Type 2 A Huge Fright Just Now

[asparagusp]

Fasting breakfast today was 4.7 and two hours post breakfast with two consecutive readings, both 4.1 just now so I have taken a bite of a glucose tablet. This has never happened to me before and I find it so scary. I will take another reading in 15 minutes.

 

[asparagusp]

It's now gone up to 4.6 after the glucose. It looks as if I will have to reduce the Gliclazide to prevent going too low after breakfast.

 

[tim2000s]

@asparagusp Why do you need to reduce the Gliclazide? 4.1 to 4.6 is a perfectly normal range.

 

[Jaylee]

@asparagusp Why do you need to reduce the Gliclazide? 4.1 to 4.6 is a perfectly normal range.

She's on Lantus & metformin too...

 

[asparagusp]

This was a fall post breakfast of 0.6 heading towards a hypo. In the late afternoon in the last few days since changing to taking Lantus in the morning, I have been feeling extremely hungry when out.

 

[Jaylee]

This was a fall post breakfast of 0.6 heading towards a hypo. In the late afternoon in the last few days since changing to taking Lantus in the morning, I have been feeling extremely hungry when out.

"The late afternoon"? About "tea time"? What were your figures then...??

 

[tim2000s]

Let's put it a slightly different way @asparaagusp, you are quite unusual in that you are using Gliclazide, Metformin and Lantus together. Your glucose levels this morning, from what I can see were very good, and the blood test results you got were within the normal potential deviation of the meter you were using (0.6 change on 4.7 is 12.6% which is within the 15% tolerance) .

As a result, it's questionable as to what you saw. Was it:

1. An aberration in glucose readings emanating from the meter?
2. A sudden drop caused by Gliclazide before eating breakfast?
3. Normal deviation within blood glucose levels at a level that is normal?

The normal advice in T1 terms relating to seeing something that you've never seen before is not to change it after the first occurrence, and I think that applies here too. You only change it if there is a clear pattern with the same thing happening on multiple occasions. So as it stands, don't change the Gliclazide.

See what happens with the same breakfast on the next two days and make an assessment based on a fuller set of data rather than a knee jerk reaction to a one off, however disturbing it might have been for you.

 

[asparagusp]

What did you have for breakfast?

Lantus doesn't make you feel hungry as far as I'm aware.

The same as always - unsweetened organic cocoa made with semi skimmed organic milk. Usually the post breakfast readings are within range, never low like this. The late hunger though is since increasing Lantus dose to 8 units a week ago so yes perhaps it might be that but perhaps two I could decrease the Glaiclazide which I would prefer. I have emailed my nurse so I'll see what she says.

 

[asparagusp]

Let's put it a slightly different way @asparaagusp, you are quite unusual in that you are using Gliclazide, Metformin and Lantus together. Your glucose levels this morning, from what I can see were very good, and the blood test results you got were within the normal potential deviation of the meter you were using (0.6 change on 4.7 is 12.6% which is within the 15% tolerance) .

As a result, it's questionable as to what you saw. Was it:

1. An aberration in glucose readings emanating from the meter?
2. A sudden drop caused by Gliclazide before eating breakfast?
3. Normal deviation within blood glucose levels at a level that is normal?

The normal advice in T1 terms relating to seeing something that you've never seen before is not to change it after the first occurrence, and I think that applies here too. You only change it if there is a clear pattern with the same thing happening on multiple occasions. So as it stands, don't change the Gliclazide.

See what happens with the same breakfast on the next two days and make an assessment based on a fuller set of data rather than a knee jerk reaction to a one off, however disturbing it might have been for you.

Yes of course you are right, thank you. Yes it's scary though especially as I am on my own, (apart from the Forum!)

 

[asparagusp]

I really don't understand where you're coming from. 4.1 is not low. It's perfectly normal and definitely within range. If you'd dropped from say 7 to 4.1 I'd be concerned but not enough to change my meds straight away. I'd be looking for a pattern to the drops.

Sorry I have only just noticed your reply. My point is that I have never dropped post breakfast to what could have been a hyp. My fasting was 4.7. I took two post breakfast readings, both 4.1.

 

[Jaylee]

I really don't understand where you're coming from. 4.1 is not low. It's perfectly normal and definitely within range. If you'd dropped from say 7 to 4.1 I'd be concerned but not enough to change my meds straight away. I'd be looking for a pattern to the drops.

I have to admit I would be punching the air & dancing about like Kevin Backon in Footloose if I started my day with a "flat one" like that..?!

Of course I'd need to nip it up to 5 if I was driving.

 

[Juicyj]

I too would be pretty happy with that, however speaking from experience if i'd been running high then came down to 4.1 I would get fairly nervous about the possibility of dropping lower, however on the whole I really only start to press the panic button when I hit 3.8mmol/l.

 

[asparagusp]

Of course it was going to go up after a bite of a glucose tab.

Did you have any symptoms of a hypo?

Ah Mahola the fasting level was 4.7 then it fell to 4.1 then after the glucose, 4.6!! Thanks.

 

[Jaylee]

Ah Mahola the fasting level was 4.7 then it fell to 4.1 then after the glucose, 4.6!! Thanks.

I don't normally ask this of a fellow diabetic.. Could you check your blood sugars NOW please..
Scanning this thread.
I feel you are expressing a familiar behaviour associated with hypoglycemia..

 

[Jaylee]

Funny you say that. I was very confused so checked mine. I'm fine. The confusion is not down to a hypo. Phew.

I check out fine too!

However, I am genuinely concerned for @asparagusp 's.. One can loose a sense of time on a gadget & serious lows can creep up..

 

[asparagusp]

Thanks Guys for all your help. Very much appreciated.

 

[Daibell]

Hi. If you're worried about actually going hypo then agree with the GP to reduce the Gliclazide just a little?

 

[asparagusp]

Thank you. I had dropped the evening 1 tablet Gliclazide completely a couple of months ago when I was taking Lantus in the evening in an attempt to spare me these night time hypos so to me it makes sense to decrease the dosage, if this happens again after breakfast. I'm waiting for my nurse to reply yo my email. Thanks again.

 

[Indy51]

I find the concept of being on a sulfonylurea and insulin at the same time confusing as hell. Seems like a really odd combination for a HCP to recommend at all, especially if they haven't done a c-peptide test to check endogenous insulin. Wouldn't insulin by itself (with maybe metformin to reduce IR) be a simpler regimen to manage? Have you ever had a c-peptide test, @asparagusp?

 

[asparagusp]

I find the concept of being on a sulfonylurea and insulin at the same time confusing as hell. Seems like a really odd combination for a HCP to recommend at all, especially if they haven't done a c-peptide test to check endogenous insulin. Wouldn't insulin by itself (with maybe metformin to reduce IR) be a simpler regimen to manage? Have you ever had a c-peptide test, @asparagusp?

Sorry I have just found your post. Yes I had a c-peptide test in mid July. I'll find the result and post it later. Thanks for your very helpful answer..

PS I have just found this interesting bit of research saying Lantus and Gliclazide MR combination is better than twice daily mixed injections - https://www.ncbi.nlm.nih.gov/pubmed/25952634 I wonder too if I couldn't just have Toujeo as a substitute for both Lantus and Gliclazide as it lasts up until 36 hours?

What is IR?