I saw a new endo yesterday and he suggested that I use glipizide xl and my basal insulin. I'm waiting for test results on my c peptide levels, I'm pretty sure i have some functioning left in my pancreas. The more I research glipizide the more scared I get....I thought it was a great idea, but now I'm not sure if the drug looks safe. Any thoughts out there?
I've been pumping for 8 years.
Glipizide pushes your pancreas to release insulin, it usually causes a decrease in fasting levels. It is not advised for T1 and many people (including myself a T2) consider it unsafe and that it leads to burning out your remaining beta cells. I don't think it is safe, I would seriously question it's use in a T1 and I would ask why someone would even suggest that it would replace a bolus insulin.
Your doctor may be attempting to rediagnose you as a T2 and using this to "prove" it. A very dangerous thing given you have been T1 and insulin dependent for 8 years.
My question is why. I am a T2 pumper and I take no oral T2 meds. My goal when I started insulin was to get away from the oral meds. Glipizide and other meds that push the pancreas are believed to hasten the demise of any remaining beta cells. The jury is still out on that question but I say why chance it.
If you doctor is questioning your diagnose ask for antibody tests before switching treatment.
I'm not sure what the benefit would be to switching your regime even if glipizide were safe for you. It doesn't sound as if what you're doing now isn't working. You will still have the threat of hypoglycemia if you're taking basal and I can imagine your insurance company wondering if your pump is really necessary if you're not using bolus insulin. Lot's of ways for this experiment to work out badly and not much to gain other than not having to match your meals to your insulin dose.
Since Glipizide makes your pancreas secrete continuous insulin, I'd think that if your endo wanted you to take it, you'd take it instead of basal and continue to use bolus. If your endo suspects some insulin resistance, I'd think he'd prescribe Metformin before glipizide, as glipizide has nothing to do with insulin resistance. Something doesn't sound right here.
That being said, I'd leave it. If your endo insists, I'd find a new-new endo.
I've researched these pills because my endo suspects MODY and they supposedly work well for it. However, after researching the sulfonylureas, I'd hesitate to take them and I'd strongly consider insulin instead. That's just me, but I don't like the side effects (extreme hunger, weight gain, the potential to burn out the beta cells), and I'd prefer lows from insulin than lows from a pill.
Thanks for the replies everyone! I appreciate your feedback and am definitely waiting before I switch my treatment and/or bolusing :)
You mention pancreas function... Are you LADA with a lot of lingering insulin production, or a similar kind of T1 with extended honeymoon and very low insulin needs? And maybe a lot of after-meal hypos that result from variable bolus needs
Basal+Glipizide has been used with some success, like using Metformin in a T1 it is "off label" but could be clever way for you to "lighten up" on especially bolusing. I don't do it myself but it could be worth a shot especially if you don't like bolusing or it's not possible due to other restrictions.
I've always been told I'm a type one. However, my new endo explained to me that I may be a genetic type one vs. juvenile type one since I was diagnosed in my twenties.
Frankly, saying you are "a genetic type 1 versus a juvenile Type 1" would cause me to run screaming from that endo and never go back! That is an utterly ridiculous statement. Type 1a diabetes, diagnosed at any age, is associated with HLA genes.
Glipizide causes insulin secretion by remnant beta cells in people with Type 1 with some remaining endogenous insulin. Multiple studies have shown that Glipizide "burns out" those remnant beta cells, which is exactly what you DON'T want.
Again, I would run away as fast as I could if I were you.
Thanks for the reply. Definitely Not taking glipizide.
You need to get a better understanding of what your endo has said. There is a form of diabetes called Monogenic Diabetes or Maturity Onset Diabetes of the Young (MODY). It has at various times been categorized as a form of Type 1, but most classifications put it into a totally separate category these days. There are forms of MODY where some individuals may respond well to sulfonylureas (like Glipizide) (see Jenny Ruhl who has MODY-3). We have a group here on Monogenic Diabetes and you can join that group to ask more specific questions about MODY.
But I would recommend that you get a clear understanding of what your doctor has said and that you work with him to make an informed decision before undertaking a particularly risky direction such as stopping insulin and starting Glipizide.