Metformin Increase

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TerryP

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Relationship to Diabetes
Type 2
Hi
Just had review with DB Nurse (HbA1c increased to 67 from 54) and I have been doubled up to a Maintenance dose of 2000 mg/day plus 320mg per day of Glicazide. My very brief research seems to indicate this is ok, but just wanted to check if this is likely to cause any issues at this level (Hypo etc) - (I have only had 1 Hypo in 18 months)

Thanks in advance.
 
Glic can definitely cause them, and so can Metformin in combination with alcohol and exercise.
 
I think it's always wise to keep a close eye on levels following a change of doses or addition of extra meds.

You should be prescribed a meter and strips as Gliclazide can cause hypoglycaemia.

Let us know how you get on @TerryP 🙂
 
I took metformin and gliclazide for a while and found that the gliclazide was effective in reducing blood glucose but never got into "hypo" territory. It is well worth asking for a blood glucose meter to be prescribed (your surgery might be enlightened enough to say yes) so that you can make sure that your levels do not go to low.
 
By way of update, I'm not convinced that adding the additional dose of Metformin is such a good idea. I started it on Monday morning (2 in the morning, 1 in the evening) and today I started off at 7.5. I went for a walk at around 12:00 (only 0.7 of a mile), started to feel like (you know what) so tested when I got home and was down to 6.1. Tested again before lunch and had dropped to 4.5, and whilst this is not officially a Hypo it certainly felt like it and is outside of my specific target of 5 - 8. I will continue with it for a couple of days but there is no way I am going to double up my evening one until I get a grip on this. Does anyone have any thoughts on how long an increased dose takes to settle in. The only advice I was given was to call the DB Nurse if I drop below 4.

Thanks
 
Update to my Update: DB Nurse called me today (Saturday!) and said not to double dose the Metformin in the evenings as it seems the Gliclazide and Metformin together are likely to have caused the drop and to review in 3 months with another HbA1c.
I think I'm ok with this as a solution, as it was taking the second double dose in the evening that was really worrying me.
 
Update to my updated update. Well it happend, went for a 0.5 mile walk and dropped to 3.8. Managed to recover myself to 6.8 but looking to drop both my double doses of Metformin as this is the 3rd time that I have either been in, or close to Hypo Territory since starting double dosing. :-(
 
Metformin and Sulfonylureas in combination can cause hypos.
 
harbottle said:
Metformin and Sulfonylureas in combination can cause hypos.
Click to expand...
I was tempted to add "but probably will not" to that statement when I came up against the thing I often remark on. That is there does not appear to be any accepted numerical evaluation of the probability of such a combination causing hypos. Just a bit of vague guesswork and an assumption that it is theoretically possible.

So @harbottle, your comment is sound but I wish I could find numerical evidence which says whether I should be very worried, a bit worried, hardly worried or that the chances are so low you can forget about it.

PS... my experience as I said above is that I took a combination of the two for a year or so and never got anywhere near hypo territory. Don't know whether I am the norm or an oddity but if it were a significant problem I suspect we would hear a lot more about it.
 
I'm sure there's some research out there with numbers in it. I may have seen some a while ago. Apparently, more modern variants of the drug type have a lower risk anyway.

As Metformin + fasting and exercise does introduce a small risk of hypos, this, in combination with glic is probably something that needs to be monitored...

I've seen my BG go very low ( < 4.) with just Metformin (500mg a day) and exercise.
 
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