"Anything Meds Can Do, You Can Do Better" - Part 2 of 12 - Renal Glucose Reabsorption

Renal Glucose Reabsorption 

Renal Glucose Reabsorption, SGLT2 Inhibitors, and Simple Steps You Can Take
Learn Renal Glucose Reabsorption in plain language. Amber and Richie explain SGLT2 meds, side effects, costs, and easy lifestyle tips for type 2 diabetes.

Episode Snapshot

In this episode, we break down Renal Glucose Reabsorption. That is how your kidneys handle sugar. We keep it simple and real. We talk about what happens in a healthy body, what changes in prediabetes and type 2 diabetes, how SGLT2 drugs work, side effects to watch for, costs, and what you can do today. We also share why building muscle helps insulin resistance, and why food and movement still matter.

What Is Renal Glucose Reabsorption?

• “Renal” means kidneys.
• “Glucose” means sugar.
• “Reabsorption” means your body takes it back in.

Your kidneys filter your blood all day long. They are like smart strainers. They filter out waste. They keep the good stuff. One “good stuff” is glucose. In a healthy state, your kidneys pull most of the sugar back into your blood so your body can use it. This is Renal Glucose Reabsorption.

Fun fact from Amber: your kidneys normally pull about 180 grams of glucose back into the blood each day. That is normal and helpful.

There is also a “spill point.” If blood sugar goes above about 180 mg/dL, some sugar starts to spill into the urine.

What Changes in Type 2 Diabetes and Prediabetes

In type 2 diabetes and prediabetes, insulin resistance shows up. That means:

• Blood sugar in the bloodstream is high.
• But your cells cannot use that sugar well.
• Your cells “feel” hungry even when sugar is there.

Your kidneys “listen” to these hungry cells. The kidneys make more SGLT2 transporters (think: more vacuums). These SGLT2s pull even more sugar back into your blood. This is one of Ralph DeFronzo’s “dirty dozen” core defects in type 2 diabetes.

So:

• Blood sugar is high.
• Cells are still “starving.”
• Kidneys reabsorb more sugar.
• The problem gets worse.

Richie put it simply: it’s a communication fail. The body is trying to help, but it backfires.

SGLT2 Inhibitors: What They Are and How They Help

SGLT2 inhibitors are a class of medicines. Common ones:

• Farxiga
• Jardiance
• Invokana

What they do:

• They block (inhibit) the SGLT2 “vacuums” in the kidney.
• That lowers Renal Glucose Reabsorption.
• More sugar leaves the body in urine.

Main benefits:

• Lower blood sugar.
• Help with weight loss (you pee out extra calories).
• Can protect the heart and kidneys in people who already have heart disease or kidney disease.

Amber’s take: these meds can help the core defect. They also work best alongside lifestyle changes.

Side Effects and Safety: What to Watch For

Most common:

• Urinary tract infections (UTIs). Sugar in urine can feed bacteria.
• Genital yeast infections (female genital mycotic infections). Sugar can feed yeast.

Rare but serious:

• Fournier’s gangrene (a very serious infection of the area between the genitals and the anus). If anything feels wrong “down there” on these meds, seek care now.

Diabetic ketoacidosis (DKA), including “euglycemic DKA”:

• DKA is when your body cannot use glucose well, so it burns fat fast and makes ketones. Ketones can build up and make your blood acidic.
• Signs can include nausea, vomiting, belly pain, lightheadedness, and fruity or nail polish remover breath.
• With SGLT2s, DKA can happen even if your blood sugar is not super high (it might be around 200–250 mg/dL).
• Higher risk if you are insulin-deficient (some people with long-standing type 2) and in type 1 diabetes.
• SGLT2 inhibitors are not FDA-approved for type 1 diabetes.

What to do:

• If you feel sick, have the signs above, or something “down there” is painful, red, swollen, or hot, get medical help right away and tell them you take an SGLT2 inhibitor.

Cost Talk

• Copays vary by insurance. Many people pay about $30–$80 per month.
• That is about $650 per year at the median estimate Amber shared.
• Over 10 years, that adds up.
• This is one reason we aim for remission when possible and work on the root cause.

Why Lifestyle Still Matters (A Lot)

You can out-eat any diabetes medicine. We see it. Even on max doses of SGLT2s, metformin, GLP-1s, and insulin, blood sugar can still be high if eating patterns and movement do not support insulin sensitivity.

Big levers you control:

• Lose extra weight if you have it. This reduces insulin resistance.
• Build metabolically active tissue:
  • Muscle mass
  • Bone density
    More muscle = better