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I was put on metformin & victoza.
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<blockquote data-quote="SimonCrox" data-source="post: 1618300" data-attributes="member: 388174"><p>Fantastic weight loss, and good to hear that you feel better for it.</p><p>Coming clean, I have prescribed a lot of victoza and metformin in my time.</p><p>The first thing anyone would do is to look at your progress and say how good it is, but as you say, can we do better?</p><p>There would be several different approaches:-</p><p>1: You are doing well - wait and see; but you have stated that this problem with the higher glucose levels has only been a problem for two weeks, so this is not a sensible option.</p><p>2: Optomise your present regime ie push the doses to maximum metformin for your renal function / gastro-intestinal tolerability, push the victoza to 1.8 mg per day.</p><p>3: Add in a different tablet to take your glucose levels down throughout the day and help lose weight eg with an SGLT-2 inhibitor such as empagliflozin. I would place this as a better bet than pioglitazone which has lots of benefits, but tends to put weight on.</p><p>4: One of the features of T2DM is this way the liver releases glucose overnight, as you say; so one could address this by giving a shot of insulin in evening/bedtime to suppress the liver dump; we would all worry about the weight gain, but there is less weight gain with levemir at bedtime than other insulins, and it is more gentle than other insulins which means it might take longer to titrate up the dose, but less chance of hypos cos going gently, and defo less hypos than a traditional cloudy NPH insulin.</p><p>Sorry if this is a bit technical.</p><p>Best wishes</p></blockquote><p></p>
[QUOTE="SimonCrox, post: 1618300, member: 388174"] Fantastic weight loss, and good to hear that you feel better for it. Coming clean, I have prescribed a lot of victoza and metformin in my time. The first thing anyone would do is to look at your progress and say how good it is, but as you say, can we do better? There would be several different approaches:- 1: You are doing well - wait and see; but you have stated that this problem with the higher glucose levels has only been a problem for two weeks, so this is not a sensible option. 2: Optomise your present regime ie push the doses to maximum metformin for your renal function / gastro-intestinal tolerability, push the victoza to 1.8 mg per day. 3: Add in a different tablet to take your glucose levels down throughout the day and help lose weight eg with an SGLT-2 inhibitor such as empagliflozin. I would place this as a better bet than pioglitazone which has lots of benefits, but tends to put weight on. 4: One of the features of T2DM is this way the liver releases glucose overnight, as you say; so one could address this by giving a shot of insulin in evening/bedtime to suppress the liver dump; we would all worry about the weight gain, but there is less weight gain with levemir at bedtime than other insulins, and it is more gentle than other insulins which means it might take longer to titrate up the dose, but less chance of hypos cos going gently, and defo less hypos than a traditional cloudy NPH insulin. Sorry if this is a bit technical. Best wishes [/QUOTE]
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