Why did my doc prescribe 4 times as much medication as I needed?

[1MoreT2]

Well hi everyone...just another T2 here, 14 months out from diagnosis. Gotta query for the folks here.

My Magic Number was 11, and my doc said I needed to get down to 7, so he prescribed 2000mg metformin daily and 60mg gliclazide.

After I regained consciousness... and became the world's major source of unnatural gas, I, as a founding member of Ornery Blokes Unanimous, cut my dosage to 500 plus 30.

A year later I'm pulling a solid 7, still at 500 + 30.

So my question for you learned people...why did my doc prescribe me the Full Monty when One Quarter Monty would have done the job?

Have any of you had the same experience?

(OK, why don't I ask him? I don't want to challenge my doctor directly. It's just not something blokes do

 

[Squire Fulwood]

After my experience of Metformin I am surprised that you attribute any of your success to it since it did nothing for me except to make food taste like plastic. I suspect you have also changed your diet a little.

No-one knows why Metformin is pushed so much. I have heard stories about doctors being paid to do it. I have no such evidence myself but nearly everyone gets them.

The Gliclazide is presumably doing something but I have no experience of those.

These days I manage on just diet. The results I get are significantly better than the pills I was prescribed.

 

[Tim55]

I can't speak for your Doctor but I had a similar exerience.

On diagnosis, some 15 months ago, my Doc prescribed 1 x 500 mg Metformin daily, increasing to 2 in a couple of weeks.

I then had to go see the Diabetic Nurse, who told me to up it gradually to 4, which I did.

My initial HbA1c was up around 107, which, if I've done the maths right, is around 16.6.

I immediately went onto the LCHF route and rapidly got that down to more encouraging levels, last HbA1c was 34 or 5.3.

I also started taking three supplements, as although my levels were Ok I was struggling with peripheral neuropathy which are Alpha Lipoic Acid, methyl B1 and methyl B12.

At my last annual review with the DN we discussed the possibility of reducing the metformin which both the DN and (later) the Doc were happy with, so I went to 3 for a few weeks and then to 2.

I test twice a day and my FBG levels are better now than they were on the full dose, so I am contemplating dropping it just one too.

If I were to speculate I think the major problem the HCP see is the high FBG levels and Metformin is the first drug of choice to address that symptom, and little further thought seems to be given to getting to the real root of the problem - which is "why are you insulin resistant?"

JMTC

Tim

 

[martsnow]

I was only diagnosed six weeks ago, but the doctor insisted, that I take Gliclazide, to bring my levels down quickly, part of the reasons being, I was already starting to show, physical symptoms.

The other thing to point out, is that different people, tolerate and metabolize, the same dose of medication, at differing rates. So I think initially one size/dose doesn't fit all

As an example, both my brother, and myself, are the same weight, height and same build, and we both, take Lithium, (not for diabetes)

To get a blood reading of 0.8 mmol]/L (the therapeutic dose for Lithium 0.4 - 1.0 mmol/L)

I take 400mg, but my brother, has to take 1200mg, to give the same, blood levels.
Due to us being the same, weight, build and height, I can only assume, that our bodies, metabolize the drug, at differing rates

 

[mazz33]

Well hi everyone...just another T2 here, 14 months out from diagnosis. Gotta query for the folks here.

My Magic Number was 11, and my doc said I needed to get down to 7, so he prescribed 2000mg metformin daily and 60mg gliclazide.

After I regained consciousness... and became the world's major source of unnatural gas, I, as a founding member of Ornery Blokes Unanimous, cut my dosage to 500 plus 30.

A year later I'm pulling a solid 7, still at 500 + 30.

So my question for you learned people...why did my doc prescribe me the Full Monty when One Quarter Monty would have done the job?

Have any of you had the same experience?

(OK, why don't I ask him? I don't want to challenge my doctor directly. It's just not something blokes do

Two years post diagnosis, I'm still on 'the full monty' and I wasn't aware that it's unusual until I read your post. But I struggle with diet and other conditions so maybe I need to be on it. Is magic number hba1c? Mine was 6.6 last time.

 

[Andy-Sev]

I was initially on Insulin but my DNS put me on Metformin instead (I am in diabetic type limbo) and said we will start you on 1 tablet at breakfast and step it up after a week. Several weeks later I am still on 1 tablet in the morning and will remain that way until something happens to suggest I need to up my dose, not because it is the NORM to have to take more.

That I believe is the thing, in the first few weeks of diagnosis all the docs and nurses can do is treat you statistically and if most people need to take a high dosage then that is what they will try and get all new patients on, especially if many patients accept that doctors know best. But of course we all know that we are all different and for many of us who speak up we don't actually match the diabetic stereotypes with the professionals seem to work with.

In truth I don't mind taking that solitary tablet of Metformin as I haven't had any side effects, at least none you hear horror stories about and having read up on the other benefits of the tablet I am happy to suffer the occassional bout of mild nausea.

 

[Sirmione]

As I have learned on here is every person's diabetes is different and every persons's body reacts differently to Metformin.
It seems the norm that new T2's start on 1 Metformin per day then after a few weeks upped to 4 then the dosage can be reduced. For me 2 per day +LCHF seems to work.

 

[Robo42]

Appears I fitted in the recent NHS guideline of take Metformin if the hba1c was over 50 or so (new recommended), me 54.
Prescribed 1 x 500mg Metformin first, go to 2 x Metformin after a week, gave this 4 weeks bad stomach side effects.
Then went to Metformin SR 1 x 500mg , gave it 4 weeks also bad side effects.
Then given Gliclazade MR 1 x 30mg, been on 7 weeks, ok with the stomach but wondering if this is causing the following:
Feeling tired
Muscle, back aches, bit shaky
Heart palpitations
Lightheaded, dizzy a few times with low sugar reading and also not low
Always hungry
Cold sweats
Fast heart rate

Certainly lost weight on these drugs, or as least made it easier to lose some 7-8lbs.

I felt really good before all this drug taking and had only recently peaked at the 54 reading after some 8 years on diet control.

 

[Lamont D]

Appears I fitted in the recent NHS guideline of take Metformin if the hba1c was over 50 or so (new recommended), me 54.
Prescribed 1 x 500mg Metformin first, go to 2 x Metformin after a week, gave this 4 weeks bad stomach side effects.
Then went to Metformin SR 1 x 500mg , gave it 4 weeks also bad side effects.
Then given Gliclazade MR 1 x 30mg, been on 7 weeks, ok with the stomach but wondering if this is causing the following:
Feeling tired 7
Muscle, back aches, bit shaky
Heart palpitations
Lightheaded, dizzy a few times with low sugar reading and also not low
Always hungry
Cold sweats
Fast heart rate

Certainly lost weight on these drugs, or as least made it easier to lose some 7-8lbs.

I felt really good before all this drug taking and had only recently peaked at the 54 reading after some 8 years on diet control.

I think that it is the glicizide that's giving you these symptoms, do speak to your doctor, if your readings are as good as I've perceived them to be, they you don't really need them.
They are the symptoms of either false hypos or you are sensitive to being near hypo levels.
Do you know if you are going hypo, have you a metre?
Do you check your levels when you feel this way?
If you continue to have lows, do speak to your doc!

 

[Robo42]

I think that it is the glicizide that's giving you these symptoms, do speak to your doctor, if your readings are as good as I've perceived them to be, they you don't really need them.
They are the symptoms of either false hypos or you are sensitive to being near hypo levels.
Do you know if you are going hypo, have you a metre?
Do you check your levels when you feel this way?
If you continue to have lows, do speak to your doc!

Thanks for comments, I was waiting for an appointment with Diabetic nurse, as nearly run out of Gliclazade. I have tried to get the DRs to listen to my comments on atorvastatin and metoprolol that I take are known to give diabetes, I wanted to see about changing or coming off them and monitoring changes, but so far on deaf ears. Following NHS recommendations are Ok but very generic and not necessarily good for everyone.
I do check with a meter now & then, when felt a bit funny& light headed I have readings of about 3.5 so low, but also have been 5 ish.

 

[Lamont D]

Thanks for comments, I was waiting for an appointment with Diabetic nurse, as nearly run out of Gliclazade. I have tried to get the DRs to listen to my comments on atorvastatin and metoprolol that I take are known to give diabetes, I wanted to see about changing or coming off them and monitoring changes, but so far on deaf ears. Following NHS recommendations are Ok but very generic and not necessarily good for everyone.
I do check with a meter now & then, when felt a bit funny& light headed I have readings of about 3.5 so low, but also have been 5 ish.

Which NHS recommendations are you following?
You do n need to start to record your readings regularly and keep a diary as this will help in persuading your docs that you don't need the glicizide or the hypos/hypo feeling will get worse.
Are you on a low carb diet?

 

[Robo42]

Which NHS recommendations are you following?
You do n need to start to record your readings regularly and keep a diary as this will help in persuading your docs that you don't need the glicizide or the hypos/hypo feeling will get worse.
Are you on a low carb diet?

WELL! I was quoted by the diabetic nurse that over 48 hba1c was the recommendation for Metformin and I had crept up on last 2 blood tests 48 and 54 I believe. I was also told NOT TO do any self testing and they refused to prescribe any more test strips. I now have a blood tester that has cheap test strips so do test now and then. I had originally tested a lot to get a good idea of what affects me. I am pretty low on CARBS, with better CARBS if possible as well, oats instead of wheat etc & no CARBS for breakfast which I cannot handle but are better later in the day. Yes does sound a good idea to have test data to show the DRs, at moment its just their hba1c test every 6 months.........................

 

[Lamont D]

Hi, carbs is carbs!

No matter what label they put on them! Wether 'good' 'complex' 'better'!!
All carbs turn into glucose!
Yes, some like wholemeal and rolled oats digest slower, but they all turn into glucose.
Consider that all your blood is a big glass, full of all the different things that make it up and your glucose, is too much for your body's insulin to cope with. To get rid of, so you only need a little more to go above your limit!
Your limit is over every time you eat. And because you are consistently going over your limit, the insulin resistance gets worse. So then you need more meds and your body struggles to lower your blood glucose levels even more, so you probably need insulin eventually!
That's what happens when you have too much sugar and glucose in your diet!
By reducing your carbs, you don't go over your limit and your body's ability to cope with the glucose becomes better and your insulin resistance is better, so your blood glucose levels come down. Your average hba1c comes down.
You don't create as much visceral fat, so you lose weight and your organs become healthier, because of the less visceral fat.
You want to read the low carb diet forum as there are some great suggestions and recipes, to how to eat low carb.
I, myself having been very low carbing for over two years and I have lost five stone and my health is great, I'm fit and healthy!

Keep posting and let us know how you are doing.

Talk to your doctor, try low carb, it works.