I may need to increase my medication - gliclazide or straight to insulin?

[LittleGreyCat]

T2 diagnosed 2008.
Slim - I weigh around 11 stone 7 lbs (73 kilos) on a good day.
I am 6 foot tall (I may have shrunk to 5 foot 11.5 inches but in my mind I am still 6 foot).
My BMI is 21.8 so in the middle of the healthy range.
Last HbA1c (September 2025) 8.5%/69 mmol/mol

My current medication:

Metformin 2,000 mg split morning/evening
Allopurinol 200 mg (gout)
Forxiga/Dapagliflozin 10 mg (current pills are not Forxiga branded)
Vipidia 25 mg

My numbers are slowly getting worse.
I used to be able to include "treats" without my BG going haywire, but I have less capacity for this.
To get my HbA1c back to an acceptable level - below 7.5% - I may need to change my medication.

Noting that winter is always a bad time as my exercise drops right off.
Currently I manage only 1 or 2 walks per week and I can't cycle 20 miles every Wednesday because of the weather.
When I manage a cycle ride and more walks my numbers come down a bit but I don't want to have to exercise for 2 hours or more every day come rain or shine.
Who knows, as the days lengthen and the weather warms I may get my numbers back under control.

Anyway, I am looking at the next stage of medication.

I think this would normally be Gliclazide (which thrashes the remaining Beta cells) then Insulin.
I am wondering how long the Gliclazide is likely to be effective before it burns out my Beta cells and forces me onto Insulin, and if it would be more sensible to go straight to Insulin.
I don't want to go onto either of these drugs because of the potential for hypos, and the restrictions on driving.
However I may not have any choice.

Assuming anyone reading this has reached a similar stage, what can you tell me about your experience?

Did you take Gliclazide first?
If so, how long did your pancreas last, and did you have many hypos?

Were you advised to go straight to Insulin?

 

[Antje77]

Anyway, I am looking at the next stage of medication.

I think this would normally be Gliclazide (which thrashes the remaining Beta cells) then Insulin.
I am wondering how long the Gliclazide is likely to be effective before it burns out my Beta cells and forces me onto Insulin, and if it would be more sensible to go straight to Insulin.

We've had members being on gliclazide doing the job well for years, I don't think it's a given it'll burn out your beta cells. (But correct me if I'm wrong, the last time I did some serious studying on gliclazide was 9 years ago, when I was considering this as my preferred medication when still diagnosed as a T2.)

Even if it will burn out your beta cells and you'll end up on insulin, gliclazide may postpone this if you'd prefer pills and less hassle. The end result would be the same in this scenario, only at a later time.

I loved going on insulin (I was still very much believed to be a T2 at this time, in case you're wondering about cross posting) because it gave me a tool to directly control my numbers. But this only worked once my practice nurse agreed on prescribing me a mealtime bolus insulin in addition to my background basal of course. Basal insulin is much like gliclazide: daily dose needs to cover everything, your beta cells need to do the rest.
They both increase your circulating insulin. Gliclazide by increasing your output (if your beta cells are capable - mine weren't, wrong type of diabetes), insulin simply increases insulin levels by adding it.

No advice from me, medication advice is very much against forum rules.
I think there's something to say for both approaches, and a lot depends on personal preference.

 

[lovinglife]

I can’t advise what would be best for you @LittleGreyCat, but I was on max strength Gliclizide for the best part of 10 year until I came off it over a period of 6 months reducing my dose until I became diet only so don’t take the burn out of your beta cells as a given. It certainly didn’t do it for me.

 

[LittleGreyCat]

I can’t advise what would be best for you @LittleGreyCat, but I was on max strength Gliclizide for the best part of 10 year until I came off it over a period of 6 months reducing my dose until I became diet only so don’t take the burn out of your beta cells as a given. It certainly didn’t do it for me.

Thanks, very helpful.
If you came off it, was it because you had reduced your insulin resistance?
Which could imply that you were fully, perhaps over, producing insulin? So plenty of beta cells?
I think that I am under producing insulin with at most a small portion of insulin resistance. So weak/limited beta cells.

Please note I'm not asking for advice, just lived experience.

 

[LittleGreyCat]

We've had members being on gliclazide doing the job well for years, I don't think it's a given it'll burn out your beta cells. (But correct me if I'm wrong, the last time I did some serious studying on gliclazide was 9 years ago, when I was considering this as my preferred medication when still diagnosed as a T2.)

Even if it will burn out your beta cells and you'll end up on insulin, gliclazide may postpone this if you'd prefer pills and less hassle. The end result would be the same in this scenario, only at a later time.

<snip>
They both increase your circulating insulin. Gliclazide by increasing your output (if your beta cells are capable - mine weren't, wrong type of diabetes), insulin simply increases insulin levels by adding it.
<snip>

Thanks.
"if your beta cells are capable - mine weren't".
This is my concern.
I think I may possibly be slowly coming to the end of an 18+ year honeymoon period.

How did you confirm that you were LADA?
Antibody tests?
Or just Gliclazide failing to work effectively?

I may have a bit of a struggle getting antibody tests from the NHS at this point.

 

[lovinglife]

Thanks, very helpful.
If you came off it, was it because you had reduced your insulin resistance?
Which could imply that you were fully, perhaps over, producing insulin? So plenty of beta cells?
I think that I am under producing insulin with at most a small portion of insulin resistance. So weak/limited beta cells.

Please note I'm not asking for advice, just lived experience.

I’m not sure as I never had that tested. I did lose a LOT of weight, but I also reduced my carbs as I reduced my Gliclizide, I went from 130-140g carb a day to less than 20g carb a day so I think that was a big factor also.

Never managed remission which I think is bandied about a bit too easily, saying don’t eat carbs you’ll get non diabetic numbers doesn’t always correlate. I’ve never had lower than a HbA1c of 46 I think.

With my lived experience from Gliclizide, if in future I need something to help me then I’d go Gliclizide first before insulin. I was on insulin too for a very short time at the beginning & found the gliclizide much easier to manage, as long as I ate within 20 minutes of eating and had some carbs - my sweet spot was 25-30g a meal when on max dose - reducing down to 10-15g when I was on minimum dose until I stopped altogether. Hypos we’re not a regular recurrence, usually because I didn’t eat enough carbs or was late with my lunch, or did more exercise than expected

I took my doses with breakfast & evening meal

 

[Antje77]

Thanks.
"if your beta cells are capable - mine weren't".
This is my concern.
I think I may possibly be slowly coming to the end of an 18+ year honeymoon period.

How did you confirm that you were LADA?
Antibody tests?
Or just Gliclazide failing to work effectively?

I may have a bit of a struggle getting antibody tests from the NHS at this point.

My diagnosis story is a bit unusual.
I was diagnosed with default T2, which made sense being 39 and fat. I had 6 days between diagnosis and first appointment with practice nurse, and I used it to learn everything I could, and bought a meter to test 20 times a day to find patterns. So when I had the appointment I already knew my preferred course of action was gliclazide and lowering carbs.

After a month of upping the glic, lowering carbs, and fingerpricking like crazy, it was very clear that it didn't do the job, I never saw a number below 10 in that month, usually higher. I contacted the practice nurse to tell he my findings, and tell her I wanted to go on insulin.
I went on a basal insulin and quickly titrated up until my bg was nicely below 10, unless I ate something, and I asked for a mealtime bolus insulin after another month.
By that time I was suspecting I wasn't T2, but the practice nurse couldn't understand why (glic and LC not working, needing insulin very quick after diagnosis), and had never heard of a C-peptide or antibodies test.

Never mind, treatment worked a charm and I was a pretty happy diabetic. Also very happy with my practice nurse who was very much willing to work with me and not the other way around. A rediagnosis would mean switching to an endo who'd definitely know more but may have a very different bedside manner.

Fast forward 2 years, things were still going very well, but I had been self funding Libre for ages and it looked like funding might become available for T1s. This was the main reason to ask for a referral to an endo.
Nurse still though there was no way I was not a T2, but gave me the referral anyway.

Endo tested C-petide and anti GAD (but not the other antibodies).
C-peptide came back just below low normal, anti GAD negative.
I was rediagnosed T1 based on low C-peptide and clinical presentation - very quick succession to insulin after diagnosis, needing a mealtime insulin as well, even on LC, no results from glic, very little results from LC.

She did offer to test for the other antibodies if I really wanted it but I declined. If the information we had was enough for her (and insurance) to diagnose T1, it was enough for me.
It's not a 100% certain diagnosis though.

For me, the low C-peptide was the most important result, confirming I needed insulin. (If I hadn't already tried glic, this would have been reasonable too of course. But it was a relief to know I wasn't adding insulin while already overproducing.)

 

[Melgar]

@LittleGreyCat after 18 years of T2 diabetes it could be that your beta cells have depleted as your body’s ability to replenish the beta cells is insufficient. Beta cell dysfunction supersedes insulin resistance. Also as we age our beta cell mass may decrease and/or the glucose signalling is less efficient. T2 covers a wide range of glucose dis regulation. The need for insulin doesn’t mean it is caused by an autoimmune response to our insulin producing cells. Pancreas’s are not all super efficient.

I do not produce enough insulin, my C-Peptides are on the lower end of normal . If I eat a carby meal my insulin response is insufficient, not because of insulin insensitivity, I just don’t have enough insulin. I do produce a small amount of one of the known T1 types of antibody , hopefully it will remain just the one type.

If your beta cells have diminished through wear, then a C-Peptide test may not be insufficient I would have thought. Producing two or more antibody types would confirm LADA. GADA antibodies are produced in 80% of individuals with LADA (I’ll find the stats on that for you)
I have attached an interesting paper on beta cell depletion.

Beta Cell Dysfunction and Insulin Resistance - PMC

Beta cell dysfunction and insulin resistance are inherently complex with their interrelation for triggering the pathogenesis of diabetes also somewhat undefined. Both pathogenic states induce hyperglycemia and therefore increase insulin demand. Beta ...

pmc.ncbi.nlm.nih.gov

T1 and GADA antibodies

Latent Autoimmune Diabetes of Adults (LADA) Is Likely to Represent a Mixed Population of Autoimmune (Type 1) and Nonautoimmune (Type 2) Diabetes - PMC

Latent autoimmune diabetes of adults (LADA) is typically defined as a new diabetes diagnosis after 35 years of age, presenting with clinical features of type 2 diabetes, in whom a type 1 diabetes–associated islet autoantibody is detected. ...

pmc.ncbi.nlm.nih.gov

Edited to add paper on the prevalence of GADA antibodies

 

[EllieM]

I may have a bit of a struggle getting antibody tests from the NHS at this point.

Āny chance you could get a cpeptide test? That might at least tell you whether your problem is increased insulin resistance or decreased insulin production....

And for what little it's worth my T2 dad (now 95 but diagnosed 20 years ago) was on gliclazide for some years, (came off it after low carbing) and never had any hypo issues.

 

[LittleGreyCat]

Thank you all.
Very helpful.