Dapagliflozin instead of , or with metformin ?

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Taffyboyslim

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Relationship to Diabetes
Type 2
I have been put on this , 10mg , together with a lower dose of metformin due to terrible diarrhea, flatulence and stomach cramps

I just can't handle this metformin any more . Will they keep me on the new drug on its own or will something else be added ?

I was so ill with the runs yesterday I had to take immodium instants and I clearly can't go on like that so I need to find a way forward and I would like to be informed when I see the doctor .

Thank you
 
I think it is a fairly standard combination of medication as they act in different ways, the metformin helps the body use the insulin it produces more effectively and reduces the amount of glucose the liver releases and the dapagliflozin encourages the kidneys to excrete excess glucose via urine. It is important to drink plenty I think 3 litres per day is suggested otherwise you can become dehydrated but that does have consequences of frequent loo visits.
You still need dietary changes for the meds to work effectively.
If you are still getting your unpleasant symptoms even with the reduced dose then go back to your doctor.
 
Leadinglights said:
I think it is a fairly standard combination of medication as they act in different ways, the metformin helps the body use the insulin it produces more effectively and reduces the amount of glucose the liver releases and the dapagliflozin encourages the kidneys to excrete excess glucose via urine. It is important to drink plenty I think 3 litres per day is suggested otherwise you can become dehydrated but that does have consequences of frequent loo visits.
You still need dietary changes for the meds to work effectively.
If you are still getting your unpleasant symptoms even with the reduced dose then go back to your doctor.
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What's this glicazade ?

I wonder what they can prescribe to replace the metformin

I am not prepared to put myself through this anymore , I am soiling myself in public
 
Taffyboyslim said:
What's this glicazade ?

I wonder what they can prescribe to replace the metformin

I am not prepared to put myself through this anymore , I am soiling myself in public
Click to expand...
I had a similar reaction to metformin so the pills went in the bin and I changed what I ate completely.
Still in remission after 7 years.
Ultra low carb.
 
Taffyboyslim said:
What's this glicazade ?

I wonder what they can prescribe to replace the metformin

I am not prepared to put myself through this anymore , I am soiling myself in public
Click to expand...
Gliclazide is another oral medication which encourages the pancreas to produce more insulin. the risk with that is that people can get low blood glucose (hypos) which would mean they should be finger prick testing more frequently particularly before driving.
It sounds as if you may need to be dropping the metformin if slow release or lower dose doesn't help
 
Leadinglights said:
Gliclazide is another oral medication which encourages the pancreas to produce more insulin. the risk with that is that people can get low blood glucose (hypos) which would mean they should be finger prick testing more frequently particularly before driving.
It sounds as if you may need to be dropping the metformin if slow release or lower dose doesn't help
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So I can take dapagliflozin on its own ?

I have looked on Google and they do a combination tablet with saxagliptin which I assume is the same sort of drug as metformin and glicazade ?

Obviously I need to see a doctor but I do appreciate your advice . It's a minefield .
 
Taffyboyslim said:
So I can take dapagliflozin on its own ?

I have looked on Google and they do a combination tablet with saxagliptin which I assume is the same sort of drug as metformin and glicazade ?

Obviously I need to see a doctor but I do appreciate your advice . It's a minefield .
Click to expand...
I think some people do, you are certainly not the only one who can't tolerate metformin in any shape or form.
I do urge you to look at dietary changes there may be lots more you can do on that front.
 
Taffyboyslim said:
So I can take dapagliflozin on its own ?

I have looked on Google and they do a combination tablet with saxagliptin which I assume is the same sort of drug as metformin and glicazade ?

Obviously I need to see a doctor but I do appreciate your advice . It's a minefield .
Click to expand...
A few years ago, I attended a presentation where an Endo stated there are over 400 combinations of meds available to treat T2. Not 400 drugs, but combinations of drugs.

If you have given Metformin a bit of chance, and it really isn't suiting you (soiling yourself very much fits that category!), then in your shoes I'd be stopping it.

Your GP can't make you take anything. You take it by choice at each dose. Best if that can be a conversation with the Doc though, so that he can take it into consideration when planning your care.

As and when your meds are changed, it can be helpful to just check whats in them. DrGoogle can be helpful there.

I hope you feel better soon.
 
hey @Taffyboyslim
(info taken from https://www.sign.ac.uk/assets/diabetes_algorithm.pdf - what NHS Scotland follows to the letter and its the same guidelines for England)

The usual as stated would be to switch metformin to gliclazide (sulphonylurea). Your dapagliflozin (SGLT2 inhibitor) is a 2nd line medication so they would likely just make the switch in the first line vs add another one from 2nd line.
Your GP might feel wild and go off the flow chart but unlikely 🙂
metformin.jpg
 
AndBreathe said:
A few years ago, I attended a presentation where an Endo stated there are over 400 combinations of meds available to treat T2. Not 400 drugs, but combinations of drugs.

If you have given Metformin a bit of chance, and it really isn't suiting you (soiling yourself very much fits that category!), then in your shoes I'd be stopping it.

Your GP can't make you take anything. You take it by choice at each dose. Best if that can be a conversation with the Doc though, so that he can take it into consideration when planning your care.

As and when your meds are changed, it can be helpful to just check whats in them. DrGoogle can be helpful there.

I hope you feel better soon.
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That's a very kind and helpful comment . And very wise , as are all the comments on this forum .

I have a very good relationship with my gp and I am going to work with them
gll said:
hey @Taffyboyslim
(info taken from https://www.sign.ac.uk/assets/diabetes_algorithm.pdf - what NHS Scotland follows to the letter and its the same guidelines for England)

The usual as stated would be to switch metformin to gliclazide (sulphonylurea). Your dapagliflozin (SGLT2 inhibitor) is a 2nd line medication so they would likely just make the switch in the first line vs add another one from 2nd line.
Your GP might feel wild and go off the flow chart but unlikely 🙂
View attachment 23833
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So basically I am currently on metformin and dapagliflozin 10 mg

As I am already on dapagliflozin then they would suggest I stay on that ? With no additional medication ?
 
they would likely replace the metformin with gliclazide and keep you on the dapagliflozin (or will if they follow the guidelines to the letter which is what my lot do/did)

They also might try you on slow release metformin to try if you haven't already.

They do prefer metformin over gliclazide in any form which I think comes down to cost to NHS. Metformin is cheap and the slow release is about double the price and gliclazide is about in the middle of the two, however, with the hypo risk of gliclazide they should provide a meter and test strips on repeat script which increases their cost dramatically.
 
That is all assuming you need more medication.... What was your most recent HbA1c and when was it? If you have made some dietary changes you may not need even the Metformin.
 
gll said:
they would likely replace the metformin with gliclazide and keep you on the dapagliflozin (or will if they follow the guidelines to the letter which is what my lot do/did)

They also might try you on slow release metformin to try if you haven't already.

They do prefer metformin over gliclazide in any form which I think comes down to cost to NHS. Metformin is cheap and the slow release is about double the price and gliclazide is about in the middle of the two, however, with the hypo risk of gliclazide they should provide a meter and test strips on repeat script which increases their cost dramatically.
Click to expand...
Tried slow release metformin , it's awful
 
It might be worth doing a search for ..type 2 treatment algorithm ..to find and download the ✻flowchart✻ to help you suss out the options available.
 
Taffyboyslim said:
What's this glicazade ?

I wonder what they can prescribe to replace the metformin

I am not prepared to put myself through this anymore , I am soiling myself in public
Click to expand...
I take mine with gliclazide and tummy issues so much better but must keep fluids up to reduce risk of uti and thrush as both drugs make you pee out excess sugar
 
Hope the chat with your GP goes well @Taffyboyslim, and you are able to agree on an alternative treatment option that might suit you better.

How have your levels been responding to the meds and lifestyle changes you’ve made so far? Have you had a follow-up HbA1c recently?
 
everydayupsanddowns said:
Hope the chat with your GP goes well @Taffyboyslim, and you are able to agree on an alternative treatment option that might suit you better.

How have your levels been responding to the meds and lifestyle changes you’ve made so far? Have you had a follow-up HbA1c recently?
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I am requesting a new one , the gp I think has to give that the go ahead ? My numbness is causing me a lot of anxiety suggesting to me my levels which were 53 might have pushed up ?
 
everydayupsanddowns said:
Hope the chat with your GP goes well @Taffyboyslim, and you are able to agree on an alternative treatment option that might suit you better.

How have your levels been responding to the meds and lifestyle changes you’ve made so far? Have you had a follow-up HbA1c recently?
Click to expand...

Dr persuaded me to stick with 2 x 500 metformin and the dapagliflozin 10mg until I get a bloods in a month's time to see where thi ngs are . I was down from 87 to 53 at last test .

He said it was OK to use an occasional immodium to firm things up but I needed to be careful and keep up the fluid
 
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