Hormonal
Sodium-glucose cotransporter type 2 inhibitors (SGLT2is) reduce HbA1c, fasting plasma glucose, and body weight in Type 2 Diabetic athletes, but pose risks of hypovolemia, dehydration, and euglycemic DKA.
If you take SGLT2 inhibitors (like empagliflozin or dapagliflozin) for Type 2 Diabetes, you will likely lose weight and improve your blood sugar control. However, these drugs make you urinate more, which can lead to dehydration and dizziness during exercise. Drink extra water, watch for signs of low blood pressure, and be aware of the rare risk of euglycemic DKA (diabetic ketoacidosis with normal blood sugar).
In a network meta-analysis of randomized controlled trials (RCTs), all SGLT2 inhibitors (SGLT2is) used as monotherapy were found to be significantly more effective than placebo in reducing HbA1c levels from baseline... and reducing mean body weight... SGLT2 inhibitors (SGLT2i), such as empagliflozin and dapagliflozin, provide glycemic control without relying on insulin. However, they pose three significant risks for athletes: hypovolemia/dehydration from osmotic diuresis, an increased risk of hypoglycemia when used with insulin or sulfonylureas, and the potential for euglycemic DKA.
Why this rating
The efficacy data is supported by Grade A evidence (network meta-analysis of RCTs).
Source
Nutritional considerations for athletes with diabetes: optimizing performance and glycemic control
Liguang Xu et al. · Frontiers in Nutrition · 2026
DOI 10.3389/fnut.2026.1737219
More from this paper
- Athletes with Type 1 Diabetes should maintain pre-exercise blood glucose levels between 7.0–10.0 mmol/L to offset the risk of hypoglycemia, as exercise increases glucose disposal via GLUT4 translocation and insulin sensitivity.Moderate
- Carbohydrate intake of 3–12 g/kg/day, adjusted for exercise duration and intensity, is recommended for athletes with diabetes to optimize glycogen storage and performance.Moderate
Related findings · Hormonal
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