Type 2 diabetes: a three-month A1C follow-up

Good morning, Mrs. Hughes. I'm Dr. Lee. It's been three months since we added empagliflozin to your metformin. Before I go through your results, what would you most like to cover today?

Those are both important, and I'll come back to each of them. Let me start with the good news. Three months ago, your A1C was 8.6 percent. Now it's 7.2. That's a big improvement. What have your home blood sugar readings been like?

That fits nicely with the A1C. How are you feeling overall compared with three months ago?

That's great to hear. Most people miss a pill now and then, especially when their routine changes. How often do you think you miss the metformin or the empagliflozin?

Thank you for telling me. That's a practical problem, and we can solve it together. First, let's talk about side effects. Apart from going to the bathroom more, have you noticed anything else, like more thirst, or itching or irritation in the genital area?

I'm glad you did. Itching is a common side effect of this medicine, and it's treatable. I'd still like to examine you and check a urine sample today, to make sure there isn't an infection that needs its own treatment.

Understood. Have you had any spells where you felt shaky, sweaty, or confused, as if your sugar was too low?

Any changes in your vision, any chest pain, or any sores on your feet that are slow to heal?

Good. Now, your kidney worry. What have you been thinking the extra urination means?

It can, and that's exactly why we check. Your kidney tests look healthy. Your eGFR, which measures how well your kidneys filter, is 78, and the urine test for protein is normal. The extra urination is how empagliflozin works. It helps your kidneys pass extra sugar out in the urine, and water goes with it. That's also why you've lost some weight, and it can cause that itching. At your kidney level, this medicine actually helps protect your kidneys and heart.

Exactly. Now, about cutting down the metformin. I understand wanting fewer pills. Your A1C is 7.2 because both medicines are working together. If we cut one, your numbers would likely go back up. I'd suggest we keep both at the same doses and aim to keep your A1C around 7. How does that sound?

That makes sense, and taking both pills every day gives you the best chance of staying on pills. So let's make weekends easier. What do you always take with you when you travel?

Then how about keeping a small pill case with a few empagliflozin pills in your makeup bag, and setting a daily reminder on your phone?

Great. For the itching, keep the area clean and dry, and drink enough water, especially when you travel. If the itching doesn't settle, or you get burning, a fever, or pain in your side, call us. And call us right away if you feel sick to your stomach, vomit, have belly pain, or feel unusually tired, even if your sugar reading looks normal. That can be a rare but serious problem with this medicine. Also, if you're sick and can't eat or drink normally, or you're scheduled for surgery, check with us first, because you may need to pause the empagliflozin for a few days.

Thank you. Today I'd also like to do your yearly foot check, and we'll repeat your A1C in three months. So I know I've explained things clearly, could you tell me the plan in your own words?

That's exactly right. Let's start with your feet.