My wife was recently diagnosed with severe heart failure and an LVrEF of 30-35%. She has had permanent atrial fibrillation for the last 14 years and has had type 1 diabetes for over 40 years.
When she was discharged from hospital she was given a variety of medications which the dispensing nurse went through and explained one by one. When it came to the Dapagliflozin, however, she was puzzled as to why it had been prescribed as she thought that it was not suitable for a type 1 diabetic. She withheld it and crossed it off the list.
The hospital cardiologists had been confused about her diabetes and didn't want to accept that she was type 1, despite it being clearly stated on her notes and her having been type 1 and using insulin at least 4 times daily for over 40 years. It was an odd situation.
I had expected her to be told about the blood sugar lowering effect of Dapagliflozin and advised that she might need to adjust her insulin dose accordingly. Dapagliflozin is supposed to have some clear benefits for heart failure, my wife has very good blood sugar control and would never run the risk of ketoacidosis (a known side-effect of Dapagliflozin) by allowing her blood sugar to rise to dangerous levels.
When my wife saw the heart failure nurse a few weeks later, she brought this up. The nurse thought it was a good point and said that she would bring it up with the cardiologist as it seemed unhelpful to deny her a drug with a clear benefit because of a practically non-existent risk.
She hasn't had a reply to that query, she will see the heart failure nurse again next week and will bring up the subject again. I am not sure, given the cardiologist's previous confusion about her diabetes, that he has a good grasp of diabetes management. Meanwhile, her GP has said that she doesn't think that Dapagliflozin is a good idea. Perhaps she doesn't know how well controlled my wife's diabetes is, or perhaps there is some other circumstance, not connected to high blood sugar, that might trigger ketoacidosis in her case?
Sorry to be so long-winded, it is complicated. Neither the cardiologist, the heart failure nurse nor the GP seem to have a clear answer as to whether Dapagliflozin is a good idea or not in her case...I wonder if anyone has any "real world" experience of this...?