Guest guest Posted August 13, 2005 Report Share Posted August 13, 2005 Thanks Edd.. My pharmacy is giving me grief over taking an extra 1/2 of regular glip along with my 1 extended release glipizide. At most, it is 7.5 milligrams.. Jeepers! You would think I was taking 3 times the maximum dosage! I'm ready to throw in the towel. Nobody listens when I explain why I am taking the extra 1/2 tablet. They refused to refill my regular glipizide....... Thanks again, Cindy > Check out: http://www.rxlist.com/cgi/generic/glip_ids.htm > also: > http://www.pdrhealth.com/drug_info/rxdrugprofiles/drugs/glu1189.shtml > > It says the maximum recommended dose of the regular glipizide is 40 > mg/day or for the extended release version, 20 mg/day. This maximum > dose may be due to decreasing effectiveness rather than safety. The > warnings about overdosing only discuss the dangers of hypoglycemia, > which are easily treated with orange juice, etc. > > > Edd Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 13, 2005 Report Share Posted August 13, 2005 Cindy wrote: > Thanks Edd.. My pharmacy is giving me grief over taking an extra 1/2 > of regular glip along with my 1 extended release glipizide. At most, > it is 7.5 milligrams.. Jeepers! You would think I was taking 3 times > the maximum dosage! I'm ready to throw in the towel. Nobody listens > when I explain why I am taking the extra 1/2 tablet. They refused to > refill my regular glipizide....... > > Thanks again, > > Cindy I imagine that they're freaking because we're all supposed to follow our doctors' orders without modification. You must have a good reason for taking the extra 1/2. What does it do for you? Have you discussed this with your doctor, or is he one of those who isn't listening to you? Edd Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 14, 2005 Report Share Posted August 14, 2005 Before I get into this too deep, I don't use glipizide, so I am speaking from what I have learned from using other 'extended' release meds (like metformin ER or XL). Everything I have read about extended release pills/tablets is that you should not cut or break them in half, nor should you chew them, just swallow them intact. The reason is that to achieve the extended release feature, the active components in the pill (in this case the glipizide) is incased in a matrix that releases the med in a slow (time release) manner usually as the matrix disolves. When the pill/tablet is broken or crushed, the med is no longer slowly released, but is released in an unpredictable manner which can be very rapid. It sounds like you have been lucky, so far. You should be very careful as you could have a very serious low in the middle of the night. > My reason for taking the extra 1/2 regular glipizide is to cover > carby meals in the evening. When I was taking just the regular 5mg > glipizide only, I would have deep valleys and high peaks. So I asked > to switch to the extended release. It acts like a basal insulin, > keeps my numbers fairly steady during the day but will not cover the > carbs from a late evening meal. My day runs from 9am to 2am.... so I > eat a late dinner between 8 and 9 pm and the extended release glip > can't handle the carbs then. So I started adding the extra 1/2 glip > to keep my numbers more even and prevent an over night surge. It > works very well and even allows me to have a piece of fruit > occasionally. I always check my bg before bed and keep a close watch > on it during the day. > =+=+=+=+=+=+= Maurer Type II diabetic since 4/87 (diet, exercise, & meds) Insulin dependent Type II since 9/04 (diet, exercise, Lantus, Humalog, & Metformin XR) =+=+=+=+=+=+= Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 14, 2005 Report Share Posted August 14, 2005 Before I get into this too deep, I don't use glipizide, so I am speaking from what I have learned from using other 'extended' release meds (like metformin ER or XL). Everything I have read about extended release pills/tablets is that you should not cut or break them in half, nor should you chew them, just swallow them intact. The reason is that to achieve the extended release feature, the active components in the pill (in this case the glipizide) is incased in a matrix that releases the med in a slow (time release) manner usually as the matrix disolves. When the pill/tablet is broken or crushed, the med is no longer slowly released, but is released in an unpredictable manner which can be very rapid. It sounds like you have been lucky, so far. You should be very careful as you could have a very serious low in the middle of the night. > My reason for taking the extra 1/2 regular glipizide is to cover > carby meals in the evening. When I was taking just the regular 5mg > glipizide only, I would have deep valleys and high peaks. So I asked > to switch to the extended release. It acts like a basal insulin, > keeps my numbers fairly steady during the day but will not cover the > carbs from a late evening meal. My day runs from 9am to 2am.... so I > eat a late dinner between 8 and 9 pm and the extended release glip > can't handle the carbs then. So I started adding the extra 1/2 glip > to keep my numbers more even and prevent an over night surge. It > works very well and even allows me to have a piece of fruit > occasionally. I always check my bg before bed and keep a close watch > on it during the day. > =+=+=+=+=+=+= Maurer Type II diabetic since 4/87 (diet, exercise, & meds) Insulin dependent Type II since 9/04 (diet, exercise, Lantus, Humalog, & Metformin XR) =+=+=+=+=+=+= Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 14, 2005 Report Share Posted August 14, 2005 > My reason for taking the extra 1/2 regular glipizide is to > cover carby meals in the evening. <snip> > She has volunteered to write a letter to my doctor explaining > the situation and recommending that I be referred to an endo. > I'm just hoping this will work because if not, I'm sunk. Cindy, I've been away for a week and don't know all the background. At the risk of stating something that has already been said, why don't you just cut the carbs in those evening meals? Cheers, Alan, T2 d & e, Australia Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 14, 2005 Report Share Posted August 14, 2005 > My reason for taking the extra 1/2 regular glipizide is to > cover carby meals in the evening. <snip> > She has volunteered to write a letter to my doctor explaining > the situation and recommending that I be referred to an endo. > I'm just hoping this will work because if not, I'm sunk. Cindy, I've been away for a week and don't know all the background. At the risk of stating something that has already been said, why don't you just cut the carbs in those evening meals? Cheers, Alan, T2 d & e, Australia Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 14, 2005 Report Share Posted August 14, 2005 Helen Mueller wrote: > Cindy, what kind of doctor is this doctor? Maybe she needs to get a > diabetes for dummies book and do some reading. > > Go to http://www.rxlist.com and look up metformin. Print the prescribing > information out and bring it to her. I hate having to stand on my head > to deal with an idiot doctor! > > Ask the pharmacist for the print-out that comes with the drug. It should > also give her information about dosage. Also you can ask your doctor to read the PDR, it's a reference book which she will have in her office which gives the same information. It may impress her if she sees this information in her own reference book. Edd Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 15, 2005 Report Share Posted August 15, 2005 Maurer wrote: > Everything I have read about > extended release pills/tablets is that you should not cut or break > them in half... Although she is using the extended release, she said that the pill she is cutting in half is a regular glipizide. That pill can be cut. Edd Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 15, 2005 Report Share Posted August 15, 2005 Maurer wrote: > Everything I have read about > extended release pills/tablets is that you should not cut or break > them in half... Although she is using the extended release, she said that the pill she is cutting in half is a regular glipizide. That pill can be cut. Edd Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 15, 2005 Report Share Posted August 15, 2005 On Sun, 14 Aug 2005 15:35:43 -0000, " Cindy " wrote: >My reason for taking the extra 1/2 regular glipizide is to cover >carby meals in the evening. When I was taking just the regular 5mg >glipizide only, I would have deep valleys and high peaks. So I asked >to switch to the extended release. It acts like a basal insulin, >keeps my numbers fairly steady during the day but will not cover the >carbs from a late evening meal. My day runs from 9am to 2am.... so I >eat a late dinner between 8 and 9 pm and the extended release glip >can't handle the carbs then. So I started adding the extra 1/2 glip >to keep my numbers more even and prevent an over night surge. It >works very well and even allows me to have a piece of fruit >occasionally. I always check my bg before bed and keep a close watch >on it during the day. Re: the pharmacy. Time to change pharmacies. I have awful memories of such hassles from the chain pharmacy I used to use. I switched over to a local pharmacy owned by the pharmacist. In return for giving up conveniences such as 24 hour open and internet renewals, I get NO hassles about my scripts, refills when they expire with any effort on my part, even an occasional (non-schedule) drug without a script. If something fouls up with my insurance, he fills the script and carries it on the books until the foulup is fixed. You may have to look around a bit to find such a pharmacist but I bet there's one in your town. The independents are in a battle to the death with the big chains. They can't compete on price or technology so they have to offer superior service. > >As for my doctor, well when I saw her last in May, I went in with my >journal prepared to discuss the roller coaster I was on due to the >regular glipizide. She didn't even look at it. Because my A1C was >5.3, she just assumed everything was great and wouldn't listen to a >thing I said. I was instructed to take my medication EXACTLY as she >had prescribed and not to worry about numbers in the 200's after a >meal because even non-diabetics have numbers that high after meals. >(maybe so, but their bgs don't stay that high after 2 or 3 hours on a >low carb meal plan!) So, that is the story... I have been VERY >frustrated with my doctor but unable at this juncture to change >physicians. However! I have an appointment with my diabetic >educator on Wednesday. I explained what was going on to her. She >listened to me. She checked my A1C which was down to 5.2 by that >time even though I was still having readings in the 200's after late >meals. She has volunteered to write a letter to my doctor explaining >the situation and recommending that I be referred to an endo. I'm >just hoping this will work because if not, I'm sunk. If I was stuck with a doctor I didn't like who was committing malpractice at my expense, I'd do the letter writing. I suggest you write your doc a letter outlining basically what you've written in your note, perhaps along with some supporting evidence in the form of medical papers that describe the harm that comes from sugar in the 200's. I'd request a written response as to why (s)he's denying you the proper treatment. I'd send it certified, return receipt, addressee signature required so that (s)he has to sign for it personally. Once (s)he receives the letter, (s)he's on written notice and the liability for any subsequent problems lie with her/him. If you don't get satisfaction at that point, I suggest doing whatever is necessary to change docs or if you really can't, hiring a lawyer to write a " come to Jesus " letter. IMO, there is NO excuse other than warped inflated ego for a doc to deny you therapy that is working. I think I might even file a complaint with the state board of medical examiners. If (s)he's telling you that " 200 is OK " , what is being told to people with 250? 300? --- De Armond See my website for my current email address http://www.johngsbbq.com Cleveland, Occupied TN Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 15, 2005 Report Share Posted August 15, 2005 On Sun, 14 Aug 2005 15:35:43 -0000, " Cindy " wrote: >My reason for taking the extra 1/2 regular glipizide is to cover >carby meals in the evening. When I was taking just the regular 5mg >glipizide only, I would have deep valleys and high peaks. So I asked >to switch to the extended release. It acts like a basal insulin, >keeps my numbers fairly steady during the day but will not cover the >carbs from a late evening meal. My day runs from 9am to 2am.... so I >eat a late dinner between 8 and 9 pm and the extended release glip >can't handle the carbs then. So I started adding the extra 1/2 glip >to keep my numbers more even and prevent an over night surge. It >works very well and even allows me to have a piece of fruit >occasionally. I always check my bg before bed and keep a close watch >on it during the day. Re: the pharmacy. Time to change pharmacies. I have awful memories of such hassles from the chain pharmacy I used to use. I switched over to a local pharmacy owned by the pharmacist. In return for giving up conveniences such as 24 hour open and internet renewals, I get NO hassles about my scripts, refills when they expire with any effort on my part, even an occasional (non-schedule) drug without a script. If something fouls up with my insurance, he fills the script and carries it on the books until the foulup is fixed. You may have to look around a bit to find such a pharmacist but I bet there's one in your town. The independents are in a battle to the death with the big chains. They can't compete on price or technology so they have to offer superior service. > >As for my doctor, well when I saw her last in May, I went in with my >journal prepared to discuss the roller coaster I was on due to the >regular glipizide. She didn't even look at it. Because my A1C was >5.3, she just assumed everything was great and wouldn't listen to a >thing I said. I was instructed to take my medication EXACTLY as she >had prescribed and not to worry about numbers in the 200's after a >meal because even non-diabetics have numbers that high after meals. >(maybe so, but their bgs don't stay that high after 2 or 3 hours on a >low carb meal plan!) So, that is the story... I have been VERY >frustrated with my doctor but unable at this juncture to change >physicians. However! I have an appointment with my diabetic >educator on Wednesday. I explained what was going on to her. She >listened to me. She checked my A1C which was down to 5.2 by that >time even though I was still having readings in the 200's after late >meals. She has volunteered to write a letter to my doctor explaining >the situation and recommending that I be referred to an endo. I'm >just hoping this will work because if not, I'm sunk. If I was stuck with a doctor I didn't like who was committing malpractice at my expense, I'd do the letter writing. I suggest you write your doc a letter outlining basically what you've written in your note, perhaps along with some supporting evidence in the form of medical papers that describe the harm that comes from sugar in the 200's. I'd request a written response as to why (s)he's denying you the proper treatment. I'd send it certified, return receipt, addressee signature required so that (s)he has to sign for it personally. Once (s)he receives the letter, (s)he's on written notice and the liability for any subsequent problems lie with her/him. If you don't get satisfaction at that point, I suggest doing whatever is necessary to change docs or if you really can't, hiring a lawyer to write a " come to Jesus " letter. IMO, there is NO excuse other than warped inflated ego for a doc to deny you therapy that is working. I think I might even file a complaint with the state board of medical examiners. If (s)he's telling you that " 200 is OK " , what is being told to people with 250? 300? --- De Armond See my website for my current email address http://www.johngsbbq.com Cleveland, Occupied TN Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 15, 2005 Report Share Posted August 15, 2005 On Sun, 14 Aug 2005 15:35:43 -0000, " Cindy " wrote: >My reason for taking the extra 1/2 regular glipizide is to cover >carby meals in the evening. When I was taking just the regular 5mg >glipizide only, I would have deep valleys and high peaks. So I asked >to switch to the extended release. It acts like a basal insulin, >keeps my numbers fairly steady during the day but will not cover the >carbs from a late evening meal. My day runs from 9am to 2am.... so I >eat a late dinner between 8 and 9 pm and the extended release glip >can't handle the carbs then. So I started adding the extra 1/2 glip >to keep my numbers more even and prevent an over night surge. It >works very well and even allows me to have a piece of fruit >occasionally. I always check my bg before bed and keep a close watch >on it during the day. Re: the pharmacy. Time to change pharmacies. I have awful memories of such hassles from the chain pharmacy I used to use. I switched over to a local pharmacy owned by the pharmacist. In return for giving up conveniences such as 24 hour open and internet renewals, I get NO hassles about my scripts, refills when they expire with any effort on my part, even an occasional (non-schedule) drug without a script. If something fouls up with my insurance, he fills the script and carries it on the books until the foulup is fixed. You may have to look around a bit to find such a pharmacist but I bet there's one in your town. The independents are in a battle to the death with the big chains. They can't compete on price or technology so they have to offer superior service. > >As for my doctor, well when I saw her last in May, I went in with my >journal prepared to discuss the roller coaster I was on due to the >regular glipizide. She didn't even look at it. Because my A1C was >5.3, she just assumed everything was great and wouldn't listen to a >thing I said. I was instructed to take my medication EXACTLY as she >had prescribed and not to worry about numbers in the 200's after a >meal because even non-diabetics have numbers that high after meals. >(maybe so, but their bgs don't stay that high after 2 or 3 hours on a >low carb meal plan!) So, that is the story... I have been VERY >frustrated with my doctor but unable at this juncture to change >physicians. However! I have an appointment with my diabetic >educator on Wednesday. I explained what was going on to her. She >listened to me. She checked my A1C which was down to 5.2 by that >time even though I was still having readings in the 200's after late >meals. She has volunteered to write a letter to my doctor explaining >the situation and recommending that I be referred to an endo. I'm >just hoping this will work because if not, I'm sunk. If I was stuck with a doctor I didn't like who was committing malpractice at my expense, I'd do the letter writing. I suggest you write your doc a letter outlining basically what you've written in your note, perhaps along with some supporting evidence in the form of medical papers that describe the harm that comes from sugar in the 200's. I'd request a written response as to why (s)he's denying you the proper treatment. I'd send it certified, return receipt, addressee signature required so that (s)he has to sign for it personally. Once (s)he receives the letter, (s)he's on written notice and the liability for any subsequent problems lie with her/him. If you don't get satisfaction at that point, I suggest doing whatever is necessary to change docs or if you really can't, hiring a lawyer to write a " come to Jesus " letter. IMO, there is NO excuse other than warped inflated ego for a doc to deny you therapy that is working. I think I might even file a complaint with the state board of medical examiners. If (s)he's telling you that " 200 is OK " , what is being told to people with 250? 300? --- De Armond See my website for my current email address http://www.johngsbbq.com Cleveland, Occupied TN Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 15, 2005 Report Share Posted August 15, 2005 I'd (1) Insist on more metformin. The 500 mg isn't apt to do much for anyone. (2) Print out the articles about the glipizide, highlighting one or two of the most important sentences, and say you'd rather not take a sulfonyurea. In the meantime, try to eat as few carbs as is feasible. That's nother way of keeping BGs down. Some people are now recommending insulin for newly diagnosed type 2s as an interim measure to reduce glucotoxicity. Then when BGs have reached normal levels, the insulin can often be discontinued. Gretchen Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 15, 2005 Report Share Posted August 15, 2005 I'd (1) Insist on more metformin. The 500 mg isn't apt to do much for anyone. (2) Print out the articles about the glipizide, highlighting one or two of the most important sentences, and say you'd rather not take a sulfonyurea. In the meantime, try to eat as few carbs as is feasible. That's nother way of keeping BGs down. Some people are now recommending insulin for newly diagnosed type 2s as an interim measure to reduce glucotoxicity. Then when BGs have reached normal levels, the insulin can often be discontinued. Gretchen Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 15, 2005 Report Share Posted August 15, 2005 > Sue, I asked her about increasing the metformin and got a resounding > NO! I don't understand it myself. She said an increase wouldn't make > any difference.......... ????????? I think you need a new doctor. Gretchen Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 15, 2005 Report Share Posted August 15, 2005 > Sue, I asked her about increasing the metformin and got a resounding > NO! I don't understand it myself. She said an increase wouldn't make > any difference.......... ????????? I think you need a new doctor. Gretchen Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 15, 2005 Report Share Posted August 15, 2005 Thank you Gretchen. I did ask for more metformin but she turned me down flat. I'm sincerely hoping I can see an endo because I just don't think my internist is going to budge much on her opinions. Cindy > I'd > > (1) Insist on more metformin. The 500 mg isn't apt to do much for anyone. > > (2) Print out the articles about the glipizide, highlighting one or two of > the most important sentences, and say you'd rather not take a sulfonyurea. > > In the meantime, try to eat as few carbs as is feasible. That's nother way > of keeping BGs down. > > Some people are now recommending insulin for newly diagnosed type 2s as an > interim measure to reduce glucotoxicity. Then when BGs have reached normal > levels, the insulin can often be discontinued. > > Gretchen Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 15, 2005 Report Share Posted August 15, 2005 Thank you Gretchen. I did ask for more metformin but she turned me down flat. I'm sincerely hoping I can see an endo because I just don't think my internist is going to budge much on her opinions. Cindy > I'd > > (1) Insist on more metformin. The 500 mg isn't apt to do much for anyone. > > (2) Print out the articles about the glipizide, highlighting one or two of > the most important sentences, and say you'd rather not take a sulfonyurea. > > In the meantime, try to eat as few carbs as is feasible. That's nother way > of keeping BGs down. > > Some people are now recommending insulin for newly diagnosed type 2s as an > interim measure to reduce glucotoxicity. Then when BGs have reached normal > levels, the insulin can often be discontinued. > > Gretchen Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 15, 2005 Report Share Posted August 15, 2005 Thank you Gretchen. I did ask for more metformin but she turned me down flat. I'm sincerely hoping I can see an endo because I just don't think my internist is going to budge much on her opinions. Cindy > I'd > > (1) Insist on more metformin. The 500 mg isn't apt to do much for anyone. > > (2) Print out the articles about the glipizide, highlighting one or two of > the most important sentences, and say you'd rather not take a sulfonyurea. > > In the meantime, try to eat as few carbs as is feasible. That's nother way > of keeping BGs down. > > Some people are now recommending insulin for newly diagnosed type 2s as an > interim measure to reduce glucotoxicity. Then when BGs have reached normal > levels, the insulin can often be discontinued. > > Gretchen Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 16, 2005 Report Share Posted August 16, 2005 Vicki wrote >Cindy...your doctor is wrong about increasing metformin making no difference. The 500 you're taking now is MINIMAL dose. Maximum dose is 1500 per day and I'm sure it says that on Rxlist.. Go there and print it out and show it to her. If she still insists it would make no difference I'd suggest finding another doctor.> rxlist says: " Dosage of metformin HCl must be individualized on the basis of both effectiveness and tolerance, while not exceeding the maximum recommended daily dose of 2550 mg. Metformin HCl should be given in divided doses with meals and should be started at a low dose, with gradual dose escalation, as described below, both to reduce gastrointestinal side effects and to permit identification of the minimum dose required for adequate glycemic control of the patient. " and " Usual Starting Dose: In general, clinically significant responses are not seen at doses below 1500 mg per day. However, a lower recommended starting dose and gradually increased dosage is advised to minimize gastrointestinal symptoms. " Bea Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 16, 2005 Report Share Posted August 16, 2005 Thanks Bea and Vicki, I printed out the info and will take it with me when I see my doc in September. Cindy > Vicki wrote > >Cindy...your doctor is wrong about increasing metformin making no > difference. The 500 you're taking now is MINIMAL dose. Maximum dose is > 1500 per day and I'm sure it says that on Rxlist.. Go there and print it > out and show it to her. If she still insists it would make no difference > I'd suggest finding another doctor.> > > rxlist says: > " Dosage of metformin HCl must be individualized on the basis of both > effectiveness and tolerance, while not exceeding the maximum recommended > daily dose of 2550 mg. Metformin HCl should be given in divided doses with > meals and should be started at a low dose, with gradual dose escalation, as > described below, both to reduce gastrointestinal side effects and to permit > identification of the minimum dose required for adequate glycemic control of > the patient. " > > and > > " Usual Starting Dose: In general, clinically significant responses are not > seen at doses below 1500 mg per day. However, a lower recommended starting > dose and gradually increased dosage is advised to minimize gastrointestinal > symptoms. " > > Bea Quote Link to comment Share on other sites More sharing options...
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