Gliclazide - 'expert' discussion

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pmailkeey

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Hi all,

I just wondered what you experts have discovered about gliclazide !

My findings with 80mg Gliclazide is that taking 2 tablets is no more effective than taking 1.

I've found that taking 1 80mg tablet lowers my blood sugar by 1 mmol/l in 1 hour and 2 mmol/l in 2 hours - but no more after that.

If you want more effect from taking 2 80 mg gliclazide, take the second one 2 hours after the first. If you're taking more Gliclazide each day, space them out at at least 2 hour intervals.
 
Experts is pushing it a bit for most of us. Trouble is our expertise is limited to us as individuals and some care needs to be taken when using it to predict what might happen to somebody else.

Anyway, I take 30 mg gliclazide a day - yep, one 40 mg tablet on one day and half of one the next. A couple of years ago, at the suggestion of the DN, I stopped taking it and within a week my average BG was up from 6 to around 8. Restarting gliclazide brought it back down.
 
I personally did not find reductions in levels predictable and that was even on slow release.
 
I am a bit confused at what you are trying to do, as it sounds like you are using Gliclazide like a bolus insulin, to achieve an immediate effect, rather than as a bolus one to have a continuous one? And the level of reduction gained is somewhat meaningless in isolation.

Normally if taking 160 mg you would split it between the morning and evening meal, as its half-life is up to twelve hours so that way gives you a constant benefit. So using it to receive an immediate burst of insulin would not work.

Also, when you are fasting and you body is in good balance, the pancreas is still producing insulin that it stores ready to release immediately when you eat. So you do not just want the benefits when eating. And Gliclazide is particularly good at helping this first phase of insulin released compared to other similar medications, which also reduces (though does not eliminate) the risk of hypos from just over-producing insulin.

So if you take both tablets together then you will have a better response for half the day, and a poorer one of the other half compared to splitting the dose. And depending on what you are doing and eating in that half of the day, you may not be gaining any benefit if you are not needing that insulin and instead you body is just having to release more glucose to keep it under control.

But I am no expert either. If you read the patient information leaflet it should tell you that if you need more than one tablet a day they should be split like this rather than taken together. It is why if only on 80 mg it will normally be as two 40 mg tablets rather than one 80 mg one. Though as always this is in general and there may be individual reasons to take a single dose.

When I was diagnosed I was put on 40 mg Gliclazide twice a day. On the first day my morning and evening fasting levels were 10.3 and 10.6 mmol/L. Around a month later they were constantly around 5 and 6 respectively. Unfortunately I was not told to test after a hypo, so my notes make reference to many that were probably false ones as my body was not used to being that low.

That was enough to get me from 11.2 % / 99 mmol/mol on diagnosis to 5.0% / 31 a year later, with no real lifestyle changes and it was not particular bad to begin with. Ironically when I was diagnosed I had been thinking I really need to drink less pop (and I only drank diet versions) and more fruit juice, so that never happened.

Apparently within that first year I hypoed for six days in a row, eight days in eleven, so stopped taking Gliclazide. Which lasted for just over a month because my evening fasting levels rose to around 10 mmol/L so I restarted it.

I have no memory of that, but what makes it interesting is that after taking my last tablet on a Monday evening, I felt shaky with a 4.2 the following day. Then on Wednesday hypoed with a 2.9, and also hypoed on Thursday, Friday, and Saturday. So I think that suggest something about how Gliclazide builds up in your system that it takes about a week to clear, and therefore why it is not helpful to think of it as having an instant effect but instead as keeping your system topped up.
 
I personally did not find reductions in levels predictable and that was even on slow release.
The reductions should be the same but to be able to assess them properly you need to take into account anything else that might affect levels - like physical activity, food, other (diabetic) meds.
 
Hi. Gliclazide works for about 10 hours or so. It doesn't build up over time. It's like a medium acting insulin. It works during that approximate 10 hours by stimulating the beta cells to produce more insulin. As side issue, a T2 with a lot of excess weight may not benefit from taking Gliclazide as the body may already have too much insulin thru insulin resistance. It's of most use for those with failing beta cells such as early stage LADA.
 
Gliclazide works for about 10 hours or so.

Medical researchers and manufacturers all claim a duration of action between 10 and 24 hours with a half-life of 10–12 hours, or between 10 and 20 hours for the modified release version. There seems to be no dispute on that. Other modern sulphonylureas are active for a similar duration, though generally have shorter half-lives.
 
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