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Suggest Remedy For High Blood Glucose Levels After Stopping Metformin
Question: Metformin adversely affects me. I get severe gastric distress and cannot leave my house for fear of bowel accidents. My doctor took me off of Metformin at my insistence. He has offered no replacement but my blood glucose levels have increased. I was staying at normal fasting test and now am between 150 and 200. Evening tests go as high as around 300. Right now I take 1.8 of Victoza before breakfast and 65 of Lantus Solostar at bedtime. Is there nothing but Metformin?
Brief Answer:
Solutions exist
Detailed Answer:
Hello Mam,
Good day. Thanks for writing to HCM. I am Dr Praveen and I will be answering your query today. Noted the contents.
Metformin is an insulin sensitizer. It helps use lantus better and also your body's own insulin better for glucose control. Now that you are off metformin your sugars have evidently risen. We need to substitute metformin with another insulin sensitizer and the next best available medication is Pioglitazone.
Its also a very good drug and will take about 3 wks to reach its maximum efficacy . Patients can experience a slight weight gain. Its use was a little controversial until a year back but now its widely back in use and the risks seem rather unwarranted. Its not widely preferred in patients with osteoporosis, especially post menopausal women but in your case its a risk-benefit ratio we need to weigh our decision on.
Another option would be to switch to twice daily premixed insulin. It will give you good meal time and basal cover and ensure better sugar control but you may need more than 65 units to achieve that.
The third option would be to use a sulfonylurea like glimepride or gliclazide. Though its not a sensitizer it will help you control glucose levels if your body is still producing insulin.
In my opinion, the best option would be to switch to twice daily premix insulin along with victoza. You can check your blood glucose levels and titrate the insulin accordingly.
I will be happy to answer if you have any more queries.
Warm regards.
Dr Praveen
Solutions exist
Detailed Answer:
Hello Mam,
Good day. Thanks for writing to HCM. I am Dr Praveen and I will be answering your query today. Noted the contents.
Metformin is an insulin sensitizer. It helps use lantus better and also your body's own insulin better for glucose control. Now that you are off metformin your sugars have evidently risen. We need to substitute metformin with another insulin sensitizer and the next best available medication is Pioglitazone.
Its also a very good drug and will take about 3 wks to reach its maximum efficacy . Patients can experience a slight weight gain. Its use was a little controversial until a year back but now its widely back in use and the risks seem rather unwarranted. Its not widely preferred in patients with osteoporosis, especially post menopausal women but in your case its a risk-benefit ratio we need to weigh our decision on.
Another option would be to switch to twice daily premixed insulin. It will give you good meal time and basal cover and ensure better sugar control but you may need more than 65 units to achieve that.
The third option would be to use a sulfonylurea like glimepride or gliclazide. Though its not a sensitizer it will help you control glucose levels if your body is still producing insulin.
In my opinion, the best option would be to switch to twice daily premix insulin along with victoza. You can check your blood glucose levels and titrate the insulin accordingly.
I will be happy to answer if you have any more queries.
Warm regards.
Dr Praveen
Note: For further follow-up, discuss your blood glucose reports with our diabetologist. Click here.
Above answer was peer-reviewed by :
Dr. Prasad
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