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If I can't take metformin, then what?

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#1
TomB

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I've been taking metformin 1000mg and have proudly displayed a 6.5 A1c. I also have had about a dozen angiograms, getting a stent during most of them. At least 2 days before a procedure I would stop metformin because a reaction between it and the contrast dye is extremely hard on the kidneys.
Was getting angina pains while doing the TV couch potato thing and a few days ago my cardiologist described what that meant and showed me the results of a recent echo and thallium stress test. The blockages are not really ripe enough to do much at this time, but the couch potato pain is unstable angina, which is highly unpredictable. If a few nitroglycerin tabs don't cure it then it's off to the ER and I best be able to have an angiogram without delay.
The "without delay" thing hit me as I was about to take my metformin this morning. I didn't take it. And called my regular doc to have a little chit chat about this. I'll see her next week, hey, that's a quick response considering it's the VA. I'll tell her about being ready for an angiogram and that I really don't think it wise that I am taking metformin. As in my heart, arteries and kidneys are way more important than an A1c number.
So, what will she say? Actos is out because it gives me 50-60mg hypos a couple times a week. Any other pill that might replace metformin? Or am I looking at insulin? Before seeing her, I'd sure like to have an idea of what I'm in for.

#2
mzteacher

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hi tom,
sounds like you are faced with some scary stuff....i know there is glipizide...i take a small amount of that with the met...i don't know about taking it with out....and there are people on here taking byetta...they can give you more info about that....good luck to you as you sort all of this out!
susan

#3
beau91

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there is Januvia don't know if its good for you
Sitagliptin phosphate (Januvia) By mouth Doesn't cause weight gain May cause upper respiratory tract infection, sore throat and diarrhea; little is known about other potential side effects High: $175 to $250 a month
The comment are from the Mayo clinic site.
Bye Ricky
Hi my name is Richard for short Ricky .I'm from Montreal Canada .Diabetic since 1993.



A diplomat is a man who always remembers a women birthday but never remembrs her age . Robert Frost[SIGPIC][SIGPIC][[SIGPIC][/SIGPIC]

#4
DonnyC

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Try insulin, its the way to go. You will eventually
reduce your meds. Its what your body would naturally
produce. It just makes sense to give your body what it needs.
There are no life altering side effects. It sounds like
you can't take a chance with a side effect from some new drug.
Diagnosed Type 2: Feb 2003
Currently treat with oral med/insulin combo
Meds: Glipizide, Metformin, Altace
Insulin: Novolin Nph
Diet & Exercise, Garlic, Chromium

#5
Isometric

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I agree with Donny, but conditionally. No pill can match the control you have with insulin, but it is a very difficult decision for the majority of type 2's to make. I have a friend who's been having a very rough time lately - A1c's up near 14, an ulcerated sore on one of his toes, and he's already on a whole host of oral meds. His doctor - let me rephrase - the airhead he sees for medical problems, including diabetes, keeps stringing him along with the ol' "let's try one more thing before insulin" line. Twice (seriously, twice), this person that just happens to have a medical degree, has prescribed a medication that my friend is already on. Doc Dimwit even asked my friend how long he'd been a diabetic....when he's the one that diagnosed him 12 years ago! Anyway, here's my point - my friend has acknowledged and come to terms with the fact that he's going to have to go on insulin, and much sooner rather than later. He knows it, he says he's ready to do it, and he realizes that his "doctor" is a major dufus...but he keeps going along with the "one more thing" plan. It's one thing to say that you're ready for it, but it's quite another when you're preparing to give yourself a shot for the first time. I think this is mostly because going on insulin represents failure to most of us type 2's. It's been drilled in to us since diagnosis, overtly or otherwise, that this is what we want to avoid. For some, that's fine, but for most of us (or at least more of us), that's an unrealistic expectation. Some of the pills they have come up with are amazing, and they really do work wonders, but they cannot get a 14% A1c down to an 8%. Heck, they can't even get a 14% down to an 11%. They just can't. Obviosuly, you've got a pretty good A1c going on now, but if metformin is one of the key ingredients in that control, going without it could definitely turn a 6.5% in to a 10.5%. If you are very seriously considering getting off of it, I'd encourage you to take a closer look at insulin as a means to keep the tight control you already have. It can be difficult to start (mostly a mental thing, IMO), but the "fear factor" vanishes almost immediately.
Diagnosed Type 2: May, 2003
Currently treat with oral med/insulin combo
Meds: Glipizide, Metformin, Simvastatin
Insulin: Lantus, Novolog.
A1c: 12.9% - Spring '07
6.8% - 2/18/08
7.3% - 5/19/08
7.0% - 8/29/08

#6
TomB

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Thanks DonnyC. I was afraid that someone like you would come along and tell me what I didn't want to hear. Insulin. I hadn't though about getting a surprise side effect from a new drug. So what you said is probably the best way to go. I just don't like the idea of sticking a needle in me.

#7
TomB

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Sage advice, IOSMETRIC. You kind of nailed my inner thoughts about insulin. It's not the going on insulin that bothers me. It's the needle part of it. And then the figuring out how much and making sure it's not too much and filling needles and etc, etc, etc.
But I've done it before. After an angiogram you have to stay off metformin until all the dye has flushed out, usually a day or two. So I've had a few shots, but not willingly. And a few times I cheated and just let the numbers float up in the heavens for awhile. But this time it looks like it might be like forever. My thinks it be time for a wee bit of liquid courage and a good night's sleep to let this settle in.

#8
Isometric

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Hahaha - not too much liquid courage, I hope - unless it's low-carb liquid courage! :)

I don't know how sage it is - I've just made the switch myself (last Spring), so the feelings are still a little fresh. I came to a decision in what sounds like a similar way - I realized that I was going to need it, but I didn't like it. Every blood draw I've ever had done, I look away because I can't abide watching the needle go in to my arm. Somehow, though, watching multiple needles go in to my abdomen every day stopped bothering me within a week. The first was hard. I think I even shed a tear while I had a little pity party for myself, but I had to go to work still, so I took a good hard look at myself in the mirror, told myself to suck it up and get going, and did. I've had a couple of days since where I find it hard to watch my wife (or anyone else for that matter) just pick up something and eat without thinking about it or counting the carbs, but then again, if I didn't have to think about what I ate, I'd eat far worse than I do. Not being really excited about needles can actually be healthy. I think twice about whether or not I really want that snack if it means I've gotta count it, then draw and take a shot for it. The bottom line for me, though, is this: I have better control AND more flexibility with insulin than I ever did with just oral meds. With medication, or even with 1-2 shots daily insulin regimens, you have to eat for what you take, whereas mimicking the body's way of doing things with a long-acting shot and rapid-acting meal shots allows you to take for what you eat. People can, and certainly do, abuse this, but as long as you don't entirely throw self-discipline out the window, it can make a big difference.

I'm being awfully verbose tonight, so I'll leave you with that. I'll be away to the coast for several days with my wife and daughter, but I wish you both peace and clarity of mind as you figure this out for yourself. I'll be eager to hear what update you might have when I get back. :) Take care!
Diagnosed Type 2: May, 2003
Currently treat with oral med/insulin combo
Meds: Glipizide, Metformin, Simvastatin
Insulin: Lantus, Novolog.
A1c: 12.9% - Spring '07
6.8% - 2/18/08
7.3% - 5/19/08
7.0% - 8/29/08

#9
DonnyC

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Don’t get hung up on the needle thing. The insulin
is injected using a “pen’. The actual needle is less than
a ¼" long, and is as fine as a frog hair. (lol). What I am
saying is it is not the typical ”needle” you are imagining.
It quick and painless. It’s the results that will make you smile.
I myself struggled for many years to keep my numbers in check.
I even struggled more trying to make the decision to switch to insulin.
Even the day of the appointment with my doc, I second guessed myself.
Looking back now, I wish I would have made this decision years ago.
It would have saved me a lot of depressed moments seeing my numbers
high and having the sense of absolute no control of my health.
And staying healthy is what its all about. :) :)
Diagnosed Type 2: Feb 2003
Currently treat with oral med/insulin combo
Meds: Glipizide, Metformin, Altace
Insulin: Novolin Nph
Diet & Exercise, Garlic, Chromium




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