Gliclazide and "skipping" meals

[debs248]

Rambly thoughts from a newbie, will try to stick to the point above...

I'm used to eating only 1 meal somewhere between 4-8 pm, then a snack before bed.

This week I was diagnosed with diabetes (HbA1c 113), the GP tested my blood glucose (20.1) and ketones, and prescribed Gliclazide and Metformin. I'm supposed to take 40mg Gliclazide once per day for 4 days, then twice per day for 3 days, then add the metformin in gradually increasing doses. She insisted that I must start eating another meal every day, NO EXCUSES, even though I had explained to her that this would be extremely difficult to arrange in my current situation.

She also gave me a blood glucose meter and told me to check first thing, before or after a meal (can't remember which so I plan to do both) and before bed.

As you might know if you've seen my other thread, I haven't been able to get a decent blood drop so no testing yet. So far I've taken Gliclazide once per day with my first or only meal and am supposed to up it to twice today. I haven't had much in the way of side effects so far - I had a bit of a weird wibbly feeling an hour or two after taking it on Friday but as I'd had a reasonably carby pub lunch I reckon it wasn't a hypo, just exhaustion after a stupidly busy week.

I'm trying to find a balance - obviously bringing down my blood glucose to sensible levels is high priority but I don't want to either eat extra food unnecessarily or risk a hypo. Not being able to test blood glucose means I'm flying blind here.

I'm sort of thinking that if I can't fit in a 2nd meal and don't take the 2nd dose of Gliclazide, that's better than taking it on an empty stomach? The meals are supposed to be 10-12 hours apart which would mean eating the 2nd one between 2-6am which is a bit ridiculous!

I could just try taking it without a meal today and see what happens. Or delay the snack to 2am and take it then. Has anyone had a similar experience? (unlikely for I am very "special" 😛 )

 

[everydayupsanddowns]

Could you eat a smaller meal 4-8pm, and another smaller meal earlier in the day (perhaps mid morning or first thing?). Sort of split your current meal in half (or 2/3rds later, 1/3rd earlier)?

Sometimes the body can get a bit twitchy if no fuel comes after waking/rising and provide stored glucose from muscles and liver to ‘fire up the burners’ for the day. So you can get a pretty hefty BG rise in the morning even without eating - but some people find they can ‘switch off’ the liver dump by eating breakfast and reassuring their metabolism that fuel is available.

 

[silver minion]

From personal experience I wouldn't recommend it. I have been taking Gliclazide since last July. Started off one x 40mg in the morning then gradually increased to twice a day, with breakfast and evening meal.
I find I must eat regular meals including lunch or my BG drops too low. If I get really busy and eat a late lunch I start feeling unwell quite quickly. Fortunately my hypo awareness is good so I have only had one mild hypo.
I also try to keep carb intake split evenly across the three meals.
Unfortunately my HbA1c is still high so the dose was increased again in February.
The only other change to my diet apart from reducing carbs, for which I have to thank the good advice from this forum, is I rarely have snacks now.

Talk to your nurse again before making any changes. I think it would be worth getting a 14 day free trial of libre CGM to get a better idea of how your lifestyle and current diet affects your blood glucose levels throughout the day and the difference the medication makes.

 

[saffron15]

Before diagnosis breakfast was hit and miss now I have eggs sometimes on toast or full fat yoghurt berries plus nuts or seeds. I find it fills me up and I take my metformin and SGLT2 with food at breakfast. I don't forget it.
Look at the freshwell app and the websites at lower left for ideas. I don't know if you need to lose weight but you may have belly fat.
Make sure you move more and try not to panic.

Diabetes & Metabolic Health | New Forest PCN

newforestpcn.co.uk

 

[rebrascora]

I would be really loath to encourage someone whose BG is very high (20) to eat/drink high glucose products just to take medication to try to lower that level. By all means keep these hypo remedies with you at all times in case you drop too low but I would not recommend taking them just so that you can take medication to try to lower your levels.
The gliclazide will mostly work on encouraging your insulin production to ramp up a bit when you eat, so that you don't spike so high and come down quicker. I don't believe it does much to improve base level BG.

@debs248 I believe you are having difficulty testing your BG so you really need to work on that and I would not increase the Glic to twice a day if you aren't eating a second meal, until you can competently test. Once you get the hang of testing, then I would chose a day when you are not too busy and test first thing in the morning and if your levels are above 10, then I would take the Gliclazide without food but have hypo treatment to hand and test after an hour and then again at 2 hours and 3 hours post medication and see if the Glic has any impact in lowering your levels?

When I took Metformin and Glic, I was started on Metformin first and then Glic a couple of weeks later and upped to max dose by week 5 and following a very low carb diet at the same time, but I was testing very regularly to keep myself safe and to see the impact and I did manage to get my levels down to about 7 doing this, but my diet was very low carb indeed by then and I had also been encouraged to be low fat, so the weight was dropping off me at 4lbs a week and it just wasn't sustainable. They eventually started me on insulin and subsequently tested me for Type 1.... Your initial assessment of Type is usually based on hopefully educated guesswork by whoever is treating you, so you may not necessarily be Type 2. The HbA1c over 47 just tells them that you are diabetic and then they take into consideration age and weight/BMI, lifestyle factors and clinical presentation to point them towards what Type you might be but there is a strong temptation to assume you are Type 2.

Anyway, those are my thoughts, that if you decide to take Gliclazide without food then you need to be able to test reasonably confidently, so your choices are, eat a small breakfast or lunch and take it or just stick to one for now until you can test successfully.

 

[Captainmartin]

I would suggest eating a little more regularly rather than just one meal. Find out if you can get a dual glucose/ keytone meter and check your keytones as well.

 

[Leadinglights]

It would be worth asking if it was a possibility that you may be Type 1 rather than Type 2 as if you are only eating 1 meal a day and unless that was a hugely carb heavy meal it would seem surprising that your blood glucose is as high as it is.
Keeping a note of what you are eating with an estimate of the carbs and your blood glucose readings when you get some would provide good evidence for your GP.
There are some good Ytube videos of taking finger prick tests.

 

[debs248]

I've had more success testing since really working at hydration and the BG numbers have been coming down.

Hubby volunteered to get up at 6:30 this morning and fry some eggs so I could take the gliclazide twice - 2nd dose around 6pm with a 20g carb meal. It would have been 30g but I felt full after eating 2/3 of it and might as well save the rest to eat with morning meds.

So far I've not noticed any side effects, either from the meds or the changed mealtimes but I wouldn't want to eat at 7am every day! Going to experiment with ~10 am breakfast tomorrow and maybe 8pm dinner? A 12 hr eating window is far too much for me.

 

[debs248]

It would be worth asking if it was a possibility that you may be Type 1 rather than Type 2 as if you are only eating 1 meal a day and unless that was a hugely carb heavy meal it would seem surprising that your blood glucose is as high as it is.

It's certainly a possibility but I've been insulin resistant to some degree for at least 20 years and there's family history so just assumed I'd end up T2 one day.

Hopefully I'll get to see a diabetic nurse soon and ask.

 

[debs248]

I would suggest eating a little more regularly rather than just one meal. Find out if you can get a dual glucose/ keytone meter and check your keytones as well.

They've given me a dual meter but no ketone test strips. I believe they're quite expensive.

I'm trying to eat a second meal for the meds but it's really a struggle. I've never enjoyed eating in the mornings but it's hard to fit in 2 meals 12 hrs apart if I start in the afternoon! Ideally I'd have my main meal around 4-6 pm then a snack at midnight but that's too close together for the meds.

 

[rebrascora]

Good to hear that you are having a bit more success with testing. Practice makes perfect as they say. It might be easier if they have you urine ketone test strips rather than blood because as you say, the ketone blood test strips are a lot more expensive and you wouldn't want to be wasting loads of those because you can't get enough blood.

Can you explain why you need a 12 hour gap between breakfast and evening meal? Sorry if I missed that somewhere! I just took my Gliclazide about half an hour before my food whenever that was and it certainly varied day to day so I didn't stick to any rigid schedule with it.

 

[Lucyr]

Hubby volunteered to get up at 6:30 this morning and fry some eggs so I could take the gliclazide twice - 2nd dose around 6pm with a 20g carb meal

There’s no point eating eggs especially so you can take gliclazide, they don’t have carbs in. Just have whatever breakfast you want or don’t have it if you don’t want it.

Unclear why he had to get up at 6:30 to cook eggs, if it’s only you that needs to be out that early can you not make your own breakfast?

 

[JITR]

@debs248

Do you have anything at all containing calories between meals (snacks, sugary/milky drinks, nuts ...), or absolutely nothing?

Have you considered fitting meal replacement shakes into your lifestyle?

 

[debs248]

Can you explain why you need a 12 hour gap between breakfast and evening meal? Sorry if I missed that somewhere! I just took my Gliclazide about half an hour before my food whenever that was and it certainly varied day to day so I didn't stick to any rigid schedule with it.

GP said to take it 12 hrs apart

Now I can test I'm going to reduce that gap until it starts causing problems. Aiming for 10 hrs between doses today and 8 tomorrow. My ideal eating window is about 6 hours.

There’s no point eating eggs especially so you can take gliclazide, they don’t have carbs in. Just have whatever breakfast you want or don’t have it if you don’t want it.

I did wonder if a zero carb meal would count, but it was his suggestion. I find eggs easy to eat first thing.

Unclear why he had to get up at 6:30 to cook eggs, if it’s only you that needs to be out that early can you not make your own breakfast?

No, I'm pretty much bedbound. It's extremely hard to conjure up an extra meal every day and the GP wasn't interested.

 

[debs248]

@debs248

Do you have anything at all containing calories between meals (snacks, sugary/milky drinks, nuts ...), or absolutely nothing?

Usually just tea with a splash of milk

Have you considered fitting meal replacement shakes into your lifestyle?

Not really, they're expensive and sound disgusting (I hate milk on its own). Thanks for the suggestion but they're not for me. I don't believe I need extra meals anyway except for the purposes of taking these pesky meds!

 

[JITR]

I agree with you about those shakes.

Still the question is where all the glucose is coming from.

Instead of shakes, or a dietitian, I used and use cronometer a brilliant app for recording what I eat and adding up each of my macro-nutrients (protein, carbs, fat) and 80 odd micronutrients.

Cutting back on the carbs might help to stop the tail (medication) wagging the dog (you).

 

[rebrascora]

GP said to take it 12 hrs apart

Now I can test I'm going to reduce that gap until it starts causing problems. Aiming for 10 hrs between doses today and 8 tomorrow. My ideal eating window is about 6 hours.

I wonder if you have either misunderstood the GP or he has not been thinking clearly when he told you to take them 12 hours apart. The general advice is to take each dose before/with breakfast and evening meal whenever you normally eat those meals. UNLESS you have the slow release version of Gliclazide which is usually just taken once a day before/with breakfast. I am assuming you have been prescribed standard release and not slow release.

Good diabetes management is all about carefully experimenting on yourself, to see what works best for you as an individual, so your idea to slowly adjust the timing of breakfast dose and test to see how that is impacting your levels, is a good one and shows you have a proactive approach to self managing the condition. Hopefully you will find a good balance of meal timing which works well for you with the Gliclazide.

 

[JITR]

Just wondering if insulin would be better than gliclazide for you @,debs248

 

[rebrascora]

Just wondering if insulin would be better than gliclazide for you @,debs248

Yes, I wondered that too, but if levels are looking like they are starting to com down with Gliclazide, then maybe not.

 

[debs248]

I wonder if you have either misunderstood the GP or he has not been thinking clearly when he told you to take them 12 hours apart.

My husband was with me so pretty certain that's what she (GP) said. Having done some reading here and on other websites I'm coming to the conclusion that she's just worryingly clueless about diabetes. (Worrying because she's been a GP for over 30 years, she's had plenty of time to learn what I've discovered in less than a week)

The general advice is to take each dose before/with breakfast and evening meal whenever you normally eat those meals. UNLESS you have the slow release version of Gliclazide which is usually just taken once a day before/with breakfast. I am assuming you have been prescribed standard release and not slow release.

Yes it's standard release. Those guidelines seem easier to follow IMO.

Good diabetes management is all about carefully experimenting on yourself, to see what works best for you as an individual, so your idea to slowly adjust the timing of breakfast dose and test to see how that is impacting your levels, is a good one and shows you have a proactive approach to self managing the condition. Hopefully you will find a good balance of meal timing which works well for you with the Gliclazide.

Thank you. I'm a scientist/ geek by training and inclination so will no doubt be analysing the data remorselessly in due course...