Should my dad switch from Insulin back to Metformin?

Question

Hi doctor.

My father has type 2 diabetes and is currently on insulin, 14 units daily, sometimes twice a day. He has been diagnosed with diabetes for about seven months. Over the past few weeks, he has been experiencing severe abdominal pain and has lost a significant amount of weight. Since starting insulin, he has also developed swelling in his feet and yellowing of his eyes. We did a complete blood analysis and urine analysis, and everything was normal except his blood sugar levels.

He started rapidly losing weight and having more pain since he started using insulin, about three weeks ago. He has a lack of sleep and weakness, and his blood sugar is somewhat regulated. Before insulin, he was on Metformin, but his blood sugar levels remained high. Now, with these new symptoms, his condition seems to be getting worse. I am really concerned and not sure what to do next. He also takes Amoxicillin, Paracetamol, and Ibuprofen.

Should he consider switching back to Metformin, or is something more serious going on?

Please advise.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Based on your description, it appears that your father has had poorly controlled type 2 diabetes mellitus for at least seven months. Although he was initially started on Metformin, his blood glucose remained elevated, leading to the initiation of insulin therapy. However, the symptoms you are describing, like abdominal pain, weight loss, swelling of the feet, and yellowing of the eyes, may not be directly related to insulin. These signs raise concern for possible systemic involvement, particularly of the liver or kidneys, which may be contributing to his current condition.

Given the jaundice (yellowing of the eyes), liver disease should be strongly considered. Additionally, kidney function may be compromised, especially if he has been using NSAIDs (non-steroidal anti-inflammatory drugs) like Ibuprofen regularly, which can negatively impact kidney health, particularly in diabetic patients. Discontinuing ibuprofen immediately is advised. It is also important to ensure proper insulin administration technique, including correct injection sites and checking for any local site reactions or infections.

At this point, I recommend the following investigations to better understand his condition:

Liver function tests (LFTs).
Renal function tests (RFTs).
Complete blood count (CBC) with ESR (erythrocyte sedimentation rate).
Hemoglobin A1c (glycated hemoglobin).

Treatment:

Additionally, it is worth evaluating why insulin was started directly after Metformin. There are several other oral anti-diabetic agents available that are more potent than Metformin and may have been considered, provided there were no contraindications.
Meanwhile, it is essential that your father follow a proper diabetic diet and engage in regular aerobic activity, ideally 30 minutes a day, as tolerated.
If insulin is continued, please ensure it is stored correctly and injected using proper technique. Depending on his clinical stability and lab results, he may be a candidate for transitioning back to oral anti-diabetic medications under physician guidance.

Please follow up with his primary care physician or an endocrinologist promptly for a comprehensive evaluation.

I hope this helps.

Kindly follow up if you have more concerns.

Thank you.