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Any better med options to Metformin & Dapagliflozin?

M

Max68

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Long time no see, hope all are well. Type 2 here since around 2012. Been on slow release metformin (the max I think) for years and years, and have added in recent years Dapagliflozin and Gliclazide. Numbers haven't been too bad thanks to a lot of walking on the golf course but unfortunately last HBA1c wasn't good after a bad knee injury scuppered much exercise over the winter. Hoping to get that back down now the knee is on the mend.

Pretty up and down medical history but my two main issues, bar the diabetes, has been Irritable Bowel and Irritable bladder lasting years, which brings me to the point of my question. In the last three years or so I have suffered terribly with a complaint called rectal tenesmus, which is basically the feeling of needing to go to the bathroom even though you have already been. Usually lasts most mornings into the afternoon but strangely by evening it clears up, it's most strange. However in the last few months it has been accompanied by severe stomach discomfort which again strangely goes in the evening. It's quite awful, especially when you are going out and it has really been affecting my life.

I have tried everything, medications, fodmap diets, you name it I have tried it. Finally a pro active GP sent me for some tests different to the usual. FIT test was thankfully normal but something called faecal calprotectin, which I had never ever heard of came back really high which apparently can be suggestive of Inflammatory Bowel Disease or some other inflammatory issue. Not keen on thinking about the worst case scenario. All a tad strange though as I had a clear sigmoidoscopy performed winter 2024, so just over a year ago again to check for the reasons for the tenesmus. As it was clear they just discharge you. My GP has referred me to Gastro but not looking forward to some of the tests they put you through!

Thing is since my results I tried something. Monday evening I decided to come off Metformin. I am seeing the diabetic nurse tomorrow anyway so assumed it was ok to try for a week. Strangely the stomach issues went the next day, totally settled, felt the best I have in ages. No tenesmus, no stomach discomfort, all suggestive that it was the metformin causing the issue. However, surely metformin wouldn't cause stomach inflammation so bad that it shows up in such fashion on a test? Plus I have been on it for years and years, can it suddenly just start giving stomach issues after being on it for so long?

The one downside is I am peeing a hell of a lot more. Which may be because my blood sugar is higher due to coming off the metformin. That along with the Forxiga which clears your kidneys out anyway, not a great med for someone with an irritable bladder! A bit of a rock and a hard place shall we say!

So (sorry for long winded post) are there any suggestions I could ask my diabetes nurse about other oral med combos that could replace metformin but without the GI issues as side effects, and meds to replace the Forxiga without the excessive peeing side effects? Or are my options limited and I am sliding towards insulin?!

Thank you.
 
Hi, I am on Metformin 2x500mg and Gliclazide 1x40mg.

Had a problem with what I described as explosive diarrhea and stomach pains which was very limiting and required me to plan outings to ensure supermarket toilet etc was easily available within striking distance. Have had all sorts of surgery issues over the years with poor treatment for T2. HBa1C hovered around 45 to 50 for years.
However, eventually saw doctor who felt that Metformin I had been on for 26 years could be culprit. She changed my Metformin to modified release varirty - still 2x500mg and touch wood after 6 months have not had recurrance.

If only surgery actually listened to daibetics am sure I would have been better off years ago.
 
It might be the Dapagliflozin that is causing the peeing, as its diuretic effect is well known. I take it and my life is very restricted for that reason. Might be worth you checking if you can come off it safely.
 
Thanks for the replies. Interestingly after a bit of research on the web I came across an article that suggested Lansoprazole of which I have been on long term, can cause tenesmus. I came off that for a couple of weeks along with staying off the Metformin and the GP retested the faecal calprotectin and the concerning score of 360 came down to 53. Normal levels are 50. Apparently you are meant to come off PPI's before you have a faecal calprotectin test but no-one told me that! The downside was I started getting bad heartburn again! :banghead: When I was in Sainsbury I thought I would try a different PPI and accidently picked up esomeprazole rather than omeprazole. Once again felt good, no tenesmus. Thinking it was the lansoprazole I went back on the slow release metformin but the stomach discomfort started again. So stopped metformin and stomach is again fine.

So right now it looks like Lansoprazole gives tenesmus and metformin gives stomach issues or the other possibility I have some form of IBD where it keeps flaring up and it just happens to be coincidental around the times of swapping or stopping certain medications. Maybe Gastro will be able to tell but there is a 45 week wait! One downside is that now the stomach has settled is I lean towards constipation but after years of the other way it is more preferable.

As for the bladder it's the night time volume my body is producing that is the concern. I did mention the Dapagliflozin but the GP said quite rightly that I have seen urologists for the problem before being prescribed the drug. She is looking into diabetes insipidus which I am not really aware of but my blood sugars can go high so can you have both insipidus and type 2?!

In the meantime she has upped my Gliclazide to 40mg lunch and 80mg evening along with the Dapagliflozin and the stomach seems to be handling those ok at the moment.

Thank you.
 
Diabetes insipidus is a very rare condition like @Outlier says nothing to do with T1 or T2. I’ve been in the forum since 2009 and can’t recall ever having a member have this condition. According to NHS it affects 1 in 25,000, that’s not to say you haven’t got it but there’s no one on the forum with experience of it

www.nhs.uk

Diabetes insipidus

Diabetes insipidus is a rare condition where you produce a large amount of urine and often feel thirsty.
www.nhs.uk www.nhs.uk


Edited to add some punctuation
 
Yep I think the GP is reaching a bit but you never know! Personally I always have thought there is a link between IBS and an irritable bladder compounded by possibly the Dapagliflozin. Somewhat surprised that they put me on that whilst on Mirabegron and Solifecanin for the irritable bladder, but who am I to question the "experts"!
 
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