Anyone else on Sukkarto?

Just had my normal Metformin scrip replaced with one for Sukkarto 500 mg tabs. I have used Metformin SR 500 for several years, and this last year my readings were regularly in the 4 to 7 mmol/l range for both pre and post prandials, with an overall daily average of 5,8 on my meter. Since this change last week my bgl is now running in the 7 to 11.5 mmol/l range, and the jump for my 2hr PP is often about 4 mmol.l on LCHF diet. So I seem to find the new med is not equivalent to my original med. My daily average is now running st 7.5 which it has not been for over a year.

I am wondering if I should yellow card this new med?

Edit to add: Just noted that my new scrip has also halved my metformin dose, and whilst this was not normally a problem in the past, it may be adding to the change. Normally Metformin working range is only a couple of points at best, so a 4 point rise is still out of character.

I will go back to keto mode to see if this improves things back again. It may be an adjustment of diet is all that is needed, Still it was a bit of a shock, and the air turned blue for a while here at Vartr towers.

douglas99 said:

There have been a few threads on changing to this recently.
Must be a cheaper form of Metformin.

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It is a generic form, but is supposed to be equivalent in all respects. Not sure yet if it satisfies this.

The Forum on the OTHER Side is showing others having similar problems, but seems to be new topic on this Forum.

Generally people on the other forum are quoting the OEM information sheet and press releases, but I want to see what others are experiencing in the Real World.

Contralto said:

The active substance is metformin hydrochloride. Each
prolonged release tablet contains 1000 mg of metformin
hydrochloride. The other ingredients in the tablets are Stearic
Acid, Shellac (Refined bleached), Povidone K-30, Silica,
Colloidal Anhydrous, Magnesium Stearate, Hypromellose,
Hydroxy Propyl cellulose, Titanium dioxide, Propylene
Glycol, Macrogol 6000 and Talc.

i looked up the 100 mg extended release ingredients

There are a number of bad reactions if you are taking certain medications like ACE inhibitors

from drugs.com

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Have you researched further what EACH of these ingredients does to us humans? As I said in my post above most people can look this list up and print it, but without knowing what the effect of each ingredient does to us, then this info is useless, and does nothing to answer my question.

As it happens, as Johnson & Johnson found out recently to their cost, Talc is actually a carcinogen as was proven in court. I remember also that shellac is not that benign for humans either. Propylene is a plastic, and polypropylene is what is causing all the flammability problems in tower block cladding. So although these are probably trace amounts I am not sure I want these. I am not a fan of prolonged Release tablets myself, so I will ask to be put back onto standard Metformin again.

douglas99 said:

You need to look at the context for some of those statements.
Talc may be carcinogenic, but only in a powdered form, and used in certain areas. Any fine dust may be carcinogenic, even mdf in those circumstances.
Shellac seems to be ok as the actual shellac resin, maybe not as good in a solvent as a furniture coating.
Propylene Glycol is not the same as Propylene, it's not even a plastic.

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The 'certain areas' you refer to are external surface skin areas, but this is in an Oral med taken internally. The shellac resin is indeed a varnish coating, amd refers to the SR prolonged release enteric coating layer of the tab. again, not sure how healthy it is when taken orally. The propylene glycol ingredient is the main ingredient in the base if my hemorroid cream, and also in the base for the Canesten and clotrimazole ointments I have to use on my external areas occasionally. Again, this is an oral application, and the glycol is actually a plasticiser. None of these ingredients here is needed in a standard release variant of the Metformin tab, but is actually present in any film coated tab, which most modern meds are sold nowadays, so we are stuck with these ingredients anyway. The shellac seems to be only applicable to the SR variants, and may be the time delay enteric ingredient.

for standard film coated tab, it has
Film coating is: opadry white OY−L−28900 consisting of lactose monohydrate,
methylhydroxypropylcellulose, titanium dioxide (E171), polyethylene glycol 4000 and purified water.


I have asked my GP to put me back on standard release since I have experienced problems with the XR / SR versions of Glucophage before, and although it is probably a side effect of the ACE inhibitor and the PPI I am using, there may be others who may find similar reaction to an unannounced med swap for a so called generic med that is actually different from what we were using before the CCG bean counter stepped in.

My Gp has just rung me to change my scrip back to standard, and it seems I am not the only one reporting difficulty with the changed med this month.

Contralto said:

Thank you for further making my point, Oldvatr,

I took the time and trouble to find the list and, since I do this kind of tedious research for myself due to allergies, the inactive ingredients in one formulation are not the same in another. I try not to ingest the ones I bolded, I am aware that talc has several class action suits that have won such huge settlements that lawyers advertise on TV for new clients who have used talcum powder in their lifetimes (most everyone), I see no reason to ingest paint (titanium dioxide) or paint thinner.

Depending on which brand of regular garden variety Metformin possibly causing lactic acidosis and stomach issues you use, your inactive ingredients could be the same, similar, more injurious, and the like.

Nor should we take even imminent doctor's advice concerning brand names for I have bad reactions to the Glucophage that Bernstein touts as preferable. It's the artificial coloring, I think.

Which brand do you use?

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If it is the active ingredient that is the cause of the Lactic Acidosis, then it would seem that standard Metformin should not be any different than the modified release version since it is the added enteric varnish that delays the absorption.

There may be differences in filtering or purifying the active ingredient that differs between brands. but should not make it any more injurious or dangerous. Glucophage was actually the first supplier of Metformin for diabetes use, having derived it from the French Lily otherwise known in folk lore as Goats Rue, so the stomach after effects seems to be something we share with goats. Certainly the standard Release Metformin is supposed to give worse side effects, but I was on standard tabs for many years without too much trouble.

The TiO2 is purely colouring for most white tabs on the market and applies to both standard and XR . SR variants, so is unavoidable it seems. but a lifelong habit of 4 large tabs a day will amount to a veritable paintpot of the stuff, which is why I have elected to halve my dose. There are reports that TiO2 can be retained by the kidneys in humans in vivo. Theres a novelty - white kidneys!

The replacement tabs arrived this morning, but are film coated (but not delay action time bombs. so do not have the shellac). Will be interesting if my bgl stabilises or drops again after swapping the others out. I was prepared to need to adjust my diet to compensate for halving my dose, but the size of the bump has taken me by surprise.

Contralto said:

check out WHICH versions have shellac and which not. There are extended release versions without it, including the one I am taking of Metformin, which ingredients I posted yesterday

As far as the lactic acidosis, Bernstein has posted the chapter of his book where he claims that fenformin, an earlier variation of metformin also used for weight loss, that was taken off the market entirely, as being the only formulation that really caused it

BUT, interestingly, he suggests that some blood tests rarely done as part of most diabetic practice and done always in his practice SHOULD be done in order to prevent certain Metformin side effects. Or are we only talking about the formulation that rhymes with pluckkarto?

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The incidence of metformin associated lactic acidosis is quite rare, about 1 in 10k. However there is an FDA warning (revised 2016) that applies, which we still need to take note of, as follows:
https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0090404/

I think the XR versions tend to use shellac or chitin, but the SR ones use a plastic matrix that swells when wet, and allows slow release throught the gunk. Acrylic or similar polymer is used, hence the plasticiser I indicated earlier, Either way it is not too clear as to how safe these substances are in the long term (10 or more years) especially when taking 2 grams of tabs a day like I was.

This thread is intended to be about Sukkarto (not the Phillipines ex president) as this is what was slipped into my medi wallet without my knowledge, and I am concerned about a sudden rise in bgl since starting it. I know it may just be the dose alteration, but may also be the way I react to XR meds. Now I am using IR variant, and will see if things change for the better or worse. It is also a raspberry across the GP practice for making a change without telling me and it was not directly compatible with the med I was on. Others may suffer this subterfuge and this is a warning to check the packets when they deliver them especially if re-packaged in a medi wallet without the packaging or literature. I had to go to the pharmacist to ask what Sukkarto was, since it is not apparent that it is Metformin, or that it is modified release.

Update on Day 1 following replacement of Sukkarto by IR Metformin.

Before my medi wallet changed, my daily bgl was running at 5,9 mmol/l
Yesterday after 1 week of new meds regime it had risen to 8.3 mmol/l
Today, being day 1 on standard MET no other change, it dropped to 7,7 mmol.l

Note that today I had an additional carby snack of 6 wheat crackers with cheese, so my pre meal reading was higher than it would have been, Since starting the new meds I had adjusted my diet to compensate for the halved dose anyway, so I now have bacon, egg, on ham which replaces my 2 toast breakfast. so yes, I was surprised when my pre meal readings rose when they should have dropped following the LC drop in the morning. This was the clue that made me investigate the New Metformin tabs.

Update #2: From the way my blood sugars rose after I went in this med, I get the impression that I was not metabolising this med, and my daily average jumped in a week from 6.2 mmol/l to 8.5 mmol/l at which point I went back onto standard release Metformin. Looking at the ingredients I see that the enteric coating is shellac, which is different from the normal slow release(SR) variant, This is actually the Extended Release tab (ER) variant. I had a similar reaction to Glucophage ER tabs too, so it seems the harder to dissolve coatings can make the meds difficult to metabolise. I think my PPI med make be making me more susceptible to this since it reduces stomach acid.

My daily average on standard Met is currently 7.2, and the peaks and troughs are lower. This is what I was expecting when my meds dose was halved.

So Sukkarto seems to be a generic substitute for Extended Release, not Slow Release, and I should not have been changed over without consent since it was not a like for like replacement.

Just done an interesting experiment. My pharmacy just supplied next months supplies, and, guess what? They once again substituted Sukkarto for the Standard Metformin that I had asked my doctor to revert me back to. (their cockup, I hasten to add) Any how, in the week preceding my starting the new pack, my daily averages were running at
6.2 / 6.8/ 7.1 / 7.2 / 7.2 mmol/l

I was only on Sukkarto for 1 day while the pharmacy sorted out a corrected dose for me, and that night my daily average shot up to 8.2 on a beef curry, on Lidl Roll. and then the next day I started standard Met. My daily bgl for this second day was 9.9.

The following day I had exactly the same meal (leftovers) for both breakfast and evening meals, and my daily average was 6.5

I made sure I had the similar eating pattern I normally use, especially the content of the main meal which I repeated. It is a meal that I have used successfully several times as an LC meal, and normally it did not spike me.

I offer the explanation that I was unable to digest the Sukkarto, and so my build up of Metformin active ingredient dropped sharply as a result, but needed a full day to recover when the Met re-started, so recovery was delayed as stocks built up again.

I think this is further proof that I was right in my case to insist on stopping the Sukkarto when I did.

Sparrow456 said:

Went to get my prescription today and was told by the pharmacist that the GP has changed my medication to Sukkarto SR 500mg tablets. Bit of a shock as I would have hoped to have been told this by the GP, not in the middle of Boots. The box given to me had already been opened (as I only need 28, not the full 56) and there is no information sheet in it to read. I am unsure if this change will have any effect on me (side effects etc), so want to know what others have experienced. The chemist did say that another drug (Atenolol) that I take daily may mask the normal systems of a hypo, so I will need to monitor this.

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https://www.ncbi.nlm.nih.gov/pubmed/6339540

I am on Atenolol myself, but no one warned me of this. I had had many hypo near misses recently due to my high dose of meds, but did not notice any problem in my case. Now I have reduced my meds significantly, I am running my bgl at a higher level than before, so have less chance of hypos anyway. My GP wants me at 7 mmol/l rather than my previous target of 5.6 which he thinks is too low, I got there, but did get weekly H events, though none that needed assistance or lasted more than a chocbar or so. Probably better that I do not run that low for extended time.

Farrowlily said:

Hi all I've just been changed to sukkarto from metphormin I take 1000mg twice a day so a bit worried about what's in them I'm also on humilyn 3 insulin I've found that I've been having a lot of lows and because I struggle with being sensible I'm putting on wait I'm wondering wether to goto docs and see about reducing dose of sukkatro

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The active ingredients in Sukkarto and Metformin are the exact same. The difference is in the coating used to delay absorption to slow down the medication. Different manufacturers use different methods and hence have different patents to proect their market share. Neither pill is considered to be involved in weight gain, but Metformin acts as an appetite suppressant so helps weight loss, but the effect is small so it is not a slimming pill. It is also not generally associated with causing hypo events since again the effect of Metformin is small and limited.