Question to general practitioner Maarten: Medication use in diabetes mellitus (diabetes)
Maarten Vasbinder lives in Isaan. His profession is general practitioner, a profession that he mainly practiced in Spain. On Thailandblog he answers questions from readers and writes about medical facts.
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Dear Martin,
Go back to the previous contact. I took your proposal for a Bun-to-creatinine ratio test last Saturday. The result was CH086 Creatinine with GFR 1.56
eGFR 43.73
HbA1c 6.9
This means moderate kidney damage.
My doctor Surin thought that continuing with Metformin is not responsible, I looked on Google myself and they say that metformin should not be used in case of kidney damage. I still had Minidiab 5 mg at home and started using it again since yesterday.
Please answer.
Many thanks and best regards,
B.
******
I use Janumet as prescribed by my doctor, as well as the above-mentioned Januvia (sitagliptina). I buy it at the Fascino Pharmacy, and pay 2440 bath for a box of 56 tablets of 50 mg. Intake 1 x daily. So that is about 44 bath for 1 tablet. “Expensive” is of course always a relative concept, but I cannot call 44 bath per day expensive for this medicine!
Janumet is a combination of Sitaglipina and Metformin.
Duration is a relative term.
Sincerely,
Maarten
In the case of moderately reduced kidney function, Metformin 500 mg, 2 tablet twice a day, is considered safe here in the Netherlands. Instead of Tolbutamide as an addition to long-acting insulin, Gliclazide 1 mg (max 80 times a day, taken with meals) is safer, and the dose does not need to be adjusted if the eGFR continues to decline. GLP-3 has no preference in declining kidney function, but on the other hand: every kg of weight loss helps protect the kidneys, improve blood pressure, and also improve your glucose levels. A DPP1 inhibitor is more expensive (not reimbursed in the Netherlands for insulin use), but some types can be used safely (sometimes in lower doses) in case of declining kidney function. Galvus (Vildagliptin) 1 mg once a day for EGfr <4 (cheapest) and Linagliptin or Trajenta 1 mg regardless of renal function (most expensive). Preferably no Januvia because of the need to always adjust the dosage to the kidney function.
Sincerely, Andrea
Thank you Andrea,
Good advice. Gliclazide is available here according to my intelligence.
If I were you Bert I would finish my Minidiap and then switch to Gliclazide (Diamicron)
If that doesn't work, we'll see.
Sincerely,
Maarten