How commonly prescribed is Insulin + sulphonylurea.
Anyone summarise the treatment rationale?
Newly registered in 1981
How commonly prescribed is Insulin + sulphonylurea.
Anyone summarise the treatment rationale?
Where am I?; In the Pharmacy.
Who are you?; The new Number 2.
Who is number 1?; You are number 6.
What do you want?;..................
Moderator
My brother had metformin and injected insulin, towards the end of his life he would have an icecream and then inject some insulin to compensate.
johnep
Newly registered in 1981
Insulin + Biguanide (metformin) - have seen around 8 people on that.Originally Posted by johnep
Most of them tend to be towards the 'heavy end' of the scales.
Where am I?; In the Pharmacy.
Who are you?; The new Number 2.
Who is number 1?; You are number 6.
What do you want?;..................
Fantastic Member
I'm 18, on insulin and Metformin (well meant to be) I don't take it, They made my blood all over the place, and not only that, I'm on an insulin pump, which I am connected to 24/7. Similiar to what Johnep with insulin pumps, having to count carbohydrates is essential to get good control. The reason why they use insulin and Metformin is to help with insulin resistance. So I've heard.
Pharmanaut, what do you mean by, 'Most of them tend to be towards the 'heavy end' of the scales'?
Keep it surreal
Problem with sulphonylureas + insulin is that they can both cause hypoglycaemia, which is more common with the long acting sulph'ureas chlorpropamide and glibenclamide. Also both drugs can cause weight gain. Metformin however is less prone to cause weight gain, which is probably why more patients take insulin + metformin rather than insulin + sulph'urea.
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”We are real. We are not glam sh*t or anything else. We are Guns N’ Roses.”
Newly registered in 1981
The location where I practice (South "eee by 'eck" Yorkshire) most of the patients on insulin and Metformin tend to be late type II diabetics who are overweight, hence me politely saying 'heavy end of the scales'.
Back to the original question.
Metformin allows glucose into peripheral cells.
Sulphonylureas stimulate insulin secretion. So what's the rationale of giving them (in this case gliclazide) with Insulin (Lantus). Must be a simple explanation?
Where am I?; In the Pharmacy.
Who are you?; The new Number 2.
Who is number 1?; You are number 6.
What do you want?;..................
Keep it surreal
Couple of other things sulph'ureas do - increased tissue sensitivity to insulin + possibility also increased bioavailability due to less extraction from pancreas. Maybe these are the reasons for both being given together
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”We are real. We are not glam sh*t or anything else. We are Guns N’ Roses.”
Top-Class Member
Is combination sulfonylurea and insulin therapy useful in NIDDM patients? A metaanalysis -- Pugh et al. 15 (8): 953 -- Diabetes Care
With combined therapy, lower insulin doses may be used to achieve similar control. Obese patients with higher fasting C-peptides may be more likely to respond than others.
http://www.diabetesincontrol.com/mod...rticle&sid=123
CONCLUSIONS—Early addition of insulin when maximal sulfonylurea therapy is inadequate can significantly improve glycemic control without promoting increased hypoglycemia or weight gain.
Last edited by ramroum; 14th, March 2009 at 07:34 PM.
Newly registered in 1981
Thanks for that.
I feel a bit of CPD coming on.
Where am I?; In the Pharmacy.
Who are you?; The new Number 2.
Who is number 1?; You are number 6.
What do you want?;..................
So did you give it before finding out the rational - or did you delay dispensing until you were satisfied that it was suitable?
Jeff
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