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September 9, 1999

Medications: Pills for Diabetes

Question from Las Vegas, Nevada, USA:

Our 13 year old son has recently been having ups and downs with his blood sugars: high during the night and waking up in the 300's even with adjusted insulin doses. His endocrinologist suggested Glucophage twice a day to give him better control until he starts using the pump this summer. What are your thoughts on this?

Answer:

It would be unusual for a 13 year old to be treated with Glucophage [metformin, a pill for Type 2 diabetes] if he is insulin dependent. Usually this oral medication is used in individuals who have type 2 diabetes which can occasionally occur in teenagers. Theoretically it might help improve control in type 1 diabetics, especially if they are overweight, as Glucophage helps improve sensitivity to insulin. However, it doesn’t replace insulin — you either have to make it on your own as in type 2 diabetes or inject it.

The use of Glucophage in type 1 diabetics has never been evaluated as far as I know. I don’t understand how it would be a substitute for an insulin pump, however. The purpose of the pump is to give more flexibility in insulin administration and give you more ability to “fine tune” how much insulin is working during different parts of the day.

I suggest you ask your son’s doctor to explain his or her rationale for using Glucophage.

TGL