Type 2 Metformin vs Gliclazide?

[Ian9024]

After initial diagnosis in Jan 2017 with a HbA1c of 94 I was given Merformin (2 x 500mg per day).
I have since gone on a strict weight loss campaign and lost 35lbs by end of March and my follow up blood tests show my new level of HbA1c is now 55. Unfortunately, it also showed my kidney function was poor, my initial tests had my GFR at 74, this dropped to 61 with my follow up bloods. I was give a repeat renal blood test which has shown an even further drop if GFR of 55. As a result my GP has stopped Metformin suggesting this could be the reason and told me to have a further blood test in two weeks. The plan is then to try Gliclazide as an alternative and I'm a little concerned with seemingly potential side effects as I seemed to take to Metformin quite well with only mild stomach discomfort. My worries are driven my GP warning about potential weight gain (I've worked my whatsits off to lose this) and having to self test before driving due to potential drop in BS levels,..I have a 90 mile commute for work! Just wondered if anyone had any comments or advice as I'm a little unsure around the GFR issue and impact?

Thanks in advance...

 

[Providence 62]

Thanks for putting up this post, very relevant to me at the moment. Doc is thinking of adding a bit of glicazide to my canagliflozin as my blood levels shoot up very easily. Be interested to hear what people have to say as, like Ian I have worked quite hard to get my weight down.

 

[Daibell]

Gliclazide has a completely different way of working than Metformin. Gliclazide stimulates the pancreas to produce more insulin. Metformin helps the liver reduce it's glucose output a bit and reduces your appetite a bit. Gliclazide only causes weight gain if you have too many carbs. I was on max dose for years with no weight or any side effects but I have a low-carb diet. The important thing about Gliclazide is to get the dose right and not to have more than you really need to control blood sugar.

 

[Bluetit1802]

The GFR issue means your kidneys aren't filtering properly and only working at 55% (currently). This is of concern, and I believe NICE recommends not to prescribe Metformin when there are known kidney problems as it can make matters worse.

Have you tried to control your glucose levels by diet? If you give this a go you may find you can manage with a very low dose of Gliclazide. Yes, you do have to self test before driving, and every 2 hours during a long drive, but if you want to take this disease by the scruff of its neck and control it by diet, you need to self test anyway.

When I say by diet (with the aid of some Gliclazide) I mean really cutting down on carbs

 

[Ian9024]

The GFR issue means your kidneys aren't filtering properly and only working at 55% (currently). This is of concern, and I believe NICE recommends not to prescribe Metformin when there are known kidney problems as it can make matters worse.

Have you tried to control your glucose levels by diet? If you give this a go you may find you can manage with a very low dose of Gliclazide. Yes, you do have to self test before driving, and every 2 hours during a long drive, but if you want to take this disease by the scruff of its neck and control it by diet, you need to self test anyway.

When I say by diet (with the aid of some Gliclazide) I mean really cutting down on carbs

Thanks for the reply. Having been diagnosed 3 months ago I've followed the GP and DSN lead so far although I have carefully adjusted my diet which has involved watching carbs, hence losing over two stone since diagnosis. I guess the answer is to try Gliclazide and see the reaction...

 

[Bluetit1802]

Thanks for the reply. Having been diagnosed 3 months ago I've followed the GP and DSN lead so far although I have carefully adjusted my diet which has involved watching carbs, hence losing over two stone since diagnosis. I guess the answer is to try Gliclazide and see the reaction...

Well done on that weight loss - that is excellent.

Maybe "watching" carbs isn't enough. You need to count them carefully and arrive at a number of grams you can tolerate. Your meter will help you to do this. Eat to your meter and you can't go wrong!

 

[Mbaker]

Hi @Ian9024, a third way is just diet and exercise. Your drop is similar too mine, look at my graph. On your current trajectory you will be either in the pre-diabetic or non diabetic range within your next 1 or 2 HbA1c's.

I would ask to see a Kidney specialist. My GFR went down also under Metformin (why don't these.... warn of this possible side effect). It cannot be coincidence that I have had an increase since ditching this. I did some research about what to eat for Kidney health. This is not an exhaustive list, as I have removed carby stuff:

Bamboo Shoots
Olives
Blackberries
Bell Peppers
Cabbage
Cucumber
Onion
Eggplant
Radish
Lettuce
Capsicum
Garlic
Ginger
Carrot
Turnip
Peas
Green leafy vegetables
Olive oil
Black Pepper
Fenugreek
Coriander
Bay leaves
Mint
Vitamin D
Fish

I would also try and take the pressure off of your kidneys by eating no more than twice a day and having an adequate amount of water. It is also important to reduce your blood pressure; for this I recommend the Camry hand grips (grip for 2 minutes, rest 2 minutes and repeat 3 times), and to eat 2 cloves of roasted garlic maybe 5 out of 7 days. Loosing weight will also help blood pressure, along with brisk walking.

Hope this helps but please see a specialist, insist on it.