Q: My 56 years old mother is suffering from type 2 diabetes. She is using a Glyciphage (500 mg) before dinner. But her blood sugar level has not reduced – it is still at 200 mg/dl. Is it safe to continue Glyciphage?

A:I think the dosages can be increase as mentioned below. You should also check HbA1C which gives up three months average of sugar control.

Medications

Metformin (Glycomet /Glyciphage/Riomet /Carbophage /Cetapin) Comes in 2 forms Sustained or extended release (SR or XR) or immediate release (IR) or plain form.
This is the first line drug in almost all patients who are overweight. This should be continued for life except in moderate kidney dysfunction (Creatinine more than 1.5 mg/dl) or side effects to this medication. This is the safest medication originally extracted from plant extract and we have used it for almost 50 years. This medication in diabetes is so important that you should ask your doctor to put the patient on it. This medication is slow acting i.e. it may take weeks before you can notice significant effect on sugar level.

Advantages of Metformin

1. This controls sugars or normalizes sugars but has almost negligible risk of causing low blood sugar (hypoglycaemia)
2. It also reduces risk of heart disease
3. It is suitable in most patients and can be used with any other oral diabetes medication and insulin as well.
4. This works with most of the other medications in diabetes
5. Also safe in most patients who have mild liver or heart problem like heart failure

Dosage

Sustained or extended release (SR or XR form)

It should be used at the maximum tolerated dose as risk of hypoglycemia is less and benefit is more with higher dosages. We use sustained release formulation (SR or XR) version. We recommend starting at 500 mg once a day with dinner and over few days (5 to 7) increase to twice a day which can be taken before or after meals or along with the meals.

Later, we usually recommend increasing to 1000 mg (1gm) twice a day. In case side effects occur, this can be reduced to lower dosages of 500 mg twice a day.

Immediate release (IR) or plain form

With plain or immediate form of Metformin the dosage is around 500 mg three times a day with each meal (after or just before) starting with one meal and gradually increasing to three times a day, in which case it can be increased to 850 mg thrice a day. If well tolerated, the drug can be taken up to 1000 mg three times a day.

Timing of the meal - Along with meal or before or after

Side Effects - There are almost no long lasting side effects of this medication. The drug prevents progression of diabetes rather than make you dependent upon medication. Common side effects are usually seen in the first few days of staring the drug but later they wear off. This is one of the oldest medicines in use, has the best safety record and is beneficial to most patients with diabetes. Common side effects are - abdominal pain or discomfort, nausea or vomiting, diarrhoea, not feeling hungry and abnormal taste. These side effects are reversible. If you continue to have side effects, than you can reduce to once a day and take the medicine after meals with water or reduce the dosages to half. The risk of hypoglycaemia is almost negligible as long as it is not being taken with other diabetes drugs.