Stopping gliclazide.

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Docb

Docb

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Relationship to Diabetes
Type 2
On 1 Jan I stopped taking gliclazide (30 mg/day) after a discussion with the DN because she was concerned that my HbA1c at 36 was getting a bit low. I treated it as a bit of an experiment and, of course, I kept on doing blood glucose readings so that I could see what the effect was.

It is quite interesting. For the couple of months prior to stopping gliclazide, my readings generally sat in the 4-6 band. Could get readings higher than 6 if I tested whilst my system was processing post meal glucose and periodically I had short periods where levels went up a bit for no apparent reason but dropped back again into the 4-6 band a day or two later. Getting back to pre meal levels in a couple of hours was the norm.

Since stopping the gliclazide, my levels overall have taken a step upwards and now generally sit in the 6-8 band. I have not had a reading below 6 since the gliclazide cleared the system and if I test an hour after eating I get double figures quite easily and after a couple of hours I am still 2 or so above the pre meal reading.

I will carry on to get more data but it first indications are that for me, a low dose of gliclazide generally reduces blood glucose levels by 2mmol/l and speeds up processing of glucose after eating.

Thought some of the number nerds might be interested.
 
1642846091202.png

To give some more info on what happened when I stopped gliclazide. The graph above shows my blood glucose variation during the day. The blue line is what it looked like through November and December when I was taking gliclazide and the red line the what it looks like for January when I stopped taking it. I have made efforts to keep all other factors unchanged, at least as unchanged as they can be in real life.

It is interesting to see that stopping the gliclazide has pushed my blood glucose up right through the day so that means that I am one of those for whom gliclazide has had a measurable effect on blood glucose. Won't bore you with the statistics but I'm happy that the difference is not due to random chance. It is also interesting to note that the benefits of gliclazide seem to be more marked when my pancreas is dealing with the glucose arising from eating my tea. Also, it would appear that the speed with which my system dealt with post meal glucose was increased by the gliclazide. Other preliminary points are that my overall mean blood glucose has risen from under 6 to about 6.5 and the variability has increased.

A point for all those new to blood glucose monitoring and interpreting the results. You can see just how much blood glucose varies through the day and the result you get after eating depends very much on when you test because your blood glucose can be changing quite rapidly. We talk a lot about looking for patterns. That is what I have tried to do here. I don't suggest you need this level of sophistication, but you need to bear it in mind when trying to make sense of individual results.

Also, some might think that stopping the gliclazide was a bad thing because my blood glucose levels have gone up and are in the range 6-9 and not 5-7. I don't see it that way. My next HbA1c is due end of March and I will, for a bit of fun, try and predict it from my data and see how close I can get. Currently thinking it will be in the low 40's and that will be good enough for me. No need to try and hammer the HbA1c down and try and get it out of sight. It is a difficult thing to do and probably not very healthy.
 
Gliclazide does make you produce more insulin, so a rise would be expected.
Having said that, I always found any change took at least two weeks or more to settle down, so there may still be changes.
As a matter of interest, what time of day did you take it?
Another interesting point off those graphs is that you appear to be a classic peak of two hours after the rise starts, much the same as I found my response was.
 
Ah, this is a summary of results taken through January where I have quite deliberately changed testing times each day so I did not "take it" at any particular time of day. Because my routine, both with times of eating and what I eat does not vary a lot, I have compiled the results together as if they had all been taken on the same day. Hope that makes sense.

Agree about the time to settle down. I intend to keep going for the next couple of months to see what happens in the longer term but I am happy that these data suggest that you can see the effect of stopping gliclazide in a couple or three weeks.

Yep, the peaks are there after a couple of hours no matter what, but I suspect there are subtleties in the way the gliclazide influences the rate of rise and fall of blood glucose either side of the peak.

As I have said before, this sort of stuff has much in common with Sudoku when it comes to exercising the brain. It is preferable to Sudoku because unlike the game, it might produce something more useful than feedstuff for the wastepaper basket!
 
Interesting, @Docb.

Whilst recognising that you are not in the first flush of youth therefore your remaining life span isn't limitless, I seriously wonder how many years you can stay pretty healthy and capable with your BG elevated even to the degree it is elevated. Snag being of course no-one can tell you that. However I'm definitely more risk averse than I used to be with my own health - so once you have the evidence of your next A1c, I'd be having a debate with myself as to whether to start the Glic again .....
 
Ah, I meant what time did you used to take the gliclazide?
Morning, evening meal.......
Was it a slow acting version.....
Just curious at the evening difference.
 
Sorry, @travellor, always first thing in the morning and it was not a slow acting version.. Yes, it is tempting to speculate that the way it was utilised by my system varied through the day and that its effectiveness increased as time progressed.

That conversation is to be had @trophywench. I'm happy it can wait a couple of months if only to satisfy my inner need to have a robust data set. Keep on suggesting that you should not react to early data and I don't want to be hung by my own petard!
 
trophywench said:
Interesting, @Docb.

Whilst recognising that you are not in the first flush of youth therefore your remaining life span isn't limitless, I seriously wonder how many years you can stay pretty healthy and capable with your BG elevated even to the degree it is elevated. Snag being of course no-one can tell you that. However I'm definitely more risk averse than I used to be with my own health - so once you have the evidence of your next A1c, I'd be having a debate with myself as to whether to start the Glic again .....
Click to expand...

There were two lines of thought on that for a type 2.
Gliclazide is a safe, and good medication. But it does promote production of insulin.
One line of thought was a rest is good at times, as it allows the beta cells to recover, and a single injection of insulin a day could cover any shortfall. Sort of saving the beta cells for later, less but longer as it were.
The other is obviously to carry on, as it works for many.

Both theories have there own merits for me, and their own downsides.
 
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Really interested to see where you end up with your deliberations @Docb

It doesn’t look like you were having many (if any?) hypos on glic? I think that would be part of the concern about an HbA1c being ‘too low’?

In fact if your before/after traces are typical, aside from the 2pm(ish) dip it would all look pretty peachy?
 
You are right, I've never had a hypo whilst on gliclazide. As far as I can see, my system never let me get below 4.5 or thereabouts. Lowest reading I have ever had was 4.1 and I did not trust it. Its all pretty much what you might expect and one of the reasons I posted it was to let people new to testing the sort of variability you can get through the day which hopefully will give a perspective on readings they might see.

The difference between glic and no glic in the evening is really quite interesting. I will repeat the analysis in a couple of weeks time to see if it is still there.
 
Been poking around my data set again.

We often get asked about the relationship between finger prick readings of blood glucose and HbA1c so what I did was to get my HbA1c's from patient access and the dates they were taken. I then went to my data set and for each of those dates found out what the average blood glucose was for the three months prior to those tests. I plotted one against the other and got....

1643113653600.png

I know the relationship is a bit dependent on the high reading but that is all I have got. Nevertheless it does suggest that there is a reasonable relationship between the two and if my average BG is below about 6.5, my HbA1c will be below 40. My post gliclazide BG average is heading for somewhere close to 7 which would predict my next HbA1c (due end March) to be somewhere in the mid 40's.

Did a bit more jiggery pokery but it seemed that a simple average of all readings was as good as anything when it came to predicting HbA1c but it helped that I had taken readings at all times of the day whilst looking at effects of meals.
 
Best part of a month since I stopped the gliclazide and I am quite convinced that there has been discernable effects on my blood glucose levels. I have tried to keep other factors equal.

In summary...

1. The effects were not instantaneous, it's taking a month or so to stabilise and I am not sure that it is fully settled yet. Nevertheless, my levels are now generally in the range 6-11with regular double figures . With gliclazide, the range was generally 4.5-8 and I only saw double figures occasionally. My 30 day average ( the average of tests taken over the previous 30 days is now 6.85 whereas before it was normally below 6. I think that it will go over 7 when things have completely settled.

2. My waking BG now hovers around 6 whereas before it hovered around 5. The results are a tad fuzzy but I am sure the increase is real.

3. The rise in my bedtime BG is also distinct and far less fuzzy. The range is now between 6 and 8 whereas before it was between 4 and 6.

4. Overall, one thing for sure is that I am not meeting the oft quoted guidelines of 4-7 before meals and a rise of no more than 2 after eating. I'm above that but not to an extent I find disconcerting.

My current thinking is that it is clear that gliclazide will reduce blood glucose for me, and I suspect anybody else who shares my version of diabetes, whatever that is. There is more to be gained from this experiment in particular getting some indication of daily variations with and without gliclazide.

I am happy to continue as is but I cannot help but think that my moderate carb diet is important to my levels. Testing that is an experiment I would have to think about!
 
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Been watching your experiments. Not much to add to your results, just wanted to say its been interesting 🙂
 
Docb said:
Best part of a month since I stopped the gliclazide and I am quite convinced that there has been discernable effects on my blood glucose levels. I have tried to keep other factors equal.

In summary...

1. The effects were not instantaneous, it's taking a month or so to stabilise and I am not sure that it is fully settled yet. Nevertheless, my levels are now generally in the range 6-11with regular double figures . With gliclazide, the range was generally 4.5-8 and I only saw double figures occasionally. My 30 day average ( the average of tests taken over the previous 30 days is now 6.85 whereas before it was normally below 5. I think that it will go over 7 when things have completely settled.

2. My waking BG now hovers around 6 whereas before it hovered around 5. The results are a tad fuzzy but I am sure the increase is real.

3. The rise in my bedtime BG is also distinct and far less fuzzy. The range is now between 6 and 8 whereas before it was between 4 and 6.

4. Overall, one thing for sure is that I am not meeting the oft quoted guidelines of 4-7 before meals and a rise of no more than 2 after eating. I'm above that but not to an extent I find disconcerting.

My current thinking is that it is clear that gliclazide will reduce blood glucose for me, and I suspect anybody else who shares my version of diabetes, whatever that is. There is more to be gained from this experiment in particular getting some indication of daily variations with and without gliclazide.

I am happy to continue as is but I cannot help but think that my moderate carb diet is important to my levels. Testing that is an experiment I would have to think about!
Click to expand...

I have never really been able to understand why the rise of two?
If someone starts at 7 and finished at 9, how is that worse than starting at 4 and finishing at 9. We all know meals are completely unrepeatable, next time the same meal could start at 4 and finish at 6, and without testing before eating everytime BG could anywhere.
I'm much more happy with a reasonable endpoint.
 
Thats the problem with guidelines, @travellor, they can mean different things to different people!
 
Docb said:
Best part of a month since I stopped the gliclazide and I am quite convinced that there has been discernable effects on my blood glucose levels. I have tried to keep other factors equal.

In summary...

1. The effects were not instantaneous, it's taking a month or so to stabilise and I am not sure that it is fully settled yet. Nevertheless, my levels are now generally in the range 6-11with regular double figures . With gliclazide, the range was generally 4.5-8 and I only saw double figures occasionally. My 30 day average ( the average of tests taken over the previous 30 days is now 6.85 whereas before it was normally below 6. I think that it will go over 7 when things have completely settled.

2. My waking BG now hovers around 6 whereas before it hovered around 5. The results are a tad fuzzy but I am sure the increase is real.

3. The rise in my bedtime BG is also distinct and far less fuzzy. The range is now between 6 and 8 whereas before it was between 4 and 6.

4. Overall, one thing for sure is that I am not meeting the oft quoted guidelines of 4-7 before meals and a rise of no more than 2 after eating. I'm above that but not to an extent I find disconcerting.

My current thinking is that it is clear that gliclazide will reduce blood glucose for me, and I suspect anybody else who shares my version of diabetes, whatever that is. There is more to be gained from this experiment in particular getting some indication of daily variations with and without gliclazide.

I am happy to continue as is but I cannot help but think that my moderate carb diet is important to my levels. Testing that is an experiment I would have to think about!
Click to expand...

I have never taken any meds to help blood sugars, so my standpoint could be skewed, but personally, I'd prefer not to ustilise Gliclazide, just on the basis it stimulates insulin secretion. My rationale is that many of those living with T2 already over secret insulin to deal with insulin resistance, so pumping more into my system mightn't be the best move, without fully understanding my insulin production.

I don't know when you were diagnosed, but there are a huge array of meds available to those with T2, and perhaps your sensible choice would not necessarily be an immediate reversion to Gliclazide, but to explore if three are other, options available. The world of T2 treatments seems to have been pretty fast moving in the time I have been diagnosed.

Did you every try Metformin? I know it's certainly not for everyone, but it is considered a gentle drug for those whose systems tolerate it.

If you did try it, was it right at the start of your journey, perhaps before you had tweaked your diet? I have read quite a few times that some people only experience issues if the over indulge in carbs.

Clearly everyone in individual in both their condition and approach, but those might be a few of my thoughts, were it me.
 
Interesting observations @AndBreathe. Started off on metformin but reacted badly to it. Anything over 500mg and I was in trouble, even with SR versions. Currently taking 500mg/day. I have never been convinced that it had any effect on my blood glucose - I was monitoring BG whilst taking various doses of metformin. Anyway, taking it pleases the DN and is doing me no harm, so that's OK by me.

I am quite happy when it comes to taking medication and something that promotes insulin secretion does not worry me. I find the idea that all T2 is due to insulin resistance unconvincing. It may well be the case for some, perhaps the majority of T2 cases, but maybe not for all. My interpretation of my position is that I have problems with blood glucose control because the way my pancreas either reacts to blood glucose level, or the rate at which it produces insulin is not up to scratch. That seems to me to be most consistent with getting control by reducing carb intake and taking an insulin promoting medication. It is also consistent with my observations with regard to the effect of metformin.

I think you are absolutely right about individuality but suspect that it would be advantageous to divide T2 into a few subgroups each with their own recommended approach. A bit more science up front would help. Bundling everybody who is not a blindingly obvious T1 into the same T2 box, is, for me, not the most efficient way of dealing with poor control of blood glucose in what seems to be becoming a significant and increasing proportion of the population.
 
Another graph for all you data fiends...
1643531835002.png

This is one of my standard plots, the readings taken over the last sixty days (the blue line) and the short term running average (the red line).

I stopped taking the gliclazide on 30 Dec and you can clearly see the effect on my blood glucose. Now it is generally always above 6, lots of 8's and a few 10's and above. The overall average has crept above 7. All other factors have not changed. My weight is still 66 kg +/- not a lot, my diet is the same and exercise levels not changed. So, no question, for me, gliclazide was a key factor in getting my blood glucose into the sub "pre diabetes" levels.

Could I get them back down again without the medication? I doubt it. Not much room when it comes to losing weight, it would be a right fag to reduce my carbs to a lot less than the 100g/day I eat now and although there is room for a bit more exercise, that would mean a big change in routine which would be tricky as a carer and in any case is limited by my neurological problems..

I intend to keep going because I am sure at these levels I will still come in at under diagnosis level at my next HbA1c in a couple of months time.

Usual cavet.... this is about me and my version of T2 diabetes. There maybe others who might fit this pattern but they will be a select bunch. For the rest it just shows how important it is to look at your data as a whole and not focus on individual results.
 
Docb said:
Another graph for all you data fiends...
View attachment 19924

This is one of my standard plots, the readings taken over the last sixty days (the blue line) and the short term running average (the red line).

I stopped taking the gliclazide on 30 Dec and you can clearly see the effect on my blood glucose. Now it is generally always above 6, lots of 8's and a few 10's and above. The overall average has crept above 7. All other factors have not changed. My weight is still 66 kg +/- not a lot, my diet is the same and exercise levels not changed. So, no question, for me, gliclazide was a key factor in getting my blood glucose into the sub "pre diabetes" levels.

Could I get them back down again without the medication? I doubt it. Not much room when it comes to losing weight, it would be a right fag to reduce my carbs to a lot less than the 100g/day I eat now and although there is room for a bit more exercise, that would mean a big change in routine which would be tricky as a carer and in any case is limited by my neurological problems..

I intend to keep going because I am sure at these levels I will still come in at under diagnosis level at my next HbA1c in a couple of months time.

Usual cavet.... this is about me and my version of T2 diabetes. There maybe others who might fit this pattern but they will be a select bunch. For the rest it just shows how important it is to look at your data as a whole and not focus on individual results.
Click to expand...
This has been a really interesting thread, thanks
 
Kopiert said:
This has been a really interesting thread, thanks
Click to expand...
Thanks @Kopiert. I'll try to keep updating it. Beginning to get some ideas on the effect of gliclazide on waking and bed time readings and the influence it has on the time it takes to process carbohydrate sourced glucose.
 
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