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Diabetic. Have high insulin level. Prescribed istamet 50 mg and 500mg. Are these medicine safe?

Aug 2012
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Answered by

Practicing since : 1999
Answered : 362 Questions
Good evening dr,

I have been diagnosed with type 2 diabetes. my fasting Blood glucose level is 133 mg/dl and fasting Insulin level is 119.61 iu/ml. And my pp blood glucose level is 274 mg/dl and insulin level is 214 iu/ml. and my Hba1c level is 8.8. I have been prescribed with tab ISTAMET 50 MG/ 500MG. How does this combination of two drug help in control of diabetes. would there be any side effects for this medicine. while surfing internet i found that sitagliptin 50 mg present in the ISTAMET could cause pancriatitis, cancer etc.
Posted Tue, 26 Mar 2013 in Diabetes
Answered by Dr. Madhuri Patil 10 hours later

Thank you for your question.
First of all let me tell you that taking plain Metformin- part of tab Istamet- has always been the first step of managing new onset diabetes. Addition of Sitagliptin, a drug from DPP 4 Inhibitor category, is not recommended right away especially when your fasting is less than 140, your insulin levels are so high and HbA1c is less than 9%. The second thing I want you to understand before I come to answering your main question is that never ever check your insulin levels in the blood as they are not essential, they can be misleading to you and ultimately it is waste of resources and money on these kinds of unnecessary tests.
Now how the drug Sitagliptin acts: We have a gut hormone called incretin secreted when you consume food. This gut hormone, along with the glucose and proteins coming from food itself, stimulates insulin secretion in your blood stream. This hormone is easily detroyed by an enzyme called dipeptidyl peptidase-4 (DDP-4). To avoid easy metabolism of the incretin hormone scientist developed the inhibitor of the enzyme so that incretin hormone can work for longer time in people with diabetes. This is what the tablet Sitagliptin does.
Now you are given this tablet completely unnecessarily in spite of your doctor knowing the excess insulin levels in your blood. This excess insulin is not working normally and hence your blood sugars are high. First thing to do is to use this excess insulin properly and not to waste your insulin secreting cells' (beta cells') energy over secretion of more and more insulin further!
Hence you need to take only plain Metformin in higher dose than what you have been given. This will give rest to your insulin secreting cells which are over functioning since many months and this will save the insulin reserve. So please go back to your doctor or any other good Diabetologist for appropriately increased dose of Metformin.
The cancer and pancreatitis cases of Sitagliptin were there during all sorts of clinical trial. But the FDA approved the drug because the company making the drug proved that the cases were proned to develop these problems even though they would not have used the medication Sitagliptin itself and the number of these cases was clinically not significant meaning the durg is safe to be used for masses. Now there are lots of contraversies over this from people who have interest in selling this drug and people who oppose it. But FDI took a decision based on scientific data provided to them from all sorts of clinical trials and hence gave approval for use in public looking at basic safety. This is true in most of the medications available in the market that you would always see very bad side effects listed in their profile which you never find happening to you! The simplest example is tablet Crocin.
In short, even though the drug is ok to use, you do not need to use it at this stage of your diabetes and along with proper diet, exercise you need to take proper dose of tab Metformin for excellent results.
I hope you got an answer. Please get back for any further query. Take care.
Above answer was peer-reviewed by
Follow-up: Diabetic. Have high insulin level. Prescribed istamet 50 mg and 500mg. Are these medicine safe? 12 hours later
Hello Dr,

Thanks for your reply. from your reply I understand that SITAGLIPTIN present in ISTAMET Induces to secrete more insulin to control blood glucose level. but in my case Insulin secretion in body itself is high so that it is not advisable to take Istamet at this stage.

I hope that i have construed your answer in right way.

I consulted another doctor he also explained about Istamet. he has prescribed tablet GLUCOBAY M - 50. this tablet also seems to be a combination of two medicines. I want to know how this medicine acts in controlling diabetes
Answered by Dr. Madhuri Patil 48 minutes later
Hello again.

You understood my answer very correctly.

The tablet Glucobay delays breaking down the food into simple glucose which increases the post meal sugar fast. This is also not necessary tablet at this stage, though not absolutely wrong to prescribe at this stage. You can take this. But very ideal for you is increased dose of tab Metformin alone.

Anyway, take the tablet now and check your sugars after a month and let me know where you stand.

Take care. and get back for any further query.
Above answer was peer-reviewed by
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