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March 16, 2008

Daily Care, Pills for Diabetes

Question from Hannibal, Missouri, USA:

I recently moved to Missouri from Wisconsin. In Wisconsin, my internist had me taking 2500 mg metformin and 40 mg glipizide each day, plus 16 units of Lantus at night. The doctor here has me on two pills a day of 5 mg/500 mg glipizide-metformin. He also told me to take 26 units of Lantus in the morning before breakfast. My blood sugars have been terrible. So, why did he change me? I am now taking less than half the medication I used to. And, why is he having me take the Lantus in the morning? The way I was doing it in Wisconsin worked just fine.

Answer:

There is really no difference between taking the combination pill versus taking the two separate pills. Obviously, you are on a bit less medication, in terms of the specific dosage of medication. Even though you are taking more Lantus than before, you probably could go up on the combination pill. In most cases, you do not have to go to the highest glyburide or glipizide doses to get close to the maximum effect. The dose-response effect of glipizide is such that you don’t get the same degree of glucose lowering going from 20 to 40 mg per day that you get going from 0 to 20 mg per day. Some people do not titrate the glipizide all the way up to 40 mg for that reason. However, your sugars are higher and the increase in metformin dose would probably help your sugars.

As far as Lantus, there is not a lot of difference between giving the Lantus in the morning compared to the evening. It is a non-peaking insulin with a duration of action longer than 24 hours. Some people actually forget to take their Lantus at night or go to bed. In these situation, I move the Lantus to the morning. There shouldn’t be much difference in action.

I would talk with your physician about increase the oral medications. If you want to move Lantus to the evening, you have a reasonable request when you talk to your physician.

JTL