Type 2 Can I take 2 x Metformin without the ok from my Doctor?

john5220 said:

The sad thing is my brother isn't even fat and he got diabetes at 32 years old aswell and he is a pretty active fella.

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Ok, so I've got me, brother, son, nephew, sis-in-law, bro-in-law, nieces-husband and had mother, grandfather and a few aunts who are now sadly deceased. We have the full deal, T1, T1.5 & T2 spread across us but everyone of us just get's on with life and deals with it in their own way. You make in sound like you've got terminal cancer, you haven't, it is pretty straightforward to control if you make the effort.

Or let me put more bluntly a study done around 10 years ago showed that 50% (yes half) of totally uncontrolled T2 diabetics are dead within 10 years with the remaining half (of the uncontrolled diabetics) having loads of complications such as blindness and amputations. Which half do you want to be in?

... and of the

john5220 said:

That sounds as bad as cancer, ***!!

Is it possible to be in neither? that is living as healthy as anyother person who doesn't have diabetes? If I had to be in either I would prefer to be dead, who would want to live blind? that is insane.

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... and the half who did control their diabetes by losing weight, controlling their sugars etc. went on to live happily ever after and pretty much had normal lifespans.

Considering you don't have a terminal illness, I guess the answer is mostly up to you?

So most guidelines around the world say you should try to be around 100 (5.5mmol) pre-meal and 140 (7.8mmol) or below 2 hours after eating. Your readings are worse than that but they're nowhere near "uncontrolled". Most T2's find cutting out sugar and cutting down on starchy foods (rice, pasta, bread, potatoes, cereals and anything made with flour) will help their blood sugars regardless of their current weight. If you want to try to fully reverse T2 then you'll need to lose the weight as in T2 it's the extra weight that stops the insulin your pancreas produces from working properly. If you lose the weight your insulin works again and your diabetes goes away, or that's the theory.

I take two 500 in the morning and two 500 in the evening that what my Dr got me down for so cannot see to much of a problem but everyone is different get some advice to be on the safe side from your Dr, do you also have blood check device with strips Ive got one with repeat strips from my Dr so I can see what my sugar levels are doing worth getting

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To get rid of the visceral fat that is around your pancreas and liver, you first need to get rid of all the fat everywhere else on your body! I have given myself two goals now that I have T2D - to get down to my BMI weight, which is 175lbs and to not be dead! I started out at 266lbs two months ago and I've dropped 34lbs so far and guess what I have given up entirely? Bread, pasta, rice and just about everything else that has sugar in it. It was seriously hard to begin with but the cravings disappeared after a week or so. It can be done, even on a budget, but you have to want to deal with it in your head first. Look in a mirror and you'll see who is responsible for you eating all the wrong things for years. Best of luck.

1. Metformin tablets at this stage of your diabetes is minimum of 500mg with breakfast, lunch and evening meals which is 1,500mg daily.

BNF (British National Formulary) recommends maximum of 2,000mg daily in divided doses.

2. Gliclazide is a short-acting sulfonylurea used in overweight diabetics. As you pointed out it acts by argumenting insulin secretion from the pancreas but there is no evidence that it burns down the pancreatic beta-cells even in 10 years time you quoted.

Please see your doctor for prescription review plus take reasonable exercise for control because you are on high carbohydrate diet.



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achike said:

2. Gliclazide is a short-acting sulfonylurea used in overweight diabetics. As you pointed out it acts by argumenting insulin secretion from the pancreas but there is no evidence that it burns down the pancreatic beta-cells even in 10 years time you quoted.

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Nope that's not entirely true. I agree there is no definitive evidence but there are many studies that link sulfonylureas to a significant increased risk of pancreatic cancer and a large study in 2013 found a 58% increase in all-cause mortality as opposed to those like me who just take Metformin or those who control purely by diet.see Sulfonylureas May Raise Death Risk
as one of many example studies.

On the purely anecdotal evidence of the many thousands of members of this site who have posted over the last 10 years those T2's that avoid any insulin stimulating drug by primarily managing their diet have managed to slow, stop or reverse the progression of the disease far better than those who have used them. While I accept this is not evidence that sulfonylureas cause burn out I think it does suggest those who do use insulin stimulants find the disease progresses faster for whatever reason.

There are also other negatives to sulfonylureas in the sense they work all the time so if makes it more difficult to lose weight even if you're trying and of course there is an associated hypo risk if you forget to eat enough carbohydrates. The more modern DPP-4 drugs like Januvia are better in that they only stimulate when you eat however there are studies showing these have their own set of risks. Better appear to be the new SGLT2 Inhibitors as like Metformin they work without increasing insulin production.

To xyzzy.
I hope that you have good evidence to pass on to NICE on Januvia that you are recommending.

I only elaborated on the fear of Gliclazide burning out the pancreas. All medicines have side effects but before approved for public use the benefits should outweigh them.

I have a T2 diabetes for 20 years and Metformin that I combine with Gliclazide has put me on good control with moderate exercise.

I am not on low carbohydrate diet but limit the portion of my foods which are loaded with vegetables, fruits and nuts but low oil or fats.

My opinions on this forum are based on my experience as a medical doctor since 1978.

Though am now retired, I was a practicing GP in Nigeria before I specialised as a pathologist in England. I post my opinions based on research and Best Practice. Please feel free to take or ignore them with best wishes.

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achike said:

To xyzzy.
I hope that you have good evidence to pass on to NICE on Januvia that you are recommending.

I only elaborated on the fear of Gliclazide burning out the pancreas. All medicines have side effects but before approved for public use the benefits should outweigh them.

I have a T2 diabetes for 20 years and Metformin that I combine with Gliclazide has put me on good control with moderate exercise.

I am not on low carbohydrate diet but limit the portion of my foods which are loaded with vegetables, fruits and nuts but low oil or fats.

My opinions on this forum are based on my experience as a medical doctor since 1978.

Though am now retired, I was a practicing GP in Nigeria before I specialised as a pathologist in England. I post my opinions based on research and Best Practice. Please feel free to take or ignore them with best wishes.

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Why would I need to send evidence to NICE about DPP4's are already recommended by NICE in their latest guidelines? I have nothing against Januvia or any other diabetes medication in fact I would actively encourage the use of medications to anyone who either wants to or is not or is unable to control their condition by other means.

I take your general point that all medicines have side effects however surely it is better to choose the ones with the least side effects as that minimises risk?

You are not the first GP or medical professional to post on this site. There have been many before you and all have had differing viewpoints over the years. Your profession is pretty divided on its recommendations so for example you have your opinion but both my current GP & my previous GP (I moved a couple of years ago) encourage a low carbohydrate minimal medication approach as does one of the countries leading diabetes clinics (my son who is T1 since a teenager sat as a patient representative on their guidance committee for a number of years).

Personally I find the anecdotal evidence of 1000's of diabetics real experiences over 10 years quite compelling but feel free to ignore them.

The art in this is to find the way that works for you long term and so I congratulate on your 20 years of control.

Take care

Hi. I would certainly ask the GP to increase the Metformin but it never has a great effect on blood sugar. I would also query the Gliclazide as it's purpose is to stimulate the pancreas to produce more insulin and I suspect your body may be swimming in it but unable to use it. The jury is out on whether it burns out the pancreas or not. Note that Newcastle Uni are a bit hung up on liver and pancreatic fat. The problem is visceral fat all over the body and in particular muscle cells which is why insulin can't be used effectively. You must control the carbs in your diet to get the weight down. Try to set yourself a daily limit of, say, 200gm. Note that there are one or two weekly injectables the GP could prescribe to help with weight loss when obese; Victoza is one of them.

What about vegetables- greens all types..beans..lentils ..tomatoes
And sweet potatoes which are not counted as a carbohydrate as potatoes and rice and pasta are for example

I'm sorry but I think you will find sweet potatoes are as carby as normal potatoes they just take longer to act.

john5220 said:

Alright it seems that I have to give up the bread and rice, so I have no choice but to plant my own food now. What a bummer not being able to eat bread again.....

Wish there was never a thing like diabetes so sad I got this at 30 years old

I have a question what about eating my bread but waiting 1 hour for it to digest and then doing 20 minutes cardio?

I eat like 3 hops in 1 eating we have world class bakery bread here in the Caribbean I get the ones with no preservatives it tastes and smell like heaven.

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Eat granary or wholemeal with added seeds etc

dbr10 said:

Suphanylaureas are cheap.

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