Change of medication - worse BG?

[Wolfman Bob]

I have been on Gliclazide for the last 5-6 months (40mg bd) and my Hba1c has come down from 8.5 to 7.1 so far. In the early days I tested regularly to find out what things I could eat - and what to avoid! On tests two hours after eating I aimed for about 7.5 - 8.5 (depending on how virtuous I had been).

I have now been taking Metformin (500mg bd) for the past week or so. Initially I did not retest (my new GP reckons the tests are a waste of time and has stopped my prescription for the strips) as I assumed that the impact of the medication would be similar.

However, I tested yesterday and was shocked by the result - over 10 after a meal I can usually eat with a result of less than 8.0!

Since then I have tested two hours after every meal - with consistent results of about 25-30% higher than before (this is on meal combinations that I had thoroughly tested previously with relatively unvarying lower results).

Not sure what to do about this - apart from retest everything again! Before that though, really wanted to ask/confirm the question "Is Metformin is known to be less effective than Gliclazide when it comes to BG reduction"?

Any thoughts/experiences about medication changes would be much appreciated. Thank you.

 

[BioHaZarD]

I have been on Gliclazide for the last 5-6 months (40mg bd) and my Hba1c has come down from 8.5 to 7.1 so far. In the early days I tested regularly to find out what things I could eat - and what to avoid! On tests two hours after eating I aimed for about 7.5 - 8.5 (depending on how virtuous I had been).

I have now been taking Metformin (500mg bd) for the past week or so. Initially I did not retest (my new GP reckons the tests are a waste of time and has stopped my prescription for the strips) as I assumed that the impact of the medication would be similar.

However, I tested yesterday and was shocked by the result - over 10 after a meal I can usually eat with a result of less than 8.0!

Since then I have tested two hours after every meal - with consistent results of about 25-30% higher than before (this is on meal combinations that I had thoroughly tested previously with relatively unvarying lower results).

Not sure what to do about this - apart from retest everything again! Before that though, really wanted to ask/confirm the question "Is Metformin is known to be less effective than Gliclazide when it comes to BG reduction"?
Any thoughts/experiences about medication changes would be much appreciated. Thank you.

I have only been on Metformin so cannot comment, but it would appear so,I would argue with your gp about test strips and say since you have had them taken away you cannot control your levels as good. He may up your Metformin dose though.

 

[Daibell]

Hi. Are you saying that your GP replaced the Gliclazide with Metformin? This is very unusual; perhaps there was a good reason? What was the reason for the changeover? Usually your are started with Metformin and then Gliclazide is added to improve control if needed. Sometimes if you are under-weight then you are started with Gliclazide as it can cause weight gain. If you are receptive to Gliclazide and not over-weight then it may have more effect in lowering blood sugar than Metformin. I found that having both Metformin and Gliclazide was not enough and my GP added Sitagliptin which helped a bit. Each drug has a different mechanism so it's a different solution for every patient.

 

[Anonymous]

Yes, metformin is definitely not as effective as gliclazide. Docs usually use metformin as their first drug of choice... not sure why your doc put you on metformin??? Perhaps you had high BGLs and your doc used gliclazide to get your overall BGL down??? Did you have a recent HbA1c done??? Be careful to note everything as not all drugs do a great job and everyone is different. If the drug isn't working for you, be sure to let your doc know.

 

[Ali H]

Two different actions, glic encourages the pancreas to make more insulin, metformin to aid the insulin's action, ie make you less insulin resistant, as I understand it.

You would normally take Metformin first with Glic added if needs be.

Ali

 

[MaryJ]

not knowledgable re meds but from what I've picked up on here met is first glic added later - so it does sound an odd decision

You mention your control was good so perhaps doc thought a reduction in meds ok BUT perhaps you could handle more carbs with the glic than you can with the met. so I'd say yes back to the drawing board re testing with the met and reduce carb intake accordingly.

Mary x

 

[Ali H]

Not always Mary, I had Glic first in order to achieve a quicker reduction in levels so the GP might have had a reason to do it that way around in this case too.

Seems odd to stop the Glic and start Met though if good control was being achieved with it!

Ali

 

[tree-peony]

Are you still taking the Gliclizide, or just Metformin? My BG went up initially with Metformin and every increase in dose, but hopefully it's on the way back down again.

 

[))Denise((]

One 500 mg metformin is not going to reduce levels as much as 40 mg of gliclazide. Once I started taking 40 mg gliclazide on top of 2550 mg metformin it reduced my levels by 1 - 1.5 mmol. The maximum dose of metformin 2000 mg (I take the old maximum) will reduce levels by 1 - 2 mmol.

Sounds like you need to be on more metformin, but they start you slowly with it to hopefully prevent the stomach problems people get with it. I would go back to the doc to find out if it is correct that you are not increasing the dose.

Gliclazide encourages your pancreas to produce more insulin, this isn't necessarily a good idea as you don't really want to stress out your poor old worn out pancreas and make it possibly fail sooner. This may be the reason you were taken off the gliclazide. Another reason why you were taken off it was the strips issue. With Gliclazide there is a possibility of hypos, so you need to test before driving, metformin isn't a hypo inducing drug, so that is their rationale of no strips. Of course you do need strips to find out how food is affecting you, but doctors don't see it that way.

 

[Wolfman Bob]

Thank you all for your feed-back. I started on Gliclazide because of kidney issues (transplanted 3 years ago - doctor nervous about prescribing Met as can have issues if poorish kidney function, so chose Glic).

However, at last renal consultant visit, the consultant decided that my kid function was good enough to take Met, so recommended my GP switch me to it instead (as Met has additional benefits for somebody in my circumstances - not sure if related to the fact I have NODAT (New Onset Diabetes After Transplant)).

I spoke to him today and he said he would have no problem if I upped my dose from 2*500mg to 3*500mg. I said I would try it, and get back to him if it did not help (I think he hopes I will just go away, as we had a slight disagreement over the fact I was not prepared to wait 2-3 months for my next Hba1c so see how well it was working (or not!).

Anyway, will see if the dosage increase helps...

Thanks again for you input

 

[Wolfman Bob]

Another thought I had - undoubtedly nonsense though - was that I wondered whether when Glicazide was stopped, the pancreas had a bit of a reaction to its withdrawal? After all, the drug had been "persuading" that organ to work harder than it had been before, so maybe when that "persuasion" was removed the pancreas thinks it needs a (hopefully brief!) holiday to recover from its extra exertions

 

[paragliderpete]

Hi, You don't say what type of metformin you are on. there is standard ( fast) or extended release (slow) . They are taken in different ways. It may be obvious but try checking the tablets information sheet , to see it matches how you have been told to take them. Fast release are normally taken before meals and extended release normally taken in the evening or morning.
I had a similar problem when the chemist gave me the wrong type. I didnt realise until I lost control of my blood sugars

 

[Wolfman Bob]

Hi - and thanks for the heads up regarding different types of Metformin. I was aware that there were two types, but thought the slow release was used when the other caused too many nasty side-effects - rather than differing control methods on blood sugars!

Having examined the tablet info sheet I can find nothing to say which sort it is (does not even say when to take it at all!). However, on the box it says to take with or after food - does this suggest that it is more likely to be the "fast" sort please?

You say having the wrong type gave you problems - do you mean that the Slow or Extended Relaease type gave you better control? I do hope so, as my results at the moment seem to be pretty scary! :?

If I should be on the other sort, what do you suggest the best way would be to persuade my GP to change me over to the other type? As you may have noticed from my other posts on this forum, I am not exactly brimming over with confidence that my new GP has any especial interest in stabilising my BG quickly (seeming to prefer to see what the 6 monthly (well, 3 monthly courtesy of my renal consultant) HbA1C results show).

Thanks again.

 

[paragliderpete]

Hi . Does the box have the word sr, er or extended release after the word metformin. or is it a generic product such as glucophage sr, bolymin. All of these would indicate that they are extended release. not totally sure about the spelling of the name , but shouldn't be to far out.

The difference between standard and extended release, is that the time for maximum effect and concentration in the body ( Tmax and Cmax) is approx 2hrs for standard and 8hrs for extended release. You tend to take extended release in the evening. I take mine at 10pm with supper and get the maximum effect at 6am to prevent a morning effect. Supper has to be protien and no carb to prevent a rise in blood sugar.
If you were to take standard release at 10pm its maximum effect would be by midnight, and i would have a big morning effect.

In reverse if you take and extended release tablet just before you have a meal. you would get a big spike , with the metformin hours away from being of full effect .

Hope I made sense , It's a bit more complex than I state,but in general terms it's a timing thing .

Hope this helps, I'm no expert. I just know what problems the chemist caused when he gave me the wrong type. A chemist should be able to tell you which type you have if you take him the box

 

[Wolfman Bob]

Thanks for the reply and detail - it did make perfect sense but I fear that it will not help me in my situation.

I think the only solution for me is to retest every thing/meal that I ate, and drastically cut down on portions that I could get away when I was on Gliclazide

I will try very hard to be good, but if I do not get my sugars down to sensible levels I will have to go to my GP, as I do not want to wait months permanently spiking before my HbA1c reflects the worsened situation.

Anyway, thanks again.