Doctor changed diabetes meds to lower blood sugar

DEAR DR. ROACH

» I have a question about medications. I’m a soon to be 77 female. I have had Type 2 diabetes since about age 53. I am still on medication — metformin, glipizide and Actos. I previously was on glyburide and was doing well with an A1C around 7.1% or 7.2%. Then my doctor suddenly said glyburide was a dangerous drug and I must stop taking it. She substituted glipizide. This drug does not seem to work, as my A1C is now in the 7.8% range. Both of those drugs are in the same class and have the same warnings of heart failure, etc. I can’t get my doctor to relent and give me back the glyburide. She instead wants me to take an injectable, Victoza, and I’m not interested. What do you think?

— S.H.

DEAR READER » I think your doctor is concerned about glyburide causing low blood sugars. Glyburide not only lasts a long time, but it is metabolized by your body into other compounds that can also lower blood sugar. Especially in the elderly, those active compounds can cause a high risk of dangerously low blood sugars, and many experts do tend to avoid glyburide and use glipizide or glimepiride instead. If you have had any low blood glucose readings, I would agree with the change.

Liraglutide (Victoza) is called a GLP-1 antagonist. It is very helpful in people who need to lose weight, which includes many people with Type 2 diabetes, and in people with known cardiovascular disease. In my opinion, this class of drugs is proven to be safer than medicines like glyburide, and effective in people with those risk factors or who are at higher risk for low blood sugars.

Finally, A1C is a measurement of overall blood sugar levels in the body, and I’m not sure additional medication is necessary for someone in their mid-70s with an A1C of 7.8%. A reasonable goal is 7.5%, and perhaps changes in diet or exercise may bring you there more safely than any additional medication.