How is the decision made about which drug to prescribe?

[shellysexbomb]

Hi all, newbie here, 2 weeks post diagnosis
When meeting with my diabetic nurse she said she was giving me 8 weeks to get the BG levels down then putting me on gliclazide (sp?) I just wondered how the professionals decide which one to start you on? Some of the stuff I have read makes me NOT want to start on this as I get the impression it will burn my pancreas out and I'll be injecting in no time

 

[Crimsonclient]

Hi and welcome, as far as I am aware if they start you on drugs it's metformin to start with, and if that doesn't help reduce your bg levels then they decide what sort of plan to go forward with everyone is different with their required plans


Type 2 diagnosed 24/01/2013.
Novomix 30, Victoza, metformin 2000mg sr (but not taking them as they play havoc with my insides,

 

[shellysexbomb]

Yeah Crimson, I expected her to say metformin (my diabetic mother is on that) so was surprised when she said gliclazide. Not liking what I read about it. I shall challenge her as to why not metformin to start and see what she says :/

 

[catherinecherub]

She should be following the NICE pathway for treatment for you. Metformin comes after trying diet and exercise.

https://pathways.nice.org.uk/pathwa...therapy-for-type-2-diabetes.xml&content=close

 

[shellysexbomb]

Ah, thanks Catherine....that useful to know. The section about WHY she might be considering gliclazide straight off says:
When to consider sulfonylurea as an alternative to metformin
Consider sulfonylurea here if:

• not overweight (tailor the assessment of body-weight-associated risk according to ethnic group, see the diet pathway for more information)
• metformin is not tolerated or is contraindicated, or
• a rapid therapeutic response is required because of hyperglycaemic symptoms.

Offer once-daily sulfonylurea if adherence is a problem.
Prescribe a sulfonylurea with a low acquisition cost (not glibenclamide) when an insulin secretagogue is indicated.
Educate the person about the risk of hypoglycaemia, particularly if he or she has renal impairment.

Now I KNOW I am overweight, so can ask the question of which of those criteria is me when I next meet her. You never know though, I might get control and not need any drugs ( a girl can only try lol ) and I notice you have done exactly that Catherine, well done

 

[Crimsonclient]

Now that is a question, and one I honestly can't answer. I would ask her why that direction as she may feel this may be the best way forward for your management, but saying that they do have guidelines to follow, and those guidelines have been posted in this thread,


Type 2 diagnosed 24/01/2013.
Novomix 30, Victoza, metformin 2000mg sr (but not taking them as they play havoc with my insides,

 

[Crimsonclient]

She should be following the NICE pathway for treatment for you. Metformin comes after trying diet and exercise.

https://pathways.nice.org.uk/pathwa...therapy-for-type-2-diabetes.xml&content=close

Thanks CC I haven't seen that document before either


Type 2 diagnosed 24/01/2013.
Novomix 30, Victoza, metformin 2000mg sr (but not taking them as they play havoc with my insides,

 

[))Denise((]

There was someone else on here the other day who had been prescribed gliclazide first. They were told that it would bring their levels down more quickly. Unless you have some problems with your liver or kidneys then metformin should be prescribed first according to the NICE guidelines.

 

[Ymdawd]

Thats a very good question. As a locum pharmcist my diabetic nurse told me my HBA1 was 7.5. Not great but not bad. I will put you on gliclazide 80mg twice daily. After a week it has been hell with all the classical signs of gliclazide side effects. I developed a severe urinary infection and calf muscle cramp, due i suspect to bad electrolyte disturbance. It was a totally inappropriate dose

I refused to see this nurse but since she is the only diabetic nurse in the practice i must find a new doctor. At least this frees me to consider a malpractice suite to hopefully curb the caviller prescribing of this nurse. I have never felt so ill in my entire life.



Sent from the Diabetes Forum App

 

[jack412]

Google will tell you It was the wrong dose to start with, start small and build up

 

[MarcoRiveira]

The 1st 2 weeks after being diagnosed with type 2, i was on 2 500 mg metformin. I also had blood and urine tests. Next visot to my doctor, my fasting reading was 11. He read my blood test chart, told me i still had insulin in my blood, which meant my pancreas was still working but not enough insulin. So he told me he'll try adding 30mg Diamicron MR. This really worked in my case. After a month, doctor said i should take it early morning even without breakfast to keep the glucose levels good througout the whole day. It did, giving me 5 to 6 levels from morning to before dinner.

Of course, i try to help by eating low GI foods. My doctor said continue with the same dose and see him again after 2 months. So far, so good.

I am not overweight by the way, and i feel no side effects except for the usial gastric problems with metformin, but that's gone now. I have more blurry vision, but my doctor said it's normal and will get clearer later. I have also started more rigorous isometric exercises to help build muscle to use any glucose i have.

 

[Ymdawd]

There was someone else on here the other day who had been prescribed gliclazide first. They were told that it would bring their levels down more quickly. Unless you have some problems with your liver or kidneys then metformin should be prescribed first according to the NICE guidelines.

Hate to tell you but Doctors are not legally required to use guidelines at all. It is probably advisable for them to do so but is not obligatory.

 

[ickihun]

Hat. to tell you but Doctors are not legally required to use guidelines at all. It is probably advisable for them to do so but is not obligatory.

That's true but have to have a good reason not too if legally questioned.

 

[ickihun]

How are you now @shellysexbomb ?

 

[Ymdawd]

That's true but have to have a good reason not too if legally questioned.

Agreed

 

[shellysexbomb]

How are you now @shellysexbomb ?

Ah its all going pear shaped at a rate of knots. Diabetes is the LEAST of my worries right now. I have a 22mm gallstone that they wont sort out until I lose more weight and now am currently waiting a hematolgist/oncologist appt to find out which nasty blood disorder I have :'(

Thanks for asking, hope you're doing ok xx

 

[Virtuoso12]

Hi and welcome, as far as I am aware if they start you on drugs it's metformin to start with, and if that doesn't help reduce your bg levels then they decide what sort of plan to go forward with everyone is different with their required plans


Type 2 diagnosed 24/01/2013.
Novomix 30, Victoza, metformin 2000mg sr (but not taking them as they play havoc with my insides,

Hi Crimsonclient

If you’re having problems with the dose of metformin and the effects on your stomach I suggest going back to the GP/diabetic nurse and telling them. Exactly the same happened to me when they doubled metformin from 500mg twice a day to 1000mg twice a day. I’m now on 1000 mg glucophage once a day. It’s a slow release and hasn’t upset my stomach. They also gave me 10mg forxiga once a day and that’s made me lose 9lbs in a fortnight and it’s stayed off for three months.

 

[Ymdawd]

When i was going onto insulin i asked the diabetic nurse how she arrived at my starting dose. A ‘guestimate’ was her reply. At least she was honest.

 

[AnnM99]

Hi all, newbie here, 2 weeks post diagnosis
When meeting with my diabetic nurse she said she was giving me 8 weeks to get the BG levels down then putting me on gliclazide (sp?) I just wondered how the professionals decide which one to start you on? Some of the stuff I have read makes me NOT want to start on this as I get the impression it will burn my pancreas out and I'll be injecting in no time

Hi. I am in exactly the same boat. My Gliclazide tabs are still in box. Only diagnosed on 3rd June. Am petrified. How are you?

 

[Dr Snoddy]

Hi AnnM99. I can't answer your query but this is a very old thread. Hopefully someone will come along soon who can.