Diabetes Talking

Question:

- Hide quoted text — Show quoted text – I’m a 51 year old type II who was diagnosed back in January.  After being on 5 mg of glucotrol for the past 5 months, I switched to 500 mg of glucophage 5 days ago, and will increase to 1000 mg in two days. It seems to be quite a change. With the glucotrol, I could eat quite a bit with on appreciable rise in the Bgs and kept a pretty constant range of 80-130. with the Glucophage, the amount of food that I can eat has really dropped and the between meal snacks which were a necessity with the Glucotrol are now pretty much out of the question. Yesterday on the drive home from work, I munched on a handful of pretzels and found my BG to be a whopping 165 when I got home, but dropped to 127 in an hour. Is this normal for Glucophage, or will things fall more into "normal" when I increase the dosage to 1000 mg. From my own reactions to Glucophage and glyburide, plus what I have read here, it is obvious that individuals’ reactions vary quite a bit. The ordinary effects of Glucophage are threefold:    It increases insulin sensitivity    It slows the absorption of sugar in the gut    It inhibits the release of sugar from the liver. Contrast this with glyburide (Glucotrol), which has the basically the sole effect of whipping your pancreas into producing additional insulin. While this therapy lowers the BG’s, it does so by creating hyperinsulinemia, which is implicated in long-term cardiac problems. There is some reason to believe that hyperinsulinemia may also be increasing the insulin resistance, i.e., making your diabetes worse. Because of the above, Glucophage is, theoretically, far better for the classic type 2 diabetic, i.e., those of us who are strictly insulin resistant. However, besides the potential gastric problems, Glucophage also seems to have an upper limit on its effectiveness. For some reason, dosages above about 2000 mg/day don’t seem to have any additional effect. Therefore, if you are severely insulin resistant, the maximum dosage of Glucophage may not be adequate. In this case, the endo generally prescribes additional glyburide. Before starting on Glucophage, I was taking the maximum dosage of glyburide (20 mg/day), and my BG’s were a tad on the high side. Now I am taking 2000 mg/day of Glucophage, which has allowed me to cut the glyburide back to 2.5 to 5 mg/day. In fact, if it is a day when I have planned heavy exercise, I can cut the glyburide completely. According to my endo, the effectiveness of Glucophage for me seems to be just about on target, based on clinical results. However, I have read messages here from people who have said that Glucophage did absolutely nothing for them. It is obvious that the range of results varies considerably. What I am saying is that there is no real way for anyone to say that your results are right or wrong. You are changing the way you treat your diabetes, and that means you have to do additional testing and figure it out for yourself. It will take a while for you to get the hang of it but, if you keep testing, you will figure out how to match your diet to the time and quantity of medications you are taking. And one additional thought — I am kind of surprised that your endo did not put you on Rezulin (troglitazone). It has recently been released and, from the literature, seems to be a far better medication than Glucophage. I am sure I will be giving it a try as soon as my current supply of Glucophage and glyburide runs out. It is extremely expensive, however. BTW, I seem to be one of the lucky 66% who don’t seem to have adverse reactions to the glucophage. Your mileage may vary on this also. I had no adverse reactions at all when I started at 850 mg once a day. Then I went to South America for a while and could get it only in 500 mg tablets, so I changed to 500 mg twice a day. Still no adverse reactions. When I came back, my endo decided I should go to 1500. This cause enormous gastric upsets — intense pain for about 24 hours, decreasing slowly over several days. It became bearable after a day or two, but it took a full month before the gastric symptoms disappeared completely. Later I moved up to 2000 mg/day, but this time experienced no gastric problems at all. According to my endo, this is a little unusual, but not unheard of. It seems that the dosage level that triggers the gastric problems varies quite a bit from one individual to the next. You may not have any adverse reactions yet, but don’t be surprised if the next increase makes you feel as though you’ve been kicked by a donkey in the solar plexus. NOTICE: The e-mail address is deliberately incorrect. Replace the ISP with "nwpacifica.net."

 I am on Glucophage (500 mg), and another benefit is that it does not give you hypos and does not make you gain weight as the other medications, including insulin, do.

Response:

I’m a 51 year old type II who was diagnosed back in January.  After being on 5 mg of glucotrol for the past 5 months, I switched to 500 mg of glucophage 5 days ago, and will increase to 1000 mg in two days. It seems to be quite a change. With the glucotrol, I could eat quite a bit with on appreciable rise in the Bgs and kept a pretty constant range of 80-130. with the Glucophage, the amount of food that I can eat has really dropped and the between meal snacks which were a necessity with the Glucotrol are now pretty much out of the question. Yesterday on the drive home from work, I munched on a handful of pretzels and found my BG to be a whopping 165 when I got home, but dropped to 127 in an hour. Is this normal for Glucophage, or will things fall more into "normal" when I increase the dosage to 1000 mg.

From my own reactions to Glucophage and glyburide, plus what I have read here, it is obvious that individuals’ reactions vary quite a bit. The ordinary effects of Glucophage are threefold:    It increases insulin sensitivity    It slows the absorption of sugar in the gut    It inhibits the release of sugar from the liver. Contrast this with glyburide (Glucotrol), which has the basically the sole effect of whipping your pancreas into producing additional insulin. While this therapy lowers the BG’s, it does so by creating hyperinsulinemia, which is implicated in long-term cardiac problems. There is some reason to believe that hyperinsulinemia may also be increasing the insulin resistance, i.e., making your diabetes worse. Because of the above, Glucophage is, theoretically, far better for the classic type 2 diabetic, i.e., those of us who are strictly insulin resistant. However, besides the potential gastric problems, Glucophage also seems to have an upper limit on its effectiveness. For some reason, dosages above about 2000 mg/day don’t seem to have any additional effect. Therefore, if you are severely insulin resistant, the maximum dosage of Glucophage may not be adequate. In this case, the endo generally prescribes additional glyburide. Before starting on Glucophage, I was taking the maximum dosage of glyburide (20 mg/day), and my BG’s were a tad on the high side. Now I am taking 2000 mg/day of Glucophage, which has allowed me to cut the glyburide back to 2.5 to 5 mg/day. In fact, if it is a day when I have planned heavy exercise, I can cut the glyburide completely. According to my endo, the effectiveness of Glucophage for me seems to be just about on target, based on clinical results. However, I have read messages here from people who have said that Glucophage did absolutely nothing for them. It is obvious that the range of results varies considerably. What I am saying is that there is no real way for anyone to say that your results are right or wrong. You are changing the way you treat your diabetes, and that means you have to do additional testing and figure it out for yourself. It will take a while for you to get the hang of it but, if you keep testing, you will figure out how to match your diet to the time and quantity of medications you are taking. And one additional thought — I am kind of surprised that your endo did not put you on Rezulin (troglitazone). It has recently been released and, from the literature, seems to be a far better medication than Glucophage. I am sure I will be giving it a try as soon as my current supply of Glucophage and glyburide runs out. It is extremely expensive, however. BTW, I seem to be one of the lucky 66% who don’t seem to have adverse reactions to the glucophage.

Your mileage may vary on this also. I had no adverse reactions at all when I started at 850 mg once a day. Then I went to South America for a while and could get it only in 500 mg tablets, so I changed to 500 mg twice a day. Still no adverse reactions. When I came back, my endo decided I should go to 1500. This cause enormous gastric upsets — intense pain for about 24 hours, decreasing slowly over several days. It became bearable after a day or two, but it took a full month before the gastric symptoms disappeared completely. Later I moved up to 2000 mg/day, but this time experienced no gastric problems at all. According to my endo, this is a little unusual, but not unheard of. It seems that the dosage level that triggers the gastric problems varies quite a bit from one individual to the next. You may not have any adverse reactions yet, but don’t be surprised if the next increase makes you feel as though you’ve been kicked by a donkey in the solar plexus. NOTICE: The e-mail address is deliberately incorrect. Replace the ISP with "nwpacifica.net."

Response:

I’m a 51 year old type II who was diagnosed back in January.  After being on 5 mg of glucotrol for the past 5 months, I switched to 500 mg of glucophage 5 days ago, and will increase to 1000 mg in two days. It seems to be quite a change.  With the glucotrol, I could eat quite a bit with on appreciable rise in the Bgs and kept a pretty constant range of 80-130. with the clucophage, the amount of food that I can eat has really dropped and the between meal snacks which were a necessity with the clucotrol are now pretty much out of the question.  yesterday on the drive home from work, I munched on a handful of pretzels and found my BG to be a whopping 165 when I got home, but dropped to 127 in an hour. Is this normal for glucophage, or will things fall more into "normal" when I increase the dosage to 1000 mg. BTW, I seem to be one of the lucky 66% who don’t seem to have adverse reactions to the glucophage. Bob

Response: