DEAR DR. ROACH: I’ve been recognized with Sort 2 diabetes and prescribed 1,500 mg of metformin. My A1C is now 6.0, though even when it was 5.8, my endocrinologist saved the identical dosage. My main care doctor advised I minimize the dosage right down to 1,000 mg, however my endocrinologist instructed me that taking 1,000 mg slightly than the 1,500 mg is like “taking nothing.” I’ve learn there are benefits of taking metformin, so for now I’m staying the course.
ANSWER: Practically all medicines have a dose response, that means that extra of a medication usually means extra effectiveness. Nevertheless, they’ve toxicities as properly, and once more, the upper the dose, the larger the chance of toxicity. A prescriber’s job is to search out the dose with the optimum effectiveness at an appropriate toxicity.
With metformin, the same old dosing is 1,000 mg as much as 2,550 mg per day. My expertise is that 1,000-1,500 mg is sort of as efficient as 2,000 or extra. Many individuals could have abdomen upset or diarrhea at excessive dosages. Utilizing a slow-release formulation significantly reduces this impact.
As you recognized, there are different benefits to metformin, particularly serving to folks preserve their weight down. It might be that the endocrinologist is worried about this, as a result of an A1C of 5.8% and even 6% is a decrease objective than vital for many Sort 2 diabetics.
As a main care physician, I give a substantial amount of deference to the specialists who assist handle my sufferers’ medical circumstances. It’s doable your endocrinologist discovered that for you, the 1,000 mg dose wasn’t efficient however the 1,500 mg was, though in most individuals the impact is analogous.
DEAR DR. ROACH: I’m a 55-year-old feminine who was just lately hospitalized for a critical case of ocular shingles, though happily it didn’t invade the eyeball and my imaginative and prescient is undamaged. The shingles affected the left aspect of my face with extreme migraines, eye ache, swelling, vomiting, fever and weak point. Ought to I obtain the Shingrix vaccine, and in what timeframe? I learn that after having shingles, one ought to wait three years to obtain the vaccine. I’m in any other case wholesome, with fragrance/scent induced bronchial asthma.
I needed to obtain the vaccine final 12 months at my annual wellness examination, however my main care doctor suggested me to attend. She needed to see what long-term results the vaccine would have. I don’t ever wish to undergo this once more.
ANSWER: The brand new shingles vaccine, Shingrix, could also be given as quickly because the rash from shingles has crusted over, however the danger of creating a recurrence of shingles inside a 12 months of an outbreak is low. You may get it anytime inside that 12 months.
I perceive that some docs are reluctant to prescribe new remedies, however the information and years of expertise with the Shingrix vaccine are convincing sufficient that I like to recommend it for everybody over 50 who doesn’t have a medical purpose to not take it. That is true for individuals who have had shingles earlier than in addition to those that haven’t.
Dr. Roach regrets that he’s unable to reply particular person letters, however will incorporate them within the column each time doable. Readers might electronic mail inquiries to ToYourGoodHealth@med.cornell.edu or ship mail to 628 Virginia Dr., Orlando, FL 32803.