T2D - Glucophage (name brand) > Metformin (generic) ?
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Sunny_Bunny_ wrote: »Dr. Bernstein's most recent admonishment that metformin generics "are not nearly as potent" as brand Glucophage (starts around 35'30"):
https://youtu.be/A1QyXWy1_SQ
Omg! You just reminded me that I missed the teleseminar! I think it was yesterday! I asked a question on it I was hoping he would answer! Do you know if they put those up so you can still listen afterward?
I think this video is the January teleseminar, since it was just posted and he announces February's date & time at the end.
There's a lot of T1D discussion (and the obligatory, gratuitous jab at LCHF, which he seems to think entails LP.....)
My Qs have never gotten on; hope yours met a better fate!
Good. I will watch it today. It would be awesome if he got my question.
@KnitOrMiss it sounds like you've had a serious mental breakthrough. I hope this brings you progress. You truly deserve it. I'm thinking positive thoughts for you.
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@KnitOrMiss, it's never simple, it seems. N=1 experiments, mine at least, are tough to control. Many of the things I thought I knew in 2016 I not only don't know in 2017, but have come to doubt.
I suppose the fact that things appear differently now than they appear to have appeared then is an artifact of feeling a different part of the elephant (even though the elephant is us....).
Anyhow, here's a 2014 review of studies involving Metformin and kidney disease:
http://jamanetwork.com/journals/jama/article-abstract/2084896
FYI, Dr. Bernstein was able to "reverse" (his word) his kidney disease by maintaining tight BG control.
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This is kind of wacky and interesting. It implies that Metformin doesn't actually reduce insulin resistance - that it works directly on the liver...
https://diabetesselfmanagement.com/blog/diabetes-metformin-and-your-liver/
I find it frustrating to find information that explains how Metformin works without the presence of elevated blood glucose levels...2 -
KnitOrMiss wrote: »This is kind of wacky and interesting. It implies that Metformin doesn't actually reduce insulin resistance - that it works directly on the liver...
https://diabetesselfmanagement.com/blog/diabetes-metformin-and-your-liver/
I find it frustrating to find information that explains how Metformin works without the presence of elevated blood glucose levels...
Yep. Lots of ????s.
@midwesterner85 knows a lot about Metformin (check upstream in this thread for some of his observations).0 -
KnitOrMiss wrote: »This is kind of wacky and interesting. It implies that Metformin doesn't actually reduce insulin resistance - that it works directly on the liver...
https://diabetesselfmanagement.com/blog/diabetes-metformin-and-your-liver/
I find it frustrating to find information that explains how Metformin works without the presence of elevated blood glucose levels...
I'm thinking of it this way...
Currently you have high insulin and insulin resistant cells that must force any dietary source of glucose into cells in addition to any internal source of glucose. So there are only certain things you can do to reduce the glucose your cells have to respond to.
1.) reduce carbs or at least reduce fast carbs.
2.) reduce internal glucose production. Which is what I believe metformin does right?
And a 3rd option is to do both.
It's fairly straightforward how to control intake of glucose but it's not as simple to control your body producing it. Metformin should provide you more control of your body's total glucose load if I understand how it's supposed to work.0 -
KnitOrMiss wrote: »This is kind of wacky and interesting. It implies that Metformin doesn't actually reduce insulin resistance - that it works directly on the liver...
https://diabetesselfmanagement.com/blog/diabetes-metformin-and-your-liver/
I find it frustrating to find information that explains how Metformin works without the presence of elevated blood glucose levels...
Yep. Lots of ????s.
@midwesterner85 knows a lot about Metformin (check upstream in this thread for some of his observations).
@RalfLott - I've been following this thread since the beginning, and caught up on the last 20 responses or so today, but the main reason I posted this was that I've always been told that Metformin REDUCES INSULIN RESISTANCE. If it doesn't, yes, this should still help my overall levels of insulin, theoretically, but it may not do specifically what I need it to do. I'm still going to the Metformin/Glucophage trial for as long as I can...but...the mechanism seems to NOT be what everyone assumes... What everyone says Met does is an odd byproduct resulting from what it does do, but it isn't the mechanism of the medication itself...1 -
Yep, I believe Metformin makes the body more sensitive to the insulin you produce, but this is not just from reducing muscular, hepatic, and adipose resistance, but also from an effect on the pancreatic beta-cells (and probably other organs).
If you buy the idea that the reason for diabetes is to ensure that the brain has enough glucose to function, then perhaps it also makes the brain's use of glucose more efficient. Pure speculation....
I haven't read any articles whose authors don't caution that the workings of metformin remain unclear and that more research is needed.2 -
<refresh> for new groupies0
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jetsamflotsam wrote: »I was taking metformin for PCOS related insulin resistance (have since been able to get off it successfully)... but when I was taking it... here where I live my pharmacist stopped carrying the name brand metformin because the gov't subsidized medical plan would only cover the generic. Even though I don't qualify for subsidy, he went ahead and changed me over to generic without telling me. I went from having no stomach issues to non stop diarrhea. He INSISTED there was no difference, but after a couple weeks I convinced him to bring back the name brand one for me and my stomach issues totally stopped.
Ugh this makes me so mad for you! If the Glucophage works starting tomorrow after six months of the dumping/stool samples/glipizide issues I'm gonna be so mad at metformin!!!!0 -
Be mad at the pharmaceutical industry. They're the ones who allow generics to use whatever crap they want... Like gluten in thyroid medications. Soy, dairy, sugar, too... In almost everything.0
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KnitOrMiss wrote: »Be mad at the pharmaceutical industry. They're the ones who allow generics to use whatever crap they want... Like gluten in thyroid medications. Soy, dairy, sugar, too... In almost everything.
That is a pisser, all right. The FDA has pretty tough sledding, but still, better quality control would be in the mix if the FDA served us lowly consumers and not the pharmaceuticals that have the ears of Congress, the FDA, ADA, AHA, etc.
And the unregulated state of supplements is a major hole that doesn't look like it'll be plugged any time soon.
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"but those things don't matter" so they should be able to use whatever... Only, they do matter, so where does that leave us? I've found certain generics of allergy meds actually work BETTER for me than the brand name, so it is possible. It just wish it weren't so hard to keep ourselves from being contaminated when we're fighting everything that passes our lips....0
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Well, you can't poison someone who won't eat.
Of course, there are still a few glitches to be worked out in that approach....0 -
Dümp0
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@RalfLott - so I was looking through this again, but I keep getting distracted, and have only made it back through the first page.
Since I am the exception to the rule and seem to have more of a glucose/insulin spike with meals, regardless of content (I spike more WITH crap food or too many calories, period, but I still spike with pretty much everything somewhat), and less problems regulating fasting glucose, my Endo agreed to try the IR instead of ER. However, the cost came back as $90 due to a "patient pays the difference" rider in my current insurance formulary. The generic is $15 or something...
Since the $90 is absolutely NOT doable this month (after 8/1, might be willing to deal with it through new FSA stuff with my company), my options are to keep my current 500 XR Glucophage once per day, get generic IR Metformin 500 pills with Doctor instruction to break them in half and start with 1-2 meals, aiming for 3 meals over the course of the day as end goal - IF I CAN FIGURE OUT WHICH GENERIC OF METFORMIN IS SAFEST TO TRY, or something else that hasn't occurred to me yet...
So, long store short, the question is 1) do you know which of the generics you were inclined to believe were "safer..." or which you yourself had ruled out? Or have any idea where I can look?
I have a day or two before I HAVE to fill it...but I'd rather only make one trip, and I have two others to grab while there...
Head is spinning from this...0 -
KnitOrMiss wrote: »@RalfLott - so I was looking through this again, but I keep getting distracted, and have only made it back through the first page.
Since I am the exception to the rule and seem to have more of a glucose/insulin spike with meals, regardless of content (I spike more WITH crap food or too many calories, period, but I still spike with pretty much everything somewhat), and less problems regulating fasting glucose, my Endo agreed to try the IR instead of ER. However, the cost came back as $90 due to a "patient pays the difference" rider in my current insurance formulary. The generic is $15 or something...
Since the $90 is absolutely NOT doable this month (after 8/1, might be willing to deal with it through new FSA stuff with my company), my options are to keep my current 500 XR Glucophage once per day, get generic IR Metformin 500 pills with Doctor instruction to break them in half and start with 1-2 meals, aiming for 3 meals over the course of the day as end goal - IF I CAN FIGURE OUT WHICH GENERIC OF METFORMIN IS SAFEST TO TRY, or something else that hasn't occurred to me yet...
So, long store short, the question is 1) do you know which of the generics you were inclined to believe were "safer..." or which you yourself had ruled out? Or have any idea where I can look?
I have a day or two before I HAVE to fill it...but I'd rather only make one trip, and I have two others to grab while there...
Head is spinning from this...
Well........
I'm afraid I'm not going to be of much help.
1. 1x ER daily does not seem sufficient to maintain a constant level. I try to time my daytime dose 6-8 hours before my first meal, so right when I get up.
2. Dr. Bernstein recommends taking IR before a meal, if you can stomach it.
3. I have no firm idea about generics at this point, as I was still eating, or recovering from eating, too many carbs when I took them. Teva ER seemed to be a problem at the time, but I might not have a problem with it now.
(I never took IR; Dr. Bernstein says brand ER is easiest to take for many people.)
So....
Try adding more brand XR? My insurance gives me the same $60 copay whether I take 500 or 2500mg per day (so I get 2500 but usually take only 2000).
You could at the same time also experiment with generic IR (cheap or free from chain pharmacies) and see how it goes.
You're already aware of phthalates in various generic forms of ER...
Good luck & keep us posted!0 -
We have a "benefit" that "patient pays the difference." So essentially, I pay by the pill. 30 pills of Glucophage costs me $30.18. 60 is around $60, and 90 pills is around $90. Doesn't matter if IR or ER. If Glucophage, I'm paying a premium per pill.
So that really isn't much of an option... BUT... I'm thinking that I might be able to see if they will do 30 pills instead of 90, IR instead of ER, and at least I could split doses on my own, as doc suggested.
Going to read through to comments and linked page for any suggestions on this... http://diabetesupdate.blogspot.com/2011/02/differing-brands-of-generic-metformin.html?m=1
Oh, and @RalfLott - Doc has been wanting me to take the 500 XR twice a day since April, but my FSA ran out in March, so I haven't been able to justify the cost difference.
One other thing did occur to me. I was NOT taking Digestive Enzymes when I took generic Metformin before. I AM taking them now, with brand name Glucophage. Does the digestive portion, and how the medication is metabolized, affect the side effects? Does anyone know?
P.S. As I'm getting digestive response from the Iron I've added, I honestly don't know how much worse Metformin could be added on top of it, though I really probably don't want to know.0 -
Here is the secondary site where he summarizes it all! http://www.phlaunt.com/diabetes/14045911.php0
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Dang! An insurance >Gotcha!<
That linked page is interesting. Looks like Teva XR was fine for the author, at least in 2011.
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KnitOrMiss wrote: »Here is the secondary site where he summarizes it all! http://www.phlaunt.com/diabetes/14045911.php
That would be "she" (Jenny Ruhl. Her "101" books are good, as you might expect.) 0 -
The author of the original article was a man. I didn't realize until after I posted it that he had linked to a separate site.
Decided to get a week of the brand name Rx. Doc wants me to break the pills in half, at least to start, as they apparently don't make 250 in non ER... So starting with that, tomorrow, as my pharmacy had to order it out for me. 1 week of Rx'd 500 mg 3x daily (as the end goal) but starting with split in half 2x a day should make one week stretch enough to give it a good trial run!1 -
KnitOrMiss wrote: »The author of the original article was a man. I didn't realize until after I posted it that he had linked to a separate site.
Decided to get a week of the brand name Rx. Doc wants me to break the pills in half, at least to start, as they apparently don't make 250 in non ER... So starting with that, tomorrow, as my pharmacy had to order it out for me. 1 week of Rx'd 500 mg 3x daily (as the end goal) but starting with split in half 2x a day should make one week stretch enough to give it a good trial run!
Aha gotcha. It will be interesting to see how the IR works for you!0 -
Have you tried using the GoodRx app? They are also online. It's free and I have been getting really cheap prices for my meds. They may have a coupon for name brand Glucophage. I am finding it cheaper to find the prices through them and go to other pharmacies, then go to my "required" in network, CVS.
The Free Metformin (generic) from Publix Grocery was Ascend Lab. Two days ago, they switched to Time-Cap Labs. I had no problems with Ascend. We'll see how it goes with the new supplier.0 -
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Generic metformin vs brand name Glucophage is a minor consideration.
Far more important is exercise and a LCHF diet.
IF you are maximizing diet and exercise and you are considering a SECOND medication on top of your generic metformin, that's when you may want to try brand name Glucophage.
I appreciate your insights, but I have to disagree with you on this one. Dr. Bernstein has treated thousands of diabetics and found brand Glucophage to be more effective and more easily tolerated, and that's been my experience.
So if your insurance is cooperative, I see no reason not to start with Glucophage and avoid the possible nightmares with the generics.
(If you're already on a generic that's working well for you, that's a different matter.)0 -
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Brand name Glucophage IS more effective vs generic metformin. It's also a lot more expensive. But it's far cheaper than adding a GOOD second DM medication. That's why Dr Bernstein recommends it. And it's why I recommend it before trying a second med.
My second DM med after I try generic metformin and the brand name Glucophage would be victoza or a basal insulin. Both of them are far more expensive vs brand name Glucophage.
Diet and exercise are BY FAR your most important weapons against DM. That's where most DMs blow it. Your meds are a distant third.
Gotcha.
I think you're generally right, but as far as meds go, I'm not convinced they're an also ran for every T2D.
PS. You need to be writing public info brochures for the ADA.2 -
KnitOrMiss wrote: »@RalfLott - so I was looking through this again, but I keep getting distracted, and have only made it back through the first page.
Since I am the exception to the rule and seem to have more of a glucose/insulin spike with meals, regardless of content (I spike more WITH crap food or too many calories, period, but I still spike with pretty much everything somewhat), and less problems regulating fasting glucose, my Endo agreed to try the IR instead of ER. However, the cost came back as $90 due to a "patient pays the difference" rider in my current insurance formulary. The generic is $15 or something...
Since the $90 is absolutely NOT doable this month (after 8/1, might be willing to deal with it through new FSA stuff with my company), my options are to keep my current 500 XR Glucophage once per day, get generic IR Metformin 500 pills with Doctor instruction to break them in half and start with 1-2 meals, aiming for 3 meals over the course of the day as end goal - IF I CAN FIGURE OUT WHICH GENERIC OF METFORMIN IS SAFEST TO TRY, or something else that hasn't occurred to me yet...
So, long store short, the question is 1) do you know which of the generics you were inclined to believe were "safer..." or which you yourself had ruled out? Or have any idea where I can look?
I have a day or two before I HAVE to fill it...but I'd rather only make one trip, and I have two others to grab while there...
Head is spinning from this...
FYI, drugs.com has inactive ingredient lists for some meds. So, for example, for Teva Metformin XR 500, it discloses:
*silicon dioxide
*hypromelloses
*magnesium stearate
*polyethylene glycol
*titanium dioxide
(Despite appearances, it's not classified as a laxative.)
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KnitOrMiss wrote: »The author of the original article was a man. I didn't realize until after I posted it that he had linked to a separate site.
Decided to get a week of the brand name Rx. Doc wants me to break the pills in half, at least to start, as they apparently don't make 250 in non ER... So starting with that, tomorrow, as my pharmacy had to order it out for me. 1 week of Rx'd 500 mg 3x daily (as the end goal) but starting with split in half 2x a day should make one week stretch enough to give it a good trial run!
Aha gotcha. It will be interesting to see how the IR works for you!
@RalfLott - Started Saturday I think... Half a pill so around ~250 with each meal. Stools are looser shortly after a meal, but not as acidic and generally only once after, unless I've been longer between meals (bile trickle constant due to no gallbladder, etc.)... Adding in iron has also loosened my stools recently, so I'm not sure which is to blame. But, so far it is mildly inconvenient/irksome, but not hellish levels of misery or anything that would end the test period early.
This morning, I tried the Gluc. 20-30 minutes before I ate (I think I dropped the time around 20 minutes, because I started getting some heartburn/indigestion which for me is very hard to rebound from right now, so I ate before had intended to), but with around 25 grams of carbs, I still crashed some, so that tells me there was a spike. If I can survive on the half pills until Friday, or even better, the 1st, I'm going to fill the whole Rx and try with each pill 500 per meal, 30 minutes before. I'm going to go through this week on the IR before doing my tests on Saturday, if I can, for my Endo, so he can see the impact...1 -
A related question for you guys. A friend has been prescribed Metformin for insulin resistance and her sister being a pharmacist advices her not to take it, but to try another remedy instead: Berberine, anyone tried this product in place of Metformin?
https://www.healthmonthly.co.uk/swanson_premium_berberine_complex?af=gaw&gclid=CjwKCAjwtdbLBRALEiwAm8pA5Xqrj8aqfc-yWgktouL9TTNY-1uTwVKIhXpXsfQAYKk22EMWoHTM_BoCPIgQAvD_BwE
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