Medication Reduction; Should I ask??

[akindrat18]

I am now back in my home town living with my parents and so far my blood sugars have been ok as they have been between 3.5 and 7.2 over the past week and my average is 6. Now last Thursday the diabetic nurse rang me up and told me that when I sign up with a gp at home, that I should ask the gp to be put on Victoza if I am still getting hypo's even though I am on 2000mg metformin, 320 mg gliclaizde and 10mg of ramipril a day. Last night I had to have a glass of pure orange juice, a double decker chocolate bar and a cup of tea with a teaspoon of sugar as my blood sugars was at 3.5 and then 4.7 and then down to 3.8 and up to 4.3. and finally to 7.6 and this morning i woke up from a hypo with a reading of 3.1

What should I do as I am confused on what to do.

 

[Spiker]

Sounds like it would be advisable to reduce the gliclazide. This is a generation 1/2 sulfonylurea so it stimulates insulin secretion. If you switch to Victoza (liraglutide) which is a GLP-1 agonist, you would probably also want to reduce the gliclazide, even if you weren't already having hypos. How long have you been on the ramipril? Is it precautionary or do you have signs of kidney problems? Ramipril is an ACE inhibitor and there are reports these can possibly potentiate (increase) the action of gliclazide.

Talk to your DSN about all this before changing doses by any significant amount.

 

[Daibell]

Yes, I agree with Spiker that you may need to reduce the Gliclazide. Do discuss this with the DSN. Victoza is normally given to those who are overweight, so if you are then do reduce the carbs if not already doing so. This may need an even further reduction in the Gliclazide? Yes, 10mg of Ramipril is quite high unless it is being prescribed for high blood pressure. I'm on 1.25mg as kidney protection as I have about normal blood pressure.

 

[akindrat18]

Sounds like it would be advisable to reduce the gliclazide. This is a generation 1/2 sulfonylurea so it stimulates insulin secretion. If you switch to Victoza (liraglutide) which is a GLP-1 agonist, you would probably also want to reduce the gliclazide, even if you weren't already having hypos. How long have you been on the ramipril? Is it precautionary or do you have signs of kidney problems? Ramipril is an ACE inhibitor and there are reports these can possibly potentiate (increase) the action of gliclazide.

Talk to your DSN about all this before changing doses by any significant amount.

I have been on ramipril for 3 months after advice from my gp as he found signs of protein in my urine and my bp was quite high. About a month ago I had the ramipril up to 10mg instead of 5mg as my bp was 136/70.

Yes, I agree with Spiker that you may need to reduce the Gliclazide. Do discuss this with the DSN. Victoza is normally given to those who are overweight, so if you are then do reduce the carbs if not already doing so. This may need an even further reduction in the Gliclazide? Yes, 10mg of Ramipril is quite high unless it is being prescribed for high blood pressure. I'm on 1.25mg as kidney protection as I have about normal blood pressure.

Well I am obese and since i've been back to my parents my blood sugars have dropped significantly and i'm not even low carbing as can't afford to low carb. I have had weetabix, rice crispies, a pie, white bread sandwiches, bologonese, a takeaway chinese, steak and chips with pasta n sauce, curry with rice, naan bread and chips.

This is not even including the easter eggs that I've had given to me and so far only had a mini one and still got 4 left.

 

[Daibell]

Wow. That diet is seriously bad for a diabetic. Not all low-carb foods are expensive. If your blood sugars are going down with Victoza that's good, but do see if you can tweak that diet.

 

[akindrat18]

Wow. That diet is seriously bad for a diabetic. Not all low-carb foods are expensive. If your blood sugars are going down with Victoza that's good, but do see if you can tweak that diet.

I am not on Victoza yet, my blood sugars are down to the metformin, gliclazide and ramipril.

 

[Spiker]

I am not on Victoza yet, my blood sugars are down to the metformin, gliclazide and ramipril.

I'm not T2 so I'm just guessing, but could your hypos be due to the combination of Easter eggs, white bread, and drugs? A strong insulin reaction to these very sugary foods, over amplified by the gliclazide + ramipril + metformin. Particularly if you were low carbing until recently, your insulin response and insulin sensitivity would both have improved.

A separate point - your family need to be 100% on side with not giving you things like white flour and Easter eggs. If they think that is a way of showing you love, then that's part of the problem. Loving you means not poisoning you, which is what is happening at the moment. If they just don't know what the right and wrong things are that you need to eat, please tell them. They can and should be a force that helps you to be healthier, not the other way around.

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[Spiker]

Wow. That diet is seriously bad for a diabetic. Not all low-carb foods are expensive. If your blood sugars are going down with Victoza that's good, but do see if you can tweak that diet.

In the light of the information about your diet I am changing my suggestion. The first priority should be to cut out all these high GI foods you have started eating and see if the hypos go away. Your hypos may be reactive hypos caused by high GI foods. Try this before altering any medication.

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[akindrat18]

I'm not T2 so I'm just guessing, but could your hypos be due to the combination of Easter eggs, white bread, and drugs? A strong insulin reaction to these very sugary foods, over amplified by the gliclazide + ramipril + metformin. Particularly if you were low carbing until recently, your insulin response and insulin sensitivity would both have improved.

A separate point - your family need to be 100% on side with not giving you things like white flour and Easter eggs. If they think that is a way of showing you love, then that's part of the problem. Loving you means not poisoning you, which is what is happening at the moment. If they just don't know what the right and wrong things are that you need to eat, please tell them. They can and should be a force that helps you to be healthier, not the other way around.

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My family is 100% behind me, I've already told them everything that they need to know and have been in contact with a relative in the family who is also diabetic and eats a moderate healthy diet. He has gone of his medication and treats himself at the weekend. My family though can't afford to pay for more food for me and my parents and sister are all carb junkies.

Also my parents and my sister all have different eating patterns; my dad and my sister rarely eat breakfast and lunch and when they do its all carbs, my mum on the other hand is different and she is always the main food shopper.

For tonight I'm having pork loin steak with potatoes, peas and sweetcorn with gravy, and my parents are sending me to get the food in plus bread, chips, beans, and biscuits. My parents said that from next week, getting food in will be difficult so will be living on basic foods.

 

[Spiker]

Ok understood. They still shouldn't be giving you Easter eggs.

There was a "low carb on £1/day" thread on here recently...

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[akindrat18]

Today I had a real shock as I was outside cutting the lawn and when i finished i felt a bit anxious and irritable. Then when I tested my BS it was really low at 2.7. I didn't take my morning medication as BS were 3.8 and had 4 weetabix biscuits with no sugar for breakfast instead of the normal 2 that I have. When lunch arrived I had a ham and tomato cheese bap and my BS after that was 5.4. I am now concerned and so are my parents as they don't want me to suffer a diabetic coma. I have a meeting with my new gp tomorrow at 3:00pm and i am worried what is going to happen tomorrow if i am prescribed victoza.

 

[Spiker]

Just be sure to get the doctor to reduce the gliclozide. That's what is probably what is causing the hypos.

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[akindrat18]

Just be sure to get the doctor to reduce the gliclozide. That's what is probably what is causing the hypos.

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Well I've had my gliclazide reduced down to one in morning and one in evening instead of two in morning and two in evening.