According to the Center for Disease Control and Prevention, 25.8 million adults and children, or roughly 8.3 percent of the population have diabetes. Up to 24 million people suffer from Type 2 diabetes. Despite taking various oral medications, some patients having Type 2 diabetes continue having elevated blood sugars. Increasing physical activity or altering dietary intake may help. If these measures prove ineffective, physicians often alter medication dosages or change medications. As diabetes research continues, Janssen Pharmaceuticals, Inc. recently received FDA approval for the anti-diabetic formulation canagliflozin, sold by the company as Invokana.
Type 2 Diabetes Overview
After consuming food, the body begins the process of breaking down food and absorbing nutrients. Starches and sugars covert to glucose, which serves as cellular food. Glucose cannot enter cells without assistance from insulin excreted by the pancreas. One of two different physiological changes typically occurs in Type 2 diabetes. The pancreas produces insufficient levels of insulin or cells resist insulin, which blocks glucose absorption. Unused, the glucose circulates through the blood and to the kidneys, where the renal filtration system cleans the blood and eliminates a portion of the glucose through the urine. The kidneys also reabsorb glucose and the circulatory process continues.
Canagliflozin belongs to a new classification of medications known as sodium-glucose co-transporter 2 inhibitors. Sodium-glucose co-transporters or SGLT2 line the top region of the microscopic tubules in the kidneys known as enthrones. SGLT2 reabsorb glucose into the bloodstream. Canagliflozin plugs these filters, which prevents glucose reabsorption and lowers blood glucose levels. Physicians may prescribe canagliflozin alone or in conjunction with other anti-diabetic medications for the treatment of Type 2 diabetes. Jansen Pharmaceuticals does not recommend the medication for patients diagnosed with diabetic ketoacidosis, Type 1 diabetes or renal impairment.
Canagliflozin doses begin at 100 milligrams daily, taken before eating the first meal of the day. Doses may increase to 300 milligrams every day for increased blood sugar control as long as blood tests indicate that patients continue having normal kidney function. Patients demonstrating impaired glomerular filtration rates must remain on lower doses of the medication.
The most common side effects associated with canagliflozin include the development of yeast infections in men and women. Patients might also have a greater risk of developing urinary tract infections. Patients commonly experience increased thirst secondary to increased urination. Fluid loss may cause abdominal discomfort, nausea, constipation, dehydration and hypotension. Dehydration might also create life-threatening concentrated levels of blood potassium. Low-density lipoproteins, known as bad cholesterol often increase. The likelihood of hypoglycemia increases when taking canagliflozin with insulin. Some patients may suffer allergic reactions.
Canagliflozin becomes less effective when taken with substances known as UGT inducers. Examples of UGT inducers include carbamazepine, nicotine and rifampicin. Patients taking the medication with digoxin require routine monitoring, as canagliflozin increases the blood concentration levels of the heart medication.
National Center for Chronic Disease Prevention and Health Promotion. Division of Diabetes Translation. (2011, January). “National Diabetes Fact Sheet, 2011.” “Fast Facts on Diabetes.” Center for Disease Control. Retrieved from