Type 2 Diabetes Medication

[Smileyface]

I've been on Trulicity for about 18 months as I can't take Metphormin. Due to not being able to get Trulicity regularly I've stopped taking it 6 months ago, although it was working. I stopped taking it because every time I restarted taking after being unable to get it from the chemist it was making me very ill for a couple of weeks. My doctors tell me it is now time to restart some form of type 2 diabetic treatment. What do other people take? So that I have some idea of what to expect at the consultation. Thanks

[Tina_Maria]

Hypothyroidism can affect glucose metabolism when not treated correctly, as the slowed down metabolism could mean that the liver has difficulties clearing glucose from your system, hence levels can increase. However, if your thyroid is optimally treated and your glucose is still high, you should be given treatment.

I used to work in diabetes research and there are various medications that can be prescribed. If your glucose has been consistently high, you need some form of treatment, as elevated glucose levels can damage your blood vessels, including those in the kidneys, over time.

Metformin is usually the first line treatment, it works as an insulin sensitiser, making your body more receptive to insulin action. However, many people cannot tolerate metformin well, as it can cause nausea, vomiting, diarrhoea and stomach aches.

Sulfonylureas increase insulin production in the pancreas, but it is an older medication and can cause severe hypoglycemia (low blood sugar), therefore nowadays not routinely given.

Sodium glucose co-transporter 2 inhibitors (SGLT2 - e.g., dapagliflozin, empagliflozin), work by excreting the excess sugar through the kidneys, can help with weight loss and improve cardiovascular outcomes. Sometimes dapagliflozin can be prescribed, if you do not tolerate metformin well.

Dipeptidyl peptidas-4 inhibitors (sitagliptin, linagliptin) work by inhibiting the enzyme DPP4, which prevents the inactivation of GLP-1, which stimulates insulin secretion in the pancreas. They are generally well tolerated.

Trulicity, which you ave been given previously, belongs to the family of glucagon-like-peptide 1 (GLP-1) inhibitors, which are medicines (e.g., exenatide, dulaglutide, semaglutide) that prevent the breakdown of GLP-1 and therefore increase insulin secretion from the pancreas to deal with glucose. Nausea can be a problem at the beginning of therapy, but that should subside after a couple of weeks and people should start on a low dose and then slowly titrate up. Some people can also loose weight on these medications, which could be a desired side effect.

You should discuss all options with your GP to find a suitable medication that you can tolerate. The more modern treatments have a lower risk of hypoglycemia (low blood sugars), hence they should be preferably prescribed.

Hope this will help!

[Smileyface in reply to Tina_Maria]

Thank you very much for the information. This has been really helpful. They seem really stuck on metformin and very vague about alternative treatments.

[Tina_Maria in reply to Smileyface]

Well, these other medicines are more expensive and metformin and sulfonylurea are very cheap (I would refuse sulfonylurea due to the hypoglycemia). However, if these cheap medicines make you sick and cause you problems, that is not good, as you need to take something that you can comply with, so your glucose can be controlled effectively.

There can obviously be side effects with every medication, but these more modern treatments are usually much better tolerable and that's the whole point. So you can argue if they prescribe you a medication that you cannot tolerate, you are most likely not taking it, hence this is missing the point and therefore they should give you something that is much better tolerable and effective and that you can easily take.

I hope you can persuade them to prescribe you something that is effective and more tolerable for you.

[Smileyface in reply to Tina_Maria]

Thanks, I do too, I've managed to get an appointment with the diabetic nurse who prescribes the medication in a fortnight and hopefully we can have a discussion with which medication is the best way forward. If there hadn't been all the supply problems with Trulicity I would have been happy to stay on it.

[Tina_Maria]

Just a thought though, how is your T3? I have seen in a previous post that your T3 was only a third through the range - has this been improved by now? Your T3 is actually the engine of your metabolism, so if this is low, you metabolism is slowed down and as a result your glucose can creep up and you could go into the pre-diabetic or even diabetic range. This is the same with cholesterol levels, they can go high if you do not have sufficient T3 for metabolising lipids.

Might be worth (if you can) doing a private thyroid function test to check you TSH, T4 and T3 and if T3 is still quite low, I would try to improve this, as this could have a great impact on improving your glucose metabolism, maybe even to a point where you might perhaps not need medication? Certainly worth a check, there are cases where glucose and cholesterol levels have normalised, when people had optimal levels of T3.

[Smileyface in reply to Tina_Maria]

I did a test last week, my t3 was 5.4 (3.1 - 6.8) T4 22 (12 - 22) i messed up the b12 test so I'm redoing it. My Vit D was 67 so I've changed how I take vit d to the protocol with all the other vitamins. My hba1c was 55mmol . Do you think my t3 is still too low.

[Tina_Maria in reply to Smileyface]

It is good that you have checked the T3, your levels show that it is 62.2% through the range, so not too bad. Your T4 is right on top of the range (I guess your TSH is very low too), so this is not ideal as it is better to have the T4 a bit lower. Problem is though, if you lower your T4, you will lower your T3 as well, which might be counterproductive, so it is difficult to say. It probably could be a bit higher, but without actively adding T3 in, this might be a bit tricky to achieve.

Definitely work on improving your nutrients, especially the Vitamin D, as it helps with the conversion. Are you doing any exercise? I have found that even a short walk (20-30min) can have a positive effect on your glucose metabolism (and lipid metabolism!). Even though I am not diabetic, my HbA1c has dropped 3 points since I have started to walk every day and my lipids have also improved (especially triglycerides). I know it can be a pain and especially when the weather is not that bright it is not very appealing, but after a while you get so used to it, that you really feel it when you miss it. And it really does make a difference. As they say, every little helps!😉

[Smileyface in reply to Tina_Maria]

Thanks, I do walk every day, as I have 2 dogs, but due to 1 dog declining due to age only every other day is a good 3 mile walk. I had considered dropping my levo to 100mcg to alternate days of 125mcg. I'm currently taking 125mcg every day. What you think?

[Tina_Maria in reply to Smileyface]

Great about the walking, that's really good for your metabolism.👍😉

I would not reduce too much in one go, if you want to try it. Sometimes just a small tweak can do the trick. If you take 125mcg per day, I assume you have 100mcg and 25mcg tablets? So you could split the 25mcg in half and take 112.5mcg every other day and see how you are getting on with that, it might be a bit more gentle. Or if even that is too much you can do the 112.5 on just 2 days a week. It can be a bit trial and error when playing around with the dose, but I am sure you can find your sweet spot. Hopefully this can bring your T4 down a bit without affecting the T3 too much. Fingers crossed! 🤞

[Smileyface in reply to Tina_Maria]

Thank you very much for all your advice.

[Tina_Maria in reply to Smileyface]

No worries, I hope that all goes well. 😉