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Hi all, I've been on Metformin for several years now and my doctor is thinking about putting me on insulin but he says there are other drugs he can administer before we get to insulin. So, my question is what comes after Metformin and before Insulin? I've been really comfortable with Metformin and I feel rather awkward about taking in new medications. Has anyone had this happen and what did you decide to do about it. I'm really scared about insulin cause I've heard some bad things about it. Any information would be appreciated. Thanks for taking the time to help me.


Hello, You still have options if you want to continue with oral medications. If you haven't been able to maintain an A1C of less than 7 percent and you have been given the max amount of metformin, other drugs can be added to your metformin to try and help stabilize your blood sugar levels. Some of these meds include sulfonylureas, meglitinides and thiazolidinediones. There are newer meds available but I haven't kept up with all of that yet. Some of the newer ones are receptor agonists and enzyme inhibitors, but that's another story. My suggestion is the sulfonylureas. They have been around a long time and have been shown to lower A1C by somewhere between 1 to 2 percent. The nice thing is that they are inexpensive in generic forms. The way they work is to bind to the ATP dependent potassium channels in the pancreas causing insulin to be released.


Now it depends on whether you are having hypo or hyper issues. Sulfonylureas have been know to cause hypos. If you are older or have kidney problems sulfonylureas can cause hypos. Their also reported to cause weight gain, however the weight gain is very slow and it is known that they decrease their function over time.


According to my husbands doctor, glipizide is the best choice for a sulfonylurea. It's supposed to have inactive metabolites and it has a shorter duration of action. Hypos are less common with this one. The sulfonylureas are approved by the American Diabetes Association.