Type 2, sugars suddenly gone high

[AKThree]

Hello all.

Just a quick question. So I'm writing this on behalf of a relative who isn't computer literate but wanted some advice. I realise you've got to go with what your doctor says but it would be interesting to know from people that also manage diabetes on their thoughts.

She is type 2 and it was generally well controlled for many years with 1000mg metformin twice a day and Glicazide 80mg twice a day. She wasn't checking sugars often but her regular bloods showed it was all in check.

Last year she was only taking metformin as adding glicazide was too much. Fast forward to this year and since Feb her blood sugars have been unstable. Her diet hasn't changed but her sugars were around 15mmol in the mornings, and near 20mmol two hours after meals and bed times. There has been some days where morning/fasting glucose levels have been 8-14mmol but other times its high. She has since been put back on glicazide and is now on 160mg twice a day (max dose). Some days it had normalised but most days it's gone back up, despite this increase.

The doctor says it's OK and all that matters is fasting results and blood tests which show a 3 months average (but that is high too). Just wanted to get some thoughts on this please as we never used to measure her sugars so stringently.

Her diet hasn't changed (and she is watching her carbs even more) and how she exercises hasn't changed (she still does her usual routine). Any advice to help bring back normality?

Thanks in advance

 

[EllieM]

Welcome the forums @AKThree
Well, the first thing to try is probably to look at how many carbs are in her diet and see if she can reduce them. That seems to help many of the T2s on here.

But there are some other possibilities
1) Has she had covid? Quite a few people seem to be having issues after a covid diagnosis. Not sure what the long term advice is on this, but it's a possible explanation for the rise.
2) Not that likely but likely enough to be worth consideration, particularly if the rise has coincided with weight loss and/or her diet is already fairly low carb. It's possible that she is a misdiagnosed slow onset T1 who has stopped producing enough insulin. She's need a cpeptide and GAD tests to diagnose this, and it's important, because if she is T1 she'll get very sick without insulin.
3) General illness, stress, medications (particularly steroids) can raise blood sugars.

 

[Andydragon]

Hello all.

Just a quick question. So I'm writing this on behalf of a relative who isn't computer literate but wanted some advice. I realise you've got to go with what your doctor says but it would be interesting to know from people that also manage diabetes on their thoughts.

She is type 2 and it was generally well controlled for many years with 1000mg metformin twice a day and Glicazide 80mg twice a day. She wasn't checking sugars often but her regular bloods showed it was all in check.

Last year she was only taking metformin as adding glicazide was too much. Fast forward to this year and since Feb her blood sugars have been unstable. Her diet hasn't changed but her sugars were around 15mmol in the mornings, and near 20mmol two hours after meals and bed times. There has been some days where morning/fasting glucose levels have been 8-14mmol but other times its high. She has since been put back on glicazide and is now on 160mg twice a day (max dose). Some days it had normalised but most days it's gone back up, despite this increase.

The doctor says it's OK and all that matters is fasting results and blood tests which show a 3 months average (but that is high too). Just wanted to get some thoughts on this please as we never used to measure her sugars so stringently.

Her diet hasn't changed (and she is watching her carbs even more) and how she exercises hasn't changed (she still does her usual routine). Any advice to help bring back normality?

Thanks in advance

Has she maintained the diet the same way through and is the diet quite high in carbs? Over time without dietary changes it is quite common for drugs to reduce impact leading to more drugs and eventually insulin especially if BMI could be improved or there is the potential for internal fat (TOFI - Thin outside, fat inside). There is a reason many medical professionals will say it's progressive, and that's because it can be without other improvements. Unfortunately NHS advice sometimes also helps contribute to that

As for the doctor saying it's okay, well unfortunately another facet of diabetic advice is that for older people, sometimes the levels doctors are happy with isn't as low as some of us would be happy with

Do you have a rough idea of how many carbs?

 

[Daibell]

Hi. The GP sounds a bit like mine and didn't really understand the possibility of LADA/T1. I would get the relative to ask the GP for the two tests for T1 i.e. GAD and C-Peptide. I was on 320mg Gliclazide (max dose) and it stopped working. That is the time to insist on the T1 tests. Can I just check your relatives BMI? If not overweight then the time has probably come to start insulin?

 

[Roggg]

The red flag for me is being well-controlled through the use of gliclazide. This is controlling the symptoms but not addressing the underlying cause. As far as I'm concerned, it's not a sustainable long-term state, and will generally result in a progression of symptoms eventually. That could be what's going on, or it could be something else. There really isn't enough info to go on. I feel like a good path to actually holding off progression (or even getting reversal) is in low carb eating. Intermittent fasting can boost those benefits as well.

As to the why in this case...It could be a natural progression of the disease, or it could be something else. The something else could be stress, or chronic illness. It could be issues with hormones. It could be type 1 / LADA coming on. It's hard to know. I hope she can get it sorted. Good luck.

 

[AKThree]

Welcome the forums @AKThree
Well, the first thing to try is probably to look at how many carbs are in her diet and see if she can reduce them. That seems to help many of the T2s on here.

But there are some other possibilities
1) Has she had covid? Quite a few people seem to be having issues after a covid diagnosis. Not sure what the long term advice is on this, but it's a possible explanation for the rise.
2) Not that likely but likely enough to be worth consideration, particularly if the rise has coincided with weight loss and/or her diet is already fairly low carb. It's possible that she is a misdiagnosed slow onset T1 who has stopped producing enough insulin. She's need a cpeptide and GAD tests to diagnose this, and it's important, because if she is T1 she'll get very sick without insulin.
3) General illness, stress, medications (particularly steroids) can raise blood sugars.

Thanks for the warm welcome and insight...great forum

So no, she hasn't had covid but has had her 1st vaccine (Astra Zeneca) and whilst things kind of changed at the same time it is not suspected to be the cause of this. She has lost weight as she was unwell due to gallstones but has gained weight but certainly not more than what she was on before. I don't know her actual carb intake but naturally she doesn't eat much carbs and sticks with three meals a day.

Other than blood pressure medications, she is not on anything else major.

I'll mention to push for those tests but at the moment her GP is busy so we've been told to wait.

I was however wondering, at the moment she takes glicazide in the morning and at night during her dinner (160mg both times). As it seems to spike after lunch, I'm wondering whether its possible to take 80mg in the morning, 80mg at lunch and then 160mg at dinner. We can't ask this with her GP as they don't have any availability at the moment but wondering if this helps balance things out (if it can be taken that way).

 

[bulkbiker]

naturally she doesn't eat much carbs and sticks with three meals a day.

Can you give us some meal examples so we can assess the carb intake?

Gliclazide forces the pancreas to overwork itself so it could be that insulin resistance has increased and the poor pancreas simply can't produce the extra required insulin or the medication can have broken it completely.

 

[AKThree]

Has she maintained the diet the same way through and is the diet quite high in carbs? Over time without dietary changes it is quite common for drugs to reduce impact leading to more drugs and eventually insulin especially if BMI could be improved or there is the potential for internal fat (TOFI - Thin outside, fat inside). There is a reason many medical professionals will say it's progressive, and that's because it can be without other improvements. Unfortunately NHS advice sometimes also helps contribute to that

As for the doctor saying it's okay, well unfortunately another facet of diabetic advice is that for older people, sometimes the levels doctors are happy with isn't as low as some of us would be happy with

Do you have a rough idea of how many carbs?

My understanding is she has reduced a considerably number of carbs and fat in her diet. She no longer eats oily food like chips / fries for example.

Yes I think the doctors saying its normal is potentially to do with age but from the research I've done for her those numbers still seem quite high.

I'll try and find out more on carb intake and update.

 

[AKThree]

Hi. The GP sounds a bit like mine and didn't really understand the possibility of LADA/T1. I would get the relative to ask the GP for the two tests for T1 i.e. GAD and C-Peptide. I was on 320mg Gliclazide (max dose) and it stopped working. That is the time to insist on the T1 tests. Can I just check your relatives BMI? If not overweight then the time has probably come to start insulin?

Thanks for the advice . I've noted those tests down for her so she can push for those. I'm not sure of her BMI but I do know that she was overweight but recently has lost weight to no longer to be considered overweight.

 

[AKThree]

The red flag for me is being well-controlled through the use of gliclazide. This is controlling the symptoms but not addressing the underlying cause. As far as I'm concerned, it's not a sustainable long-term state, and will generally result in a progression of symptoms eventually. That could be what's going on, or it could be something else. There really isn't enough info to go on. I feel like a good path to actually holding off progression (or even getting reversal) is in low carb eating. Intermittent fasting can boost those benefits as well.

As to the why in this case...It could be a natural progression of the disease, or it could be something else. The something else could be stress, or chronic illness. It could be issues with hormones. It could be type 1 / LADA coming on. It's hard to know. I hope she can get it sorted. Good luck.

Thanks for the advice. When you mean intermittent fasting, is this like actually skipping meals? She has significantly reduced the amount of snacking that used to happen between meals, but even then it used to be things like crackers or a banana or clementine.

 

[AKThree]

Can you give us some meal examples so we can assess the carb intake?

Gliclazide forces the pancreas to overwork itself so it could be that insulin resistance has increased and the poor pancreas simply can't produce the extra required insulin or the medication can have broken it completely.

Hi, sure I'll get some meal examples and update. I'm guessing there is alternative type 2 anti diabetic medications if that is the case right? She also takes metformin with it.

It is strange that she suddenly changed from having just 40mg to 160mg twice a day just like that.

 

[EllieM]

but even then it used to be things like crackers or a banana or clementine.

Those are all high carb snacks so it is possible that her insulin resistance has increased and she just can't cope with the carbs.

But recent weight loss is another red flag for T1/LADA and if she has that then she will need insulin, possibly sooner rather than later. I am concerned that her doctor won't see her.

I was however wondering, at the moment she takes glicazide in the morning and at night during her dinner (160mg both times). As it seems to spike after lunch, I'm wondering whether its possible to take 80mg in the morning, 80mg at lunch and then 160mg at dinner. We can't ask this with her GP as they don't have any availability at the moment but wondering if this helps balance things out (if it can be taken that way).

Interesting article here about time profile of gliclazide

Link 12a Guideline for Prescribing and Titrating Gliclazide Therapy.pdf (bucksformulary.nhs.uk)

It claims
Onset 1-2 hours Peak 4-6 hours Half-life 8-12 hours
and has a nice little graph showing its time profile. So I doubt that adding a lunch time dose would help the lunchtime readings. (Proviso, I am not a doctor, and we aren't allowed to recommend dosages on here.)

Her diet hasn't changed but her sugars were around 15mmol in the mornings, and near 20mmol two hours after meals and bed times.

Honestly, those readings are not OK and she needs more input from her GP. In the mean time, reducing the carbs in her mid day meal might lower the lunch time spike. (The T2s on here generally reckon that if the blood glucose 2 hours after a meal goes up by more than 2 then there is too much carb in the meal.)

Good luck.

 

[bulkbiker]

Hi, sure I'll get some meal examples and update. I'm guessing there is alternative type 2 anti diabetic medications if that is the case right? She also takes metformin with it.

It is strange that she suddenly changed from having just 40mg to 160mg twice a day just like that.

The best anti diabetic medicine for a T2 in my view is dietary change.
T2's have problems processing carbohydrates which is what leads to high blood sugars and all their associated problems.
By avoiding eating them as much as possible the high blood glucose and problems tend to go away.

 

[ianf0ster]

My understanding is she has reduced a considerably number of carbs and fat in her diet. She no longer eats oily food like chips / fries for example.

Yes I think the doctors saying its normal is potentially to do with age but from the research I've done for her those numbers still seem quite high.

I'll try and find out more on carb intake and update.

It's just the carbohydrates (from both starches and sugars) that a T2 needs to limit. Reducing the fat consumptions can lead to weight loss, but usually makes Blood Glucose control worse, because the fat is normally replaced by either carbs or by protein (which can also raise the Blood Glucose).
T2's shouldn't avoid traditional fats (even saturated ones, but 'vegetable Oils' which are actually highly processed seed oils are a different matter - so cutting out chips was probably a good idea for both carbs and seed oils.

 

[Roggg]

Thanks for the advice. When you mean intermittent fasting, is this like actually skipping meals? She has significantly reduced the amount of snacking that used to happen between meals, but even then it used to be things like crackers or a banana or clementine.

Intermittent fasting generally comes in 2 flavours... One is often called "time restricted", and we'll call the other one "alternate day" for lack of a better term.
Time restricted is, as you suggest "skipping meals". Or more accurately having a longer period each day when you dont eat. For example, I often do "20/4" which means I only eat during a 4 hour window each day. For me that means I eat between 3pm and 7pm. So "snacking between meals" is okay as long as it's not between your last meal today and your first meal tomorrow. If you are going to do "time restricted" eating, you can ease into it. Start with no snacking after dinner. That should get you to about 12/12. Skipping breakfast would be a good second step, and that gets you to about 18/6. You dont necessarily need to go as far as 20/4 to get benefits.

What I'm calling alternate day involves just not eating certain days, but eating normally (but preferably low carb) on other days. This can be harder to adjust to, but may yield faster improvements in blood sugars. Strictly speaking "alternate days" means eating every other day, but there are other patterns that people use. A lot of people use 5/2. This is eating 5 days a week, and fasting 2. Some people do the 2 together, and others split them up.

CAUTION: If you do any kind if intermittent fasting while on gliclazide, you run a risk of low blood sugar. Medical supervision is best, but if I couldn't have medical supervision, I would use keto/low carb to get off the gliclazide first before adding fasting.

Fasting works much like low carb works. By not eating carbs (or for IF, not eating anything) you give your body time to clear sugar from your blood, and then your insulin levels can drop. This can lead to using fat for fuel instead of sugar for a while which is really good for improving "insulin resistance" which is at the heart of most type-2 diabetes.

It's a lot to take in... I know. If you want to know more about fasting for type-2 diabetes, Dr Jason Fung literally wrote the book on it: "The Diabetes Code". In my experience, fasting really boosts the benefits of low carb eating for diabetes, but I do think that the low carb is the more important of the two.

 

[HSSS]

Hello all.

it was generally well controlled for many years .....her regular bloods showed it was all in check.

Last year she was only taking metformin as adding glicazide was too much. ....her sugars were around 15mmol in the mornings, and near 20mmol two hours after meals and bed times. There has been some days where morning/fasting glucose levels have been 8-14mmol but other times its high. She has since been put back on glicazide and is now on 160mg twice a day (max dose). Some days it had normalised but most days it's gone back up, despite this increase.

The doctor says it's OK and all that matters is fasting results and blood tests which show a 3 months average (but that is high too). Just wanted to get some thoughts on this please as we never used to measure her sugars so stringently.

Terms like well controlled, all in check and ok are subjective and different people will have vastly different ideas what levels constitute this, even drs. Numbers are what’s needed. Some drs are not overly ambitious about what’s ok. This may be because they are fatalistic and see progression as inevitable (which it usually is with that approach). It may be because there are other factors like advanced age or other health conditions, assumed quality of life v assumed dissatisfaction with interventions. If it’s different drs reviewing the same patient and similar numbers they may come to different conclusions about what’s ok and what’s required.

What do you mean glicazide was “too much” ? Did it cause hypos’s? A year between dose changes isn’t so sudden really, particularly if neither one is actually apparently at the needed level.

All of those readings are too high. And for a doctor to say otherwise is concerning. How high is the 3 month level (it’s called hb1ac) and when was it taken?

Diet wise it may be some things are being eaten that are being mistaken as low carb when they aren’t. Eg bananas and crackers. It happens a lot. This, aging, other illness, medications wringing out a struggling pancreas can all make the condition worse and require more intervention than before.

 

[pinkjude]

Thanks for the warm welcome and insight...great forum

So no, she hasn't had covid but has had her 1st vaccine (Astra Zeneca) and whilst things kind of changed at the same time it is not suspected to be the cause of this. She has lost weight as she was unwell due to gallstones but has gained weight but certainly not more than what she was on before. I don't know her actual carb intake but naturally she doesn't eat much carbs and sticks with three meals a day.

Other than blood pressure medications, she is not on anything else major.

I'll mention to push for those tests but at the moment her GP is busy so we've been told to wait.

I was however wondering, at the moment she takes glicazide in the morning and at night during her dinner (160mg both times). As it seems to spike after lunch, I'm wondering whether its possible to take 80mg in the morning, 80mg at lunch and then 160mg at dinner. We can't ask this with her GP as they don't have any availability at the moment but wondering if this helps balance things out (if it can be taken that way).

I rang my surgery and asked for a call from the diabetic nurse. She did ring back so you can try that and say you have several concerns

 

[AKThree]

Thanks for the replies.

So we finally spoke to a diabetic specialist who seemed to have actually listened to us. They suggested to start her on a small insulin that she takes once a day to normalise her sugars (this is alongside metformin and Glicazide). This is purely to get her sugars in check for now. I did ask for a GAD / C Peptide test that EllieM suggested and they said yep we will do that but the GAD test (is there a difference between the two?) and then review what to do.

Does that sound like a fair plan for her? For now she has to try diet control 'til she gets trained on her insulin which is in a few days time. Sorry for the elementary questions here, I am learning more and trying to help at the same time

 

[TriciaWs]

Until recently most doctors thought that type 2 was often a progressive disease, not realising that the diet they recommended was the problem. So cutting out sugar and chips is not enough for most of us as all carbs will be converted into sugars in our bodies, But the oil isn't a problem so we can eat unprocessed/lightly processed fats instead.
And just relying on a 3 month average doesn't tell us how many carbs we can eat in a meal and over a day. For that I bought a meter and tested before and 2 hours after meals for the first few months, then after introducing a new food plus a regular weekly check to see if it is changing.
I was lucky, I'd come across low carb eating from looking into the way my mother's t2 got worse and worse over the years as her eyesight failed and she could hardly feel her feet. So when I was diagnosed it was the kick I needed to sort my own diet out.