Advice on medication

Status
Not open for further replies.
M

Merlin27

Member
Relationship to Diabetes
Type 2
Hi I’ve been diabetic for 5 years and I’ve been talking metformin & linagliptin. About 4 months ago my levels started rising to anywhere between 16-29 I was put on Gliclazide. That’s been increased and I’m now between 12-18 and I’ve put on 8lbs. The nurse said today that I could either get rid of the linagliptin and start taking Empajliflozin or GLP1 injections. Any advice? X
 
Sorry @Merlin27 I have no experience of the meds you have listed. Others may be along soon who do.

Apart from the increases in meds have you been able to make any changes to your diet and exercise levels. There is loads of advice on here about changes that can be made to reduce the amount of carbs at a meal, as well as suggestions over portion sizes.

I know that one of the best tips I picked up on here was ‘don’t sit down after a meal for at least 15 minutes’ our response to this varies from giong for a walk in the evening after we have eaten, or my just making sure I do the washing up, or ironing before slumping.

Sorry not to be able to help in any other way.
 
Any advice we could give rather depends on your diet, so if you could give us an outline of you regular meals that would help.
 
I’m vegetarian and have a healthy diet. Over the years the nurse has always said that my diet is fine. I always try and balance any carbs with protein and veg and Limit the amount of fruit I have .
 
Clearly the diet isn't healthy for you personally now, else you wouldn't need all sorts of different medications to try and get your blood glucose down.

Every gram of carb you consume wherever it comes from, so granulated sugar or carrot - your body doesn't discriminate it turns it ALL into glucose. Every single milligram! If your body doesn't need or can't use that glucose, it stays circulating round the body and starts causing problems with all and any of your innards.

Do you test your BG day to day? You'll have been provided with a meter and strips as you're currently on Gliclazide, if you hold a driving licence, so have you ever seen this advice on how and when to test and adjust what you eat for the best BG results?

Test, Review, Adjust

Managing blood glucose levels for type 2 diabetes. Learning how to achieve long term control by testing and diet.
loraldiabetes.blogspot.com loraldiabetes.blogspot.com
 
Merlin27 said:
I’m vegetarian and have a healthy diet. Over the years the nurse has always said that my diet is fine. I always try and balance any carbs with protein and veg and Limit the amount of fruit I have .
Click to expand...

A healthy vegetarian diet doesn't mean it's a healthy diabetes diet. As TW says, it depends entirely on how many carbs you eat. You can't "balance" protein against carbs. 100g of Tofu plus 100 g of pasta would raise your BG as high as just the 100g of pasta.

The nurse would say your diet is fine, but they are far from up to date in their advice. It is a healthy diet, but not for a diabetic. Fruit is loaded with sugars, and some veg are loaded with carbs from starch and and sugars. The name sweet potato gives the game away. Cereals are loaded with carbs. Low fat yogurt is higher in carbs than full fat yogurt, because sugars are added to the low fat to stop it being as runny as single cream.
 
I know exactly what you are saying and I try to be careful . A lot of my protein comes from cheese and I also try and include more veg on my plate than anything. I use full fat yogurts for the reasons you say. Obviously my diet isn’t perfect. I’m still fairly young - in my 40s and my BMI is just in the overweight range. I’m confused as to why I’ve been offered the injections as the research I’ve done suggest that they are recommended for people with a BMI of 35 and over.
Until a few months ago my diabetes was controlled with just metformin & linagliptin.
Is there a particular diet people would recommend - however my diet hasn’t changed from a few moths ago when my diabetes was well controlled.
 
It is always worth asking the question: "Are you sure that this is type 2 not type 1", even when you are older.
 
Hi @Merlin27

What information did the nurse give you about each to help you decide which may be better?
 
Oh 😳

I don’t have any first hand experience either but you might find the following links helpful for a very basic overview of the two types of medication the nurse is asking you to consider:

GLP-1 agonists

GLP-1 agonists are a type of medication you might need to take if you have type 2 diabetes. They are also known as GLP-1 analogues, GLP-1 RAs and incretin mimetics.
www.diabetes.org.uk www.diabetes.org.uk

SGLT2 Inhibitors

SGLT2 inhibitors are a type of medication you might need to take if you have type 2 diabetes. They are also known as gliflozins.
www.diabetes.org.uk www.diabetes.org.uk

I would say don’t rush to make your decision, have a look at both and note any questions you have about them
- it feels a bit unfair to expect you decide on your own treatment without having given you sufficient information about either.

You could give the DUK Helpline a call to talk through your options (they aren’t medically trained so won’t be able to suggest which would be best) - or do come back here with any further questions.

If you haven’t made a decision by the time your nurse is expecting then don’t feel pressured, ask her to help with the decision and to share her clinical opinion.
 
I think you would be wise to push the nurse for Type 1 testing... C-peptide and GAD antibody tests before agreeing to either med. It sounds to me like you may be LADA. (Latent Autoimmune Diabetes in Adults) which is a slow onset form of Type 1 often referred to as Type 1.5. It can initially respond to Type 2 medication and change of diet but gradually as the Beta cells in the pancreas are killed off you reach a point where they are no longer able to produce enough insulin to keep you in range. This can be months or sometimes years after diagnosis.
 
It increasingly seems to me that most GP’s and their DN’s are as much use as a chocolate fire guard. But no bad thing that we take charge of our own health.
 
Hi. The fact that the you still have high BS when taking Gliclazide is a pointer to possibly being T1 so do ask for the two tests. Being slightly overweight might influence the GP to thinking T2. Reduce the carbs and see how you go. If the BS still remains high then T1 is more likely. Personally I would avoid the GLP1 injections as they are really intended for those who are seriously overweight. What dose of Gliclazide are you taking?
 
My nurse had never heard of LADA and said that I would need to speak to the GP. They are going to do a HBA1C again next week and go from there. I’m taking 160mg Gliclazide. Thanks for everyone’s advice.
 
Merlin27 said:
My nurse had never heard of LADA and said that I would need to speak to the GP. They are going to do a HBA1C again next week and go from there. I’m taking 160mg Gliclazide. Thanks for everyone’s advice.
Click to expand...
That's a fairly high dose so should be working if you have enough working beta cells. I was started on 80mg but ended-up on 320mg with no effect shortly before going onto insulin.
 
Never heard of LADA then she is not fit got purpose. Services should be dispensed with without delay. Tell her it is "Type 1 of the old" Onset is much slower than in the young.

Hba1c will tell you sod all that you did not already know. You need a c-peptide test, and (perhaps less useful) GAD test. The former will tell if you can make insulin and how much. If there is too little insulin then any meds given by mouth will NOT work.
 
Status
Not open for further replies.
Back
Top