“Doctor, the previous doctor has given me a very strong medicine for diabetes. I don’t want to take it, I want another opinion”- demanded a grumpy, overweight, middle-aged patient.

“Why do you feel so?”

“Previously, another doctor had given me a medicine called Glimepiride, 1 mg. I had tiredness when I took it, so I went to another doctor- a very famous diabetes specialist in the biggest hospital in the city. When I told him about the tiredness, he told me to stop that glimepiride and prescribed Metformin, 500 mg instead. Nonsense! That so-called famous doctor doesn’t care. If a medicine of 1 mg made me tired, won’t something of 500 mg kill me! But it seems your people just want to push your medicines in high doses on helpless sufferers like me” the patient thundered. “I searched on the net and found that there are medicines of 0.2 and 0.3 mg doses for diabetes. I want to discuss those medicines with you”.

***

This is a common scenario. Patients assume that some doctors write “strong” medicines, and some write “weak” medicines.

Is it that simple?

It quite funny, how some people jump to conclusions based on the “number”.

Like, say, 1 mg, or 500 mg, or 1000 mg, or 0.2 mg- the higher the number, the stronger the medicine, right?

Wrong!

Are 1 dollar, 1 rupee, and 1 yen the same?

Are water and oil the same? Would you prefer to drink a glass of water, or half a glass of coconut oil?

Water? Why? Based on such patients’ logic, the coconut oil is lesser in quantity, isn’t it? Then isn’t it supposed to be “weaker”, hence “safer” and without “side effects”?

Well, metformin and glimepiride are are different as water and oil.
Get the point?

***

The previous doctor could have easily fooled our chap by writing Metformin, 0.5 g. After all, 0.5 is half of 1, isn’t it?

Hey, wait a minute!

The Glimepiride, wrongly prescribed by a quack for such very mild sugars, was 1 mg, milligram. The metformin is 0.5 g, gram.

1 gram is 1000 milligram. That’s what we learnt in school.
So 0.5 gram is not less than 1 mg.
0.5 g would still be 500 milligram :-)

***

Unbelievably, these kinds of conclusions are drawn by many people in Kerala, India’s first 100 percent literate state.

Unfortunately, literacy, is not the same as common sense.

Glimepiride and other medicines of its breed act by increasing the secretion of insulin in the body. They do this by bullying the pancreas into releasing more insulin. If you don’t take food at the right time, the excess insulin induced by the glimepiride can cause big trouble. Sugars may drop dangerously low.

This drop in sugars was the reason why our chap had tiredness. Its called hypoglycemia.

Metformin, on the other hand, makes your body utilize the insulin more efficiently. In other words, it does not really “push up” the insulin level in the body, but works with what is available. It has little to do with the pancreas- they are “spared”, in a way. Since it can’t “push up” the insulin levels, “low sugars” is almost never caused by metformin. It is, hence, safer in this aspect. Metformin, in the right dose, is usually the best to start with. It’s a wonder drug.

***

Hence the previous doctor had stopped the glimepiride recklessly peddled by the quack and prescribed the much safer metformin instead.

Even 4000 mg (yes, FOUR THOUSAND mg) of metformin would be safer then 1 mg of glimepiride, as far as the risk of sugars dropping too low is concerned. However, most doctors do not prescribe more than 2000-2500 mg of metformin in a day, because beyond that dose, it simply doesn’t have much useful effect.

Now, which is the ‘stronger’ medicine?

By the way, the 0.2 or 0.3 mg dosed medicines (Voglibose)- that our chap demanded- that medicine simply mixes with the food, and delays the digestion of starch. They have little to do with the insulin levels in the body or the way the insulin is utilized. In other words, most of the times, they have more limitations than metformin.

And, ahem, the 0.2-0.3 mg medicines are costlier than metformin.

Now who was saying something about pushing costly high-dose medicines on people?

***

Some things are best left to those who have been trained in it. To licensed practitioners.

There are plenty of such examples. There are people who believe that 500 mg of paracetamol is “stronger and more dangerous” than 50 mg of diclofenac, or that one antibiotic is “stronger” than the other.

Most doctors inwardly laugh when they hear such crap of “strong” and “weak” based on mere numbers.

***

If there is any concern about “strong and weak” about medicines, before jumping to conclusions, please discuss it with your doctor. Keep the discussion to the point, and sensible, though.

Trust your qualified doctor.

In general, the concept of “heavy” and “light” medicines, “strong” and “weak” doses, make little sense.

But yes, there are things such as the “proper” medicine in the “reasonable” doses. Leave the intricacies to your doctor.

And AVOID quacks. Ayush maan bhava!

Hope this has helped :-)

***

Jai Ho!

Republished with permission from Dr. Bijay Raj who blogs at https://drbijayraj.wordpress.com/