New to the forum. Query about Type 2 Meds

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Coanda_24

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Hello all. I'm a long term type 2diabetic. Recently my HBA1C was significantly elevated: to be honest through my own neglect. I've had a gastro issue for a month which motived me to seek out help (instinctively I think this is Gastroparesis but yet to be confirmed). I was taking Metformin and have had Gliclazide (40mg) once a day introduced 10 days ago. This has dramatically shifted my daily bloods: 4.2 to 5.9 fasting; 5.8 to 9.1 2 hours post meal. The issue I have is that in the last 4 days I've had 4 hypos: my awareness is usually good, but last night my sugars took around 30 mins to get back up to 4.2 My sugars tend to start dropping in the afternoon and evening and then the hypos happened around bedtime. Sometimes my sugars are higher in the morning compare to bedtime so I suspect I've also been having hypos in my sleep.

My Diabetes Nurse has asked me to stop taking the Gliclazide and will see me in clinic in 2 days to review. I was really hopeful that the improvement in sugars would help me turn things around. I've been having my GI issues for a month and my food intake is low - I struggle to consume more that 700 / 800 calories a day and I've lost 4kg since 2nd January. I've also been taking Lansoprazole to help my stomach. This week it felt like this and my lower sugars was gradually helping me with my stomach issues. I'm highly anxious as between hypos and my stomach I just don't know what my body's doing at the moment. I know this is all y own fault so I shouldn't be complaining.

I don't know if it's possible to have a lower dose of Gliclazide or whether I have to go to some other form of treatment like Insulin.
 
Hi. 40mg Gliclazide is the lowest dose and due to the hypos the nurse was sensible to stop it. BTW don't think Calories which are not a good measure. Think Carbs instead as these cause most weight gain rather than Fats. Make sure you have enough Proteins and Fats.
 
It's quite common for people with T2 diabetes to be high in the morning and slowly go lower as the day progresses - it's called Extended Dawn Phenomenon. Maybe the medication is making even lower.
 
Thank you all for the replies and your comments. I’m seeing my Nurse - at the GP surgery tomorrow - to look at what to do next. I don’t know if I’m a candidate for insulin or if there are any other meds I can take to replace Glicalzide - it’s such a shame because I was tolerating this med so well until the hypos. My nurse was going to get some advice from the Hospital Endocrinology team on next steps. Hopefully I’ll know more tomorrow.
 
Coanda_24 said:
Thank you all for the replies and your comments. I’m seeing my Nurse - at the GP surgery tomorrow - to look at what to do next. I don’t know if I’m a candidate for insulin or if there are any other meds I can take to replace Glicalzide - it’s such a shame because I was tolerating this med so well until the hypos. My nurse was going to get some advice from the Hospital Endocrinology team on next steps. Hopefully I’ll know more tomorrow.
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The fact that 40mg of Gliclazide has caused hypos indicates your pancreas can produce enough insulin so injecting insulin wouldn't be relevant at this stage. I was on 320gm of Gliclazide which no longer worked before I went onto insulin.
 
Were your blood glucose levels very high which led them to add the gliclazide, if that is now causing hypos then you may not be having sufficient carbs for the gliclazide to work on. It is encouraging the pancreas to produce more insulin and if there are not enough carbs then you will be more likely to get hypos.
Look at your carb intake rather than calories as that is more important.
It may be that by looking at carb intake that metformin will be sufficient without additional meds.
 
Thank you so much for the replies. My HBA1c was much higher: in fact at the beginning my Nurse was anticipating that I’d be on 80mg by now! The issue around carb intake is relevant. For the last month I’ve been having GI issues. As such I am not able to eat full meals. My instinct is Gastroparesis but I’m too early on to have a diagnosis. I’m waiting for a Gastroscopy. My stool sample taken last week has come back raised which could suggest bowel inflammation. My GP is taking advice from the Gastro team at the hospital. I tend to be able to tolerate meals in the mornings so eat well at breakfast and am often unable to face an evening meal: my hypos happen in the evenings and at bedtime.
 
Coanda_24 said:
Thank you so much for the replies. My HBA1c was much higher: in fact at the beginning my Nurse was anticipating that I’d be on 80mg by now! The issue around carb intake is relevant. For the last month I’ve been having GI issues. As such I am not able to eat full meals. My instinct is Gastroparesis but I’m too early on to have a diagnosis. I’m waiting for a Gastroscopy. My stool sample taken last week has come back raised which could suggest bowel inflammation. My GP is taking advice from the Gastro team at the hospital. I tend to be able to tolerate meals in the mornings so eat well at breakfast and am often unable to face an evening meal: my hypos happen in the evenings and at bedtime.
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When do you take the gliclazide as taking it 30mins before you have your breakfast so it then is encouraging your pancreas to produce the insulin to cope with the carbs you are eating then but will not be active later in the day when you are not eating much carbs so should help with the hypos later in the day.
 
Hi thanks for the reply. I do take it first thing in the morning usually 30 mins to an hour before my first meal. I wonder if I my Gastro issue is causing a delay in absorption. Often I can do a bedtime reading and it’ll be low to mid 5s then within an hour or so it’ll just drop. One day last week I did a profile of my sugars by taking readings every hour (I know it’s a waste of testing strips but I had to know). This was actually a good food day for me and I didn’t have a hypo on this occasion:
TimeReadingEvent
08:00​
5.9​
Fasting reading Medication at 08:15
09:00​
6.5​
Breakfast at 09:15 Tea and two slices of toast with spread
10:15​
7.3​
11:15​
7.8​
12:15​
6.1​
13:00​
5.3​
Lunch - meal replacement drink
14:15​
5.2​
15:15​
5.8​
16:15​
5.8​
17:15​
5.7​
Dinner at 17:15 soup and rice
18:30​
6.9​
19:30​
5.2​
20:30​
4.9​
21:30​
5.2​
Bedtime
 
Coanda_24 said:
Hi thanks for the reply. I do take it first thing in the morning usually 30 mins to an hour before my first meal. I wonder if I my Gastro issue is causing a delay in absorption. Often I can do a bedtime reading and it’ll be low to mid 5s then within an hour or so it’ll just drop. One day last week I did a profile of my sugars by taking readings every hour (I know it’s a waste of testing strips but I had to know). This was actually a good food day for me and I didn’t have a hypo on this occasion:
TimeReadingEvent
08:00​
5.9​
Fasting reading Medication at 08:15
09:00​
6.5​
Breakfast at 09:15 Tea and two slices of toast with spread
10:15​
7.3​
11:15​
7.8​
12:15​
6.1​
13:00​
5.3​
Lunch - meal replacement drink
14:15​
5.2​
15:15​
5.8​
16:15​
5.8​
17:15​
5.7​
Dinner at 17:15 soup and rice
18:30​
6.9​
19:30​
5.2​
20:30​
4.9​
21:30​
5.2​
Bedtime
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You are definitely not eating a lot but your reading are all pretty normal as nothing is raising your blood glucose more than the variation you might expect from a monitor. Even something quite carby like toast and rice.
=0
 
We need protein and fats in order to survive. Natural fat, not seed oils.
I seem to have been in remission for 7 years, having corrected my problem with carbs by eating only 50gm or less starting at diagnosis.
By taking medication and eating so few calories, although mostly from carbs, your blood glucose levels seem to be good, but there is nothing much to sustain Human life in the foods you listed. It might be OK to be eating that way for a while, but I suspect that its been quite long term for you now.
Stress and anxiety can cause problems with digestion, as can a punishing regime because of a belief that diabetes type 2 is all our own fault.
It really isn't. If someone can't cope with carbs it is as inbuilt as having grey eyes.
Just as you can't convert a petrol engine to diesel by filling the tank with that fuel, a type 2 diabetic isn't going to do well on a high carb diet. We do best on a diet providing protein and fat, with carbs for texture, flavour, colour and variety.
Whilst hypos can be induced by medication, they can also be the result of excessive exertion or lack of food, and they are not usually seen in unmedicated type 2s, so I am a bit concerned about the thought of using insulin when your blood glucose levels are already low.
 
Thank you so much for your replies. I think you’re right about blame: Diabeties has always be a secret shame. I think the issue here is that, maybe, with my ongoing stomach issues this wasn’t the best time to start playing around with medications. I’ve not taken Gliclazide since Monday on my Nurse’s suggestion. Today, my fasting sugars have been 7.5 - 9 and two hours after food between 11 and 13 - I just despair. The support at my GP surgery is really good so I hope we can come up with a plan when I see my nurse tomorrow.
 
Coanda_24 said:
Thank you so much for your replies. I think you’re right about blame: Diabeties has always be a secret shame. I think the issue here is that, maybe, with my ongoing stomach issues this wasn’t the best time to start playing around with medications. I’ve not taken Gliclazide since Monday on my Nurse’s suggestion. Today, my fasting sugars have been 7.5 - 9 and two hours after food between 11 and 13 - I just despair. The support at my GP surgery is really good so I hope we can come up with a plan when I see my nurse tomorrow.
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How many carbs are there in your meal replacement shakes. Pairs of readings are more useful so a before eating and after 2 hours. What meal did you have to get 13.
Info like that will be useful to your GP.
 
Thanks for the reply. So the 13 reading was 2 hours after eating two slices of toast with spread for breakfast. On waking up this morning my fasting sugars (before breakfast) were 7.5. I recognise I need to manage carbs and balance. However I’ve been eating things I can tolerate like white bread that’s easy to digest. I’ve kind of talked myself in to having Gastroparesis and I’m avoiding things like fibre and fats as that’s the advice. I’ve been in this sort of emergency ‘holding pattern’ but I can see the GI investigations aren’t going to happen quickly. Any suggestions for a better an easier to digest food would really help. I’m going to try eggs for breakfast and look into more wholesome soups.
 
Coanda_24 said:
Thanks for the reply. So the 13 reading was 2 hours after eating two slices of toast with spread for breakfast. On waking up this morning my fasting sugars (before breakfast) were 7.5. I recognise I need to manage carbs and balance. However I’ve been eating things I can tolerate like white bread that’s easy to digest. I’ve kind of talked myself in to having Gastroparesis and I’m avoiding things like fibre and fats as that’s the advice. I’ve been in this sort of emergency ‘holding pattern’ but I can see the GI investigations aren’t going to happen quickly. Any suggestions for a better an easier to digest food would really help. I’m going to try eggs for breakfast and look into more wholesome soups.
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If the toast is increasing your level so much that certainly indicates you are struggling with that amount of carb which could be as much as 40g depending on the size of your slices of bread and that would certainly increase many people's blood glucose by that much. Eggs sound a better proposition and your could try those with maybe half a slice of toast and see if that helps.
Many find full fat Greek yoghurt with berries is a good breakfast but that may not be suitable for you but you could try the high protein yoghurt (Arla or Aldi) which are low carb and low fat.
Gut issues are notoriously difficult to diagnose as symptoms can be so variable in different people but the Guts UK charity has a good web site which goes through all the different conditions with symptoms and advice which may be worth a look for you.
 
Thank you for the advice. Whist they’re figuring out how to adjust my medication I will be more aware of carb intake. I will research low carbs: I suspect it will just be some trial and error with finding what I can and can’t tolerate. However as a guide what amount of carb should I be aiming for with each meal?

My nurse has offered me 2 Libre sensors as she has a couple spare that a Rep left with her. So it will be good to have that insight. With all the hypos I’ve been burning through testing strips.
 
Coanda_24 said:
Thank you for the advice. Whist they’re figuring out how to adjust my medication I will be more aware of carb intake. I will research low carbs: I suspect it will just be some trial and error with finding what I can and can’t tolerate. However as a guide what amount of carb should I be aiming for with each meal?

My nurse has offered me 2 Libre sensors as she has a couple spare that a Rep left with her. So it will be good to have that insight. With all the hypos I’ve been burning through testing strips.
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That is a burning question as everybody is different but for people who are Type 2 and trying to reduce blood glucose by diet or diet and metformin the general guidance is no more than 130g carbs per day divided between meals, drinks, snacks so you are not over loading the body with more carbs than it can cope with at any one meal which is why people are often guided by their monitor and try to keep their meal increase to no more than 2-3mmol/l.
There are quite a few low carb foods which would be lower in fibre if that is what you need, meat, fish, eggs, cheese and dairy will be low fibre and low carb but well cooked vegetables like butternut squash, carrots, spinach, broccoli and cauliflower (not stalks), courgettes are usually ok for low fibre regimes. Sugarfree jelly and Kvarg deserts will be low carb, melon might be OK.
 
How low have your hypos been and have you felt really wobbly with them? Is there any pattern to when you have them?
Which BG meter do you use?
Diabetes itself doesn't cause hypos, it causes the opposite which is high BG levels. Certain medication for diabetes, Gliclazide and insulin, can both cause hypos if the dose is too high, so if you are having hypos on the lowest dose of Gliclazide, then it suggests you do not need it and certainly not insulin as you own body is clearly producing enough.

It is normal for people's BG to drop below 4 on occasion quite naturally, more so when not diabetic, so I wonder if either your BG meter is faulty or giving false low readings or your body is just wanting to be at this lower level.

I think your diet is not helping your diabetes and it seems to me that you have created a bit of a rollercoaster situation by eating foods which are fast release and then the Gliclazide is bringing them down. If you don't take the Glic your levels are going high and staying high because of the carbs but if you take it, you are likely going up between finger pricks and then down, perhaps too low. If you eat less carbs and slower release foods and don't take the Glic that should help to level things out more and keep you on a more even keel. There is no worry about your levels going low if you don't take the Glic, so it doesn't matter if your digestion is slow, your liver will have plenty of stores to keep your levels high enough until the food does digest..... at least unless you are running marathons regularly and seriously depleting your muscle and liver stores by that means. Our liver is like a back up battery that keeps us topped up with glucose in the absence of food and you can go several days without food and not hypo, so even if you do have gastroparesis it should not impact your BG levels unless you are taking medication which can drop them. ie Glic or insulin.

What symptoms are you experiencing which make you think you have gastroparesis?.... Have you ever had problems with your gall bladder or pancreas? I am just wondering if it might be a digestive issue due to lack of digestive enzymes rather than delayed emptying of the stomach which is gastroparesis.
 
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