I was taking metformin and glyburide, which I was getting through the Veteran’s Administration (VA) to control my blood sugars. When the last test was done, the creatinine registered 1.4 mg/dl. The VA will no longer give me metformin and, instead, switched me over to Avandia, 4 mg per day. Thirty days later, I went in for a blood test and the A1c test jumped to 10.1. They now want me to go on insulin and I would like some other alternatives.

Metformin has a contraindication so that, when kidney function is abnormal and the creatinine rises, metformin should be stopped. The reason it should be stopped is that, if it is continued in the presence of kidney dysfunction, it predisposes you to a hazardous condition called lactic acidosis. I think your physicians acted with your best interest in mind. The switch to Avandia was reasonable. However, type 2 diabetes has a progression so that, at some point, a large number of patients with this type of diabetes have failure of the insulin producing cells and insulin is necessary. If you were heading to this treatment, the lack of metformin would not have made the difference. The most important issue is to get your blood sugars under control.

JTL