Can Jardiance Cause Increased Blood Sugars in Chronically Hyperglycemic Patients?
No, initiating Jardiance (empagliflozin) in a chronically hyperglycemic patient will not cause increased blood glucose levels—it will lower them. Empagliflozin works by blocking glucose reabsorption in the kidney, causing glucose excretion in the urine, which directly reduces blood glucose levels 1.
Mechanism of Action and Glucose-Lowering Effect
Empagliflozin inhibits SGLT2 in the proximal renal tubule, preventing approximately 90% of filtered glucose from being reabsorbed back into the bloodstream 1.
This mechanism increases urinary glucose excretion by approximately 64 grams per day with the 10 mg dose and 78 grams per day with the 25 mg dose 1, 2.
The glucose-lowering effect is actually more pronounced in the setting of hyperglycemia, where significant amounts of glucose are filtered into the urine 3.
As blood glucose normalizes, the glucosuric effect diminishes, which creates a built-in safety mechanism that reduces hypoglycemia risk 3.
Clinical Evidence of Glucose Reduction
In clinical trials lasting 24-104 weeks, empagliflozin reduced HbA1c by approximately 0.8% when used as monotherapy or add-on therapy 2, 4.
In patients with chronic kidney disease and type 2 diabetes, empagliflozin 25 mg reduced HbA1c by 0.42% in stage 3 CKD and 0.52-0.68% in stage 2 CKD at 24 weeks 5.
The drug reduces both fasting and postprandial glucose levels independently of insulin secretion 2, 6.
Important Considerations in Chronically Hyperglycemic Patients
The efficacy of empagliflozin increases according to the level of hyperglycemia, making it particularly effective in poorly controlled patients 2.
However, glucose-lowering efficacy decreases significantly when eGFR falls below 45 mL/min/1.73 m² due to reduced glomerular filtration of glucose 3, 7.
Empagliflozin should not be initiated for glycemic control if eGFR is below 45 mL/min/1.73 m² 7.
Potential Confusion: Initial Fluid Shifts vs. Glucose Levels
Some clinicians may observe transient changes in glucose readings due to volume contraction from the osmotic diuresis (mean 24-hour urine volume increase of 341 mL on Day 1, decreasing to 135 mL by Day 5) 1.
This diuretic effect does not cause hyperglycemia—it may actually concentrate blood glucose measurements temporarily, but the net effect is always glucose reduction through urinary losses 6.
Safety Profile Relevant to Hyperglycemic Patients
Empagliflozin has no intrinsic risk of hypoglycemia when used alone, though hypoglycemia can occur when combined with insulin or sulfonylureas 4, 8.
When adding empagliflozin to patients on insulin or sulfonylureas, consider reducing doses of these agents by 50% to prevent hypoglycemia 9.
Monitor for diabetic ketoacidosis, particularly in insulin-deficient states, though this is rare in type 2 diabetes 3, 10.
Withhold empagliflozin at least 3 days before major surgery or during acute illness with reduced oral intake 7.