From the Guidelines
For a 76-year-old female with diabetes experiencing excess sweating while on multiple medications, including Jardiance, it is crucial to evaluate this symptom promptly, considering the potential benefits of SGLT2 inhibitors like Jardiance in reducing cardiovascular disease and heart failure outcomes, as highlighted in the 2025 standards of care in diabetes 1. Given the patient's medication regimen, which includes a statin, mirtazapine, fosinopril, bisoprolol, and Jardiance, excess sweating could be related to various factors, including hypoglycemia, a common side effect of diabetes medications like Jardiance (empagliflozin).
- Key considerations include:
- Monitoring blood glucose levels more frequently, especially when sweating occurs, to determine if low blood sugar is the cause.
- Keeping fast-acting glucose sources readily available if hypoglycemia is confirmed.
- Consulting the doctor about adjusting the medication regimen, as mirtazapine can sometimes cause sweating as a side effect, and the combination of multiple medications may be contributing to this symptom.
- Checking if the sweating occurs at night, which could indicate nocturnal hypoglycemia or a side effect of the beta-blocker bisoprolol.
- Staying well-hydrated and maintaining a consistent eating schedule. The importance of managing cardiovascular risk factors, including hypertension and dyslipidemia, as outlined in the 2016 American Diabetes Association standards of medical care in diabetes 1, should also be considered in the overall management plan for this patient.
- This includes:
- Systematically assessing cardiovascular risk factors at least annually.
- Controlling individual cardiovascular risk factors to prevent or slow the development of atherosclerotic cardiovascular disease (ASCVD).
- Implementing lifestyle therapy for patients with diabetes and hypertension, consisting of weight loss, a reduced-sodium diet, moderate alcohol intake, and increased physical activity.
- Using pharmacologic therapy that includes either an angiotensin-converting enzyme (ACE) inhibitor or an angiotensin-receptor blocker (ARB), but not both, and considering multidrug therapy to achieve blood pressure targets.
From the Research
Medications and Diabetes Management
- The patient is taking several medications, including statin, mirtazepine, fosinopril, bisoprolol, and Jardiance (empagliflozin) 2, 3, 4.
- Empagliflozin is a sodium glucose cotransporter-2 (SGLT2) inhibitor that has been shown to be effective in improving glycemic control and reducing the risk of cardiovascular events in patients with type 2 diabetes 2, 3.
- The medication has been found to have a favorable effect on non-glycemic outcomes, including modest reductions in body weight and blood pressure 2.
Excess Sweating and Diabetes
- There is no direct evidence in the provided studies that links excess sweating to the medications listed or to diabetes management 2, 5, 6, 3, 4.
- However, it is known that people with diabetes may experience symptoms such as increased sweating due to high blood sugar levels or as a side effect of certain medications.
Blood Glucose Monitoring
- Self-monitoring of blood glucose is a critical element in diabetes management, and healthcare providers should work with patients to determine the best approach for monitoring and interpreting results 5, 6.
- Regular monitoring of blood glucose levels can help patients with diabetes to manage their condition effectively and reduce the risk of complications 6.