Thursday, February 9, 2012

Glucophage "failed " Now what should I do ?

Time saver hint. Just read the bold print and save  46 seconds for the rest of your day

My neighbor is a  40 y/o female with type 2 diabetes for 4 years and takes glucophage 1000 mg  twice a day.She has lost 15 pounds since her diagnosis and walks over 30 minutes almost daily but is still is  a little  thick in the middle.  Recently she has noticed a gradual increase in her home glucose test and an increase in her  A1c  from 6.8 to 8.1 . She is concerned that her glucophage has stopped working and  wants to quit taking it. I explained that her problem is not glucophage . It is still doing it's job . The problem is that her  ability to produce  insulin has decreased and she will probable need to add another medication.


She has an appointment with her doctor tomorrow to discuss her treatment options.
She is worried because of friends who have gained weight  and have had low blood sugars on other diabetes medications . I started with my usual doctor talk  below and she stopped me  and explained that she does not need to know all of the details at this time.


She is looking for a simple list of the pros and cons of the other medicines  that will help her better understand her options before her doctor visit tomorrow. She wants to learn more about the details later.

( Please ignore doctor talk   1,2,3,4 below for now)
Players in the game that effect the decision process.
     #1 dysfunctional Beta cells in her pancreas that have sluggish insulin release and are slowly failing
     #2 dyfunctional alpha cells in her pancreas in inappropriately producing and releasing glucagon
     #3 her tissue resistance to insulin
     #4 GLP 1 deficiency


 Here is the simple list she requested.




                                        GLP1 agonist      DPP4 inhibitors    acarbose   Insulin    sulfonylureas


Effectively reduce A1c         YES                      YES                   YES       YES          YES


Preserve Beta cell function    YES                      ?                        NO         NO            NO


Promotes weight loss             YES                      NO                     + -          NO            NO


Promotes weight gain              NO                      NO                     + -         YES           YES


Do not cause hypoglycemia   YES                     YES                   YES        NO            NO


Once a week injection             YES                     NO                     NO         NO           NO


Most expensive                       YES                        +-                      NO          + -            NO

What is your first choice if money is not an issue ?
What is your  first choice if money is a problem ?
Will GLP-1 Agonist help some one with Type I  Diabetes ?

Tomorrow we will start on doctor talk with details about the above medications.

                                                                  Have fun, Be Smart and Defeat Diabetes
                                                                  David Calder,MD


No comments:

Post a Comment

Your comments and questions are appreciated. David Calder,MD