My doctor had me on Metformin 1000mg 2X daily, glyburide 10mg 2X daily, furosemide 80 mg daily, and Avandia 4mg daily. When Avandia began getting bad press, I asked him to take me off it and prescribe an alternative. He removed only the Avandia, and added Metaglip 5/500 2 tablets 2X a day. A few months later, I was rushed to the hospital in renal failure. I had been vomiting several times a week, but didn't realize that I was dehydrating. The kidney specialist said that I was at 15% kidney function. I was admitted and after 4 days of IV rehydration, they released me with insulin and Starlix and removed all other diabetic oral meds. Does anyone out there think that my doctor did me harm by having me on 4000mg daily of Metformin? This is what I have been told caused my dehydration-induced kidney failure. Thank you for any advice. My medical bills relating to this hospitalization have caused me financial hardship now, and I wonder if I didn't take proper care of myself, or maybe this might have been bad prescribing by the doctor. I often wonder if he meant to take me off the straight metformin pills when he added the additional 2000mg of metformin that is contained in the metaglip

The most common side effects of metformin are nausea/vomiting.
N/V can...especially after several days....cause severe dehydration and fluid/electrolyte imbalances.
In a diabetic patient, the kidneys are at risk for disease, as are the eyes and other vital organs.
Dehydration, on top of this, is not a good thing.
Dehydration can eventually cause acute renal failure, with other contributing factors.

Although the situation is unfortunate, it doesn't sound to me like your doctor was negligent, just probably wasn't the best combination of medications for you.
It is quite a steep dose of metformin though.
I wonder if his intentions were to discontinue the metformin and start the metaglip, perhaps he did not communicate well with you?
Typically, the max dose is 2550mg per day in healthy adults.
I'd definately question your doc next time you see him.
Are you seeing a family physician or an endocrinologist?

Also, did you have some underlying renal insufficiency prior to this? Had you had your kidney function tested prior to this illness?
I'd suggest seeing a nephrologist (for your kidneys) to follow up, and seeing a specialist for future medication.

Hope you are feeling better, I can imagine how frustrating it must have been spending 4 long days hospitalized.

I also see now that you are taking 80mg of Lasix per day.
This probably worsened the dehydration, as it pulls the potassium off of your body.
Typically, it's not a HUGE problem, but with nausea and vomiting you were probably severely hypokalemic...which is quite dangerous.

4000 mg of Metformin indeed sound like a lot. As Samantha mentioned, the usual max dosage is 2550 mg/day. As she also mentioned, the Lasix would contribute to the dehydration, as it is a diuretic. That is what it does.

Lisa, How long had you originally been on Metformin before your doctor added Metaglip? Also, do you know your serum creatinine levels when you were just on the 1000mg twice daily? Do you drink any alcohol?

Thank you so very much for responding. I'm sorry it took so long for me to reply as I don't go online that often. I was on Metformin 1000mg 2x daily for 10 years. 3 months prior to him adding the additional 2000mg daily contained in the metaglip, my blood tests were (creatinine 1.0, BUN 32, ratio 32). 3 months later upon hospitalization they were (creatinine 4.9, BUN 71). I never drink alcohol. I've been told by Bristol Myerrs Squibb that the maximum dosage is 2550 mg per day. I'm thinking about shopping for an attorney. Any thoughts? Thanks!

My thoughts are; attorneys don't know more about diabetes than most doctors...

From your original post, it sounds like you are saying you were on all those different meds at one time. I must be confused, right?

I am missing something.

I see metformin 1000mg 2x daily.

This equals 2000 mg daily.

I have been taking 2000mg daily now for over two plus years; no problem.

Ralph

Ron,Dan
Lisa is saying that she was on Metformin 1000mgX2 on a daily basis.
The doctor then irresponsibly added 2000mg more daily Metformin contained in Metaglip.
Total:4000mg daily Metformin-almost double the max dose of 2550mg.
Max for Metformin ER is 2000mg.
She has every right to be upset with the quack doctor.
Eddie

If that's the case: Sue the B_st_rd for all he's worth!!!!

I think when any Dr has you on that many oral pills and high and very high MG it is time to get another DR. Insulin is better for people than pumping so many Oral Diabetes meds in you.

I have to ask you, what kind of diet are you on? I would think a Junk out and low carb diet would bring your numbers way down.

I might have been from the Avandia, but being on all theses drug doesn't surprise me if you were dehydrated. You have to drink gallons to keep up with all those meds.

I am sure you will be better off with just Insulin and a good healthy diet.
I think you dr, should be questioned on why he gave you all of this.

I am so sorry you had to go through this, I hope you soon feel so much better. Hugs Debbie

I'm going to say that in my opinion, insulin is not the best way to go. In type II DM, if you are insulin resistant, why not try to up-regulate the insulin receptors and decrease insulin resistance in the periphery before bombarding the body with more insulin? Also, Metformin does help the lipid panels a bit. 4g of Metformin a day, with someone already possessing other risk factors can really hurt the body.


Lisa, do you by chance have any other lab values from the hospital, say electrolyte levels and pH?

If the proper dose of Metformin does not solve the problem, current ADA guidelines (and what many of us figured out years ago) is that insulin is the next step. Sulfano. drugs or Byetta are alternative next steps.

Yeppers Rob, that is my experience to. That is way to much oral meds and bouncing off each other, oh geez.......

I can understand why someone would want to avoid a bunch of oral meds. However, with a lower carb diet you wouldn't need so many meds.
Why start insulin when your body already produces too much? I know most patients do not want to use the needles. Why risk the hypoglycemia and weight gain?

According to ADA guidelines metformin, MNT and exercise are all first line for DM II. Treatment after that depends on the A1C. Insulin is not the only 2nd line option. If practioners are going straight for insulin after metformin is failed they are doing a disservice to their patients.

But back to Lisa's question. Yes the doctor did put you at risk for complications with a dose of 4000mg of Metformin. I'm going to assume that the doctor figured you would discontinue the original Metformin or that he already told you to discontinue the old dosage of Metformin before putting you on the new doses.