Medication problems.

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brettr

brettr

Well-Known Member
Relationship to Diabetes
Type 2
Hi Guys,

Within the last 6-8 month, I have had additional medications to help bring my A1c down, the first one was Empagliflozin, after using it for about 3 months, I ended up getting right sided kidney discomfort and pain, so stopped using that. I was then tried on Pioglitazone, again roughly 3 months after starting taking it, I ended up with Oedema in both legs, although the right leg was worse than the left one, so I have stopped taking that also.

The diabetes nurse at my surgery stated that I might need to start using Sulphonylureas, I flat out refused this because of the risks of having Hypo's, which I have never had taking Metformin, I don't want to start dealing with those. I have no intention of making the condition worse.

Has anyone else had problems with additional medication for Diabetes T2 ? If so, how have your Doctors surgeries helped you and what kinds of changes have they done to help get and keep your HBA1C levels down at a proper measurement ?

Thanks in advance.
 
There are people who don't tolerate various oral medications but there is a lot you can do with dietary changes as even with those medications making sure you are not having more carbs than your body can tolerate is important in reducing your blood glucose.
Do you have a monitor that you can use at home to do some strategic testing of your meals to see how well you are tolerating them.
Having a serious look at your carb intake will help. Have a look at this link for some ideas of where you could make some dietary changes. https://lowcarbfreshwell.com/
 
Leadinglights said:
There are people who don't tolerate various oral medications but there is a lot you can do with dietary changes as even with those medications making sure you are not having more carbs than your body can tolerate is important in reducing your blood glucose.
Do you have a monitor that you can use at home to do some strategic testing of your meals to see how well you are tolerating them.
Having a serious look at your carb intake will help. Have a look at this link for some ideas of where you could make some dietary changes. https://lowcarbfreshwell.com/
Click to expand...
I do have a blood glucose monitor, I should be using it more often. I will be using it from Monday to see what my levels are at with regards to what I have eaten at whatever time I wake up.
 
brettr said:
I do have a blood glucose monitor, I should be using it more often. I will be using it from Monday to see what my levels are at with regards to what I have eaten at whatever time I wake up.
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You could try a few days of testing before you eat and 2 hours after your meal and see what your levels are. If you are seeing more than a 2-3mmol/l or more than 8-8.5mmol/l for your post meal reading then your meal is too carb heavy.
If you post some typical meals then people might spot some problem foods.
 
Leadinglights said:
You could try a few days of testing before you eat and 2 hours after your meal and see what your levels are. If you are seeing more than a 2-3mmol/l or more than 8-8.5mmol/l for your post meal reading then your meal is too carb heavy.
If you post some typical meals then people might spot some problem foods.
Click to expand...
Having used my blood glucose monitor for the last couple of days, admitting that I have been getting up far too late in recent weeks. 2/11/23 - 14.30 had coffee with skimmed milk and 1 sweetex, Jam sandwich for quickness, then had my meds, my BG just before consuming these items were 18.9 mmols, 2 hours later they were 32.7 mmols, which is a 13.8 jump, far too high just for eating a jam sandwich, even I know it should not go that high after eating 2 slices of bread. I had my evening meal (18.15pm) of 1 Chicken Kiev, 5 sweet potato wedges and veg (carrot, baby broccoli, green beans and mange tout)

I checked my BG at 20.32 and it had come down to 29.2 mmols, at 12.02AM, it was 27.5 mmols (having taken my evening dose of metformin), 02.37 was 28.9 mmols, and at 04.36 it was 25.0 mmols.

Today 3/11/23, I got up very late at 16.52, BG was 17.4 mmols. 18.15 had bowl of home made veg soup, taking the reading from 16.52, as had nothing to eat but meds and cup of coffee with skimmed milk and 1 sweetex, BGB reading at 2015 was 24.1 mmols, 6.7 point up higher than what I thought it would be.

With what I have eaten over these past 2 days, is there anything I should be avoiding here ? Obviously bread is not a good idea, but it's the easy option when you have to eat something before taking meds. I try and stick to no more than 2 slices of any bread in 1 day.

I am also wondering if my meds are taking longer to get into my system because I am still overweight, which I think is because of some of my meds (side effects).
 
Those are seriously high readings and it would be worth you having some ketone urine test stick as high blood glucose and ketone puts you at risk of something serious DKA.
Bread is clearly not a good option, 2 slices with Jam all high carb, Kievs can be high carb because of the breadcrumb coating and sweet potatoes are high carb. Soup can be high in carbs if it has potatoes in it. You do seem to eat at rather erratic time not that that should make a difference.
Metformin does not act directly on the food you eat but works in the background to help the body use the insulin it is making more effectively and reduce release of glucose from the liver. The reason for advising to take with meals is it helps to reduce the possibility of stomach issues some people get.
If you continue to get these high reading then contact your GP or diabetic nurse asap as these are not good levels.
 
The foods you are eating are doing you no favours at all and with levels that high you definitely should have something stronger than metformin and if you have tried those other medications then Gliclazide or insulin would be the next step and to be honest you need to be far more worried about those persistently high BG levels than the potential risk of a hypo at this stage. I think there is a lot of fear and misunderstanding around hypos too. I naively thought when I was started on insulin that I might have one or two hypos a year if I was unlucky. In reality I have at least one mild one every other day/night. My record (not proud of it) is 7 in one day partly because I very physically active that day. It was frustrating because I got stranded in a car park with my partners horse unable to drive home for an hour but not particularly debilitating. A couple of Jelly Babies sharp fixes it but DVLA rules prevent you from driving for 45 mins after you come back up, hence being stranded. I have never needed assistance although in the early days the panic was bad due to the fear and I liked to have someone with me or at the end of the phone whilst I recovered.
The thing is that if you continue with those high levels, you are at risk of damaging your sight and the nerves and blood vessels in your feet and kidneys and if that happens it is unlikely to be reversible and it can happen quite suddenly. A hypo is generally sorted in an hour at most. And if you are lucky and your diabetes plays by the rules you are unlikely to have any or very very few hypos, so please don't let a fear of hypos stop you from having the medication that you need, or alternatively, make some significant changes to your diet. And yes 2 slices of bread can raise your levels by 10mmols or more if you have jam on them. 10g carbs usually raises your BG by 3mmols and a medium wholemeal slice is at least 15g carbs, a thick white slice 20g each or maybe more, so 2 slices is 30-40g carbs which can raise your levels by 9-12mmols.
 
Leadinglights said:
Those are seriously high readings and it would be worth you having some ketone urine test stick as high blood glucose and ketone puts you at risk of something serious DKA.
Bread is clearly not a good option, 2 slices with Jam all high carb, Kievs can be high carb because of the breadcrumb coating and sweet potatoes are high carb. Soup can be high in carbs if it has potatoes in it. You do seem to eat at rather erratic time not that that should make a difference.
Metformin does not act directly on the food you eat but works in the background to help the body use the insulin it is making more effectively and reduce release of glucose from the liver. The reason for advising to take with meals is it helps to reduce the possibility of stomach issues some people get.
If you continue to get these high reading then contact your GP or diabetic nurse asap as these are not good levels.
Click to expand...
I would need to buy the Ketone Urine test strips, as they don't come with my BG monitor, the BG monitor I have actually has a ketone monitor built in, but again I would have to buy the strips to test for ketones.

My home made soup had no potatoes in it at all, it was just all the other veg I like, deliberately didn't use spuds for that reason of high carbs. With regards to eating at weird times, that does not happen very often, that night in particular was to keep and eye on my BG to see that it came down to a better level before sleeping. My sleep patterns are all over the place at the moment and have been for quite a while. I am drinking at least 2 litres of water a day, every day, my kidneys are working well because of the amount of urine I am passing out, it is also the area of nursing I worked in for 18 years, so have quite a bit of knowledge with regards to my input to output of fluids, I am passing anything from 600 to 800 mls, my body is taking what it needs and removing the rest.

If sweet potato's are high in carbs, why are we told to have them instead of normal spuds ? It seems that no matter what I eat, something is not working right ! For instance, say I want a tuna and cottage cheese barmcake, for a snack or supper, the problem there is the barm, high carb, so what do I do if I want to have something to eat but can't have bread, Ryvita or Crispbreads are out of the question as they are again high in carbs.

I was bringing my sugars down really well earlier in the year, but I also think that my meds or mix of them is not helping as well. Doctor's prescribe us whatever pill they see fit but don't really have any true idea how they are going to affect us or things like Diabetes.

I gained weight taking Poigltazone which I hadn't realised it did that until recently on here reading that as a side effect, there is a link on here to the NICE guidelines.

I feel bewildered sometimes with all the things to do to try and keep my BG under control.
 
brettr said:
I would need to buy the Ketone Urine test strips, as they don't come with my BG monitor, the BG monitor I have actually has a ketone monitor built in, but again I would have to buy the strips to test for ketones.

My home made soup had no potatoes in it at all, it was just all the other veg I like, deliberately didn't use spuds for that reason of high carbs. With regards to eating at weird times, that does not happen very often, that night in particular was to keep and eye on my BG to see that it came down to a better level before sleeping. My sleep patterns are all over the place at the moment and have been for quite a while. I am drinking at least 2 litres of water a day, every day, my kidneys are working well because of the amount of urine I am passing out, it is also the area of nursing I worked in for 18 years, so have quite a bit of knowledge with regards to my input to output of fluids, I am passing anything from 600 to 800 mls, my body is taking what it needs and removing the rest.

If sweet potato's are high in carbs, why are we told to have them instead of normal spuds ? It seems that no matter what I eat, something is not working right ! For instance, say I want a tuna and cottage cheese barmcake, for a snack or supper, the problem there is the barm, high carb, so what do I do if I want to have something to eat but can't have bread, Ryvita or Crispbreads are out of the question as they are again high in carbs.

I was bringing my sugars down really well earlier in the year, but I also think that my meds or mix of them is not helping as well. Doctor's prescribe us whatever pill they see fit but don't really have any true idea how they are going to affect us or things like Diabetes.

I gained weight taking Poigltazone which I hadn't realised it did that until recently on here reading that as a side effect, there is a link on here to the NICE guidelines.

I feel bewildered sometimes with all the things to do to try and keep my BG under control.
Click to expand...
You may find the book or app Carbs and Cals useful as it gives carb values of various portions of a whole range of foods (there are other apps people use) but 55g of baked sweet potatoes is the same as 55g of baked potato wedges at 15g carb. A lower carb similar thing is butternut squash which is only 10g carb for a 130g portion.
You could have the tuna with a big salad and some coleslaw with some grated cheese, there are some crispbreads which are not too bad, you would need to check the packet, and likely better than bread.
 
rebrascora said:
The foods you are eating are doing you no favours at all and with levels that high you definitely should have something stronger than metformin and if you have tried those other medications then Gliclazide or insulin would be the next step and to be honest you need to be far more worried about those persistently high BG levels than the potential risk of a hypo at this stage. I think there is a lot of fear and misunderstanding around hypos too. I naively thought when I was started on insulin that I might have one or two hypos a year if I was unlucky. In reality I have at least one mild one every other day/night. My record (not proud of it) is 7 in one day partly because I very physically active that day. It was frustrating because I got stranded in a car park with my partners horse unable to drive home for an hour but not particularly debilitating. A couple of Jelly Babies sharp fixes it but DVLA rules prevent you from driving for 45 mins after you come back up, hence being stranded. I have never needed assistance although in the early days the panic was bad due to the fear and I liked to have someone with me or at the end of the phone whilst I recovered.
The thing is that if you continue with those high levels, you are at risk of damaging your sight and the nerves and blood vessels in your feet and kidneys and if that happens it is unlikely to be reversible and it can happen quite suddenly. A hypo is generally sorted in an hour at most. And if you are lucky and your diabetes plays by the rules you are unlikely to have any or very very few hypos, so please don't let a fear of hypos stop you from having the medication that you need, or alternatively, make some significant changes to your diet. And yes 2 slices of bread can raise your levels by 10mmols or more if you have jam on them. 10g carbs usually raises your BG by 3mmols and a medium wholemeal slice is at least 15g carbs, a thick white slice 20g each or maybe more, so 2 slices is 30-40g carbs which can raise your levels by 9-12mmols.
Click to expand...
With regards to my Metformin, I am on 2 grams a day, 2 pills with morning meds and 2 in the evening. There is a link on here that takes you to the NICE - Type 2 Diabetes in adults: choosing medicines.

What I forgot to say was that the soup I made was pure veg, no spuds at all. I rely on my car to get about, mainly because I am the carer for my parents, so I have to take my mum shopping 3 times a week plus any other trips or errands that we need to do. I will not start taking any meds that are going to give me hypos, I can't afford the risk with my driving licence for one thing, plus thanks to the information I have printed off in relation to the NICE: choosing medicines, I now realise that there are a range of meds available, not just the two I tried.

After the Empagliflozin and Pioglitazone didn't work out well for me, it has been suggested that I go straight to insulin or a Sulfonylurea medication like Gliclazide, both of which can bring on Hypo's.

I would rather go on the NHS soup diet than take meds to bring on any hypo. I have no problem cutting my foods down to get my BG's back to a better level, as well as hopefully losing some of the weight.

I do realise that if my BG's keep up high or go higher I am at major risk of sight loss, renal problems etc, luckily my hands and feet are not experiencing any problems, and I do know that they can suddenly come on if I am not careful.

I have to make the changes to my diet, which I had already done, but slipped, which I will admit, but there is no way I want to go on Insulin unless I really have to, sorry, but it's not happening, I don't want to lose the independence I currently have.

I will try to attach the PDF file related to the Choosing Medicines for you to look at if you already have not done so.
 

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The meds may have a risk of hypo but that is not the same as "bringing on hypos".
Provided you have fast acting carbs with you at all times to treat (or stave off) a hypo, the impact can be fairly minor.
As I have Type 1 diabetes, I have no choice but to take insulin which can cause hypos if I get my dose wrong. I was diagnosed 20 years ago and it has not affected my driving beyond needing to stop to check my BG every 2 hours and I still have my driving license.
 
Similar here to @helli. I have no choice but to take insulin.
My independence is paramount to me too and living rurally, I need my driving licence. The insulin does not impact my driving, providing I manage my diabetes well and follow the DVLA guidelines. Yes, we have to go onto a 3 year medical licence but I have not had any problems having it renewed.
If you lose your sight that will have a much bigger impact on your ability to drive I can assure you and those levels you are getting in the 20s are really dangerously high!
 
It is 100% true that Ryvita contains carbs - however - nowhere anywhere near the amount of a barm, roll, bap, cob, batch or whatever where you live calls a bread roll. A smallish bread roll is anywhere between 25 and 35 grams whereas a sesame seed Ryvita is 8-ish and therefore much lower carb!

Low carb has never, ever meant NO carb.
 
trophywench said:
It is 100% true that Ryvita contains carbs - however - nowhere anywhere near the amount of a barm, roll, bap, cob, batch or whatever where you live calls a bread roll. A smallish bread roll is anywhere between 25 and 35 grams whereas a sesame seed Ryvita is 8-ish and therefore much lower carb!

Low carb has never, ever meant NO carb.
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Thanks for your words and information With regards to Ryvita, I read that the dark rye was a better option for diabetics, but I will look into the sesame seed ones to see what their values are, I have also come to realise that I should only be eating carbs of any kind no more that twice a week if that !

I do also realise that even as diabetics, we need some carbs, just not the amount we used to eat before starting with T2 in my case. The biggest problem I do have is feeling hungry after 2 hours or so after having a meal.

Tonight for example, for my supper I mixed a standard can of tuna with 1 tomato quartered, 4 thickish slices of cucumber quartered and one long stick of celery into small pieces, mixed it all together with just enough mayo to bind everything and ate that slowly. I gather that the mayo is the worst thing there, but as it was less than 100g, I deemed that to be ok with regards to the carbs and sugars of the mayo, both of which were lower than I expected, the carbs of the mayo were about 7.5g, so under the max of 10g I have been told about previously on here.
 
Leadinglights said:
Urine ketone dip sticks are pretty cheap from the pharmacy, you don't need a monitor to read them, just compare with the colour chart on the vial. I think
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Now that you have mentioned it, I have realised I have urine test strips here at home, I bought them from Amazon, so next time, I will use one to see what the ketones are like.
 
everydayupsanddowns said:
Sorry to hear you’ve been having a negative experience with some of the diabetes meds you have been offered @brettr

The links section has a thread about the NICE flowchart for T2 meds (intended for healthcare professionals) which outlines which meds are generally offered in what order depending on how glucose levels respond.

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Thank you for the link. Am so glad I took a look at it and printed the PDF file from it. I was given Empagliflozin to help move my glucose clearance along, but as I have mentioned on here, after 3 months I started getting right sided kidney pains, so stopped it ! I was then tried on Pioglitazone, but that gave me bad oedema in both legs, so had to stop that as well.

Having spoken to my diabetes nurse a few months back she stated that I might have to go onto insulin or something like Gliclazide. This was directly after trying both those meds which didn't work for me in the end. So the discussion was or went straight to insulin and a sulfonylurea (Gliclazide) etc, something I am not willing to take if I don't need to.

It was never mentioned that there are 3 other medications I could try in the Flozins, namely Canagliflozin, Dapagliflozin and Ertugliflozin. One thing I noticed on the printed PDF document is that Doctor's are to prescribe the cheapest option available, which was the Empagliflozin. What I do know about these other 3 Flozin meds is that they are similar but each slightly different in their drug structure, hence 4 meds in the same class, but each slightly different to the other.

When I was a nurse, one of the biggest things I was taught was "Patient Choice", regarding everything about the patient. So when I next see her, I am going to point this out to her and ask why ? If she comes back about the cost, I will calmly say to her, I am not interested in that, and remind her about patient choice. If it means I have to cover the cost of trying one of the other Flozin meds, then so be it. But I am NOT being pushed onto taking insulin, as it's a huge problem with weight gain, weight I am trying to lose, plus the risks of hypo's are higher, again, not taking it based on the cost of a damn medication.

I can monitor my bloods for Ketoacidosis with my BG monitor or a urine strip.
 
Periodically people comment in this forum about insulin causing weight gain - which I think is misleading and generally wrong.

Weight gain is invariably because we are eating more than we need. If we take too much insulin then we do end up needing to feed that insulin to either fend off or deal with hypos. I am wholly insulin dependent (no pancreas) and I had my share of hypos early on after my surgery. So I know that hypos are unpleasant and I now try very hard to avoid getting that low; I also know that being low has greater long term consequences than being high occasionally. Particularly for cognitive decline.

All that said I must take insulin and I have not put back on the surplus weight I used to have a few years ago. I'm not consciously starving myself - I eat when I'm hungry. There is the odd moment when I duck eating something because I can't be bothered to take a small bolus dose - but that laziness on my part is not a real punishment and there are plenty of low carb / no carb snacks if hunger is clamouring "feed me". I do try to eat healthily and avoid too much processed foods; it's nigh on impossible to avoid all processed food - as it is to avoid all carbs. indeed one's brain needs glucose and one's body will convert proteins and fats into glucose if we starve ourselves of carbbs.

There is no need to fear insulin. If it is necessary to achieve decent BG control when oral meds are inappropriate then it has become a sensible option - from there on it just needs managing as does any other medication. Insulin does not cause weight gain on its own.
 
One drug you haven't mentioned is Linagliptin, which is what I was put on after I refused Gliclazide, for the same reason you did. Also my GP surgery has stopped prescribing Canagliflozin due to adverse reports, and has switched to Dapagliflozin.
 
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