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Newbie Question : A third drug!

P

PMA

New Member
Relationship to Diabetes
Type 2
Hi Everyone

It's good to know there is a place like this to ask questions and I hope someone can shed some light 🙂

I was diagnosed T2 some years ago and, after not seeing great results after Metformin alone, I eventually ended up on Metformin 1000mg twice a day and Sitagliptin 100mg once a day. My doctor introduced Rybelsus (3mg) as a third medication the other day because my HbA1c is still not good (74 in March 2025; it was 91 last July and 98 at some point before that).
  • Does anyone else have this combination of drugs and how have you found it?
  • What sort of results have you seen altogether?
  • Did you need to go up to 7mg of Rybelsus or was 3mg enough, taking into account the Metformin and Rybelsus as well?
  • Final question! Has the Rybelsus at 3mg had any impact on weight loss with this combination given that it's a semaglutide? I'm aware that semaglutides can impact appetite and so on.
The pharmacist has said today that the three drugs are sometimes prescribed together and the 3mg may be enough to reduce HbA1c levels, depending on my next blood test.

Many thanks
P
 
I'm afraid I can't help with the medication as I don't need any for diabetes - but, being nosey - do you check your blood glucose after eating?
What sort of numbers do you see - and what would you eat on a typical day?
I'm just curious looking at your increasing HbA1c levels despite the medication.
 
When you eat may have some impact but not as much as what you eat, all carbohydrates convert to glucose regardless of when you eat them though some people find they are less tolerant of carbs in the morning.
Do you do shift work or it is the time to eat proper meals that is a problem.
 
Leadinglights said:
When you eat may have some impact but not as much as what you eat, all carbohydrates convert to glucose regardless of when you eat them though some people find they are less tolerant of carbs in the morning.
Do you do shift work or it is the time to eat proper meals that is a problem.
Click to expand...
Thanks for your reply Leadinglights
My HbA1c was fine until it wasn't, after I began my current job and that's had an impact in a number of ways. Changing jobs will help me get back to where I used to be, eating the way I know I need to. I'm just curious to hear from others about the drug combination as I go forward.
Many thanks 🙂
 
Welcome to the forum @PMA

There’s a thread here which links to GP guidance about which combinations of meds are recommended in different circumstances

everydayupsanddowns

Thread 'NICE / SIGN flowchart for T2 medication'

Thanks to @gll and @Docb for recently sharing these helpful resources.

SIGN (Scottish equivalent to NICE) flowchart for the introduction of medications to help with T2 diabetes


And the section of the NICE guidelines on which the flowchart is based

Recommendations | Type 2 diabetes in adults: management | Guidance | NICE

www.nice.org.uk www.nice.org.uk

And again as a flowchart
  • Like
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From reading the experiences of various T2 members, approaches seem to vary from GP to GP. Some will tend to add meds in combination, layering one on top of another, while others start with Metformin as the base, then try various others in sequence, stopping one and starting another.

I suppose it will depend on the clinical experience of different GPs as to what they have found to be most effective (and least problematic) for the people they have seen over the years.

Certainly triple therapies are not unusual, and have clinical trial results to back them up.

Hope you get on well with the Rybelsus. 🙂
 
PMA said:
I think my problem is when I eat, rather than what I eat. I work in mental health, often responding to crisis situations, which means my days can be irregular but I put my foot down at work in December 2024 and that appears to have had an impact, going down to 74
Click to expand...
You’re probably misguided here. There is no need to eat on a regular schedule as a t2 on metformin and sitagliptin. The timing of when you eat won’t have made your a1c high. Intermittent fasting is actually used to improve blood sugars by some.
 
Lucyr said:
You’re probably misguided here. There is no need to eat on a regular schedule as a t2 on metformin and sitagliptin. The timing of when you eat won’t have made your a1c high. Intermittent fasting is actually used to improve blood sugars by some.
Click to expand...
Hi Lucyr, thanks for your input but that's not the topic I've raised here. There are more details to my story that I don't want to discuss in this space. My question relates to what's next. Please see my reply to Leadinglights above. I'm going to delete my reply to Drummer as satisfying Drummer's curiosity was probably misguided as it has taken the thread somewhere I didn't intend!
 
everydayupsanddowns said:
Welcome to the forum @PMA

There’s a thread here which links to GP guidance about which combinations of meds are recommended in different circumstances

everydayupsanddowns

Thread 'NICE / SIGN flowchart for T2 medication'

Thanks to @gll and @Docb for recently sharing these helpful resources.

SIGN (Scottish equivalent to NICE) flowchart for the introduction of medications to help with T2 diabetes


And the section of the NICE guidelines on which the flowchart is based

Recommendations | Type 2 diabetes in adults: management | Guidance | NICE

www.nice.org.uk www.nice.org.uk

And again as a flowchart
  • Like
  • Love

From reading the experiences of various T2 members, approaches seem to vary from GP to GP. Some will tend to add meds in combination, layering one on top of another, while others start with Metformin as the base, then try various others in sequence, stopping one and starting another.

I suppose it will depend on the clinical experience of different GPs as to what they have found to be most effective (and least problematic) for the people they have seen over the years.

Certainly triple therapies are not unusual, and have clinical trial results to back them up.

Hope you get on well with the Rybelsus. 🙂
Click to expand...
Thank you everydayupsanddowns 🙂
 
PMA said:
My question relates to what's next.
Click to expand...
I don’t understand. You already know what’s next - the rybelsus. After that either a different 3 drugs or insulin.
 
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