Time for 20mg of Glilazide?

B

Baldyman

New Member
Relationship to Diabetes
Type 2
Hello,I'm David,I was diagnosed with type 2 Diabetes last November with a finger prick reading of 20 mmol/l and HbA1c result of 114. I was prescribed Gliclazide 80mg tablets,one taken every morning after breakfast. With a modified diet my finger prick results,done at 5pm every day,quickly dropped to between 4.0 and 5.6. After experiencing dizzy spells after a few weeks and getting finger prick readings in the low 4's and a couple of 3.9's and 3.8's I asked to be put on 40mg of Gliclazide and things got better. However,over the last fortnight I have been experiencing dizzy spells,anxiety attacks,irritability and have been feeling sick. I am eating the same things at the same time but still have symptoms of low blood sugar,yesterday evening was particularly bad,very dizzy,felt really sick while out fishing,had a couple of boiled sweets and went home. Had a couple of sugar cubes when I got in as I felt dizzy again,had my tea and felt fine for the rest of the evening.
I have noticed as well,after taking my tablet,after breakfast,around forty minutes to an hour later I start feeling slightly dizzy,sick and anxious.
I realise you good folks are not doctors but I wanted to bounce this question off people who have Diabetes and understand.
Should I speak to a doctor and ask for my Gliclazide dosage to be reduced to alleviate the unpleasant problem?
 
Unfortunately there is no smaller dosage available than 40mg. I used to try to halve the dosage for morning/evening use but found the pills almost impossible to work with. So I sympathise. In the end I had to adapt my eating to ensure the tablet responded to the meal with the most sugar/carb content and limit the other meals.

You might be overdosing on sugar in trying to manage the levels. When I need to, I used to stop sugar and try to avoid the up/down spikes by eating some carbs or lower sugar fruit when needed. After a while the spikes calmed down to a gentler up/down rolling pattern. Then it's easier to introduce some variation.
 
Thank you for your reply Victor. Not good news there is no 20mg available,considered cutting a 40 in half but read somewhere you shouldn't as it affects the rate at which they dissolve. I carry boiled sweets and only eat them if I feel particularly weak and dizzy when out walking or fishing. I had the sugar cubes yesterday evening as I felt really bad.
Possibly fix the morning unpleasantness by having fruit(Blueberries,Raspberries) on my Shredded Wheat again? I used to,stopped a month or so ago as,to be honest,sick of them,and Shredded Wheat but have got to eat something in the morning. More for lunch maybe stop the late afternoon unpleasantness? Used to have Sourdough bread or Ryvita with Peanut butter(no Palm oil,just Peanut and a pinch of salt)or Marmite. Again,got sick of it,but I'm starting to realise my problems are self inflicted due to not actualy eating the same things I used to. Back to the old routine it is then and see if things improve.
Thanks again Victor,got me thinking along the right lines and realise I had made changes in my diet. David.
 
Thanks. If you are going to change your diet, maybe consider investing in a few months of a glucose monitor - e.g. Dexcom1+ or Libre2+. This way you will be able to see cause and effect on an hourly basis. Try halving the amount of Shredded Wheat you eat one day and see what happens. Substitute low carb biscuits for Sourdough and see what happens. Everyone's body reacts differently. I always used to have porage for brekkers. Wrong thing for me it turned out. I've also stopped bread.

I found in a diabetes book (Think Like a Pancreas) that the order of eating stuff affects the rate of absorption and therefore the peakiness of sugar response. Veg/Protein/Carbs/Sugar seems to be best. So now I eat some salad stuff for Bekkers and leave carbs till later (I also switched to low carb/low sugar cereals). Fruit always after other stuff so now it's cheese and then fruit. Never fruit by itself.

Having a monitor allowed me to see what all this does to the daily glucose trace and helped reduce my HbA1c from 96 in Jan to approx 40 today (plus 2x500mg Metformin and 40mg Gliclazide).

PS If you have a problem finding the carb content of foods, then try the Waitrose website. Most foods have sugar/carb %age listed. Sometimes content is also shown on a per portion or on a per 30gm quantity also. I only use the %age and then multiply by the grams to be eaten (helps that I have a postage meter !)
 
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Hi and welcome.

Well done on adjusting your diet and managing to reduce your medication as a result. What dietary changes have you made? Are you sure the dizziness and nausea are being caused by low BG and not low Blood Pressure?
Are you on any Blood Pressure medication? Following a low carb way of eating can cause people's Blood Pressure to drop and they can find that they are then over medicated for Blood Pressure too. Do your test your BP at home or just BG? That is something else to consider anyway, but you could also discuss stopping your Gliclazide altogether and see how you get on, as your levels are obviously nice and low now.

Do you also take Metformin? That could be making you feel nauseous? Different brands of Metformin can affect people differently and unfortunately pharmacists will shop around for the cheapest brand/make unless your prescription specifies a particular brand, so it could be that your Metformin, if you are prescribed it, has been changed to a different make and that is causing an adverse effect. You should notice if the packet looks different.
 
If I remember correctly gliclazide is a medication that encourages the pancreas to produce more insulin and as such it is necessary to eat some carbs in order for the medication to work correctly and it is usually taken 30 minutes before eating so you have insulin to deal with the carbs in your meal.
It could be therefore that if you take the medication at breakfast and don't have many carbs then your pancreas is producing too much insulin at the wrong time for the carbs you eat then so your blood glucose is going too low putting you in hypo territory.
You could discuss taking the medication before your meal with the most carbs which for many people would be dinner.
If you are having a low carb regime then remember it is not NO carb and the amount of carbs would be around 130g per day but only you will know how much you need to not get the hypo symptoms.
Have a look at this link for some ideas for breakfast and other meals. https://lowcarbfreshwell.com/
 
My personal experience is this : Taking Gliclazide at 6am and then eating carbs at 8am gives a high of 9.0 from a 5.6 start at about 10am. Taking Gliclazide at 6am and then eating salad etc at 8am gives a flattish response. Eating the carbs at 12am than gives no spike at 2pm.
 
victorhamesse said:
My personal experience is this : Taking Gliclazide at 6am and then eating carbs at 8am gives a high of 9.0 from a 5.6 start at about 10am. Taking Gliclazide at 6am and then eating salad etc at 8am gives a flattish response. Eating the carbs at 12am than gives no spike at 2pm.
Click to expand...
This link shows the profile of activity of gliclazide which might explain what you find.
 
So many replies,thanks to all. I will try to respond to all points raised,apologies if I miss one or two.
Glucose monitor:- Was offered one by Diabetic Nurse at first meeting but declined. Have read too many reports of inaccuracy.
Less Shredded Wheat and low carb biscuits:- Not keen on this,less carbs would surely make things worse.
Low blood pressure:- I monitor blood pressure at home,usually good with occasional slightly high readings. Nothing to worry about though.
Stopping my Gliclazide:- When I spoke to the Diabetic nurse about reducing from 80mg to 40mg because of dizzy spells/lowBG, she wanted to INCREASE to 120mg a day. She also claimed,in her notes,that my HbA1c result was 144 when the test result was 114. No confidence in her at all. The doctor I spoke to,who changed my prescription to 40mg was more interested in putting me on Statins to lower my Cholesterol,when I asked if test results showed high levels he told me my Cholesterol levels were fine but I should take Statins just in case. I declined. Not much confidence in him.
Metformin:- No Metformin,just Gliclazide.
Gliclazide encouraging insulin production:- You remember correctly,I was told to take it after breakfast not before. I had cut out fruit,Blueberries and Raspberries,with my Shredded Wheat so my carb/sugar intake was reduced which probably explains how I was feeling an hour after taking my tablet. Have to admit I did occaisonally skip lunch and just have a cup of tea and a couple of digestive biscuits,sometimes nothing at all,sometimes a Potnoodle,other times a cheese sandwich with granary bread. I don't think that helps either. Back on the sourdough from yesterday.
So,I have gone back to my "happy place" eating regime and will see if things get back to as they were before I sort of lost my way. I'll let you know in a week or so.
Thank you all for your input/advice and for making me realise I'd messed up.
 
Glucose monitors aren't completely accurate (they are allowed to be within 15% of actual blood glucose) but they allow you to see approximate rises from different meals to give you an idea of which meals are working best for your body, if you check your blood sugar before eating a meal then you hope that the rise 2 hours after the meal is within 2-3 mmol.

Having a blood glucose monitor is also essential if you drive and are having some hypo symptoms already. If you had a crash and were found to be hypo then you could be in trouble if you couldn't prove that had checked you weren't hypo before you started driving. (Though unless you have had hypos while driving you don't need to inform DVLA that you're taking glicazide as far as I am aware)
 
Baldyman said:
So many replies,thanks to all. I will try to respond to all points raised,apologies if I miss one or two.
Glucose monitor:- Was offered one by Diabetic Nurse at first meeting but declined. Have read too many reports of inaccuracy.
Less Shredded Wheat and low carb biscuits:- Not keen on this,less carbs would surely make things worse.
Low blood pressure:- I monitor blood pressure at home,usually good with occasional slightly high readings. Nothing to worry about though.
Stopping my Gliclazide:- When I spoke to the Diabetic nurse about reducing from 80mg to 40mg because of dizzy spells/lowBG, she wanted to INCREASE to 120mg a day. She also claimed,in her notes,that my HbA1c result was 144 when the test result was 114. No confidence in her at all. The doctor I spoke to,who changed my prescription to 40mg was more interested in putting me on Statins to lower my Cholesterol,when I asked if test results showed high levels he told me my Cholesterol levels were fine but I should take Statins just in case. I declined. Not much confidence in him.
Metformin:- No Metformin,just Gliclazide.
Gliclazide encouraging insulin production:- You remember correctly,I was told to take it after breakfast not before. I had cut out fruit,Blueberries and Raspberries,with my Shredded Wheat so my carb/sugar intake was reduced which probably explains how I was feeling an hour after taking my tablet. Have to admit I did occaisonally skip lunch and just have a cup of tea and a couple of digestive biscuits,sometimes nothing at all,sometimes a Potnoodle,other times a cheese sandwich with granary bread. I don't think that helps either. Back on the sourdough from yesterday.
So,I have gone back to my "happy place" eating regime and will see if things get back to as they were before I sort of lost my way. I'll let you know in a week or so.
Thank you all for your input/advice and for making me realise I'd messed up.
Click to expand...
If you drive you MUST have a monitor as you need to check your blood glucose before driving and your GP should have prescribed one and strips.
But even if you don't drive a monitor would keep you safe and allow you to make better food choices.
 
I reduced from a Hba1c of 91 down to the top end of normal just using diet and did it in 6 months without even trying all that hard - plus I lost loads of weight.
As you seem to be eating carbs to counteract the effects of the medication and wobbling a bit, maybe get a blood glucose tester and just use diet rather than be eating cereals, bread, noodles, biscuits and sweets to fight off hypos.
I've had 8 years of plain sailing since getting rid of the medication which was making me feel dreadful - I got to be suicidal in 5 weeks thanks to the side effects alone.
 
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