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crossposted from c/insurancefights by u/plain_titration_2024 — reading formulary threads from 2024 and half of it aged badly
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c/t2dglp1·posted 4 days ago by u/arne_nyberg

[Caution] stacking with a sulfonylurea is a real hypo risk, not a theoretical one

Caution Clean Column ×2

Something I noticed reading old threads that I have not seen said out loud.

The advice on metformin in this community changed substantially around the start of last year, and nobody went back and updated the older posts. So depending on which thread the search engine hands you, you get two contradictory answers with the same confidence.

I have listed what I think the current consensus is below. Correct me — that is the point of posting it.

425 up / 50 down89% upvoted23 commentsid 1t0lod26 Jul 2026

23 comments

22 in this archive, depth 5

best — the order this archive was captured in

u/stubborn_batchlist_maybe48 points·3 days ago

Strongly agree. A1c matters as much as weight.

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u/aleksi_eriksen15 points·3 days ago

Australia here. Waited 13 months on a list, gave up, went private, and the total cost was roughly what I expected.

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u/fridge_door_no12 points·3 days ago

metformin combo is standard

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u/rasmus_kimani31 points·3 days ago

Strongly agree.

Adding to this: A1c is doing more work than the comment implies.

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u/bianca_demir13 points·3 days ago

Respectfully this is a sample of one presented as a finding.

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u/arne_nybergOP0 points·2 days ago

A1c, CGM, stacking with metformin

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u/hassan_ostergaard35 points·2 days ago

My version of this: I was so worried about the injection that I put it off for eleven days. The injection is the easiest part.

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u/chain_confirm_cpayments41 points·2 days ago

CGM traces tell a story, numbers alone do not

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u/hugo_norgaard12 points·2 days ago·edited

Not convinced. The evidence does not support that reading.

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u/milan_chukwu21 points·2 days ago

Yeah, glycaemic control is the original use.

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u/fasting_insulin_fMOD35 points·2 days ago

Removed a chain here. The rule is one line long and it is not negotiable.

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u/step_count_stan27 points·2 days ago

no medication-stopping advice, ever

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u/thandi_solberg19 points·1 days ago

the 56 A1c trend is the answer

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u/neha_falk15 points·1 days ago

the 56 A1c trend is the answer

Yes, exactly this, and it is the bit that took me 25 weeks to accept.

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u/arne_nybergOP0 points·1 days ago

A1c, CGM, stacking with metformin

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u/arne_nybergOP10 points·1 days ago·edited

glycaemic control first, that is the original indication

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u/nadia_norgaard12 points·1 days ago

A1c, CGM, stacking with metformin

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u/cormac_danquah-32 points·3 days ago

Yeah, glycaemic control is the original use.

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u/chain_confirm_cpayments1 point·3 days ago

Yeah, glycaemic control is the original use.

Yes, exactly this, and it is the bit that took me 59 weeks to accept.

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u/camila_vasquez1 point·2 days ago

Edit to your parent would help — the concentration you quoted assumes one scenario and you have written another above it.

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About c/t2dglp1

Type 2 diabetes as the original indication: A1c trajectories, CGM traces, hypoglycaemia risk when stacked with sulfonylureas or insulin, metformin combinations, and why the weight-loss conversation sometimes drowns out the glycaemic one.

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