Jardiance and Glipizide Together: A Cheaper Alternative to Insulin

Jardiance and Glipizide are two oral medicines to control hyperglycemia in patients with Diabetes Mellitus Type 2.

Both drugs have different mechanisms of action. Jardiance is an SGLT2 inhibitor and helps lower blood glucose by preventing the reabsorption of glucose back into the plasma from the renal tubules.

Thus, glucose that is filtered from the plasma to the renal tubules is wasted in the urine.

Glipizide, on the other hand, is a second-generation sulfonylurea that acts by stimulating the release of insulin from the pancreas.

Thus, the effects of Glipizide are indirectly carried out by insulin. It does not lower the blood glucose directly like Jardiance or Insulin.

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When to take Jardiance and Glipizide for Type 2 Diabetes?

If you are suffering from Type 2 Diabetes and considering using Jardiance and Glipizide, here are a few suggestions that will guide you in managing your diabetes:

• STEP 1:

The cheapest and the healthiest way to lower your blood glucose is to follow an exercise routine and change your dietary habits.

These include reducing carbs and portion size. Starving yourself and trying fancy diets may not help you, rather they may be more harmful.

A diet very high in proteins, as recommended in “Keto Diet Menus” may damage your kidneys.

A 500-calorie deficit is a good starting point for diabetics, along with exercise. A brisk walk is the simplest form of exercise. It is recommended to walk for at least half an hour daily.

• STEP 2:

Most guidelines recommend starting metformin if the target blood glucose is not achieved with diet and exercise, and if there are no contraindications to its use.

Metformin is considered the first line of treatment because of the following reasons:

• It is very cheap
• It is weight-neutral or may cause some degree of weight loss as well.
• It reduces insulin resistance which is the primary defect in patients with type 2 diabetes.
• It is considered euglycemic, i.e. it is not associated with hypoglycemia.

In addition, metformin is the only drug approved for the treatment of gestational diabetes (diabetes in pregnancy).

It is commonly used in patients with PCOS and those trying to conceive. It is being studied in cancers and as an anti-aging drug to prevent or delay the onset of cognitive decline.

• STEP 3:

If despite metformin, your blood glucose is not controlled, you may first need to increase your metformin dose to the maximum tolerated dose of 2000 or 2550 mg per day.

Next, you have the following options:

If you are scared of injectable medicines, insulin, GLP-1 analogs (except Rybelsus), and Twincretins (Mounjaro) are not for you.

You are left with the following diabetes medicines that are available in tablet formulations:

Among the above oral medicines for the treatment of diabetes, Rybelsus (Oral Semaglutide) is the most potent. It lowers the HbA1C by 1.2 – 1.5% points. It is also associated with significant weight loss and is best for obese or overweight diabetic individuals.

However, it is too costly and not available everywhere. In addition, it is associated with significant GI side effects such as constipation, abdominal fullness, pain, bloating, nausea, and vomiting. It is also contraindicated in patients with pancreatitis and those with a history of MEN-2 syndrome in the family.

Like Rybelsus, DPP-IV inhibitors (Sitagliptin, Vildagliptin, and Linagliptin) are available orally once or twice daily. These drugs have no direct glucose-lowering effects. DPP-IV inhibitors increase the half-life of endogenous GLP-1 which stimulate insulin in a glucose-dependent mechanism.

However, DPP-IV inhibitors have similar side effects as Rybelsus and other GLP-1 analogs. They cause abdominal pain, constipation, bloating, a sense of fullness, nausea, and vomiting.

Jardiance and Glipizide are not associated with GI side effects. Jardiance is about 20 times costlier than Glipizide.

However, Jardiance and Glipizide have their own PROS and CONS which are discussed in the table below:

Jardiance should be your drug to add after metformin if you have:

• A heart or kidney disease
• You are overweight or obese
• You are at risk of hypoglycemia, and
• Cost is not a major issue
• You do not have frequent urinary tract infections
• You have significant GI symptoms

Glipizide should be your drug to add after metformin if you have:

• Not achieved your glucose targets despite metformin
• You are losing weight and want to maintain or gain some weight
• You are not at risk of hypoglycemia
• You don’t have other medical conditions like heart and kidney disease
• Cost is a major issue or you don’t have medical insurance and you want cheaper medicines
• You have significant GI symptoms and you don’t want to add other drugs to your regimen which may increase your symptoms.

When to use Jardiance and Glipizide together:

After metformin, you can add Jardiance or Glipizide depending on your risk factors as discussed above.

However, you should choose Jardiance over Glipizide if you have a history of heart failure, cardiovascular disease, or kidney disease, and you can afford USD 450 per month or if you have insurance that is covering Jardiance’s cost.

You can add Glipizide after Jardiance if you are not achieving your glucose targets despite changing dietary habits, exercise, metformin, and Jardiance.

On the other hand, if you can not afford Jardiance and do not have any comorbid cardiac or kidney problems, you can choose Glipizide straight after metformin.

Glipizide is more potent than Jardiance but it can cause weight gain, and hypoglycemia, and is inferior to Jardiance in lowering cardiovascular and kidney risks.

You can add Jardiance with Glipizide if you are not achieving your glycemic targets or if you want to lower your risks of cardiac and renal complications.

The combination of Jardiance and Glipizide will have a weight-neutral effect.

Prescription of Jardiance, Glipizide, and Metformin for Type 2 Diabetes:

Here is a sample prescription for a Type 2 Diabetes patient who is on a combination of Jardiance, Glipizide, and metformin combination.

The doses here can be modified according to the patient’s needs and comorbid conditions:

The maximum recommended doses of Metformin, Jardiance, and Glipizide are:

• Metformin: 2550 mg per day
• Jardiance: 25 mg per day
• Glipizide: 20 mg per day

In Summary:

Jardiance and Glipizide are diabetes medicines with intermediate to high potency. They can be used together especially if a person is not willing to go for costly medicines like GLP-1 analogs (Ozempic and Mounjaro) or Insulin.

They are also best for people who do not like injectable treatment to control their diabetes. Jardiance helps lower the risks of cardiovascular and renal diseases while Glipizide does not lower these risks, however, Glipizide is more potent than Jardiance.

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