March 4, 2004
Pills for Diabetes, Type 2
Question from Chicago, Illinois, USA:
Every day, I take three 850 mg Glucophage pills, morning, evening, and bedtime; two 4 mg Amaryl pills, morning and evening; and one 4 mg Avandia pill, in evening. My morning sugar is right around 145 mg/dl [8.1 mmol/L] to 160 mg/dl [8.9 mmol/L]. My Alc is now 8. My sister also has diabetes and is taking insulin and Actos. She also was taking insulin and Avandia, but this combination didn’t lower her blood sugars. When she changed to Actos, my sister was able to reduce her insulin from 60 units to 30. Do you think if I changed to Actos it would lower my sugar better? Avandia did a good job at first, but now it isn’t. Also, my endocrinologist took a test to see if I am producing insulin. She said I am producing plenty of insulin. Why am I taking Amaryl? What if I tried Prandin? I usually eat only at mealtimes, with no snacks. I do not want to take insulin if I don’t have to.
It appears that you are on maximum oral agents and still not meeting the goal for good control of your blood sugars. The goal would be to get the A1c to less than 7. Avandia and Actos are similar in their glucose-lowering effects. It would be unlikely that switching to Actos and away from Avandia would make a big difference in your control. The reason Amaryl and any sulfonylurea drug is helpful in type 2 diabetes, even if you are making plenty of insulin, is that they stimulate more insulin production to overcome the resistance you exhibit. It would be the same argument for adding insulin to your regimen. Prandin is a short-acting sulfonylurea. It just acts in a short time frame. It would be unlikely to add additional control above and beyond the Amaryl. It sounds like the next step would be to add a dose of long-acting insulin, either NPH or Lantus.