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dose of metformin

C

chrischivs

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1
Hi
I am currently on 2000mg metformin plus 2 x gliclazide tablets and 1 of pioglitozide daily. My doctor says the next step is insulin injections, although in the information inside the metformin box it says maximum dose can be 3000 mg daily. Can I ask to try the higher dose of 3000 mg daily. My blood sugars are anything from 7.5 to 9.5 daily.
 
Hi Chris my bloods are that every day and I'm diet only, so sorry can't help but I'm sure someone will be along soon to do so.
 
The current maximum recommended maximum dose of metformin is 2000 mg per day, it was reduced from 2550 mg (which is what I am on). Some people are still on 3000 mg per day, but this is rare as it is reckoned that anything over 2000 mg per day doesn't have much effect.

There are other drugs like Sitagliptin (Januvia) http://www.diabetes.co.uk/diabetes-medi ... nuvia.html or injectables such as Byetta http://www.diabetes.co.uk/diabetes-medi ... yetta.html or Victoza http://www.diabetes.co.uk/diabetes-medi ... ctoza.html

Insulin isn't always the next step, but to get any of the above you may need to have them prescribed by a hospital consultant.
 
Hi. I would ask your gp to try sitagliptin before insulin. It's fairly new and some HCPs aren't really aware that it's an option to reduce spikes.
 
I know quiet a few people on 3000 so it cab be worth asking as long as they monitor you because it has a risk to the kidneys however that's on any dosage of it not just the very max.
 
Hi
I was told its the Max dose. But i have had horrible side effects since they put it up. Im now on Protein Modified Fast Programme 40g carb per day. Weight flying off but blood sugars still high. They were hoping my blood sugars would go down before trying me on other meds but so far they're still high.
 

What's your diet like, Chris? Can you reduce your carbohydrate intake at all?

Viv 8)
 
Hi. I would agree with Viv, It might be an idea to have a careful look at your diet, I particular if it's possible toreduce your carb intake. You may be able to maintain or reduce your current medication.
My understanding with metformin is that the current recommended maximum dose for standard release is 2500mg and for extended release "sr" to be 2000mg. However Metformin will only lower your bm's by about 2mmol, and the gliclizide by a similar amount. The most effective means of lowering your blood sugars being dietry control. That's why I suggest you have a look at your carb intake. Why not post your typical food intake, or typical meals. There are lots of people on the forum who can give you very good advice on diet.
With regards to further medication. Your doctor will usually increase medication in 4 stages, the 4th stage being insulin.
However before you get to that, he would have the option of adding what is called a "DPP4 Inhibitor" and or a "GLP1 agonist " although I think the GLP1 type of drug is injectable. The DPP4 are oral. So he does have plenty of scope before resorting to Insulin. I suspect he will be considering the costs. i.e insulin is cheaper.
I'd still have a serious look at your diet though.
Hope the above helps. best of luck with your diet, nobody likes taking extra meds until absolutely necessary
 
Thanks for the advise. How long roughly on a low carb diet would you expect to see results with Blood Sugars?

Jackie
 
Hi jackie. It's a bit difficult to be exact, it depends on how many carbs you are eating, how high your bm's are at the moment and your glucose intolerence. It will also be dependant on how much carb you reduce from your diet. But overall you should start to see some effect fairly quickly.
I assume that you are testing at the moment. Try keeping a log of what you eat, work out the carb content, and take reading at one and two hours after eating. This will start to show you what effect that meal has on your blood sugars, you can then try the same meal with some of the carbs removed. You should soon start to see the results.
When i first started reducing carbs, I set a target of 150g per day, This wasn't low enough so I reduced them further to 100g petr day. I reduced mine finally to around 20g per day. You will have to work to your meter , keep testing and testing and you will soon start to establish what works for you.
Hope this helps. I've tried to keep it as simple as possible to get you started, maybe you've already made some attempt at lowering your carbs.
Do you have any idea of how many carbs you eat at the moment, and do you test your bm's'
I've made a lot of assumptions in my reply, post a reply and gives us some more information, there's lots of people on the forum to give you help and advice
 
Thank you I'm just at the end of wk3 of a protein sparing modified fast 40g carb per day.I was put on the diet by the hospital diabetic nurse. My blood sugars don't go below 10 first thing in the morning are worse normally between 13 and 16. I've lost 15lbs in 3wks so well happy just confused why my blood sugar is still high I'm not due to be seen at clinic till 24th Oct.
 
Don't worry too much about your fasting reading. It's most likely what's known as the Dawn Phenomenon, when your liver starts feeding you glucose to get you going in the morning. It can be the last thing to drop, but if you keep losing weight it will go. I've lost nearly 5 stone and my fastings are now normally in the 4s/low 5s, but it has taken some time. Only another 5 stone to go! :wink:

If you test just before and 2 hours after your main meal you'll probably get more realistic results. You're aiming to get your BGs 2 hours after, to witihn 2 points of the 'just before'. But don't stress about it yet - give it time! On 40g of carb you should soon see a difference. Well done on the weight loss - that sounds like an enlightened diabetic nurse!

Let us know how you get on.

Viv 8)
 
I am only on 1000mg Metformin and my blood glucose is 6.2 to 8.5 but then my doctor does not bother I have not been tested at the doctors for 6 months or more I only know those blood results because I was in hospital and they checked it
 
hi Jackie. Not sure what a protien sparing diet is. Not heard of that one. Might be worth a double check on your 40g of carbs a day. This would definitely take you into low carb. perhaps you could share with us a typical days diet.
With regards to your morning highs , this is fairly common and is called the dawn effect. As your body wakes up in the morning it relases hormones to wake you up and get active , the down side to this is to raise blood sugars. Another possibility to this is that your blood suagers are going low and your liver is dumping glucose to overcome this. Again it is down to testing again. What are your daytime and evening levels like, certainly if they are very low just before bed it might be worth trying a little carb then, and see if this has any beneficial effect.
Not sure which type of metformin you are on, If you are not on SR, ( extended release ) It might be worth discussing with your doctor going onto this type, and loading the evening dose to overcome the morning effect. Normal metformin reaches its most effect in 2 to 4 hours, whereas metformin SR will not reach maximum effect till about 7 to 8 hours and carry on being effective for much longer, so could be a good prospect for your morning problem bm's. I take 1000mg at approx 10pm in the evening, so that its at its most effective early moring when I need it . and then take another 1000mg at 8am. I found this had a big effect on my morning readings. Best thing is to discuss and agree a strategy with your doctor.
You might find your doctor will be reluctant to let you have SR because it cost more money.
Let us know how you get on
 
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