Should I start Gliclazide?

[Runboy]

Hi, any advice or thoughts would be appreciated. I've been diagnosed T2 for about 3 years now, started on metformin and my Hba1c was late 40s to early 50s. This crept up so I was put on Alogliptin but last bloods were about 97 so doctor has given me Glicazide (40mg) to take. I've never used a blood test meter and I have not changed my diet since my diagnosis - stupidly I've continued to eat and drink whatever I want, alcohol, chocolate, crisps, takeaways, the lot. That's a whole other issue but this latest blood result has given me the shock I need and I've started on a low-carb diet.

My question is should I see how my diet goes before starting the Glicazide? I don't know how the diet will affect my BG levels but now I have been given a meter I can check these at various times of the day and although I'm prescribed a low dose of Glicazide, with a low-carb diet, could I go too far the other way?

Should I give the diet a go and monitor BG levels for a few months before going ahead and starting Glicazide? I feel I've not been given a chance to get my levels down myself, although I appreciate I should have done this when diagnosed.

 

[miahara]

There are three factors that will impact on your BG level and their precise relationship and impact is difficult to determine

1. Carb intake.

2. Medication.

3. Exercise


Personally I’d have a try at controlling BG through diet (low carb) and exercise for a few months before adding medication if you find the former alone doesn’t do the job.

 

[Runboy]

Thanks @miahara, that's where I'm heading first to see what I can achieve under my own steam.

 

[cynetique]

I had to make a similar choice at the end of June.
I decided to monitor closely the evolution with a Libre continuous glucose monitor and see what would happen after a week, and then if the outcome was positive to see what happened after a month. So far so good after 4 weeks, let's now see what will happen after 3 months ; this coincide with my next A1c test.
Intermittent fasting/time-restricted feeding (fasting 18 hours a day, eating within a 6 hours window) seems to give good results for me so far. The approach is described in this article: https://clindiabetesendo.biomedcentral.com/articles/10.1186/s40842-020-00116-1
My only advice to you would perhaps be to discuss what you do with your physician first.

 

[LittleGreyCat]

I've never used a blood test meter and I have not changed my diet since my diagnosis - stupidly I've continued to eat and drink whatever I want, alcohol, chocolate, crisps, takeaways, the lot.

This will be why your Doctor (possibly with an inward sigh) ratcheted up the medication.

If you are going to radically change the way you eat (which sounds a good idea) and regularly test your BG to see which foods affect you most (which is truly excellent), then it may be OK to hold off on the gliclazide for a little while, but hold it in reserve if your BG isn't going down swiftly enough.
You can always take it for a few weeks then stop.
Do please keep your health care team informed.

 

[EllieM]

Welcome to the forums.

This crept up so I was put on Alogliptin but last bloods were about 97 so doctor has given me Glicazide (40mg) to take.

That's an average blood sugar of 14.9mmol/L so I can see why the doctor has prescribed gliclazide. Unfortunately, as you've just seen, if you don't modify your diet T2 tends to be a progressive disease.

Could you go too far the other way? Yes, it's possible for gliclazide to cause hypos (low blood sugar) and if you're taking it I would make sure you always have fast acting sugar (eg glucose tablets but jelly babies would do as well) to hand, just in case. Be aware that given your starting point you may get hypo symptoms at normal levels of bg just because your body is not used to those levels anymore - if you do a blood test you'll be able to tell. Once your levels have been normal for long enough these false hypos will stop.

It's your decision as to whether you take the drug or not, but be aware that your current levels are damaging your body, so you really need to do something to lower them. Normal levels for a non diabetic are mostly 4-8mmol/L . (And please keep your medical team informed.)

 

[VashtiB]

Agree with @EllieM . Your levels currently are a lot higher than desired and that's only the average so sometimes you may be even higher. Damage can start a lot lower than your current levels. If you really want to deal with this by diet you need to be committed. If you take the medication and go low carb at the same time you could go too low so follow Ellie's advice.

Keep your medical team informed- that's really important.

Good luck and welcome to the forum.

 

[Oldvatr]

I used Glic at max dose (320 mg) and Metformin 2000mg when I went LCHF, I did get hypo's on a few occasions, but they were mild because being T2D not on insulin, my body did moderate to compensate with a liver dump and anyway the glic is relatively quick to get excreted so I never needed any assistance. I had to be careful driving though, and was mindful of the DVLA guidelines which I followed. I also made sure I did not go to sleep with a low reading.

I am still on glic at 40mg, but have dropped the Metformin. I do not get hypos now. Glic is easy to adjust the dose anyway, and there are no withdrawal symptoms when you stop. I found it to be quite well-behaved and predictable. The one trick to remember is that glic only works while your body is demanding insulin after eating, so will not reduce bgl if you take it to lower a high bgl at other non-meal times. I take my dose about 30 mins before first bite to ensure my body is primed for the insulin demand.

 

[Laconic]

I was on it when first diagnosed at 110 HB1AC, I stopped taking it was making my sugars too low and causing blurred vision.

(edited by mod)

 

[Oldvatr]

If you go full keto and are only recently diagnosed T2D then if you can sustain keto as a permanent lifestyle, then this stands the best chance of remission with no medication. However, if you find going medium to low (non-keto) suits you better, then some medication may be necessary. I am a long-term abuser of sugar, and so I cannot maintain keto without meds.

(Edited by mod to reflect earlier edited post)