Gluconorm P (pioglitazone, metformin) is a combination treatment for patients with type 2 diabetes. The medication helps lower overall blood glucose by improving the effectiveness of insulin while inhibiting production of glucose and absorption of glucose from food.

This product is very similar to ActoPlus Met, containing the same active ingredients. Inactive ingredients may differ to some extent.

Effects of Gluconorm P while pregnant or breastfeeding are unclear; mothers should generally avoid this product except when explicitly approved by a doctor.

Gluconorm P is not effective in type 1 diabetes, nor should it be used to treat diabetic ketoacidosis.

What to Expect from Treatment

Gluconorm P comes in tablets, each of which contain both pioglitazone and metformin. Tablets are taken between one to three times per day, largely dependent on dosage strength; patients taking all but the lowest doses typically take tablets two or three times per day.

Tablets range in strength from 15 to 45 mg pioglitazone and 500 to 2550 mg metformin. Patients new to either medication are usually started on the low end, while patients taking both pioglitazone and metformin separately are typically started on a combination tablet as close to the independent doses as possible.

In other words:

• New patients should start with 15/500 mg pioglitazone/metformin once or twice per day.
• Dosage may be gradually titrated higher if needed, assuming the medication is well tolerated.
• Patients already taking pioglitazone and metformin should start with as similar dosage strengths as possible.
• Low doses of 15/500 mg pioglitazone/metformin are usually taken once per day; doses of 45/2550 mg pioglitazone/metformin are usually taken three times per day. In-between doses are usually taken two or three times per day.
• Do not exceed 45/2550 mg pioglitazone/metformin in one day.

Treatment is best individualized, according to numerous personal variables such as age, weight, other medical conditions, other medications being taken, and so forth. A doctor is best able to determine the ideal dosage.

All patients should monitor blood sugar closely at the start of treatment and following any dosage adjustments.

Patients taking Gluconorm P won't feel particularly different unless blood glucose becomes significantly low or high, either of which warrants medical attention. Ideally the medication will cause blood glucose to fall and stay within normal ranges, which is important to prevent an assortment of negative complications, some of which can be very painful, detract from independence and quality of life, or even be fatal.

Regular doctor visits should be scheduled, and attended. A doctor can not only ensure the medication is working as intended, but also monitor for side effects of the medication or diabetes itself. Caught early complications are much easier to treat than when allowed to progress unchecked.

Other Methods of Managing Diabetes

The majority of patients prescribed Gluconorm P will also be advised to make lifestyle changes to further manage the condition. Common changes include:

• Improved diet
• Regular exercise
• Reach or maintain a healthy weight
• Manage high cholesterol
• Manage high blood pressure
• Quit smoking

Advise will be individualized of course, varying from patient to patient and to some extent according to location. Not everyone who has type 2 diabetes is overweight, for example.

Lifestyle changes are important, however; they're often the only means of managing diabetes without medications. Patients who make and maintain applicable changes may eventually no longer need to take Gluconorm P or any anti-diabetic medication. Those who don't make changes---and that small percentage for whom changes make little difference---will likely rely on medications to manage blood glucose for the remainder of life.

Side Effects

Some patients are at higher risk of negative side effects from Gluconorm P; be sure to speak with a doctor prior to taking it if there is any history of:

• Heart attack or stroke
• Congestive heart failure
• Other cardiac issues
• Liver or kidney impairment
• Bladder cancer
• Diabetes-related eye problems

Gluconorm P, or rather the pioglitazone included in it, is associated with increased risk of bladder cancer in some European countries, though other studies found no connection at all. It's unclear which is correct, and patients with a history of bladder cancer may want to avoid this product.

Metformin, particularly the fast-acting formula found in Gluconorm P, is notorious for producing unpleasant gastrointestinal side effects:

• Diarrhea
• Bloating
• Gas
• Constipation
• Heartburn
• Stomach pain
• Nausea

Though common, most patients find they last only a few days following the start of treatment or dosage increases. Taking tablets two or three times per day, rather than all at once, may also help, as may taking the product with food. Patients who have persistant, disruptive side effects from fast-acting metformin often find significant relief if switching to extended-release tablets.