SGLT2 Inhibitors: How These Diabetes Drugs Work and What You Need to Know

When your body can’t manage blood sugar well, SGLT2 inhibitors, a class of oral diabetes medications that block glucose reabsorption in the kidneys. Also known as gliflozins, they help lower blood sugar by making your kidneys dump extra glucose into your urine instead of letting it back into your bloodstream. Unlike insulin or metformin, these drugs don’t depend on your pancreas or insulin sensitivity—they work wherever your kidneys are filtering blood. That’s why they’re often used when other pills stop working or when you need extra heart and kidney protection.

Three main SGLT2 inhibitors, empagliflozin, dapagliflozin, and canagliflozin. Also known as gliflozins, they are prescribed for type 2 diabetes and sometimes used off-label for heart failure or chronic kidney disease. Each one acts the same way, but studies show slight differences in how much they lower A1C, reduce weight, or protect your heart. For example, empagliflozin has strong data showing it cuts heart-related deaths in people with diabetes and heart disease. Dapagliflozin helps slow kidney damage even in patients without diabetes. Canagliflozin may raise the risk of foot amputations in some, so doctors monitor that closely.

These drugs don’t just lower sugar—they also help you lose a few pounds, lower blood pressure, and reduce swelling. That’s because every gram of glucose you pee out takes about 3.5 calories with it. You’ll also urinate more often, especially at first. That’s normal. But it also means you need to drink enough water. Dehydration is the biggest risk, especially if you’re older, on diuretics, or sick with vomiting or diarrhea. Low blood pressure, dizziness, and yeast infections (especially in women) are common side effects. Rare but serious risks include diabetic ketoacidosis, even when blood sugar looks normal, and Fournier’s gangrene, a rare but dangerous genital infection.

You won’t find SGLT2 inhibitors in the same breath as insulin shots or biguanides like metformin, but they’re now a go-to option for people who need more than one drug to control their diabetes. They’re especially helpful if you have heart failure, kidney disease, or need to lose weight. They’re not for type 1 diabetes, and they’re not safe if you have severe kidney problems. If you’re on one of these meds, your doctor will check your kidney function regularly and watch for signs of infection or dehydration.

Below, you’ll find real-world guides on how these drugs interact with other medications, what to do if you miss a dose, how they affect your body long-term, and what alternatives exist if they don’t work for you. These aren’t theoretical reviews—they’re written by people who’ve lived with these prescriptions, managed side effects, and learned what actually works.