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Glucotrol?

Question:
I have been on Glucophage for many years but because of my new found kidney disease, the doctor has put me on glucotrol. I do not understand how this medicine works. He directed me to take it every morning but how do I match my food to this technique? How does this help my fasting in the AM when I am taking the glucotrol in the am the previous day? He has me on 2.5 mg every morning taken 1/2 hour before breakfast. This doe4s not sound like very much. If there is amyone who has experience.ideas.info about this I would sure appreciate hearing from you.
Answers:
here is a website on that drug with a lot of info on it


Answers:
i was on 5 mg's a day, but opted for 2.5 mg's in the am. I found that my bs dropped drastically every so often to very low numbers like 60. My overall numbers came down to better levels now. Averging between 90 and 100 contantly. I did that for 3 months and got tired of the extreme lows so I split the 2.5 mgs to 1 1/4 at am and one in the afternoon around 2:30. Which my numbers are constantly below 100 and closer together.

I am a 51 year old make, and T2 and the only other medicine is 2 500 mgs of metformin.

I have an extreme physical fitness routine that I do 7 days a week which helps me out too.

Bob
Answers:
What about your fasting? I essm to be doing fine with the 2.5 in the am but my fasting was 140 this morning and I need for that to be under 100?
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My am counts are in the 90's. I took a 1/14 mg this afternoon and had some cashews and my bs was before dinner.

What is your excercise plan. I am heavy into PE and that helps me a great deal. I get about 30mins to and hour a day. Which is about the most I can do.
Answers:
Bob,

Glucotrol belongs to a class of drugs called sulfonylureas which stimulate the pancres to produce more inuslin. Clinical studies show that sulfonylureas stress the pancreas and shorten their insulin producing life. I was on such a medication it was failing within a year. For the last nine I have been on TZDs and secifically Avandia for the last seven. No change in medication level with steady glucose control. Avandia helps the muscles use insulin more efficiently and increases the uptake of glucose during exercise by as much as 100% as shown in a clinical study. Because of the improve efficiency of glucose use unless you eat less or exercise more you can gain weight and that is not very good. Some people also have water retention problems with Avandia.

With the help of Avandia, I have been able to build up to a serious level of weight lifting, leg press about 340, do ab exercises in the 150 pound range etc. My weight workouts are about 2 1/2 hours. I also intermix aerobic exercise sessions using an elliptical walking machine for 30 to 40 minutes at a 17 out of 20 stress level. Burns over 550 calaries in 30 minutes. I am 65 with no complications.

I am not trying to brag but trying to explain the bad experince I had with sulfonylureas and the good experience with TZDs and exercise.

Another good thing is that TZDs don't cause lows when used as a single medicaiton.

Chuck
Answers:
Chuck - Where do you learn all this informaton? We have crossed paths before on this infohighway. I am looking at replacing my glucotrol and using a more natural substance if you go to and look up dymnema and diaplex. My chiropractor is recommending those to slowy replace my medicine.

I find that when I go hard for an hour or more I am fatigued and it takes me a day to recover. I ran 4 miles the other day and played my son in racketball for 1.5 hours and was exhausted.

I am 51 years old and an avid body builder and have been working out for 20+ years now off and on, so I know my exercise program is working real good.

Bob
Answers:
Bob,

You need to work with your doctors to find what wroks for you. My experience with pancreas stimulators is they work well for a while but for me within a year they were becoming ineffective. In the case of TZDs, I have been on them for nine years, two on Resulin and seven on Avandia with NO loss of effectiveness. Because I have been on these medications, I have tried to find out as much as possible about them.

A very good book that has been helpful to me is: "The 7 Step Diabetic Fitness Plan" by Sheri Colberg-Ochs. She claimed that Avandia doubles the uptake of glucose during exercise. When I ask her where she got this information, she provided a reference to a Finnish study. I looked up other articles by the same author and found a series of clinical studies about Avandia and oomparing it to Metformin and one of the pancreas stimulators. The most interesting of these article was one that claimed that heart uptake of glucose increased by 38% with the use of Avandia. Since all diabetic complications are tied to bad blood flow, the extra glucose uptake would surely improve the heart function and blood flow. During the seven years on Avandia I have seen both inproved blood flow and improved heart function(necular stress tests showed the improved heart function).

A study called ADOPT showed a 63% higher failure rate with monotherapy with Glyburide than Avandia. Metformin had 32% worse failure rate than the patients on Avandia. ADOPT was a long study, followed patient for an average of four years and there were over 4000 patients in the study. This study with other information picked up over the years and my own experience has convinced that medications such as Glucotrol are bad for the pancreas and actually excellerate the progression of type-2 diabetes.

Because you have been on Glucotrol, and because you get exausted it may be that your pancreas is not producing enough insulin and thus your muscles aren't getting the glucose they need. If this is the case, your glucose level will rise during exercise and fall slowly afterwards (taking hours to get to pre-exercise levels). The good news is the 20+ of exercise is great for your health and will help prevent diabetic complications.

Avandia ONLY works if you have insulin resistance, so I don't know if it will be effective for you. For me the combination of Avandia and exercise has lead to substantial increases in muscle mass and effective glucose control without complications.

Hope this information helps.

Good luck.

Chuck
Answers:
Thank you Chuck. I retired from the Military and I have doctors who are not trained in this area very well and there knowledge of diabetes seems to be very limited. So I need to depend on other information to assist me.

What the are side affects of avandia. According to the notes in here one is liver issues. Sounds like the cholesterol midicine and what that does to people.

Bob
Answers:
Bob,

Resulin, the original TZD medication had liver toxisity problems. When Avandia was introduced, the claim was that it had the good qualities of Resulin, but not the liver toxisity. Resulin was voluntarly removed from the market shortly after the introduction of Avandia. Having seen no claims of liver toxisity for Avandia in the eight years it has been on the market, I believe the claim is true.

Both TZDs Avandia and Actos cause water retention in some people. This characteristic make TZDs bad for people with congestive Heart Failure or water retension problems. Like insulin Avandia enables the body to use glucose more effectively amd can cause weight gain. A year ago Dr. Nessin, who got Vioux off the market made a meta study (pooling results from many studies) and made a claim about heart problems brought on by Avandia. Unfortunately he include studies where people with congestive heart failure were given Avandia in clinical studies. By using old studies where people that should not be prescribed Avandia were given Avandia to learn about it safe use caused him to come up with false conclusions.

There are some mixed results that might conclude that people taking Avandia may have more heart attack than those on other medications. These are rather short term studies. Many that get type-2 diabetes are obese and inactive. If they start an exercise program, some plaque could break loose and cause a heart attack, but the benefits of exercise are so positive that doctors usuallly encourage people to exercise, even people that have had heart attacks. Avandia by increasing the uptake of glucose by the heart is in a sense an exercise pill and causes increased blood flow: a very good way to prevent all diabetic complications. I think the results are mixed because the screening process is better in some studies than others.

The ADOPT study followed 1393 newly diagnosed type-2 diabetics for an average of four years. Only two died from any type of heart problems, one per 2,500 diabetic years: very low rate in a population that expects 2/3s to die of heart problems or strokes. "Exclusion criteria for ADOPT included clinically significant hepatic disease, renal impairment, a history of lactic acidosis, unstable or severe angina, known congestive heart failure (CHF, New York Heart Association class I, II, III, or IV), or uncontrolled hypertension.13"

A full text of the NEJM article can be found at:

This article is quite good because it explains some of the trade offs of Avandia, Metformin, and Glyburide as shown by the ADOPT large, long clinical study.

Hope this information helps.

Chuck
Diabetes Mellitus Type
Diabetes Nursing

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