ENTOCORT & METFORMIN

[sunny]

Just wondering if anyone else has Diabetes II and taking Metformin along with Entocort? I stopped the metformin back in early Dec. when Big D started....I was told by docs to discontinue it till D "gone." I am leary of starting it again and having the D start again....yet, since Entocort raises blood sugar, that places me between a rock and a hard place, so to speak.
I have had 2 days with Norman back( altho I hardly recognized him when he returned....it has been so long!!! And I dread the cramps and D from the Metformin. Is there a chance the Entocort will help even with that????????????????
Sunny in cold Oregon....

[tex]

Hi Sunny,

I don't believe that the exact mechanism by which metformin actually works, is completely understood, despite it's known therapeutic benefits. Basically, it appears to act mainly by reducing hepatic gluconeogenesis, but it also decreases absorption of glucose from the gastrointestinal tract and increases insulin sensitivity by increasing peripheral utilization of glucose.

Budesonide, (the active ingredient in Entocort), on the other hand, like the other corticocostreoids are generally described as glucocorticoid, (carbohydrate metabolism–regulating), IOW, they stimulate gluconeogenesis enzymes in the liver. Therefore, all glucocorticoids increase gluconeogenesis, (obviously, the opposite effect of metformin). Glucose tolerance and sensitivity to insulin are decreased, (again, the opposite effect of metformin), but provided that the pancreatic islet function is normal, carbohydrate metabolism will not be noticeably deranged. Your insulin requirements may be increased while you are on Entocort, especially if you have noticed an increased appetite.

Here's a very good reference on the actions of the glucocorticoids, in general, (just ignore the fact that it is written primarily about prednisolone sodium phosphate - the information still applies to all glucocorticoids, including budesonide):

http://www.eknowhow.com/ekh_drugdatabas ... d=56&dsa=0

I found one source that stated that high doses of prednisolone, but not budesonide, stimulate gluconeogenic pathways, and increase requirements for dietary protein, so there may possibly be an exception for budesonide, but I don't believe that we should count on that, without additional supportive evidence.

I'm sorry that the effect is apparently just the opposite of what you were hoping for, but maybe it will be minimal. That's certainly possible, especially if you can eventually taper the dosage down to a maintenance level. My memory is so bad that I don't even remember if you are on a GF diet, but if you are, you may be able to taper the dose down, and then completely discontinue the Entocort, after a few months of remission.

Tex