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Type 2 medication

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Bernie 2

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Type 2
I am in my 80's and was first diagnosed type 2 about 20 years ago and have managed to keep my sugar levels more or less within a reasonable level with the help of course of a Diabetic Nurse. I have recently undergone surgery and my medication has been changed to include a 1 x .75mg Trulicity Dulaglutide injection weekly and 2 x 500mg Metformin daily but find that to keep my sugar levels at a reasonable level, I need to take a third Metformin. However, I understand that Trulicity injections can take some while before the benefits can be felt, so my question is :- Can I take the extra Metformin now when I need it and then stop it or adjust the Metformin intake when the Trulicity injection starts to work fully ?
 
Hi @Bernie 2 and welcome to the forum. As a group we are very wary about commenting on changes in medication because only your prescriber has all the information needed to be able to make a reliable suggestion. There may be members who have been in the same position as you and if there is then they will be along to compare notes and let you know of their experience. This may help in framing your approach to your GP.

Let us know how you get on.
 
Hi. You must talk to your GP. Metformin is a very tolerant and flexible med but as this and Trulicity can cause bowel upset you need to seek guidance
 
I appreciate your concern but the point of writing to this forum is to get advice independent opinions, mainly because the surgery I have been with for many years has closed and I am now dealing with a different set of Diabetic Nurses and Doctors.

My original Diabetic nurse told me they tried to keep sugar levels below 15 and provided I kept to that, it would be acceptable. After my return from hospital three months ago, a Diabetic Nurse from the new practice tells me in conversation they try to keep levels below 12. Then recently, another Diabetic nurse from the same practice, who presumably has taken over my case, then tells me the figure she looks for is 10 - all these conversations are of course conducted by phone! One Doctor prescribes me with Gliclazide to be added to Metformin, then another Doctor stops Gliclazide because it is deemed to lead to hypos ! Is it any wonder that I get confused and seek other opinions. The trouble today is that you do not get the opportunity to discuss any of this when seeing a Doctor because it is history by then and involves personalities, which I try to avoid.

All I want to know is " Do others vary their metformin medication when sugar levels appear to be rising and then reduce their medication when things return to normal and if so, has it done any harm"?
 
Unfortunately Metformin does not work how you seem to think it does i suggest you read the patient information leaflet that it comes with.
Glicliazide does cause hypos and as you are in your 80's some are wary about hypo causing medications may contribute to causing falls.
You really do need to speak to the Doctor, to discuss this.
 
Gliclazide does not cause hypos if the dose is right. You should start with 40mg and increase if needed as advised by the GP. You do have to take care if you vary your carb intake a lot. Metformin is used to reduce the overall background output of glucose a little. It does not work by adjusting it for mealtime carbs. For that Gliclazide (and insulin of course) can help with that.
 
DaveB said:
Gliclazide does not cause hypos if the dose is right. You should start with 40mg and increase if needed as advised by the GP. You do have to take care if you vary your carb intake a lot. Metformin is used to reduce the overall background output of glucose a little. It does not work by adjusting it for mealtime carbs. For that Gliclazide (and insulin of course) can help with that.
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Well I got hypos when I took Gliclazide and I even did on the slow released version. I don't see how you can titrate the dose as it works by stimulating the pancreas to produce Insulin!
 
grovesy said:
Well I got hypos when I took Gliclazide and I even did on the slow released version. I don't see how you can titrate the dose as it works by stimulating the pancreas to produce Insulin!
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Yes but the Gliclazide dosage affects how much it stimulates the pancreas. I started with 80mg and ended up with 320mg (max dose) which finally stopped working. So 40mg is the lowest start dose you can get. Some GPs start with 80mg and that can cause hypos. One solution is then to reduce to 40mg
 
DaveB said:
Yes but the Gliclazide dosage affects how much it stimulates the pancreas. I started with 80mg and ended up with 320mg (max dose) which finally stopped working. So 40mg is the lowest start dose you can get. Some GPs start with 80mg and that can cause hypos. One solution is then to reduce to 40mg
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I was sensitive to it even on the lowest dose and then quickly put on slow release, and still got hypos on it .
 
Bernie 2 said:
Many thanks both of you. I am still as confused as ever about this strange disease but have decided to have this out with my Diabetic Nurse next time round.

Regards

Bernie
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Can you not ring and get a phone appointment and have a list of questions you want to ask?
 
Because of the difficulty even getting the phone to ring at our surgery* - this week I decided to send them an email about something - quite a long email as I explained properly what my thought process was as you would in person, and the GP rang me this morning, we had a good conversation, he told me & something I wasn't aware of and explained it properly and I'm very pleased I took the trouble to do that.

* Our younger daughter and her youngest daughters are still registered at the same surgery as us, she needed to ring about her youngest and redialled the number 82 times until she got the ringing tone instead of the engaged one. Anyway - result there too!
 
DaveB said:
Gliclazide does not cause hypos if the dose is right.
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My understanding is that it does, and people are supposed to get a meter and strips when on it. I think it's because you're body can't reduce insulin (when BG goes down) as normal.
 
Bernie, I think you should use this to make notes & to prep yourself. Nab the person at the practice you can talk to best (if you can), and go through it with them
 
Hope you get the answers you are looking for @Bernie 2

I agree with others that metformin isn’t usually taken at a dose tailored to specific meals. I believe people usually take it during after meals more because taking on an empty stomach increases the chances of the gastric upheaval it is famous for.

As far as I understand it metformin builds up in the system over a number of weeks to whatever the average dose is, and works to reduce glucose output from the liver, along with increasing insulin sensitivity. It doesn‘t seem to be taken/adjusted on a per-meal basis 🙂
 
I have had Type 2 for around 25yrs and it has been kept under reasonable control with Metformin until the beginning of the year. My Doctor added an extra tablet (not sure of the name) which had no effect. He then changed it to Gliclazide about 5 months ago and this has helped to bring it back under control. Over the past week it has started rising again and goes from zero to between 15/30 by mid morning with very little encouragement in the way of sugar. Can anyone give me any indication of what comes next.
 
mullikg said:
I have had Type 2 for around 25yrs and it has been kept under reasonable control with Metformin until the beginning of the year. My Doctor added an extra tablet (not sure of the name) which had no effect. He then changed it to Gliclazide about 5 months ago and this has helped to bring it back under control. Over the past week it has started rising again and goes from zero to between 15/30 by mid morning with very little encouragement in the way of sugar. Can anyone give me any indication of what comes next.
Click to expand...

It isn't sugar which causes spikes but carbohydrate. Even so, that is a very high spike so it would be a good idea to contact your doctor or specialist nurse as soon as possible.
 
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