- Messages
- 4,238
- Type of diabetes
- Type 2
- Treatment type
- Tablets (oral)
- Dislikes
-
Diet drinks - the artificial sweeteners taste vile.
Having to forswear foods I have loved all my life.
Trying to find low carb meals when eating out.
The hole in my bucket thing is because whichever wonder drug I look at can do all these terrific things for me, but there is just one minor thing..........which I seem to have.
[This is a long post, and may get longer as I find more information.]
https://pathways.nice.org.uk/pathways/type-2-diabetes-in-adults gives some guidance.
I expect to be at the "first intensification with Metformin combination therapy" as I am on 3 * 500 mg Metformin at the moment.
I could go to 4 * 500 mg but I have Stage 3(a)CKD and the extra Metformin might make that worse.
[..but there's a hole in my bucket....]
Sulphonylurea:
The first step after Metformin, in general, seems to be a sulphonylurea.
However there do seem to be a lot of choices.
There are also warnings about increased risk of hypos if you are eating low carbohydrate.
Which I am.
I note that the sub forum isn't very active.
How do I chose which of the many sulphonylurea drugs to take?
If, of course, there is one which works well with LCHF.
Gliptins/DPP-4 inhibitor:
Aloglyptin is listed.
"It may also cause joint pain that can be severe and disabling".
Lead me to it.
"Glucagon increases blood glucose levels, and DPP-4 inhibitors reduce glucagon and blood glucose levels. The mechanism of DPP-4 inhibitors is to increase incretin levels (GLP-1 and GIP),[2][3][4] which inhibit glucagon release, which in turn increases insulin secretion, decreases gastric emptying, and decreases blood glucose levels.".
That sounds as though it might be up my street; I think one of my main issues is too much glucagon; in the morning especially.
pioglitazone:
Not with diabetic ketoacidosis; but I have blood ketones in the 1s and 2s and have been up in the 4s when fasting.
"Common side effects include headaches, muscle pains, inflammation of the throat, and swelling.[2] Serious side effects may include bladder cancer, low blood sugar, heart failure, and osteoporosis.[2][1] Use in not recommended in pregnancy or breastfeeding.[1] It is in the thiazolidinedione (TZD) class and works by improving sensitivity of tissues to insulin.".
So it could reduce Insulin Resistance, which I assume that I still have. This would be a good thing.
However I think my main problem is too much Glucagon which inhibits insulin production so increased sensitivity may be of limited use.
(Gli)Flozins/SGLT2 inhibitors:
These seem to be only allowed if a sulphonylurea doesn't work or if there is a high risk of hypoglycemia.
The NICE page doesn't seem very keen on them.
LCHF may not play well with sulphonylureas, though.
Your friends will call you Sweet Pee.
You may get thrush.
Relies on the kidneys to shift sugar via the urine, and may confuse/delay the diagnosis of diabetic ketoacidosis (high BG and high ketones combined).
See also Stage 3(a)CKD.
A number of them are listed.
Again, which one?
Glutides:
Semaglutide looks interesting.
"Semaglutide is a glucagon-like peptide-1 receptor agonist. It increases the production of insulin, a hormone that lowers the blood sugar level.[8] It also appears to enhance growth of ß cells in the pancreas, which are the sites of insulin production.[9] On the other hand it inhibits glucagon, which increases blood sugar. It additionally reduces food intake by lowering appetite and slows down digestion in the stomach.[7] In this way it works in body fat reduction.".
All good, especially the enhancement of growth of beta cells.
Not keen on weekly injections, but I could stomach that (sorry!) if the results were really good.
https://www.diabetes.co.uk/forum/threads/semaglutide.166094/#post-2091128 considers some of the up and downsides.
The one major fly in the ointment is a slight increase in the risk of retinopathy.
However there are other glutides; so which one?
Probably not ones which require daily injections as I am a wimp.
[This is a long post, and may get longer as I find more information.]
https://pathways.nice.org.uk/pathways/type-2-diabetes-in-adults gives some guidance.
I expect to be at the "first intensification with Metformin combination therapy" as I am on 3 * 500 mg Metformin at the moment.
I could go to 4 * 500 mg but I have Stage 3(a)CKD and the extra Metformin might make that worse.
[..but there's a hole in my bucket....]
Sulphonylurea:
The first step after Metformin, in general, seems to be a sulphonylurea.
However there do seem to be a lot of choices.
There are also warnings about increased risk of hypos if you are eating low carbohydrate.
Which I am.
I note that the sub forum isn't very active.
How do I chose which of the many sulphonylurea drugs to take?
If, of course, there is one which works well with LCHF.
Gliptins/DPP-4 inhibitor:
Aloglyptin is listed.
"It may also cause joint pain that can be severe and disabling".
Lead me to it.
"Glucagon increases blood glucose levels, and DPP-4 inhibitors reduce glucagon and blood glucose levels. The mechanism of DPP-4 inhibitors is to increase incretin levels (GLP-1 and GIP),[2][3][4] which inhibit glucagon release, which in turn increases insulin secretion, decreases gastric emptying, and decreases blood glucose levels.".
That sounds as though it might be up my street; I think one of my main issues is too much glucagon; in the morning especially.
pioglitazone:
Not with diabetic ketoacidosis; but I have blood ketones in the 1s and 2s and have been up in the 4s when fasting.
"Common side effects include headaches, muscle pains, inflammation of the throat, and swelling.[2] Serious side effects may include bladder cancer, low blood sugar, heart failure, and osteoporosis.[2][1] Use in not recommended in pregnancy or breastfeeding.[1] It is in the thiazolidinedione (TZD) class and works by improving sensitivity of tissues to insulin.".
So it could reduce Insulin Resistance, which I assume that I still have. This would be a good thing.
However I think my main problem is too much Glucagon which inhibits insulin production so increased sensitivity may be of limited use.
(Gli)Flozins/SGLT2 inhibitors:
These seem to be only allowed if a sulphonylurea doesn't work or if there is a high risk of hypoglycemia.
The NICE page doesn't seem very keen on them.
LCHF may not play well with sulphonylureas, though.
Your friends will call you Sweet Pee.
You may get thrush.
Relies on the kidneys to shift sugar via the urine, and may confuse/delay the diagnosis of diabetic ketoacidosis (high BG and high ketones combined).
See also Stage 3(a)CKD.
A number of them are listed.
Again, which one?
Glutides:
Semaglutide looks interesting.
"Semaglutide is a glucagon-like peptide-1 receptor agonist. It increases the production of insulin, a hormone that lowers the blood sugar level.[8] It also appears to enhance growth of ß cells in the pancreas, which are the sites of insulin production.[9] On the other hand it inhibits glucagon, which increases blood sugar. It additionally reduces food intake by lowering appetite and slows down digestion in the stomach.[7] In this way it works in body fat reduction.".
All good, especially the enhancement of growth of beta cells.
Not keen on weekly injections, but I could stomach that (sorry!) if the results were really good.
https://www.diabetes.co.uk/forum/threads/semaglutide.166094/#post-2091128 considers some of the up and downsides.
The one major fly in the ointment is a slight increase in the risk of retinopathy.
However there are other glutides; so which one?
Probably not ones which require daily injections as I am a wimp.
