Diamicron (Gliclazide) MR

[rainne]

I've just been prescribed this medication, to replace the glyburide that was causing afternoon lows (since low carbing).

Does anyone else have experience with this. Or opinions about it?

This is just my third day. I'm not noticing much difference in readings compared to the days I was not taking anything.

I stopped the cinnamon tea to get a better idea. Maybe it's no better than that... the tea that is.

Of course, three days isn't really a fair assessment...

[navkan]

I have been on Diamicron for about 7 years, most of the time 320 mg, the max dose. In general it has been ok and has helped control bg's fairly well. (I am also on Avandia so it is hard to tell which is doing what.) I have had rare episodes of hypoglycemia but I get good warning so it hasn't been a problem.

Since I got on to Bernstein, I noted that Diamicron is a sulfonylurea, which he is not in favour of. Also, since I have gone on the Bernstein diet and have much lower A1C, I am lowering my dose of Diamicron (presently at 160 mg) and am working with my doctor to try and eventually eliminate it altogether.

hope this helps

Fred

[rainne]

Thanks, Fred. That does help. I'm happy to know you were on it for quite a long while, and are still able to get good improvement on Berstein's diet.

You are very lucky to have a doctor you can work with.

I asked very specifically (and nicely, I might add) for metformin and explained why... but he insisted on the Diamicron MR. He wouldn't explain why and acted totally put out that I wasn't just following orders.

There are absolutely NO other doctors available to me within a 3 hour drive... so please, noone write and tell me I need a new one. I know I do. Lots of us around here do.

[navkan]

Yes I feel very fortunate to have a good doctor. She is fairly young, open to the new ideas and willing to work with me as a team to manage my diabetes. The only problem is she keeps going off on maternity leave!

One thing I forgot to mention. Some time ago, I investigated Diamicron and discovered (if I understand the technical jargon) that it takes awhile after ingestion to for it to stimulate the production of additional insulin. I wondered if it might be a good idea to take it an hour or so before meals to better synchronise its effect with the body's processing of the carbs. I thought this might also prevent episodes of excess insulin causing hypoglycemia. With my doctor's blessing I have been doing this and have had no negative effects. I can say that I have not had any episodes of hypoglycemia since I started doing so.

Since this is contrary to the official instructions for taking Diamicron, I highly recommend you discuss with your doctor if you are thinking of doing this.

cheers, Fred

[kjturner]

rainne, TELL your doctor you do not wish to take a sulfonylurea without FIRST exploring what Glucophage XR can do for you. FYI the max recommended dose of Glucophage XR is 2500 mg. (maximum SAFE dose per mfgr is 4000 mg.) Your doctor is not holding a gun to your head and forcing you to take the meds. Frankly, if he refuses to even try the Glucophage I'd report him to the Medical Board. You CAN get metformin over the internet without a prescription (as long as it is for personal use and not for resell). You can't get the XR version, but you can get generic metformin. Tell your doc you are very concerned about the safety of taking a sulfonylurea and that you understand metformin/glucophage is much safer (it is). Good luck in your battle with your doc. (Where the heck do you live that the next nearest doctor is 3 hours away???? Is he the ONLY doctor of ANY kind in your area? If you have a gynecologist he can also prescribe Glucophage. ANY Board Certified doctor can.) You can also call the Medical Board and discuss your problem with them and see what they recommend.

[rainne]

Hi, kj...

it's funny you should use the phrase " ... holding a gun to your head" because that was one of my thoughts as I considered my options. No-one is holding a gun to my head and forcing me to take anything. Trying again to go without any meds of any kind is something I consider a real option.

No way can I, as a Canadian, get metformin without a perscription. I'm not interested in dealing with any lisencing bodies (here it's the College of Physicians and Surgeons, I guess) -- what's more, the Diamicron MR perscribed is recommended and considered an excellent choice in my case by established standards -- so I don't see a medical basis for a complaint anyway.

The problem is simply that I live in a community with too few doctors, where lots and lots of people unable to get one, and I don't want to be one of them.

Obviously, your situation is different. Lucky you.

[c6h6o3]

Small price to pay to save your pancreas.

Doctors not making you better? DUMP 'EM!

[Lisa N]

I agree. A 3 hour drive is a small price to pay for keeping what pancreatic function you have left.
OTOH, if your choices are honestly that or nothing and you can't yet control your blood glucose with diet alone, it's probably better than having chronic high blood sugar.
There's also the possibility that even with the 3 hour drive that you will leave without what you came for, but it's better to have tried and failed than to have never tried at all.

[c6h6o3]

Originally posted by rainne
-- what's more, the Diamicron MR perscribed is recommended and considered an excellent choice in my case by established standards --

So is a diet comprised of 60% calories from carbohydrate, 20% fat and 20% protein (American Diabetic Association). Nothing will kill a modern day diabetic faster or more horribly than established standards.

[rainne]

>>So is a diet comprised of 60% calories from carbohydrate, 20% fat and 20% protein <<

So true.

And to belabour my point a bit, none of us are likely to get much sympathy if we complain to an established medical board about a doctor following established procedures, like the recommended diabetic diet.



Thanks for your opinons, all. I may just see about someone out of town afterall.

[c6h6o3]

Just vote with your feet. Not even Dr. Bernstein's office can recommend anyone in my area, and there are thousands of MDs within a ten mile radius of my house. Tens of thousands in the metro area, less than 1 hour away.

We're on our own in the big city, too. Personally, I'm starting a slush fund so that I can go see Dr. B. himself.

Good luck to you in your journey.

[rainne]

Today, I saw the doctor. I have been really unsure about how this would go, and half prepared to wind up without a doctor at all. But, as it turns out, the worst didn't happen. But then again, neither did the best.

I had to admit I took the diamicron for a week only. And then stopped.

He simply couldn't understand what my fear of his preferred drugs was. I explained as best I could. I was clear, firm, soft and - oh, jeese, even a bit obsequious. I hate myself when I do that, but it seemed called for and it also seemed to work.

"I'm following the recommendations of the Canadian Diabetes Association and Dr. K*(our eminent endocrinologist)", he said. To which I replied "I know. I know you are. You are giving me excellent care, you always have. I'd be in a real mess now if I hadn't come to you in the first place"

Gentle reader, please try not to gag.

"But", I went on, "I simply can't take something that scares me. except as a very last resort." He said insullin is the last resort, and I said I'd consider insullin before a sulfonylurea. He looked totally shocked. Then I asked "What exactly is your concern with Metformin?"

He said he thought it was a great drug, but that the newer drugs offered fewer side effects and are the preferred drugs now. I answered that I'd like to try to see if I could manage the side effects.

Then he basically said we'd settle it all next week when the lab reports are back.





I think that was progress.

[c6h6o3]

Be sure to keep us posted on this one. Turning physicians' heads around is what I live for. Can't wait to hear what the reaction is to your lab report.

Jim

[rainne]

This is a copy of a post I just put in my journal. A medication update.




I hate my doctor. I really hate him.

Today, he told me I was not cooperating with his treatment. Oh, mercy, the humanity. Imagine a patient having an opinion about wanting to take a safer medication than the riskier one the doctor likes, and likes for reasons he won't even explain. "Do you think these drugs are developed to hurt people?" he asked.
Only a wanker would ask that!

It's not that I'm nasty to him. I am nice when I'm in there -- nice to the point of sickening obsequience. And still, just because I am becoming informed, asking questions and thinking for myself, he implies I'm uncooperative and difficult.

ARRRRRGH.

All this for a medication I could get for $5 in Mexico.

So, today, after being put off and generally dickin' around this issue for the last 6 weeks and 3 appointments, we were supposed to settle it once and for all. Only today, he's decided that I need two more blood tests and aNOTHER doctor's visit, and THEN we'll settle it once and for all.

The ultimate control play, isn't it? He might end up doing things my way, but he's going to prove he has power over me by setting up some more and more hoops.

So now I have a decision to make. Do I go for this pain in the ass blood test (fasting blood work, eat, 2 hour post fasting) plus the followup visit in his
office... and get what I need (probaly get what i need. Who knows what he'll pull then) but also keep access to a doctor I could need for other things and/or the kids...

Or do I cut my losses and go to a clinic, losing this doc for good and knowing he can't be replaced in the forseeable future?

Swell. Just great choices. <sigh>

[Sherrielee]

IMO...take the blood test...try to work with this doctor, as he is so close to you. And, as you say, you may need him for something else.

If he still falters after the new test....dump him!

[rainne]

I took the blood test. Thaks Sherrielee.

We'll see what he says and does Tuesday.

[rainne]

I hope this is my final update.

I had the dreaded appointment today. The doctor was a bit pissy, but he wrote out a script for Metformin, anyway. He's satisfied that my recent blood tests showed sufficient insulin values to make it worth trying.

A friend suggested the blood test might have been a face-saving test for him more than anything else.

Anyway. I feel really good about this. My bg levels are still high in the morning, and there hasn't been anything I've been able to do about it.

Yay for stubborn patients.

[Sherrielee]

Yeahhh! A happy ending...and now you have a doc if you need some cough syrup this Winter! :)