Dosage number crunching

[Gordomac]

Colleague & friend has just had his licence suspended due early diagnosis of Type 1 Diabetes.

Early days but initial prescription confusing him.HIs inter-action with his own AME & GP are tense so I said I would ask on here as a possible quick answer.

He was initially prescribed GLUCOPHAGE 500. It is metformin.390, says "prolonged release "500" but in the release column shows 390. ????
Usage did not give the improvement sought by the Docs so he he was prescribed GLUCRON 60. This shows modified (rather than prolonged) release of some other drug, not metformin, of 60mg. (A lot less than 390 or 500 of metformin).

Question is ; how come a modified release of a lower value was prescribed in order to improve response ? It did, blood/sugar readings lowered but he did not like the side effects.

Obvious answer is that Glucron contains a stronger drug but dosage was not modified. Sugar level dropped so rapidly he feels that he nearly entered a low-sugar coma and swallowed a mars-bar, whole, in order to recover.

Just asking & trying to help. Thanks.

[First.officer]

Firstly, sorry to hear about your friends issues with the diagnosis thus far…..

So, to the crux - firstly, are you sure the diagnosis is Type 1, as opposed to Type 2 Diabetes? I only ask as whilst Metformin (Glucophage as a trade name/branded item) can be used, it would be highly likely if not an absolute, that he/she would also be on some form of insulin treatment if a genuine Type 1 Diabetic. This would make a difference, especially I would think in the early days - as if using both insulin, Metformin - quite likely to end up with a “hypo” situation as you come to terms in using both insulin and Metformin, this may explain your friend’s rapid blood sugar low?.

As to the difference in Metformin, my understanding is in the main two versions exist to try and limit gastrointestinal discomfort in the non-slow release users, by using a slower release version (SR) to essentially not “hit the body like a sledge hammer” (I.e. - you won’t **** through the eye of a needle for weeks on end if using the SR meds). There are equally base Metformin levels beyond my knowledge and I’m sure someone will correct me if my interpretation is in error.

You mention the “tense” situation with your friends AME and GP - can I ask as to what and why? If they feel they are not being treated fairly, then if like in the U.K., then you can always ask for another doctor diagnosis and opinion, or better still seek out a good endocrinologist, as they are the experts here - and at an AME and GP level, Diabetes can be very badly understood in my experience, and in the past (luckily now I have a brilliant AME) my diagnosis was missed initially by both parties - my old AME at the time was more interested in referrals to colleagues - and he did like to come out with phrases such as “oh, you need to go and see my good friend….” - be careful, as this quite often involves having your wallet “raided”, and for what benefit to the referral AME - who knows?.

In summary, be careful. Again, If like in the U.K., and you genuinely still feel aggrieved - refer to a professional body such as the GMC (or similar) for advice and recourse, as all practitioners are likely required to register and be licensed. You can also search out the practitioner by name here in the U.K. and see details on the person, to check credentials and alike.

Link attached to try and explain the Metformin query;

https://www.rxlist.com/glucophage-drug.htm

[Gordomac]

Top reply. Thank you very much.

Yes, he has early diagnosis of type 2.

I will pass on your advice.

Your story sounds very similar to my friend's. Cyprus medics are quite frosty and un approachable.

Pannyotos also has the benefit of my very similar story of blinkered diagnosis and non-existant management when I turned in high blood/sugar levels whilst employed in the Middle East. Had I gone with that diagnosis 15 years ago, I would not be here now.

My mate needs to show a managed and controlled level of daily blood/sugar readings. Certainly, the glucron hit him hard but he enjoyed the MarsBar.

Many thanks.