Why would anybody consider taking this T2 medication

[Hotpepper20000]

If recently diagnosed and unless HbA1c is through the roof why take metformin?

Because Metformin has other uses.
For me it has help along with LCHF to drastically reduce my PCOS symptoms.

 

[Krystyna23040]

Oh I've experienced that myself too.... I can't recall ever being told about side effects or risks. I've even been prescribed stuff I'm allergic to, luckily I caught it. I missed it once because it was part of an antibiotic treatment containing a mix of things... spent 2 weeks barely being able to walk from extreme pain in the Achilles tendons, but that's what happens when they don't look at the allergic list. :***:

That's dreadful. I have to watch that my allergies are picked up also - they are not always.

 

[Krystyna23040]

Should this even be available with those risks. If I were newly diagnosed and had to choose between this drug and a week or 2 of Keto flu (or should I say carbohydrate withdrawal), I think there is an obvious choice.

Actually - that is what I am thinking also.

 

[Krystyna23040]

Because Metformin has other uses.
For me it has help along with LCHF to drastically reduce my PCOS symptoms.

Several people on this forum also take Metformin. I believe it does come with a lot of health benefits and is the safest of all the diabetes drugs. LCHF and keto work well with it.

 

[NicoleC1971]

1) the drug companies only need to show a tiny reduction in HBA1c to get a product to this exciting growth market. As long as the pill does nothing to cure type 2 and does not kill people (this isn't the worst class of drug for diabetes btw) in short term trials, they are onto a winner. When the pill fails to control blood sugars Novo Nordisk can provide insulin in ever increasing quantities.
2) Doctors who believe themselves to be uninfluenced by drug reps are the ones most likely to be influenced by drug reps.
3) Side note on statins on a similar theme (I get an update re topics of itnerest to diabetes), The new US lipid lowering guidelines recommend achieving an ldl of 1.6 for high risk patients (diabetics) or 50% of their original ldl levels, then if the statin doesn't work or isn't tolerated, luckily they have a new uber drug!

 

[SaskiaKC]

That is so true - but isn't it a shame that they cannot act more ethically.

A great shame indeed. But monetary profit is not about ethical behavior, and most people can't even quote correctly that "the love of money is the root of all evil" and BigPharm seems to think money buys security.

 

[Guzzler]

If recently diagnosed and unless HbA1c is through the roof why take metformin? My HbA1c went from 53 to low 40s within the first three months just by low carbing.
Some might take longer, but early diagnosis appears to be the key to a fast reduction without drugs?

Not everyone is dx early, though. If you are 'lucky' enough to suffer symptoms early this may drive you to seek help or you may drop lucky and have T2 diagnosed from a routine blood test. What if you have none of the classic symptoms and do not have tests? Basically it is the luck of the draw.

 

[Stephen Lewis]

Hi Krystyna,
I think you are missing the point here. The pharma companies are not charities nor are they philanthropic, they exist to make a profit - so it helps if they can find ways to make patients dependent upon their products for life. Otherwise they have to charge huge prices for medicinal cures - because they only get 1 sale per patient.
So long as they can convince the regulating authorities (without cheating) then it may be quite ethical to unleash their Sales Force to target Doctors and drive sales of any of their most profitable drugs.

Whether it actually makes sense for a knowledgeable patient to actually take the drug (if prescribed) is of no concern because fortunately for the drug companies, there are very few knowledgeable patients!

Of course only one sale per patient until you get the side effects which I am sure they have more products to help with more side effects etc. etc. Am I cynical about drug companies that could have come up with safe cures decades ago? Unfortunately cures will have a negative affect on sales because no one needs those drugs that only alleviate symptoms any longer. After all we are here for the drug companies not the drug companies for us!

 

[LittleGreyCat]

Should this even be available with those risks. If I were newly diagnosed and had to choose between this drug and a week or 2 of Keto flu (or should I say carbohydrate withdrawal), I think there is an obvious choice.

I think that it is extremely disingenuous to try and compare this to Metformin on first diagnosis.
If you look at the NICE pathway
https://pathways.nice.org.uk/pathways/type-2-diabetes-in-adults
the first stage is lifestyle choices (which would hopefully these days include LCHF).
Next is Metformin.
Next after that is Metformin plus a sulphonylurea.
It is only at the second intensification after Metformin, then Metformin and a sulphonylurea combined haven't worked that a GLP-1 mimetic such as Semaglutide is suggested .

So it absolutely not a choice between this drug and a couple of weeks of keto flu and it is very misleading to suggest this.

So you have managed your diabetes with a couple of weeks of keto flu.
Bully for you.

I have have T2 diabetes for over 11 years now and there are signs that I may have to go beyond a couple of weeks of keto flu and some Metformin in the next few years.
Semaglutide is a very real (if not very attractive) option for me.
Be thankful that it doesn't currently seem to be an option for you.

 

[LittleGreyCat]

If recently diagnosed and unless HbA1c is through the roof why take metformin? My HbA1c went from 53 to low 40s within the first three months just by low carbing.
Some might take longer, but early diagnosis appears to be the key to a fast reduction without drugs?

I'm assuming that you are recently diagnosed and low carbing had a high profile when you first looked at options?
Your profile says member since June 2018 which is just over a year.

So; with the current level of understanding low carbing is an obvious option.
This was not always the case.

I note also that you lost 5 stone.
This is a wonderful result and something to be very proud of, especially considering the results you have.
However if I had lost 5 stone in the year after first diagnosis I would have weighed nine and a half stone and it would have been a very hard ask. Nine stone if you count my weight on actual diagnosis. It was the rapid loss of half a stone for no obvious reason that lead to my diagnosis.
It has taken me over 10 years to get down below 11 and a half stone, which is 3 stone below my (just pre) diagnosed weight.

Please have some thought for the 20% who were not obese on diagnosis and who are maintaining a normal weight on a low carbohydrate diet but still experiencing diabetes symptoms.

It is possible (although not certain) that I might have reversed my symptoms had I known that if I reduced my weight dramatically and drastically straight after first diagnosis this could have made a major difference.

However Roy Taylor was a few years from his breakthrough and the Newcastle Diet, and LCHF was not (as far as I can tell) even on the horizon.

 

[mojo37]

If recently diagnosed and unless HbA1c is through the roof why take metformin? My HbA1c went from 53 to low 40s within the first three months just by low carbing.
Some might take longer, but early diagnosis appears to be the key to a fast reduction without drugs?

Because some newly diagnosed are given metformin and the wrong advice re diet such as myself 5 yrs ago

 

[Mbaker]

I'm assuming that you are recently diagnosed and low carbing had a high profile when you first looked at options?
Your profile says member since June 2018 which is just over a year.

So; with the current level of understanding low carbing is an obvious option.
This was not always the case.

I note also that you lost 5 stone.
This is a wonderful result and something to be very proud of, especially considering the results you have.
However if I had lost 5 stone in the year after first diagnosis I would have weighed nine and a half stone and it would have been a very hard ask. Nine stone if you count my weight on actual diagnosis. It was the rapid loss of half a stone for no obvious reason that lead to my diagnosis.
It has taken me over 10 years to get down below 11 and a half stone, which is 3 stone below my (just pre) diagnosed weight.

Please have some thought for the 20% who were not obese on diagnosis and who are maintaining a normal weight on a low carbohydrate diet but still experiencing diabetes symptoms.

It is possible (although not certain) that I might have reversed my symptoms had I known that if I reduced my weight dramatically and drastically straight after first diagnosis this could have made a major difference.

However Roy Taylor was a few years from his breakthrough and the Newcastle Diet, and LCHF was not (as far as I can tell) even on the horizon.

It is a shame you are angry with my response, I see little reason for this as the sentiments are accurate. It drains energy to always put with respect to the 80 / 20 rule. Clearly you are in the 20 so no need to take offence, as it is clear none was intended.

The evidence is clear that Keto vs Rybelsus is a no contest comparison i.e. Keto is a much safer option without question. Your personal circumstance is regrettable, but doesn't invalidate what I stated.

 

[LittleGreyCat]

It is a shame you are angry with my response, I see little reason for this as the sentiments are accurate. It drains energy to always put with respect to the 80 / 20 rule. Clearly you are in the 20 so no need to take offence, as it is clear none was intended.

The evidence is clear that Keto vs Rybelsus is a no contest comparison i.e. Keto is a much safer option without question. Your personal circumstance is regrettable, but doesn't invalidate what I stated.

You seem to have completely missed (or ignored) the point that a direct comparison between keto and a GLP-1 receptor agonist is enormously misleading.

You are still positioning it as a straight choice between diet (including keto) and Semaglutide as the initial treatment options for newly diagnosed T2s.

If you would care to re-read my post you should note that (according to NICE at least) the initial option is lifestyle (which should include the option of keto if desired). So you have your keto option right up front.

If that doesn't work, you then get offered Metformin.

Eventually, a long way down the treatment pathway, you may be offered Semaglutide.

It is absolutely not (as you seem to believe) a straight choice on first diagnosis between keto and Semaglutide.

 

[JohnEGreen]

@LittleGreyCat @Mbaker

I think maybe you should ease up you both have opposing views and both have made good points lets not make it personal or it's going to get moderated if we are not careful.

 

[LittleGreyCat]

I read about this new wonder drug for T2D on our diabetes.co.uk website.

When we have LCHF and metformin if we need a bit more help if LCHF isn't enough to bring down BS - why oh why would Novo Nordisk think anybody would want to risk all the issues that this drug could cause:

The first glucagon-like peptide-1 (GLP-1) receptor agonist in tablet form has been approved for people with type 2 diabetes in the US.

Rybelsus, (medication name semaglutide) has been approved by the US's official drugs body the Food and Drug Administration (FDA).

Rybelsus will carry a 'boxed warning' that there is a potential increased risk of thyroid c-cell tumors. Additional warnings regarding the drug relate to pancreatitis, diabetic retinopathy, hypoglycemia, acute kidney injury and hypersensitivity reactions.

Novo Nordisk executive vice-president and chief science officer Mads Krogsgaard Thomsen said: "We are very excited that we can make the first oral GLP-1 available in the US and thereby expand the treatment options for adults living with type 2 diabetes.

Sorry for the rant - reading about this drug made me feel quite angry.

Just to hopefully wrap up a long thread, people would consider taking this drug, despite the listed side effects, if there were strong reasons why they didn't want to start on insulin, including work related issues.

NICE position it as a drug of last resort before going onto insulin. In fact, only to be used if there are reasons not to use insulin.

In general, it makes insulin look quite attractive.

I do wonder if there is an institutional prejudice, especially in the USA, against insulin users and the perceived risk of hypoglycemia.

As a cynical side note this may be one of the drugs which is being positioned as a modern alternative to sulphonylureas because they are going out of patent.

 

[JohnEGreen]

All I can say is many of the medications I take have very serious possible side effects one of which is diabetes that is why I'm here others are equally dangerous if not more so I take the meds because if I don't the alternatives are very unpalatable so the benefits out way the risk this is true of many of the drugs we take including the one this thread is about so I can understand why some one may decide to take this drug despite the risks involved if they think it may be of benefit to them.

 

[JohnEGreen]

All I was saying is like chill we are all friends here lets keep it that way no one needs to back out or leave the thread just maybe be a little less confrontational.

 

[JohnEGreen]

I have to admit this is where I miss my mate Dennis nothing to do with the thread and completely off topic bit he and I used to enjoy a flipping good row or argument if any one who didn't know us were to over hear they would think we were coming to blows but we never lost sight of our true and lasting friendship but that friendship never got in the way of a good row.

 

[Brunneria]

Hi Everyone,

A number of posts have been deleted from this thread for sustained arguing (rule A6 of the forum rules).

Nothing wrong with discussion and debate - it is what the forum thrives on, but when things degenerate into insults and accusations, people get their posts deleted.

Everyone always has the opportunity to take contentious discussions to PM of course, rather than derailing pages of an otherwise polite thread, but I would remind anyone taking up this option, that the forum rules on civil behaviour still apply, and there is a Report button under every single PM post. Members are encouraged to use this if they are ever contacted in a manner that makes them uneasy.

 

[Krystyna23040]

NICE position it as a drug of last resort before going onto insulin. In fact, only to be used if there are reasons not to use insulin.

In general, it makes insulin look quite attractive.

@LittleGreyCat I agree that insulin definitely looks to be the best option if LCHF/keto and Metformin stop working. If my pancreas ever gives up the ghost in the future I really hope that I will be offered insulin again rather than drugs that have far more side effects.

Insulin plus low carb would be so much easier than it was before when I was doing high carb plus insulin. I would probably be OK with just basal insulin and not need to do any fast acting insulin.