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Linagliptin AND Metformin together

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Falkirk Bairn

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Relationship to Diabetes
Type 2
Hello. Has anyone been prescribed Linagliptin AND Metformin together? I've just been prescribed that combination. Is it safe to take two different tablets for my diabetes?
 
Why on earth wouldn't it be safe?
 
Actually Falkirk Bairn, nobody here is a practicing medical expert!

Anyway they have come to you via two medical experts, the GP who prescribed them and the pharmacist who dispensed them. I'd trust them over an internet forum anyday. 🙂
 
No problem. My niece is a pharmacist and can get a bit vocal about the lack of appreciation of their role in trying to make sure that nobody gets poisoned by medication.
 
Thanks again. I was a bit concerned about being on both drugs. Initially, I was on Metformin for about 18 months. However, my GP thought it might be affecting my kidney function and changed my medication to Linagliptin. However, following discussions with a Renal Consultant at the local hospital, my GP has now prescribed BOTH drugs.
 
Well that's three medical experts!!!! You will have a choice of who to sue if it all goes wrong. 😉

(Just so there is no confusion, the last comment was an attempt at humour. )
 
It is perfectly safe to take two drugs, whilst they are used to treat the same condition the two you take do it in different ways so you benefit from the combined effects to bring down glucose levels. Think of it like how the best way to lose wight is to both eat better and exercise more rather than doing just one of them alone.

If lifestyle changes alone are not enough to control type 2 diabetes, it is the standard N.H.S. pathway to increase from one to three drugs as required before considering insulin based treatment.

When I was first diagnosed I was automatically put on two drugs, but having stopped responding to those I was put on a third just over a week ago. And that is in addition to a bunch of other drugs for other conditions.

The first drug prescribed is always Metformin, which makes you more sensitive to insulin, unless there is a medical reason it cannot be taken.

But if that alone is not enough a second type of drug is added to it. And if that still is not enough a third type is added to those. Those types are:

A DPP-4 inhibitor (a drug with a name ending -liptin), which reduces the release of stored glucose from the liver.
A sulfonylurea (with a -ide), which causes the pancreas to create more insulin.
Pioglitazone, which also increases insulin sensitivity but has a number of complications.

I am not medically trained, I just have an obvious self interest in knowing about this. If my simplified version does not inspire enough confidence, the official guidance is available here:

 
Hi. Those two together are fine. Metformin works by reducing slightly the liver's output of glucose. The Gliptins work by suppressing an enzyme that in turn suppresses insulin output after a meal. They can work together. A third tablet, Gliclazide, is also sometimes added and this increases the output of insulin from the pancreas but shouldn't normally be needed by a true T2.
 
DaveB said:
A third tablet, Gliclazide, is also sometimes added and this increases the output of insulin from the pancreas but shouldn't normally be needed by a true T2.
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Sorry, what does that mean?

Gliclazide is the second most prescribed drug for type 2 diabetes after Metformin, and those two are the only antihyperglycemic drugs on the World Health Organization's list of essential medications. If it is not a medication for type 2 diabetics, who is it for?
 
Becka said:
Sorry, what does that mean?

Gliclazide is the second most prescribed drug for type 2 diabetes after Metformin, and those two are the only antihyperglycemic drugs on the World Health Organization's list of essential medications. If it is not a medication for type 2 diabetics, who is it for?
Click to expand...
There is a big problem with many 'T2s' actually being mis-diagnosed T1/LADAs (I'm one of those) so for that group Gliclazide is a big help before insulin. It's only very recently that medics including DUK accept the existence of LADA. Typically these are the 15% 'slim T2s'. A T2 who has excess weight will typically have insulin resistance and it's this that prevents the body's own insulin working. A C-Peptide test will show excess insulin. Making the pancreas produce more insulin with Gliclazide is not the best solution and may have limited success. Yes, I am generalising but it's worth understanding the way Gliclazide works as some GPs just prescribe it without understanding the implications. BTW this mis-understanding has been a global problem and it's only recently that C-Peptide testing has been able to help with the correct diagnosis. Apologies for the sermon!
 
Errrr, they've been doing C-peptide tests since at least 1972, so you regard 50 years ago as recent? The Joslin Institute may have been doing them before that though.
 
DaveB said:
There is a big problem with many 'T2s' actually being mis-diagnosed T1/LADAs (I'm one of those) so for that group Gliclazide is a big help before insulin.
Click to expand...

Given how widely it is prescribed, are you saying that most of those taking it are not "true" type 2 diabetics? Is there any study show this? It should be easy for a researcher to simply look at what proportion of people prescribed Gliclazide end up having to switch to insulin treatment to show there is a need for further study.

I do not know how many diabetics are prescribed a sulfonylurea, but I would assume it is more than just 15% of them to be considered an essential medication internationally, and one that is highly prescribed in the U.K. This is why I am confused by you saying it should not be needed. The implications of that would be extremely significant and too obvious not to be noticed.
 
I'm probably guilty of de-railing this thread; sorry but to comment on Becka's and Trophywrench's replies. I'm sure C-Peptide testing has been available for many years but I've been looking at posts on this and the 'other' forum for around 15 years now (yes I'm a bit nerdy!) and the term C-Peptide has only appeared in posts in, say. the last 7 years or so. Prior to that GAD appeared to be the only test generally offered for T1 diagnosis. Ref Gliclazide I should have included those who have had T2 for so long that they have damaged beta cells and hence need a sulfonylurea.
 
…. whereas if you'd looked at the two UK forums who have consistently told the truth you'd have seen it mentioned.

GAD antibodies are only present for X amount of time; C-peptide actually determines whether the body is still producing any insulin and if so, how much. About 50% of people who have had T1 since they were very young children still have some endogenous insulin production 60 or more years later, but simply nowhere near enough to do anything useful for them. The Joslin Institute in Boston followed a large group all their lives and had 5 year get togethers for them all with their partners and one - Richard157 - used to keep us updated.
 
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