while also minimizing their negative effects by taking these drugs. What do you all think? I’ve since stopped taking empagliflozin, but might do an acarbose experiment next. But since my blood sugar is already very low, what biomarkers would I assess to see if they are having any benefit?