Key Questions and Education for Patients Taking Jardiance, Basaglar, and Rybelsus
When managing patients on this medication combination (empagliflozin, insulin glargine, and semaglutide), focus on monitoring for hypoglycemia, dehydration, and gastrointestinal side effects as these represent the most significant risks affecting morbidity and mortality.
Assessment Questions
Medication Understanding and Adherence
- How are you taking each medication? (Timing, with/without food, dosing)
- Are you able to consistently take your medications as prescribed?
- Do you understand the specific administration requirements for Rybelsus? (30 minutes before first food/drink of day with small sip of water)
- How are you storing your Basaglar insulin? (refrigeration requirements)
Hypoglycemia Monitoring
- Do you know the symptoms of low blood sugar? (confusion, dizziness, sweating, shakiness)
- How often do you experience symptoms of low blood sugar?
- What is your plan when you experience hypoglycemia?
- How often are you checking your blood glucose levels?
- What are your typical blood glucose readings?
Sick Day Management
- Do you know which medications to temporarily stop when you're sick or unable to eat/drink normally?
- Do you know when to contact your healthcare provider during illness?
Side Effect Assessment
- Have you experienced any urinary tract or genital infections? 1
- Have you had any gastrointestinal symptoms like nausea, vomiting, or diarrhea? 2
- Have you noticed increased urination or thirst? 1
- Have you experienced any unexplained weight loss?
- Have you had any symptoms of dehydration (dizziness, lightheadedness, fatigue)? 3
Patient Education
Medication-Specific Education
Jardiance (Empagliflozin)
- Explain that Jardiance works by causing sugar to be eliminated through urine 1
- Educate on potential side effects:
- Genital mycotic infections (yeast infections)
- Urinary tract infections
- Volume depletion (dehydration)
- Initial decrease in kidney function that is usually temporary 3
- Advise adequate fluid intake to prevent dehydration
- Teach about ketoacidosis risk even when blood glucose isn't severely elevated 1
Basaglar (Insulin Glargine)
- Explain proper injection technique and rotation of injection sites
- Teach proper storage requirements (refrigeration when not in use)
- Emphasize the importance of consistent timing of insulin administration
- Educate on signs and symptoms of hypoglycemia and proper management 3
Rybelsus (Semaglutide)
- Emphasize critical administration requirements:
- Take on empty stomach with small sip of water
- Wait 30 minutes before eating, drinking, or taking other oral medications
- Failure to follow these instructions significantly reduces absorption 2
- Discuss common gastrointestinal side effects (nausea, vomiting, diarrhea)
- Explain that these side effects often improve over time 2
Sick Day Management
Teach patients to temporarily stop these medications when ill with vomiting, diarrhea, or unable to maintain adequate fluid intake: 3
- Stop Jardiance (empagliflozin) immediately
- Continue Basaglar but monitor glucose closely and adjust as needed
- Consider holding Rybelsus if experiencing significant gastrointestinal symptoms
Advise patients to:
- Increase fluid intake with limited caffeine
- Monitor blood glucose more frequently (every 4-6 hours)
- Check for ketones if on SGLT2 inhibitor (Jardiance)
- Contact healthcare provider if symptoms persist beyond 72 hours 3
Hypoglycemia Prevention and Management
- Explain the increased risk of hypoglycemia with this combination therapy 3
- Teach patients to:
- Always carry fast-acting carbohydrates
- Check blood glucose before driving or operating machinery
- Recognize early symptoms of hypoglycemia
- Follow the 15-15 rule (15g carbs, wait 15 minutes, recheck)
Monitoring Requirements
- Blood glucose monitoring: frequency based on individual needs
- Regular kidney function testing (eGFR)
- Regular HbA1c testing
- Watch for signs of dehydration
- Monitor for urinary tract and genital infections 1
When to Seek Medical Attention
Instruct patients to contact healthcare provider immediately for:
- Inability to keep fluids down for more than 24 hours
- Severe or persistent nausea/vomiting
- Signs of ketoacidosis (nausea, vomiting, abdominal pain, fatigue, difficulty breathing)
- Severe hypoglycemia that doesn't respond to treatment
- Signs of urinary tract infection (burning, frequency, pain) 3, 1
Follow-up Recommendations
- Schedule regular follow-up appointments to assess medication effectiveness and safety
- Recommend regular laboratory monitoring of kidney function and HbA1c
- Consider continuous glucose monitoring to better assess glycemic patterns, especially given the limitations of HbA1c in patients with advanced kidney disease 3
This comprehensive approach to patient education and monitoring will help minimize risks and optimize outcomes for patients on this complex medication regimen.