Hi there, I'm posting, as previously, on behalf of my husband who has type 2 diabetes, diagnosed about 4 years ago. We've tried various means to bring his sugar levels down but he's struggled with everything really. The present problem is that his hba1c is now 107 and GP has given him a finger prick test pack, which he can't bring himself to use, always having had a 'thing' about seeing blood. So, two questions if you'd be so kind to advise... 1) Would a Libre test work for him? Do you buy those privately? 2) We thought he was doing well on a low carb diet... Greek yogurt/berries for breakfast, egg or meat sald for lunch and meat and veggies for dinner, plus a few snacks a day. We'd not long seriously started that regime, having previously tried but not so solidly, when the test result prompted the GP to change his medication from Aloglyptin to Glicazide, telling him in no uncertain terms that such a diet 'would never work, it'd never bring his levels down'. Was she correct? Is Glicazide a good choice for him? He's in his early 70s with severe arthritis in his knees so can't exercise as he'd like to, can't even walk very far. We both feel very disappointed and concerned, having thought he was on the right path with a low carb diet. Any advise would be most welcome. Thank you.
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Glicazide or just low carbs... in a muddle
- Thread starter Moonstar
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silver minion
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Sorry to hear that your husband is struggling to get his blood sugars down. One thing to consider if his hba1c has risen to over 100 despite a low carb diet, is whether he could be Type 1? There are others on the forum who were misdiagnosed as type 2 initially because they were adults not children.
I am also on gliclazide and metformin. I also reduced my carbs after joining the forum. It has definitely helped me reduce my hba1c over the last 12 months. I had a blip over Christmas/ New Year period and ate too many treats (still much less than previous years) and my hba1c went up in Feb.
The good thing about a meter is you can track progress and check how meals affect his blood glucose. You can get a free trial of libre CGM and buy them if your husband can't get NHS funding. He will need to get used to fingerprick testing as a back up and to confirm a hypo.
I don't like needles or seeing my own blood either but I have got better at doing the testing. It's a very small lancet and you can't see it in the pen. The drop of blood needed is tiny. Less than if he accidentally cut or scratched himself doing gardening or DIY.
I got my husband to the first ones to reduce my needle anxiety.
I also managed to increase my exercise. Are there any seated exercise classes your husband could attend?
If he takes gliclazide he should have some carbs with every meal. I currently work on 130 to 150g carbs spread across 3 meals.
How many carbs including snacks does your husband consume per day?
Sorry for all the questions and hope you can get more answers.
I am also on gliclazide and metformin. I also reduced my carbs after joining the forum. It has definitely helped me reduce my hba1c over the last 12 months. I had a blip over Christmas/ New Year period and ate too many treats (still much less than previous years) and my hba1c went up in Feb.
The good thing about a meter is you can track progress and check how meals affect his blood glucose. You can get a free trial of libre CGM and buy them if your husband can't get NHS funding. He will need to get used to fingerprick testing as a back up and to confirm a hypo.
I don't like needles or seeing my own blood either but I have got better at doing the testing. It's a very small lancet and you can't see it in the pen. The drop of blood needed is tiny. Less than if he accidentally cut or scratched himself doing gardening or DIY.
I got my husband to the first ones to reduce my needle anxiety.
I also managed to increase my exercise. Are there any seated exercise classes your husband could attend?
If he takes gliclazide he should have some carbs with every meal. I currently work on 130 to 150g carbs spread across 3 meals.
How many carbs including snacks does your husband consume per day?
Sorry for all the questions and hope you can get more answers.
rebrascora
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Yes, I was wondering if he might be a misdiagnosed Type 1 too.
In a previous thread, you mentioned that he was started on Metformin twice and the second time he ended up in hospital. Can you tell us why he ended up in hospital and what the outcome was.
If he is a genuine Type 2 then low carb should help lower his levels and an HbA1c that high whilst going low carb suggests there is something not right and I suspect he may need insulin, especially if gliclazide is having little impact either. Do you have a means of testing for ketones? Ketostix which you dip in his urine are the easiest option. If he is geting low on insulin production for whatever reason then ketones could develop and put him at risk of DKA (Diabetic KetoAcidosis) which is a very serious complication of diabetes and can cause organ failure coma and even death in untreated cases so it is really important to be aware of the symptoms for that and be able to test for ketones. You can buy a pot of 50 over the counter in a pharmacy that stocks them or online for £5-£10 and it would be worth investing in a pot so that you can test his urine when/if his Blood Glucose is persistently mid teens or above with the finger prick.
GPs really have very little understanding of the power of dietary changes in managing Type 2 but they also have very little knowledge of Type 1 or the other even less common Types of diabetes. Many GPs even think that adults can't develop Type 1 but many of us here did develop it later in life and were initially misdiagnosed as Type 2 which is potentially a dangerous situation because of the risk of DKA, so having a means of testing for ketones can be really helpful and even a life saver in some situations.
It might be worth asking his GP about testing for Type 1. The tests are a C-Peptide test which measures how much insulin his body is able to make and antibody tests which look for the antibodies associated with the immune system attacking the insulin producing beta cells in the pancreas.
Type 1 diabetes is an autoimmune condition. You mention he has arthritis which is interesting as rheumatoid arthritis is also Auto Immune (AI) and if you have one AI condition you are more likely to develop others.
Anyway those are just some thoughts that I had on reading this and previous posts you have made about your husband's situation.
In a previous thread, you mentioned that he was started on Metformin twice and the second time he ended up in hospital. Can you tell us why he ended up in hospital and what the outcome was.
If he is a genuine Type 2 then low carb should help lower his levels and an HbA1c that high whilst going low carb suggests there is something not right and I suspect he may need insulin, especially if gliclazide is having little impact either. Do you have a means of testing for ketones? Ketostix which you dip in his urine are the easiest option. If he is geting low on insulin production for whatever reason then ketones could develop and put him at risk of DKA (Diabetic KetoAcidosis) which is a very serious complication of diabetes and can cause organ failure coma and even death in untreated cases so it is really important to be aware of the symptoms for that and be able to test for ketones. You can buy a pot of 50 over the counter in a pharmacy that stocks them or online for £5-£10 and it would be worth investing in a pot so that you can test his urine when/if his Blood Glucose is persistently mid teens or above with the finger prick.
GPs really have very little understanding of the power of dietary changes in managing Type 2 but they also have very little knowledge of Type 1 or the other even less common Types of diabetes. Many GPs even think that adults can't develop Type 1 but many of us here did develop it later in life and were initially misdiagnosed as Type 2 which is potentially a dangerous situation because of the risk of DKA, so having a means of testing for ketones can be really helpful and even a life saver in some situations.
It might be worth asking his GP about testing for Type 1. The tests are a C-Peptide test which measures how much insulin his body is able to make and antibody tests which look for the antibodies associated with the immune system attacking the insulin producing beta cells in the pancreas.
Type 1 diabetes is an autoimmune condition. You mention he has arthritis which is interesting as rheumatoid arthritis is also Auto Immune (AI) and if you have one AI condition you are more likely to develop others.
Anyway those are just some thoughts that I had on reading this and previous posts you have made about your husband's situation.
Fran and Barbara, thank you so much for your replies, I really appreciate them. Before replying fully, I want to have a think and get all the facts completely correct, plus ask hubby one or two questions. Then I'll do my very best to answer your questions. Meanwhile, you've caused me to think and I thank you for that, and I wish you both the best on your own journeys. 🙂
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Hope you get some clarity soon @Moonstar
To answer one of your questions - yes a Libre 2+ (or Dexcom One+) could well work well for him, especcially if he is averse to seeing blood. These are only usually prescribed for T2s who need insulin, and are taking multiple fingerstick checks a day, but yes, they can be self-funded directly with the manufacturers
Some manufacturers offer a ‘starter kit’ so that you can try a sensor or two before committing, to ensure they work well for you. These can be a small number of sensors you purchase as a one-off, or sometimes even a single free sensor. Depending on what offers are running at the time. You’d generally need a smartphone (Apple or Android) to display results using a dedicated app.
To answer one of your questions - yes a Libre 2+ (or Dexcom One+) could well work well for him, especcially if he is averse to seeing blood. These are only usually prescribed for T2s who need insulin, and are taking multiple fingerstick checks a day, but yes, they can be self-funded directly with the manufacturers
Some manufacturers offer a ‘starter kit’ so that you can try a sensor or two before committing, to ensure they work well for you. These can be a small number of sensors you purchase as a one-off, or sometimes even a single free sensor. Depending on what offers are running at the time. You’d generally need a smartphone (Apple or Android) to display results using a dedicated app.
I agree trying a Libre would make sense. I bought my own for a year until my consultant and DN agreed to put it on prescription. I suggest your husband asks for GAD and C-peptide test although GPs can be reluctant. I had my first one done privately. If your husband is not overweight that hints strongly as LADA (late onset T1). My first GP guessed T2 despite being slim and I was on Gliclazide a for a few years which eventually stopped working probably due to only a few beta cells left. Having a low carb diet is very a wise choice and your GP is wrong to dismiss it. It hints that he may be lacking in diabetes knowledge. My super DN suggested lowering my carbs further when my BS was rising. I'm now on insulin which has made a vast difference.
Interesting. I've only been told to take it with meals, no mention of carbs. My meals vary between zero and 50g carbs, with most below 25g.
Lisa65
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Glicazide works by "squeezing" the pancreas to try and get it to produce more insulin. So if you're not eating carbs at a meal then it could theoretically make you hypo.
Leadinglights
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As it is encouraging your pancreas to produce more insulin then if you have a meal with no carbs which is quite difficult as there are some carbs even in lettuce then there is a risk of low blood glucose but also taking 30 mins before your meal gives your system a head start on being able to deal with the carbs you have. Check your product leaflet.
rebrascora
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I did very low carb with Gliclazide and I didn't hypo which I think is probably one of the indicators that I was actually Type 1 and not Type 2.
Interesting to know. I'm not very low carb all day but do often take Gliclazide with a zero carb meal of bacon and eggs, and have never come close to a hypo.
Leadinglights
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It maybe that is because your blood glucose is still too high and it would only become a risk when your level is in a normal range.
What readings are you normally getting.
9 - 11 after fasting overnight
5.5 - 8 two hours after a meal plus meds
silver minion
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I can only speak from my own experience. It is still a bit of a balancing act between the amount of carbs I eat and the level of exercise I do. I am on the maximum dose of metformin and gliclazide now but the dose has steadily increased over the last year. I suffered from false hypos for a few months last year while my BG levels went from very high to moderately high. It made me feel quite unwell on several occasions.
Only one reading under 4 in recent months. and a mild hypo because I ate lunch very late after a long fairly vigorous gardening session. Sorted very quickly by a few JBs.
Only one reading under 4 in recent months. and a mild hypo because I ate lunch very late after a long fairly vigorous gardening session. Sorted very quickly by a few JBs.
Leadinglights
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Your post meal readings look spectacular, it is your fasting readings which are remaining rather higher than desirable, it looks as if you are getting foot on the floor syndrome where your liver is being super helpful in releasing glucose to give you energy. It does seem a bit out of step with your other readings though for many morning/fasting readings are the last to come down.
Drummer
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I am 74 and a low carb diet keeps my HbA1c almost normal. Perhaps your GP has not come across a type 2 like me in their practice. As my HbA1c was 91 when diagnosed and almost normal after 6 months, I do wonder if there is more going on - or perhaps even a misdiagnosis as the diet you describe seems ideal for an ordinary type 2