Adverse events related to osmotic diuresis
and volume depletion are among the most common.
Mylle, "Micropuncture study of pressures in proximal and distal tubules and peritubular capillaries of the rat kidney during osmotic diuresis
," The American Journal of Physiology, vol.
 Although these differences lack statistical power, we believe that the trends we observed point to the probability that the slower rate of NMC is due to two short-term effects of diabetes: hyperglycemia and osmotic diuresis, with the loss of water and electrolytes.
The decrease in the rate of NMC in diabetic patients could be due to a decrease in ATPase activity, poor stimulation (due to neuropathy), osmotic diuresis (with its loss of water and electrolytes), and altered carbohydrate metabolism.
This glucose production contributes even further to the ongoing hyperglycemia and increasing serum osmolarity and osmotic diuresis.
Despite this potential limitation to obtaining a history from the patient, the nurse should attempt to elicit from family members or significant others the common complaint of polyuria and polydipsia, which are secondary to the osmotic diuresis. The patient may also have experienced a significant weight loss.
Increased glucagon levels and osmotic diuresis
SGLT2 inhibitors may cause a slight decrease of potassium levels, which in turn increases serum potassium levels with redistribution due to decreased insulin levels.17 Eighteen randomized controlled meta-analysis with SGLT2 inhibitors including dapagliflozin have showed that these drugs dose dependency can increase magnesium levels by approximately 0.08-0.2 mEq/L in individuals without kidney disease.18 In our study we have also seen a slight increase in accordance with literature.
Discussion: The mechanism of action of SGLT-2 inhibitor therapy to increase urinary glucose excretion causes an osmotic diuresis
that can result in urinary frequency, polyuria, and volume depletion-related adverse events such as hypotension and dizziness.
Canagliflozin was associated with significantly higher rates of genital mycotic infections in both men and women, as well as more adverse events related to osmotic diuresis
. The infections were symptomatic, easily diagnosed, and readily treated with topical or oral antifungals.
These include genital mycotic infections, urinary tract infections, and adverse events related to osmotic diuresis
(pollakiuria), polyuria, and volume depletion.
 Achieving moderate diabetic control may be of some benefit to the patient, possibly avoiding hypoglycemia and extreme hyperglycemia, lowering risk of infection, improving functional status, and avoiding osmotic diuresis