Love the podcast but hate taking notes? The Diabetes Podcast blog compresses every episode into a bulleted, 10 minute read AND has the podcast embedded so you can listen as you read along! Check it out at https://empowereddiabetes.com/diabetes-podcast-blog

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.

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.

• “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.

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 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.

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.

• 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.

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 insulin sensitivity. You burn more energy even at rest.
• Move more. Walk, lift, stretch. Sit less.
• Eat more non-starchy vegetables and fruits. They add antioxidants. They help lower oxidative stress. They help calm the “bad signals” from visceral fat (fat around your organs).

Simple starter tips:

• Add a veggie to every meal.
• Take a 10–15 minute walk after eating.
• Do two days a week of strength work. Bodyweight counts.
• Drink water through the day.

What is Renal Glucose Reabsorption?
It’s how kidneys pull sugar back into the blood after filtering. It’s normal and helpful—until insulin resistance shows up.

Why do kidneys reabsorb more sugar in type 2?
Cells send a “we’re starving” signal. The kidneys respond by making more SGLT2s and reabsorbing more sugar. It backfires.

How do SGLT2 meds help?
They block those sugar “vacuums,” so sugar leaves in urine. This lowers blood sugar and can help with weight and heart/kidney protection.

Who should not use SGLT2s?
Not for type 1 diabetes. Use caution if you are insulin-deficient. Talk with your provider.

What are warning signs to act on?
UTI or yeast symptoms, new pain/swelling/redness in the perineum, nausea/vomiting, fruity breath, or feeling very ill. Seek care now and say you take an SGLT2.

Can I lower insulin resistance by building muscle?
Yes. More muscle usually means less insulin resistance. Strength work helps.

• Renal Glucose Reabsorption: kidneys taking sugar back into the blood.
• SGLT2: tiny kidney “transporters” that pull sugar back in.
• SGLT2 inhibitor: a drug that blocks those transporters so sugar leaves in urine.
• Glycosuria: sugar in urine.
• Insulin resistance: your cells do not respond well to insulin, so sugar stays in the blood.
• Visceral fat: fat around your organs inside your belly.
• Oxidative stress: damage from “free radicals”; antioxidants from fruits and veggies help.
• DKA (diabetic ketoacidosis): dangerous acid build-up from high ketones. Can happen even with normal-ish sugars on SGLT2s (euglycemic DKA).
• Fournier’s gangrene: rare, severe infection of the area between the genitals and the anus.

• Renal Glucose Reabsorption is normal, but in type 2 diabetes it can keep blood sugar high.
• SGLT2 inhibitors lower reabsorption and help sugar leave the body in urine.
• Watch for UTIs, yeast infections, DKA signs, and any severe pain/redness in the perineum.
• Lifestyle is powerful: build muscle, move more, and eat more plants.
• Aim to treat the root cause: insulin resistance.

We want this to be a two-way conversation. Send your questions to [email protected] we’ll talk about them on the podcast. Tell us what you need help with, and what topics you want next.

Next episode: muscle insulin resistance and metformin. We’ll talk about what it is, what metformin does, and how it fits with your goals.

Disclaimer:

The information in this podcast is for educational and informational purposes only. It is not medical advice, diagnosis, or treatment, and it does not replace a one-on-one relationship with your physician or qualified healthcare professional. Always talk with your doctor, pharmacist, or care team before starting, stopping, or changing any medication, supplement, exercise plan, or nutrition plan—especially if you have diabetes, prediabetes, heart, liver, or kidney conditions, or take prescription drugs like metformin or insulin.

Results vary from person to person. Examples, statistics, or studies are shared to educate, not to promise outcomes. Any discussion of medications, dosing, or side effects is general in nature and may not be appropriate for your specific situation. Do not ignore professional medical advice or delay seeking it because of something you read or heard here. If you think you are experiencing an emergency or severe side effects (such as persistent vomiting, severe diarrhea, signs of dehydration, allergic reaction, or symptoms of lactic acidosis), call your local emergency number or seek urgent care right away.

We strive for accuracy, but health information changes over time. We make no guarantees regarding completeness, timeliness, or suitability of the content and assume no liability for actions taken or not taken based on this material. Use of this content is at your own risk.

Links or references to third-party resources are provided for convenience and do not constitute endorsement. By reading, listening, or using this information, you agree to these terms and understand that you are responsible for your own health decisions in partnership with your licensed healthcare provider.