Additional medication - should I keep taking?

[Elaine.wain]

I've been diagnosed for 2 years now and started on metformin. Had the horrendous problems and finally out onto slow release so thought I was sorted. Got levels down to 6.4 and all ok. Dr retired, and new dr said I needed to be on statins etc. Commenced onto atorvastatin - no problem. Went to see him and blood pressure slightly raised so put me on Ramapril. Just been again and he's now prescribed Sitagliptin. I am now back to the diarrhoea, nausea and dizziness and not sure if this is normal with this new cocktail. I've been on these for 2 weeks now but know the metformin did take a while to settle in ..... Is anyone else taking similar?

 

[LittleGreyCat]

Why did your doctor want you on statins?
Very high cholesterol, or government targets?

It sounds as though your previous doctor had an approach which suited you better.
Once you start on a cocktail of drugs then the number of side effects climb enormously.

I'm also wondering about the Sitagliptin as your control seemed O.K. with just the Metformin. This is normally recommended only after Metformin has failed.
Were you on the maximum dose and still having problems?
Your HbA1c of 6.4 sits just on the margin of pre-diabetic so doesn't seem that bad.

Also, what is "slightly raised" blood pressure?

To get an idea of how you are doing it would help if you could post some details about BP, BG, and cholesterol.
Your doctor could be an over-prescriber or you may be underestimating your current blood test results.

 

[Daibell]

Hi. I agree it sounds like your GP is a prescriber. First you only need to consider let alone take statins if your lipids breakdown and ratios indicate it plus a family history of circulatory problems. If your GP only looked at your total cholesterol then get him to think again and it's your decision. Sitagliptin (which I was on for 3 years) is only relevant if your pancreas is underperforming rather than over-performing as is the latter case with many T2s. Gliclazide would often be prescribed first before Sitagliptin. If you have some excess weight and hence have insulin resistance then diet and metformin are the normal approaches. I would ask the GP why you were prescribed Sitagliptin. As your HBa1C is quite good I would ensure I was having the right low-carb diet and question the two new meds with the GP. I am also on 1.25mg Ramipril as my BP is just over 140 in the surgery but just below at home. I don't really need it but it keeps my GP happy! It's pretty harmless but again I would test your BP at home and see what it is.

 

[Elaine.wain]

Why did your doctor want you on statins?
Very high cholesterol, or government targets?

It sounds as though your previous doctor had an approach which suited you better.
Once you start on a cocktail of drugs then the number of side effects climb enormously.

I'm also wondering about the Sitagliptin as your control seemed O.K. with just the Metformin. This is normally recommended only after Metformin has failed.
Were you on the maximum dose and still having problems?
Your HbA1c of 6.4 sits just on the margin of pre-diabetic so doesn't seem that bad.

Also, what is "slightly raised" blood pressure?

To get an idea of how you are doing it would help if you could post some details about BP, BG, and cholesterol.
Your doctor could be an over-prescriber or you may be underestimating your current blood test results.

My cholesterol is normal now. It was slightly high when I first became diabetic but with diet this came down. It was normal when he prescribed these. He explained that my previous dr had not put me on the right medication - all medicated diabetics should be on a trio of medication - metformin, statin and ramipril. I was absolutely shocked as thought I could reduce my medication! My blood pressure was high when I went to see him (can't imagine why!) so put me straight onto ramipril. I bought a blood pressure machine and it's been fine ever since. I am over weight, but since diagnosis have lost 1.5 stone. He has said I need to lose more weight and the Sitagliptin will help me. His words were "you are taking in more calories than you are using - if I put you in a room for a week and didn't feed you, you would lose weight" so that's me told. I am now seriously considering changing Drs. The only thing in his defence is that my family history is not good for heart and diabetes. My mother, father and brother all had diabetes. My mum and brother both died of heart problems and diabetes was contributory on both death certificates. My dad had his toes amputated through diabetes though did not die from this (had dementia). I am very concerned about the recent side effects of nausea and a sharp stabbing pain in my side just under my ribs. I had this for 2 days on and off but it's stopped the last 2 days. Is there anywhere I can go that specialises in diabetes?

 

[Elaine.wain]

Hi. I agree it sounds like your GP is a prescriber. First you only need to consider let alone take statins if your lipids breakdown and ratios indicate it plus a family history of circulatory problems. If your GP only looked at your total cholesterol then get him to think again and it's your decision. Sitagliptin (which I was on for 3 years) is only relevant if your pancreas is underperforming rather than over-performing as is the latter case with many T2s. Gliclazide would often be prescribed first before Sitagliptin. If you have some excess weight and hence have insulin resistance then diet and metformin are the normal approaches. I would ask the GP why you were prescribed Sitagliptin. As your HBa1C is quite good I would ensure I was having the right low-carb diet and question the two new meds with the GP. I am also on 1.25mg Ramipril as my BP is just over 140 in the surgery but just below at home. I don't really need it but it keeps my GP happy! It's pretty harmless but again I would test your BP at home and see what it is.

He does rather bulldoze me into accepting his prescribing. He advises and says this is precautionary and previous dr was wrong not putting me on trio of drugs for diabetes. Stated that he has found this with many of the previous Drs patients. I totally agree with you about the low carbs and this is now my new strategy. When first diagnosed, I came off all sugar but didn't look at carbs. I'm now looking at both and introducing more exercise to help weight. I know exactly what you mean about keeping gp happy - it seems the more they prescribe, the more they have to see you, more blood tests. I've been to my Drs more in the past year than I have been in last 10 years! I have bought BP machine and its normal all the time. It was only the once it was up when in Drs surgery so out me on ramipril. I do try and get all my results from surgery, but having problems there as we have to phone I. For results but they are unable to give readings over the phone - I have to book appointment to see dr and then have to question all the time as he just says "they are normal or slightly raised". Fact is, I've lost faith in my dr and do not feel he is acting in my best interests - time to change I think ...

 

[Serena51]

You don't have to take them even if they are prescribed.

 

[phil1966]

To be honest, if my Dr spoke down to me like yours seems to have done, I'd change immediately. No-one should be blindly prescribed drugs unless there's a medical need and to say "all diabetics" need that cocktail is ridiculous. For example, my blood pressure is 112/68 - if I went on ramapril, I'd be passing out all the time!

 

[Daibell]

He does rather bulldoze me into accepting his prescribing. He advises and says this is precautionary and previous dr was wrong not putting me on trio of drugs for diabetes. Stated that he has found this with many of the previous Drs patients. I totally agree with you about the low carbs and this is now my new strategy. When first diagnosed, I came off all sugar but didn't look at carbs. I'm now looking at both and introducing more exercise to help weight. I know exactly what you mean about keeping gp happy - it seems the more they prescribe, the more they have to see you, more blood tests. I've been to my Drs more in the past year than I have been in last 10 years! I have bought BP machine and its normal all the time. It was only the once it was up when in Drs surgery so out me on ramipril. I do try and get all my results from surgery, but having problems there as we have to phone I. For results but they are unable to give readings over the phone - I have to book appointment to see dr and then have to question all the time as he just says "they are normal or slightly raised". Fact is, I've lost faith in my dr and do not feel he is acting in my best interests - time to change I think ...

Hi and thanks. Your earlier GP sounds fare more sensible than this guy. To put all diabetics on a 'trio' of drugs is plain stupid. Sitagliptin has little to do with weight gain or loss so he needs to read-up on the drug. It's a DPP-4 family drug which inhibits an enzyme that in turn switches off the pancreas after a meal. The result is you get a bit more insulin to remove spikes after a meal. In the extreme it might cause slight weight gain (and not loss as your GP stated). Your surgery doesn't sound like the best. You can insist that reception give you your results without seeing the GP; you have a right to them. Ask to see the Practice Manager if they won't. I would take a firm line with your GP and get any drugs you don't want taken off your prescription.