Alternative to Metformin?

Puppypants · #1 (**permalink**) 03-12-2009, 07:14 PM

Since I am having issues with my kidneys, my doctor wants to discontinue metformin, which has been working really well, along with lower carb and exercise. What are some of the alternatives that are kidney friendly that won't cause hypos?

princesslinda · #2 (**permalink**) 03-12-2009, 07:34 PM

My brother in law had some kidney problems that caused the doctor to stop his metformin. He took this and Glyburide.
The endo stopped all of his oral meds, started him on insulin. He's having much better blood sugars and feels a lot better as he's not having the fluctuations he was having on oral meds.

BTW, his kidney function was much improved after just a few weeks off the oral meds. Creatinine clearance was back within normal limits.

hardeeboy · #3 (**permalink**) 03-12-2009, 09:10 PM

Quote:

Originally Posted by Puppypants

Since I am having issues with my kidneys, my doctor wants to discontinue metformin, which has been working really well, along with lower carb and exercise. What are some of the alternatives that are kidney friendly that won't cause hypos?

I'm new to Diabetes and take Metformin, is the med causing your kidneys these problems. I noticed you mentioned hypo, is it causing big drops for you?

Puppypants · #4 (**permalink**) 03-13-2009, 02:57 AM

No, no hypos, and I am not sure what is causing the kidney problems. It may be that I probably had diabetes for a few years before being diagnosed. Since being diagnosed, I have well controlled bg's, except for a few months while my father was gravely ill which led to his passing away in December.

I am a little leery of insulin. Last year, I was on prednisone for some acute hives, and had to take insulin to help control my bg. I had many hypos, some of which were very scary - I was down to 39 one morning!

fa4960 · #5 (**permalink**) 03-13-2009, 03:52 AM

Hi,

I was on Metformin (Glucophage) at the beginning but my stomach didn't like it so I got the doctor to change it. I think it was replaced by an increased doze of Amaryl.

If you are paying yourself there is a negative cost impact as Metformin tends to be cheaper - at least it is my experience out here in Thailand.

cherokee_psh · #6 (**permalink**) 03-13-2009, 11:21 PM

I fall into the 'my stomach couldn't take it' category. I recently switched to Januvia.

hardeeboy · #7 (**permalink**) 03-14-2009, 01:58 AM

Quote:

Originally Posted by Puppypants

No, no hypos, and I am not sure what is causing the kidney problems. It may be that I probably had diabetes for a few years before being diagnosed. Since being diagnosed, I have well controlled bg's, except for a few months while my father was gravely ill which led to his passing away in December.

I am a little leery of insulin. Last year, I was on prednisone for some acute hives, and had to take insulin to help control my bg. I had many hypos, some of which were very scary - I was down to 39 one morning!

I hate the word Prednisone, that's why I'm a type 2 today.

TomB · #8 (**permalink**) 03-14-2009, 02:36 PM

I had to stop oral meds this past January and switched to insulin. Sulfonylureas gave me headaches, I'm considered high risk for TIA's so they were cut out. Metformin can be very bad for kidneys when combined with iodine based contrast dye and I have those types of procedures frequently. Protecting my kidneys is extremely important. Bad kidneys means cutting out my other meds and medical procedures get much more complex if they are even possible.
I too was leary of insulin until I simply had no choice. But I quickly found out I was worried about nothing. Poking my finger hurts a lot more than the needle, if and when I even feel it at all. I take 30 units of long acting Lantus at night. Before meals I take Humalog and I'm still tweaking the # of units per carb formula for me. Right now it's 5u + 1u per 20g of carbs. Yup, it's a guess but I'm getting better.
. One of the good things about rapid acting Humalog is that finally, I can do something about post meal spiking. When that happens, I take another 3u, wait half an hour and take 3 more if I'm still above 200mg/dl.
. Protect those kidneys. Bad kidneys means much more than changing diabetes treatment. All other medical procedures get changed as well.
Tally Ho,
Tom

fa4960 · #9 (**permalink**) 03-15-2009, 04:48 AM

Hi Tom,

I understand your worries regarding your kidneys. I also check up on mine on a regulary basis as this is a problem I most defently want to avoid. However your story gives me a level of comfort when it comes to insulin. I have a upcoming endo doctor appointment this week and I need to switch to insulin as I basically can't keep my numbers down on the oral medicine plus I have a level of discomfort with the cancer stories around Januvia. However the imagined discomfort of the needle had me doing a last try on the oral meds but I must realise that my pancreas seems too damaged to handle my diabetes with the help of the oral meds.

My endo doctor seems to think that a bed time shot of either Levemir or Lantus should do the job for me. I have no preference for any of these products although I notice that it is often mentioned that Levemir is suppose to be used twice a day where as Lantus can be used once? My preference is probably a combination of the best possible insulin and the least painful pen to shoot it in, whatever that is but I will see what the doctor thinks.

Do you have any experience with Levemir?

TomB · #10 (**permalink**) 03-15-2009, 01:27 PM

Greeting FA4960,
Back in the late '60's, I spent a few months up in the north-east part of Thailand, right on the Mekong near a town called Nakhon Phanom. In air Force jargon, it was called NKP. Getting there meant stopping at Bangkok's airport and somehow I always seemed to get lost downtown for a few days while getting the airplane refueled.
OK, back to diabetes. Lantus is a 24 hour basal insulin. I take 30units at bedtime and it kind of replaces what metformin used to do. Levemer doesn't act as long and is frequently taken twice a day. Rapid acting insulins do just that are handle what a meal does to you BG.
As for needles - the VA gives me 31ga syringes that I use for Lantus and stick it in my thigh. I buy an insulin pen with a 31ga pen needle for Humalog and that goes in my stomach. That's because I use it more often during the day and the pen is really convenient. And trust me, poking for a finger prick hurts more, lots more, than the needle. Just read and follow the instructions and life will be good!
Tally Ho,
Tom

fa4960 · #11 (**permalink**) 03-15-2009, 08:15 PM

Greeting Tom,

sounds like you enjoyed your stay out here. I haven't really had the chance to explore too much of Thailand yet. A little son with his daily Nursery/Kindergarten puts some restrictions on the travel opportunities - or maybe it is just the parents willingness to handle the extra work involved.....

Anyway, your description of Lantus is exactly how I understand it to work so thanks for confirming that. Looking at my current after meal BG values I find them rather high, often 200+ and hence I have some doubts whether a Lantus shot a night will actually be enough to handle my daily BG levels. I guess the only way is to try it out and then see if fast acting insulin will be needed also.

I will opt for the pen as anything with "real" needles is probably a step too far for me, at least in the beginning.

TomB · #12 (**permalink**) 03-15-2009, 09:50 PM

FA4960 -
The bedtime shot of Lantus is for basal, or your basic insulin need throughout the day. I use my morning fasting BG as a guide for how much I need. Started at 12units and now I'm at 30u. Been getting some 120's again so I might boost it a bit more. I use a little syringe for this because the VA gives me all that stuff. They don't give me a pen, costs too much. Ah, the blessings of socialized medicine - it's cheap and by the book.
For a rapid acting insulin, I use Humalog before meals. I use this formula to kind of guess how much: 5u + 1u per 20g of carbs. If my 2hr PP is above 200, I'll take another 3u or more. I use a pen for this insulin because it is much easier for small amounts and the more frequent use.
You've probably caught on to the idea that the diabetic figures out his daily dose of insulin. And I'll assure you that just as soon as you get yourself all figured out, something's gonna change.
Where you're at, I would suggest you thing of how you'll keep your insulin cool while traveling around town. Also, use a needle only once and use an alcohol wipe. In other words, pay extra attention to avoid an infection.
Of all the places I've been to, South East Asia is my favorite with Thailand being #1. Enjoy and hope you see lots of stuff with that little one.
Enjoy!
Tom

fa4960 · #13 (**permalink**) 03-15-2009, 10:18 PM

Hi Tom,

I am basically on the "pay everything yourself" scheme so I can more or less go for whatever solution that gives me the best result as I am in the fortunate situation to be able to afford this, at least for the time being.....

I guess I will just increase the number of BG measurements in the beginning to figure out how well once a day works for me. If I can handle BG levels with slow acting insulin only I will be happy, otherwise I will need to figure out how to keep the insulin cool as you say. My job requires me to travel quite a lot so this will add additional challenges to shooting fast acting insulin if it comes down to that but I will take it one day at a time - as you say there always seems to be a new surprise around the corner just when you think you have figured out what your pancreas, kidneys and liver are up to.

Thanks for sharing your own experience, very helpful.