Off meds but BG is rising should I worry?

[miahara]

Over the past year my HbA1c improved and in September my GP reduced my Gliclazide by 50% and then last month, after discussion with me decided to stop medication. When back in September the dose was reduced my own BG readings showed a rise before falling and now I'm off meds completely my BG is showing a steep rise.
My questions are - Does coming off meds usually involve a rise and then fall in BG levels before the body gets used to the lack of medication. Should I worry? Should I wait a few weeks and hope my BG falls before seeing my GP again?
I'd love to be solely diet controlled, but half suspect I can't be!

 

[lovinglife]

I was like you and unfortunately I couldn't manage it- I ended up going back to 40mg gliclizide twice a day (I never dropped the met)

I don't want to discourage you and say it's a definite yes you will need to go back on, just giving my experience, I decided I wanted a lower Hb1ac with meds than a higher one without so spent a lot of time getting the balance of minimum meds and carbs.
Give yourself a chance it's early days - I tried for about 3 months but it just kept rising even on 20g carb - maybe try a bit longer see what happens

We would all like to manage without meds but for some it's just not possible- there's no shame in needing meds to keep you at good levels as you are proactive and understand your diabetes it's a tool in your arsenal

 

[hankjam]

The rise after coming down 50% appears to be similar to the current rise and I would suggest going from 100 to 50% is less profound (?) than going from 50 to 0%. Give it a little longer to see how it goes.
Have you changed your diet at all to accommodate the med changes? I don't know if that would be significant, just asking to understand how you've gone about dropping the meds.
Good luck.

 

[miahara]

The rise after coming down 50% appears to be similar to the current rise and I would suggest going from 100 to 50% is less profound (?) than going from 50 to 0%. Give it a little longer to see how it goes.
Have you changed your diet at all to accommodate the med changes? I don't know if that would be significant, just asking to understand how you've gone about dropping the meds.
Good luck.

Thanks @hankjam . My diet is pretty much the same LCHF that I've maintained for the past couple of years - can't cut carbs much more than I do already! I've an interim HbA1c test due in mid April so would like to hang off seeing my GP until then unless my own BG tests show BG continuing to rise over the next month or six weeks. As you say a 50% to zero reduction is more significant than the first 50% reduction.

 

[pleinster]

I'd give it a bit more time before deciding anything. We all differ, as you know, so it's impossible to predict how someone else will respond with any precision. I was placed on Gliclazide when diagnosed nearly three years ago but I chose to come off it to try managing my blood sugar purely through diet. I remember my levels went up for a week or so until thing settled...but I guess they would have stayed high had I not really cut the carbs. I see you are already on a low carb diet...so I might expect numbers to be a little higher than they were even when things settle. No-one can really say for sure, but if I were you, I would give it a wee bit more time while accepting that if the numbers are really high you may need to rethink unless you can cut the carbs a bit more. It's going to be purely about how high it gets. Cutting carbs right down is one thing, finding it sustainable is another...and some people really cope better on some meds. Keep trying but ultimately do what works. Good luck.

 

[Dark Horse]

Over the past year my HbA1c improved and in September my GP reduced my Gliclazide by 50% and then last month, after discussion with me decided to stop medication. When back in September the dose was reduced my own BG readings showed a rise before falling and now I'm off meds completely my BG is showing a steep rise.
My questions are - Does coming off meds usually involve a rise and then fall in BG levels before the body gets used to the lack of medication. Should I worry? Should I wait a few weeks and hope my BG falls before seeing my GP again?
I'd love to be solely diet controlled, but half suspect I can't be!

View attachment 25126

http://www.intranet.sheffieldccg.nh...scribing guidelines/T2 Glucose Management.pdf
The link above gives advice for when glicazide is discontinued due to low HbA1c and says that a rebound rise in blood glucose can occur:-

"The advice below is provided by Dr F Creagh, consultant endocrinologist, STH:  BE AWARE that on cessation of gliclazide, a rebound rise in glucose levels can sometimes be seen, which may be rapid and cause the patient to become very ill (hyperglycaemic hyperosmolar state).

Guidance for BG monitoring on cessation of gliclazide
1. Well patients in whom gliclazide is stopped because of low HbA1c

a. Consider substituting linagliptin* 5mg daily
b. Advise patients to make urgent appointment if osmotic symptom (thirst, polyuria),
c. Check random blood glucose 1- 2 weeks after stopping gliclazide; alternatively teach competent and willing patients to self-glucose monitor
d. Check HbA1c and review at 2 months
e. If patient self-monitoring, advise to make urgent appointment if BGs consistently in mid-teens or higher
f. For vulnerable/housebound patients ask district nurse team to check blood glucose at 1, 2 and 4 weeks"
​

As you are self-monitoring, note the advice for (e) above.

 

[david1968]

I think it's a case of keeping an eye on things and seeing what your longer term pattern's like.

I've been slowly reducing the amount of insulin I take (both basal and bolus) over the past couple of months, and for the last week I haven't been taking any bolus insulin at all. I've been trying to eat the same sort of meals each day to establish some base readings and whilst most of the readings have been within within acceptable levels (4.0 to 7.0 before eating and 4.0 to 8.5 two hours after eating) levels at the end of the week slighty higher than they were at the start of the week.

 

[ringi]

Given that Gliclazide tends to increase insulin resistance (and has risk of Hypos), I can think of many other drugs that you could talk to your GP about instead of going back on Gliclazide.

However, give it at least a few weeks, to see if your body sorts its self out. (Stopping the Gliclazide will be letting stored glucose out of your liver, but with low carb, you are not putting much back in the liver.)

 

[miahara]

Very many thanks to ALL who have replied. I now feel very much better informed and confident as to the way forward.
The Sheffield info link was particularly interesting @Dark Horse - thanks!

 

[JimPD]

Miahara
Have you tried Metformin or discussed it with your GP or DN as a possible alternative therapy?
I had a similar HbA1c as you at diagnosis and, like you, was given Gliclizide 80mg but I also got Metformin.
The potential for Hypos with Gliclizide scared me so I resolved to try and get off it.
After I was seeing decent BG levels (4-6 weeks on LC diet) I tried to drop the Gliclizide. After about a week, things had risen somewhat so I returned to a half-tablet (so 40mg/day) dose.
A few weeks later and after discussing with DN (who approved), I tried again and now haven't taken any since late November.
BG levels have continued to drop and my last HbA1c (mid Jan) was 37
I am now trying similar with Metformin - gone onto half dose (2x500mg/day) for about a week now and so far so good! Fingers crossed!

Best of luck
Jim

 

[Bluetit1802]

I hope it all works out for you @miahara

 

[miahara]

Miahara
Have you tried Metformin or discussed it with your GP or DN as a possible alternative therapy?
I had a similar HbA1c as you at diagnosis and, like you, was given Gliclizide 80mg but I also got Metformin.
The potential for Hypos with Gliclizide scared me so I resolved to try and get off it.
After I was seeing decent BG levels (4-6 weeks on LC diet) I tried to drop the Gliclizide. After about a week, things had risen somewhat so I returned to a half-tablet (so 40mg/day) dose.
A few weeks later and after discussing with DN (who approved), I tried again and now haven't taken any since late November.
BG levels have continued to drop and my last HbA1c (mid Jan) was 37
I am now trying similar with Metformin - gone onto half dose (2x500mg/day) for about a week now and so far so good! Fingers crossed!

Best of luck
Jim

Thanks Jim! I've not had any apart from one hypo with Gliclazide and that was a couple of years ago after a long flight and lack of food. My last chat with my GP when she stopped my GP she said if my BG rose there were other meds she'd try.

 

[nomoredonuts]

Hi @miahara I read this earlier on my phone app but couldn't chip in at the time.
I stopped Metformin early last year and then with a decent run of low blood pressure results, was able to persuade my GP into dumping my Bendroflumethiazide.
All was well until the new year when my blood sugar levels started to show the odd high level. My normal numbers hover between 5.3 to 6.5 and I was seeing high 7's and a freaky Christmas 8.6!
This week I've had two before-bed scores of 9.1 and I'm starting to be concerned. Am I no longer producing insulin? Am I now extremely carb-sensitive? Is this a very delayed Meformin-rebound?

 

[LittleGreyCat]

Hi @miahara I read this earlier on my phone app but couldn't chip in at the time.
I stopped Metformin early last year and then with a decent run of low blood pressure results, was able to persuade my GP into dumping my Bendroflumethiazide.
All was well until the new year when my blood sugar levels started to show the odd high level. My normal numbers hover between 5.3 to 6.5 and I was seeing high 7's and a freaky Christmas 8.6!
This week I've had two before-bed scores of 9.1 and I'm starting to be concerned. Am I no longer producing insulin? Am I now extremely carb-sensitive? Is this a very delayed Meformin-rebound?

One way to establish a bit more about what is going on is to have an insulin resistance test. However these aren't always available on the NHS.

As far as I can tell this helps by showing if you are a very low insulin producer or if you are producing loads of insulin but it isn't working properly.

 

[ringi]

Remember there are three ways to be a "very low insulin producer"

• Low Carb
• Type1, Type1.5, LADA
• Late stage of Type2 (unlikely with such good A1C in recent past)

Without "carbing up" for a few weeks before your test, I am not convinced how useful the test will be.

 

[acs1951]

I am in the same boat as my doctor has stopped my Gliclazide when readings were too low and hovering around 4. They went up to at least 6 or 7 for a week or two but qnow are down a lot and stable at about 5.7 before meals and about 7 a couple of hours later. I think give it longer and dont panic as I hope it will come down again to within a decent range. Good luck. ACS

 

[nomoredonuts]

@LittleGreyCat , a quick Google led me to the Medichecks, which in turn led me back to ... you and @ringi 's useful discussion here:
https://www.diabetes.co.uk/forum/threads/insulin-testing-which-tests-on-the-nhs.128969/
Quite interesting information.
I'll tag @bulkbiker to see how he got his blood sample. I don't know if my surgery would welcome my using the nurse's time.

 

[LittleGreyCat]

@LittleGreyCat , a quick Google led me to the Medichecks, which in turn led me back to ... you and @ringi 's useful discussion here:
https://www.diabetes.co.uk/forum/threads/insulin-testing-which-tests-on-the-nhs.128969/
Quite interesting information.
I'll tag @bulkbiker to see how he got his blood sample. I don't know if my surgery would welcome my using the nurse's time.

My surgery was very supportive.
Then again they have their own phlebotomist so the cost to them is minimal. All I take up is an appointment.

Somewhere there should be a link to a money off voucher as well, assuming it still works.

 

[nomoredonuts]

I do so like money off!

 

[Bluetit1802]

I'll tag @bulkbiker to see how he got his blood sample. I don't know if my surgery would welcome my using the nurse's time.

I believe @bulkbiker had his drawn at his surgery. I asked my DN at my last review. She had no idea if she could so went away to ask. She came back to say no, she couldn't do it because she wouldn't be insured if anything went wrong. That also applied if I had it done in the blood clinic at the same time as my HbA1c. She gave me the name of a local private GP who would do it for me. I haven't done it yet.

It won't tell you what you are hoping it might. It will only tell you if you have normal fasting insulin (akin to a non-diabetic) or high fasting insulin, which indicates insulin resistance. It won't tell you if your pancreas is wonky.

EDIT sorry ... I am talking about the fasting insulin test, not the insulin resistance test. Not sure what the difference is really.