Which drug is most effective with Metformin?

[BaliRob]

I am at the stage where I am unable to efficiently control my blood sugar levels using just Metformin. I am on 2 x 500mg per day and was told by my specialist to increase 1 x 500mg daily which made no difference except to upset my stomach. As my specialist could not diagnose the difference between chronic kidney disease and congestive heart failure I have lost confidence in him. I would welcome any experiences from those of you that have continued to use Metformin but with another control in parallel.

 

[Daibell]

If you have stomach problems you may need Metformin SR - the Slow Release version. Note that Metformin only ever has a small effect on blood sugar and is best for those who are overweight with insulin resistance. If you are normal weight, you may have a declining pancreas in which case Gliclazide is often prescribed next as it stimulates the pancreas. If you aren't already low-carbing then that is your highest priority to get both weight and blood sugar down

 

[jack412]

Edit. Same as what diabell said
Have you got any weight down and low carb diet?
Swap to slow release 1500 met up to a month to settle and build to 2000 if needed

I wouldn't add a Sulfonylureas till the 2000 metformin isn't working enough nor would I put up with high bg for very long before moving on

www.diabetes.org.uk/Guide-to-diabetes/What-is-diabetes/Diabetes-treatments/Sulphonylureas

 

[BaliRob]

@ Daibell & Jack412,

Thank you both for your replies. Last time I went on SR ( 3 x 500 daily) my stomach improved almost to constipation but average levels increased by '1' . However, the biggest factor against for me was that SR is twice the price of Metformin. I do not know why doctors increase the prescription of Metformin when the patient has rising blood sugars because it is not meant for that purpose - it is a stabilizer of various organs etc.

I do not have a weight problem but have adjusted my carb intake as from yesterday but was still 17.2 four hours after dinner and where I was averaging 7-8 before breakfast I am now averaging between 10.9 and 11 plus.

I subscribe to having "a declining pancreas" and will try to get Gliclazide which I believe is available in 40 and 80mg. If you know the correct or usual starting dose please let me know. I can Google the Med sites for this answer if necessary.

Thanking you both once more.

Rob

 

[jack412]

Metformin will reduce your A1c by about 1.5%. So a 7% will be 5.5%
Try and stay on a dose of met you can handle. It is worth it
I don't know the starter dose for gli

 

[BaliRob]

Metformin will reduce your A1c by about 1.5%. So a 7% will be 5.5%
Try and stay on a dose of met you can handle. It is worth it
I don't know the starter dose for gli

Thanks Jack - will take your advice because my last A1c had risen by 2%. Will gradually increase to 2000mg before I do anything else

 

[jack412]

This is like talking to someone down the pub. I would take the advice of a dr

 

[hanadr]

I use Metformin and Low carb, but severaal years ago, I also used Starlix [which doesn't seem very well known] I dropped it when the low carb really kicked in. I'd recommend Starlix as you only need to take it when you're eating a fairr bit of carb.
Hana

 

[mo1905]

@ Daibell & Jack412,

Thank you both for your replies. Last time I went on SR ( 3 x 500 daily) my stomach improved almost to constipation but average levels increased by '1' . However, the biggest factor against for me was that SR is twice the price of Metformin. I do not know why doctors increase the prescription of Metformin when the patient has rising blood sugars because it is not meant for that purpose - it is a stabilizer of various organs etc.

I do not have a weight problem but have adjusted my carb intake as from yesterday but was still 17.2 four hours after dinner and where I was averaging 7-8 before breakfast I am now averaging between 10.9 and 11 plus.

I subscribe to having "a declining pancreas" and will try to get Gliclazide which I believe is available in 40 and 80mg. If you know the correct or usual starting dose please let me know. I can Google the Med sites for this answer if necessary.

Thanking you both once more.

Rob

Hi Rob, you've had some good advice from our members so far but please bear in mind, nobody here knows your history and we are not qualified to give advice regarding prescription drugs. I appreciate where you live you can buy these over the counter but Gliclazide for example can cause hypo's. Please listen to the advice here but discuss with your doctor before prescribing yourself any of these meds. Nobody advising you on the forum would would take a drug advised to them from a complete stranger, please don't do the same.
Let us know your progress and what your doc says, take care, Mo

 

[BaliRob]

@ jack412 ,hanadr & mo1905,

Thank you for your advice. I thought long and hard before starting this thread because I knew it may not be understood.

All I wanted was a large percentage consensus regarding the safety and effectiveness of whichever drug was considered to
be the most successful with Metformin.. The opinion and experiences of thousands of members on this Forum was a far better bet
than asking a doctor here or even in the UK for that matter..

Some eight years ago and before I came here I went to the doctor suffering shortness of breath and was diagnosed with Type
2 Diabetes. Also, for a very serious nocturnal cramp problem, was given lifetime repeat prescription for Quinine Sulphate which,
although extremely effective, I later learned to be a banned substance in the US for causing over 90 deaths.

Here in Indonesia I has serious concerns over swollen, legs, ankles and feet and severe breathing problems. I was
diagnosed with Chronic Kidney Disease. It was only when I presented myself for an Echocardiogram was I informed that, all along,
I had been suffering with Congestive Heart Failure.

So, yes, Jack - asking for the opinion of a man in a pub could just be as valuable especially if he was a member of Diabetes.co.UK.

 

[gfmoore]

@ Daibell & Jack412,
have adjusted my carb intake as from yesterday but was still 17.2 four hours after dinner and where I was averaging 7-8 before breakfast I am now averaging between 10.9 and 11 plus.
Rob

My take mate is that you also need to concentrate on your carb intake. You need to be strict till you get your levels down to below 7 at least.

Anything above about 7.5 is possibly (probably) causing you damage!

You'll be amazed at where you can get your levels down to, then you can start seeing what different foods do to your levels. You may think you are being good cutting out the refined carbs, but at this stage you really need to be strict and that includes no rice or starches. And since you are in indonesia you need to watch out for the yummy fruit - it's sugar bliss and deadly. There's lots of threads on lchf diet on this site and elsewhere. basically meat, eggs, cheese, and leafy vegetables. Try it for a few days- see what it does.

I too am not a doctor, but what have you got to lose over a few days of being strict?

The metformin will stop your liver dumping as much glucose (created from the body's stores). As said the glic encourages your pancreas to produce more insulin. But your problem is possibly that your body is resistant to the insulin and so not able to transport your blood sugar into the cells. You need to help your pancreas recover from overwork and also give your cells chance to recover. Too much insulin in the blood/body is also pretty bad for your overall metabolism (leptin resistance). So get the blood glucose level down and that means no carbohydrates - simples.

Set yourself a target level. I personally aim for the 4/5 level, don't often get there and occasionally go into the 8 for a very short time, but by testing I know what to do - and I have find discovered that a short burst of high intensity exercise (5 min) on a bike can work wonders in getting the bg down, better than a tab of glic. I have also tried a fast one mile walk which has worked - there is another thread about getting your hbac1 level down that has some good ideas

All the best and let us know how you are getting on.

 

[BaliRob]

My take mate is that you also need to concentrate on your carb intake. You need to be strict till you get your levels down to below 7 at least.

Anything above about 7.5 is possibly (probably) causing you damage!

You'll be amazed at where you can get your levels down to, then you can start seeing what different foods do to your levels. You may think you are being good cutting out the refined carbs, but at this stage you really need to be strict and that includes no rice or starches. And since you are in indonesia you need to watch out for the yummy fruit - it's sugar bliss and deadly. There's lots of threads on lchf diet on this site and elsewhere. basically meat, eggs, cheese, and leafy vegetables. Try it for a few days- see what it does.

I too am not a doctor, but what have you got to lose over a few days of being strict?

The metformin will stop your liver dumping as much glucose (created from the body's stores). As said the glic encourages your pancreas to produce more insulin. But your problem is possibly that your body is resistant to the insulin and so not able to transport your blood sugar into the cells. You need to help your pancreas recover from overwork and also give your cells chance to recover. Too much insulin in the blood/body is also pretty bad for your overall metabolism (leptin resistance). So get the blood glucose level down and that means no carbohydrates - simples.

Set yourself a target level. I personally aim for the 4/5 level, don't often get there and occasionally go into the 8 for a very short time, but by testing I know what to do - and I have find discovered that a short burst of high intensity exercise (5 min) on a bike can work wonders in getting the bg down, better than a tab of glic. I have also tried a fast one mile walk which has worked - there is another thread about getting your hbac1 level down that has some good ideas

All the best and let us know how you are getting on.

Thanks gf - will let you know how I get on

 

[Daibell]

Hi. You say you are normal weight? If so and low-carbing doesn't help much then it's possible you are a Late onset T1 (LADA) not T2; many of us have been thru that route. I had max Metformin then max Gliclazide then max Sitaglitpin then insulin. Max Gliclazide is 320mg/day and it is often started at 80mg twice a day which I did to start with. It can cause hypos so beware. It never did that for me as my pancreas was so knackered it couldn't be stimulated! You might want to ask you doc for the two tests for LADA which are c-peptide and GAD. May be these are not available or too expensive. With normal weight and high blood sugars, then do discuss Gliclazide with the doc. You can get 40mg Glic tablets.