Gliclazide profile and blood testing for 88yo T2

[EllieM]

My 88 year old Dad has been T2 for about 10 years, last couple on gliclazide instead of metformin. He's always been told that T2s don't need to test but recently visited hospital for suspected heart attack after chest pains and came out with a meter and instructions to blood test. Of course, they did not tell him when they wanted him to test and he decided to leave it all for a couple of months till his annual 3 month visit to me (T1 daughter) in NZ.

Recent HbA1C is 54, which isn't outrageous and honestly, given his age, not something I would worry about too much. But he also wanted to lose some weight so going lower carb seems like a good idea and before arriving here he's given up on the potatoes and bread and had lost a small amount of weight (or at least waist line).

So, we're doing blood tests, mostly before meals but will move to some after meals to check how bad certain foods are. Lowest we've got is 5.5 and highest is 9, but they've drifted a bit lower on the slightly lower carb diet here compared to his home. I've only done one after meal test, and that was less than 2 above the pre-meal result, so I was pretty pleased.

My main question is does anyone know the time profile of gliclazide? I know it increases insulin production but not whether it's a 24 hour thing or a few hour thing - the nurse told him he could take 2 in morning and 1 at night (because that's when he takes his other pills) and he's tending to take his two at 7am, before getting up and breakfasting at 9am. So his relatively low before breakfast readings come two hours after taking the gliclazide. Now, as a T1, there's no way that I'd take bolus insulin 2 hours before breakfast but am assuming that gliclazide is more like a basal insulin?????

Help please.

 

[Jaylee]

Hi @EllieM ,

It's always tricky doing the right thing by close relatives & following their HCPs advice as a benchmark is always the right idea.
It's great he now has his own meter. Which most definatly should have been issued with the glick.
(Disclaimer; issued when initially diagnosed, T2 too..)

Don't quote me on this. But works by stimulating an exstra production of insulin in the pancreas when it would have been putting out anyway? To counteract insulin resistance..
So by my reckoning your dad's pancreas (with the help of glick.) may be dealing with liver dump in the time he's got up & ready for breakfast..? (Or even a higher than norm fasting BG for that matter.?)

But I'm only just surmising on the basis of a functioning pancreas with a "turbo charge" from glick.

Hopefully someone more informed will help..

 

[Daibell]

I think you will find Gliclazide works with a 10 hour period. If your Dad has insulin resistance thru excess weight, Gliclazide may not be helping that much in the same way IR affects the body's own insulin production. Carb reduction as usual is the key.

 

[EllieM]

Bumping this thread (should I start a new one?) because I am not quite understanding my Dad's response to low carb.
He's on a cocktail of meds (including pain meds) for other conditions and for the diabetes takes 3 * 80mg gliclazide, two in the morning. Because he takes pain meds with his morning pills he normally naps for 2 hours after taking the gliclzide and before eating breakfast.

His morning bg has come down drastically, so much so that it was 3.7/3.8 this am (we did the test 3 times). He was at 4.7 yesterday am. He's still at 7 or 8 before lunch, pre evening meal result is generally low 6s.

So, is the 3.8 because he took the gliclazide 2 hours before eating? Or have we gone too low carb for his meds? (And I know you can't advise on dosage but we are the other side of world from his DN and he won't be seeing her till March.) I could take him to see the emergency doctor for visitors here (and would before changing his meds) but they don't have his records so would like to do what I can first. And honestly, his lunch time reading is too high (in my opinion) to justify lowering medication, but want to understand why his morning reading is too low.

Food yesterday was
greek yoghurt and berries for breakfast plus a couple of white coffees, avocado vinaigrette for lunch plus beer and another coffee, stuffed olives for snack at tea time, chicken and nut salad for dinner plus 2 glasses of wine.

All I can think of that's different from his home diet (he'd already given up bread/potatoes/pasta/rice) is that his evening meal was probably lower in carb.... (He was buying Wiltshire farm foods frosen microwavable meals for his evening meal and their idea of low carb seems to be 30 or 40g....)

 

[Lally123]

Bumping this thread (should I start a new one?) because I am not quite understanding my Dad's response to low carb.
He's on a cocktail of meds (including pain meds) for other conditions and for the diabetes takes 3 * 80mg gliclazide, two in the morning. Because he takes pain meds with his morning pills he normally naps for 2 hours after taking the gliclzide and before eating breakfast.

His morning bg has come down drastically, so much so that it was 3.7/3.8 this am (we did the test 3 times). He was at 4.7 yesterday am. He's still at 7 or 8 before lunch, pre evening meal result is generally low 6s.

So, is the 3.8 because he took the gliclazide 2 hours before eating? Or have we gone too low carb for his meds? (And I know you can't advise on dosage but we are the other side of world from his DN and he won't be seeing her till March.) I could take him to see the emergency doctor for visitors here (and would before changing his meds) but they don't have his records so would like to do what I can first. And honestly, his lunch time reading is too high (in my opinion) to justify lowering medication, but want to understand why his morning reading is too low.

Food yesterday was
greek yoghurt and berries for breakfast plus a couple of white coffees, avocado vinaigrette for lunch plus beer and another coffee, stuffed olives for snack at tea time, chicken and nut salad for dinner plus 2 glasses of wine.

All I can think of that's different from his home diet (he'd already given up bread/potatoes/pasta/rice) is that his evening meal was probably lower in carb.... (He was buying Wiltshire farm foods frosen microwavable meals for his evening meal and their idea of low carb seems to be 30 or 40g....)

Hi Ellie. I take gliclazide but only one tablet 40mg and that's in the evening. I think it's peak action is 2-4 hrs after taking it. That's the case with me anyway, I check 2 hrs after, if it's 5 or less then I have about 20g of carb. Usually it's about 7 2hrs post then goes to 5 or 6 by 4 hrs. Couple of things with your dad though. As he's 88, his clearance is likely to be slower so it may hang around longer with him than it.does with me. My late dad was also 88 and lived with me for his last 6 months. He was on gliclazide 80mg once daily. 3 weeks before he died he had a seriously bad hypo, blood sugar was 1, took paramedics a good few hours to get it up above 5. His Dr said he had to stop gliclazide and said that generally they don't like giving it to elderly people, hypos can happen out of the blue. I wouldn't want that to happen.to your dad so personally I would be quite concerned at the high doses he has been given especially as his sugars are down in the 3s. Could you speak to your own Dr about him? My GP said also that they like the very elderly to run with a slightly higher blood sugar to avoid the risk of hypo because by the time they get to the grand old age of 88, a hypo is far more dangerous and life threatening than running a higher sugar level. Hope that helps. I will never know whether my dad's hypo was a symptom of his body beginning to fail or whether his death was triggered by the hypo and that haunts me that I should perhaps have taken it on myself to check his blood sugars, he was so very independent and had managed his own diabetes for over 50 years though and I didn't want to take everything away from him when he moved here

 

[EllieM]

Hi Ellie. I take gliclazide but only one tablet 40mg and that's in the evening. I think it's peak action is 2-4 hrs after taking it. That's the case with me anyway, I check 2 hrs after, if it's 5 or less then I have about 20g of carb. Usually it's about 7 2hrs post then goes to 5 or 6 by 4 hrs. Couple of things with your dad though. As he's 88, his clearance is likely to be slower so it may hang around longer with him than it.does with me. My late dad was also 88 and lived with me for his last 6 months. He was on gliclazide 80mg once daily. 3 weeks before he died he had a seriously bad hypo, blood sugar was 1, took paramedics a good few hours to get it up above 5. His Dr said he had to stop gliclazide and said that generally they don't like giving it to elderly people, hypos can happen out of the blue. I wouldn't want that to happen.to your dad so personally I would be quite concerned at the high doses he has been given especially as his sugars are down in the 3s. Could you speak to your own Dr about him? My GP said also that they like the very elderly to run with a slightly higher blood sugar to avoid the risk of hypo because by the time they get to the grand old age of 88, a hypo is far more dangerous and life threatening than running a higher sugar level. Hope that helps. I will never know whether my dad's hypo was a symptom of his body beginning to fail or whether his death was triggered by the hypo and that haunts me that I should perhaps have taken it on myself to check his blood sugars, he was so very independent and had managed his own diabetes for over 50 years though and I didn't want to take everything away from him when he moved here

Thanks for that, it was extremely helpful. I was happy that he wasn't getting any readings below 5 or above 9, but obviously this is no longer the case. I think his sugars were running a lot higher before he went lower carb at home and even lower carb with me. I think I'll get him into the out of hours gp, my gp won't see anyone who isn't registered there.