Open Community Question @MidwestCardioDad • 45-59F • 10mg empagliflozin + 500mg m • Week 12

▲ 48 Helpful • 2 Peer Replies

Empagliflozin 10mg AM + 10-min post-dinner walk + ALA 600mg (12 wks update): Protocol summary from a 52-year-old with type 2 diabetes, early neuropathy, and eGFR 71 — what worked for others here?

Protocol summary from a 52-year-old with type 2 diabetes, early neuropathy, and eGFR 71. Medications: empagliflozin 10 mg at 7 a.m., metformin ER 500 mg with dinner (stepped up from IR to reduce stomach upset), and a 10-minute walk starting about 10 minutes after dinner. I also added alpha-lipoic acid 600 mg once daily on an empty stomach, after discussing it with my clinician. Results: fasting glucose fell from 148 to 121 mg/dL, A1c from 7.8% to 7.0%, and the tingling in my feet eased slightly. Changes that helped: moving empagliflozin to the morning fixed night-time urination, and I drink water steadily through the day. I check ferritin and B12 yearly because long-term metformin can lower B12 (mine was 410 pg/mL). Downside: one mild yeast infection at week 5, which cleared with treatment.

⚕ Pinned FDA / NIH / PubMed Clinical Context • Nourhan Mansour — Literature & Label Auditor

In the SYDNEY 2 trial, oral alpha-lipoic acid 600 mg daily for 5 weeks improved neuropathic symptom scores in type 2 diabetes. The metformin label advises monitoring B12 periodically, since low B12 can occur in some patients on long-term therapy and can mimic neuropathy.

Connected Clinical Guides: Condition: Type 2 Diabetes Condition: Diabetes Type 2 Condition: Prediabetes Rx: Metformin Rx: Metformin Hcl Rx: Tirzepatide Supplement: Vitamin B12 Supplement: Magnesium Glycinate Supplement: Berberine

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Verified Peer Replies (2)

@RedRockClimber_NV • Verified Cohort Member • Week 14

Good to see a B12 check, since low B12 can mimic or worsen neuropathy symptoms. A common threshold is that a level under about 200 pg/mL is deficient, and 200-300 pg/mL is borderline, where methylmalonic acid can help. Alpha-lipoic acid can lower glucose, so it's worth tracking fasting readings after adding it.

@FingerLakesHiker_NY • Age 45-59 • Week 16

I made a similar switch from metformin IR to ER with dinner and my stomach issues dropped a lot. I also separated my calcium and iron supplements from other pills by 2 hours. Fasting glucose is down about 20 mg/dL on empagliflozin 10 mg.