Medication Spotlight: Jardiance

Going forward, I hope to make a regular habit of sharing some portion of what I learn in medical school with the people who read this blog! That's why I'm starting a series of posts called "Medication Spotlight" where I take the time to share just a little bit about some supplements/medications you might see advertised on TV.

I just happened to finish my endocrine block in medical school, so I thought I'd briefly describe a medication that came as we talked about a less-than-rare disease: Type 2 Diabetes. The particular drug that I'm highlighting today is Jardiance (empagliflozin), which has been making some rounds on some of the TV channels I've seen. To understand exactly why Jardiance is a medication used to treat Type 2 Diabetes, it's important to have a brief understanding of exactly what diabetes is.

Diabetes In a Nutshell

One of my professors a couple weeks ago very aptly described diabetes as a "derangement of fuel metabolism". To those of us without a PhD, what he meant is that diabetes is a situation where your body has issues moving the sugar you eat into the places where it can be used to help give your body energy. Sugars, and specifically glucose (a type of sugar), are essential parts of helping your body's cells generate the energy they need to function.

When you eat something sugary, your body normally absorbs the glucose into your bloodstream, where it can travel throughout your body to get to the cells that need it most. There's a lot of crazy biochemistry that goes into how your cells use sugar to make energy, but just for now assume that glucose is like a battery that helps fuel your body!

Once it gets in your bloodstream, though, the glucose needs a little more help to get where it needs to go. That's where an incredibly important molecule called insulin comes in. Insulin is kind of like the key that glucose uses to get into your cells once it's in your body. When lots and lots of glucose is in your blood (i.e., after you drink a sugary pop), your body produces insulin to help get that sugar into your cells where it can be used. We don't need a bunch of "batteries" (glucose) hanging out where they can't be used (outside of your muscle cells, etc.)! The insulin then lets the glucose into the cells, and all is well and good and sunshine and roses. Except when it's not.

See, in diabetes (both Type 1 and Type 2), your body has some issue with how well insulin ends up working to help get the glucose in your cells. In Type 2 diabetes specifically, your cells don't respond well to the insulin that your body makes. Essentially, the "lock" that the "key" (insulin) is trying to open is broken in a lot of your cells, and therefore the glucose can't get where it needs to go. Since the glucose just sits in your bloodstream, your cells can't get any energy from it!

Just A Few Facts About Type 2 Diabetes

On top of that, the glucose can keep accumulating in your blood to the point that it starts hurting different parts of your body. Once again, lots of biology and chemistry go into how that happens (which I'd be happy to describe if you were interested), but for our purposes, just recognize that lots and lots of sugar in your blood is bad for your body. Over time your kidneys, blood vessels, and even your eyes can get damaged because of the immense amounts of glucose that gets trapped in your blood.

So how do we fix this? That's where a medication like Jardiance comes in.

What Jardiance Does to Help

Jardiance is a medication that is part of a group of drugs called SGLT-2 Inhibitors. I realize that the chances are that that meant absolutely nothing to you. After reading this, hopefully it'll mean a little to you.

Jardiance works, interestingly enough, not in your bloodstream but in your kidneys. Your kidneys filter out waste products (which can include extra glucose) that float around in your blood. SGLT-2 is a certain type of transporter in your kidneys that keeps glucose in your blood instead of letting it get passed out in your urine.

Jardiance blocks this transporter from reabsorbing the glucose into your body, allowing lots and lots of the extra glucose to leave your body when you go to the bathroom. This helps to lower the amount of glucose that stays in your blood and to prevent all the bad things that happen when you have high blood sugars. In short, Jardiance helps you to pee out the extra sugar in your body!

One of the interesting things about this type of drug (SGLT-2 inhibitor) is that it can seem a little counterintuitive to someone who knows what "diabetes mellitus" (Type 2 diabetes) means. "Diabetes mellitus", when translated to its original Greek and Latin roots, essentially means "honey/sweet urine". The disease gets this name because the high levels of sugar in your body causes some glucose to spill into your urine naturally because your kidneys cannot reabsorb all of the glucose being filtered. It may seem odd that we would give a person a medicine (Jardiance) that would make their urine even more sugary, but it actually helps a lot in the long run to prevent the worst symptoms of diabetes. All I know is I'm glad I wasn't the guy who had to figure out how diabetic urine tasted!

The Important Points

• Your body needs sugar for energy

• Insulin is the "key" to help sugar get into your cells

• Type 2 Diabetes is a disease where insulin doesn't work as well as usual

• When insulin doesn't work, the sugar just stays in your blood and accumulates

• At a certain point, blood sugar that is too high starts to cause lots of issues

• Jardiance is a drug that helps lower blood sugar in Type 2 Diabetics

• It blocks a transporter in the kidneys that reabsorbs glucose, making you expel more of the glucose in your urine, thus lowering your blood sugar

• Don't go around tasting different types of urine to see which one is the sweetest (not in the article, just a piece of advice)

Thank you so much for reading! Let me know if you enjoyed this article, and I'll gladly make some more!