HpprKM said:I am really mystified why doctors seem adamant not to self test, my own GP - a very reasonable and helpful lady - really does not want me to self test - I am not asking for strips to be paid for (though not sure why we should be entitled to this, as diabetes is a potentially a life threatening disease), so I do find it difficult to understand where she is coming from :?
- this sounds like good advice, I think I will this and get back to you with the answer!Next time you see your GP why not ask her, she may have a convincing answer but I somehow doubt it.
HpprKM said:I read this post with interest, then have to confess ignorance- what are 'sulfonylureas...'?
HpprKM said:what are 'sulfonylureas...'?
Sulfonylureas
The sulfonylureas act mainly by augmenting insulin secretion and consequently are effective only when some residual pancreatic beta-cell activity is present; during long-term administration they also have an extrapancreatic action. All may cause hypoglycaemia but this is uncommon and usually indicates excessive dosage. Sulfonylurea-induced hypoglycaemia may persist for many hours and must always be treated in hospital.
Sulfonylureas are considered for patients who are not overweight, or in whom metformin is contra-indicated or not tolerated. Several sulfonylureas are available and choice is determined by side-effects and the duration of action as well as the patient’s age and renal function. Glibenclamide, a long-acting sulfonylurea, is associated with a greater risk of hypoglycaemia; for this reason it should be avoided in the elderly, and shorter-acting alternatives, such as gliclazide or tolbutamide, should be used instead.
Metformin, the only available biguanide, has a different mode of action from the sulfonylureas, and is not interchangeable with them. It exerts its effect mainly by decreasing gluconeogenesis and by increasing peripheral utilisation of glucose; since it acts only in the presence of endogenous insulin it is effective only if there are some residual functioning pancreatic islet cells.
Metformin is the drug of first choice in overweight patients in whom strict dieting has failed to control diabetes, if appropriate it may also be considered as an option in patients who are not overweight. It is also used when diabetes is inadequately controlled with sulfonylurea treatment. When the combination of strict diet and metformin treatment fails, other options include:
Acarbose, an inhibitor of intestinal alpha glucosidases, delays the digestion and absorption of starch and sucrose; it has a small but significant effect in lowering blood glucose. Use of acarbose is usually reserved for when other oral hypoglycaemics are not tolerated or are contra-indicated. Postprandial hyperglycaemia in type 1 diabetes can be reduced by acarbose, but it has been little used for this purpose. Flatulence deters some from using acarbose although this side-effect tends to decrease with time.
Nateglinide and repaglinide stimulate insulin release. Both drugs have a rapid onset of action and short duration of activity, and should be administered shortly before each main meal. Repaglinide may be given as monotherapy for patients who are not overweight or for those in whom metformin is contra-indicated or not tolerated, or it may be given in combination with metformin. Nateglinide is licensed only for use with metformin.
The thiazolidinedione, pioglitazone, reduces peripheral insulin resistance, leading to a reduction of blood-glucose concentration. Pioglitazone can be used alone or in combination with metformin or with a sulfonylurea (if metformin inappropriate), or with both; the combination of pioglitazone plus metformin is preferred to pioglitazone plus sulfonylurea, particularly for obese patients. Inadequate response to a combination of metformin and sulfonylurea may indicate failing insulin release; the introduction of pioglitazone has a limited role in these circumstances and the initiation of insulin is often more appropriate. Pioglitazone is also licensed in combination with insulin, in patients who have not achieved adequate glycaemic control with insulin alone, when metformin is inappropriate. Blood-glucose control may deteriorate temporarily when pioglitazone is substituted for an oral antidiabetic drug that is being used in combination with another. Long-term benefits of pioglitazone have not yet been demonstrated.
I have previously been on max doses of Metformin and Gliclazide for a while, then stopped the Glic and eventually came off the Met too. I now take 1g Met in the morning as an adjunct to my Byetta and haven't found it has made any detrimental difference to weight.
Monitoring blood glucose
A speedometer on your car helps you control your speed... monitoring helps you control your blood glucose.
Blood glucose readings:
Let you know what your blood glucose level is at the moment you take it.
Help you understand the relationship between the food you eat, physical activity, medications and your glucose level.
We use cookies and similar technologies for the following purposes:
Do you accept cookies and these technologies?
We use cookies and similar technologies for the following purposes:
Do you accept cookies and these technologies?