High in Mornings but very low late evening

[johnoo]

I am Type 2, last HBa1C 7.7, am on Metfomin 4@500mg & Gliclazide 3@80Mg per day.
I have very high BS before Breakfast circa 10/12 but it drops to very low circa 3.5 on occasions late evening.
Find that Porridge/Bread gives very high BS.
We eat a lot of fruit, mostly at lunchtime
Breakfasts vary between Fried or Kippers or Omelette.
Supper is generally home cooked food.
Like a glass of wine/Whisky but keep this to 3 evenings a week!
Monitor my BS 2/3 times per week or when I think I'm going into Hypo.

Does anyone suffer the same, high/low situation?

Any ideas as to how to even out the figures?

Thanks in advance

 

[johnoo]

Strange no replies, am I unique?

 

[scottish-jim]

I doubt if you're unique - hang on in there.

Some say it could be Dawn Phenomenom which I think is when the liver thinks you're hungry and produces blood sugar to compensate. I'm not sure!

I only test twice a day, unless I'm driving, and I get high readings in the mornings and lower at evening. My diabetes nurse finds this odd but I think it's due to me taking Quetiapine, an anti-psychotic tablet in my case used for depression.
Internet research shows the quetiapine can raise blood sugars. So I put it down to the tablets and if I medicate to combat the tablets I would surely hypo in the evening. I've asked for consideration to give me an alternative tablet.

So in answer to your questions:

Yes I do have highs and lows

I've no idea how to even out the figures unless you, like me, are taking other medication which may be effecting your blood sugars.

There is a similar topic here: http://www.diabetes.co.uk/diabetes-forum/viewtopic.php?f=15&t=39494

 

[pav]

I have recently switched to gliclazide 80 mg in the morning and found that my lows are around 2 pm, and if I have a omelette for tea it will cause another low around 11 pm, as a result I tend to have a slice or two of wholemeal bread with it.

I find white bread and cereals sends my BS levels sky high, I tend to eat some fruit though out the day an apple, 1/2 a orange, a banana 1/2 in the morning and 1/2 in the afternoon or night. Might have a banana sandwich at lunch or tea using one of the halves of the banana.

I have not had a drink since I was diagnosed 13 ish years ago, as alcohol can cause problems with BS levels, there are several threads on here about drinking.

As you are on gliclazide I think you need to test more often as gliclazide does reduce BS levels a fair bit, its brought mine down form the 20's to the 4's to the 8's with a few spikes in the 12's. I monitor mine very closely at the moment to find out what certain foods do and don't do and I am still in the learning curve of using gliclazide.

I test first thing in the morning and last thing at night as a minimum, this will tell me if I need to have a late snack in case what I had for tea was sufficient to last over night. The morning one will give me an indication of what my BS will be like by lunch time. My next important one is the pre lunch test as that will dictate what and when I need to eat as my lunch time varies greatly as can't easily have it at a set time. In all a min of 3 times a day but often I test more than that as I still need to working on foods I can't eat.

Also if you drive you need to be aware that DVLA requires you to test before driving and your BS must be a min of 5.0, then retest every 2 hours until your home or at your destination.

 

[johnoo]

Thanks for the replies & help.
Think I need to re-look at my testing procedures & timings.
Also because I have this high morning problem I am trying to control Blood Sugar measurements at 9 in mornings, 2 hours after Breakfast & 7 in the evening 2 hours after my meal.
Do you think this is a reasonable plan?

 

[pav]

Only going off the what I did, when starting on gliclazide I tested before breakfast (actually when I got up) then 2 hours after, repeated for the other meals and last thing at night.

Then when you know what your regular results are you may want to skip certain tests, like I have the same thing for breakfast every day. So as long as the morning readings are within my acceptable range, I don't do the 2 hours after test 95 %. The same will be for lunch. Though if any thing is different I will test accordingly.

Its really down to the individual and their results pattern, that can determine when to test. I am still getting caught out mainly with odd highs up to around 11.5 and working on what's causing them.

Then it comes down to driving, no matter when I have previously tested, I will test before driving so I have a record of my starting point, and if the reading is less than 5.0 will have a snack or some thing to boost my levels so while I am driving my levels will be above the min required.

If doing the big super market shop once I am back at the car I will retest to again check I am within the guide lines, though I have had a funny look off some one parked next to me. I now also carry sweets like fruit pastels or jelly babies, just in case I feel I need to give myself a little boost.

 

[johnoo]

Again many thanks & will take the advise.
But getting even more concerned/scared, this is last nights story:-
Had my tablets, 2 Metfomin & 1.5 Gliclazide & then had Supper, 2 hours after BS was 7.7
Sat down, relaxed & watched 2 hours of television, BS dropped to 2.8!
Had Mars bar & sandwich BS went up to 6.7
This morning tested before Breakfast BS was 8.5

Questions:-
1 Why the drop from 7.7 to 2.8 in about 2 hours?
2 Would a idea to correct be to increase Gliclazine in morning & reduce in the evening. IE I am taking 3 tablets a day, 1.5 morning & evening, would change to 2 morning & 1 in the evening even out results?
I know I could just try this, but advise would help

Thanks

 

[Daibell]

Hi. It could certainly be worth trying to adjust your Gliclazide. Apart from your overnight highs, which could be the Dawn Phenomenon, your figures tend to be quite good and I wonder whether reducing from 3 to 2 Gliclazide a day might be worth trying? One other thought is that there is a variant of diabetes called MODY where sugars fluctuate wildly. I wonder whether it's worth suggesting this to your Doc?

 

[johnoo]

Hi. It could certainly be worth trying to adjust your Gliclazide. Apart from your overnight highs, which could be the Dawn Phenomenon, your figures tend to be quite good and I wonder whether reducing from 3 to 2 Gliclazide a day might be worth trying? One other thought is that there is a variant of diabetes called MODY where sugars fluctuate wildly. I wonder whether it's worth suggesting this to your Doc?

Again thanks, am going away for short break, on return I will undertake a trial with Glicazide timings, will post results.

 

[dcoppard]

I also used to have very high readings in the morning compared to my 'normal' daily readings. It always used to annoy me intensely when I was doing the overnight fasting test. I would have a meal at 6 pm, test at 11 when I went to bed and had a normal 5.6. Next morning prior to my blood test I would test again and be about 10 or 11. My diabetic nurse thought that some people have hormonal changes overnight which can affect sugar levels and that it was also widely thought that the liver would pump out sugar especially when no food had been taken for any prolonged length of time. That why some of us have been told that's its better to eat small meals often rather than big meals less frequently.

Having said all that I don't now have much of a problem and my morning readings are always between 5 and 7, never above. I switched to a low GI diet which I stick to most of the time which helped. However probably the main reason its better is that I was put on insulin about two years ago and that, together with the metformin I still take has managed to stabilise my levels quite well. Obviously that's not a recommendation, just an observation

Anyway I think its worth having an experiment with the timings of your oral medication. I do know that gliclazide when I used to take it, could have quite a dramatic effect on levels so taking it later in the day might be worth a shot.

Incidently a glass of whisky or wine seems to lower my sugar levels and can be quite beneficial, (one or two only per night). :wink:

Good luck

 

[terryhalford]

I experienced a rapidly dropping BS level in the mornings when I first started using diet control on my diabetes I.E. This then changed to high readings before breakfast. I am fairly certain that this was due to my eating apples in the evening giving 'slow release sugars time to enter my bloodstream by morning, stopping eating apples returned me to lower 'fasting' readings. check your evening foods - are you eating 'slow release' foods.

 

[terryhalford]

Reading the comments listed here some of you seem unaware of the action of Metformin and Gliclazide.Metformin only works if your BS is above a certain level. Gliclazide will reduce BS no matter how much sugar is in the blood. Taking 2 Gliclazide in one dose could reduce BS by as much as 10%. Therefore you could 1. have a hypo 2. drop your BS to what seems a 'good' level but the action from your food will allow it to rise from this low level once achieved. to understand BS readings therefore needs to take this into account . 6 months ago I was on 4 Gliclazide, 4 Metformin and 1 Sitaglyptin a day. Using Dietary control and finger prick readings I was able to prevent Hypos, lose 4 stone in 4 months ( a secondary effect of sugar intake reduction) and no longer need any Gliclazide or Sitaglyptin I only take one Metformin every few days if I have been unable to resist eating rounds of sourdough bread with 'low' sugar jam on it. Recent tests show E.C.G. on my heart - perfect, lungs - perfect, cholesterol levels - perfect, blood pressure - perfect, hgba1c test dropped from 11.1 to 6.1 (I am expecting much lower results at next test) This can be done by anyone BUT I MUST STRESS THAT YOU NEED TO UNDERSTAND THE ACTION OF GLICLAZIDE ON ANYONE UNDERTAKING A LOW SUGAR DIET. IF YOU REDUCE YOUR SUGAR INTAKE YOU MUST REDUCE YOUR GLICLAZIDE TO PREVENT HYPOs !
I used the G.L. glycaemic level of foods to keep my sugar low and reduced my GLICLAZIDE tablets until I no longer needed them, then began to reduce my Metformin. I MUST ALSO STRESS THAT AS MY B.S. BEGAN TO STABILISE THE SIDE EFFECTS FROM OTHER TABLETS BECAME MORE PROMINENT, SO LIAISE WITH YOUR DOCTOR FREQUENTLY - ALSO BE AWARE THAT MY OWN DOCTOR FAILED TO RECOGNISE THE EFFECTS OF A LOW SUGAR DIET. IF YOU HAVE TROUBLE SWALLOWING IT IS CAUSED BY SITAGLYPTIN.
THIS CAN BE VERY SERIOUS AS IT CAN RESULT IN YOU BEING UNABLE TO GET AIR INTO YOUR LUNGS UNTIL THE FOOD OR WATER CAN REACH YOUR STOMACH. In short if you are serious about a low sugar diet YOU MUST REDUCE YOUR SUGAR REDUCTION TABLETS - TAKE FINGER PRICK TESTS BEFORE AND AFTER YOUR MEALS AND IF NECESSARY REDUCE THE QUANTITIES UNTIL THE G.L. GIVES YOU READINGS THAT YOU FIND SATISFACTORY (G.L. 10 = LOW. G.L. 11-19 = MED. ABOVE = HIGH) GOOGLE GLSHREDDED WHEAT WILL GIVE YOU GL OF 22(high) ETC. YOU WILL FIND THAT 30g (two heaped tablespoons) SCOTS PORRIDGE OATS gives a G.L. of 8 o.k. to have as breakfast. Once you do this to all of your food you can reduce your finger prick testing to very occasionally. KEEP A GRAPH OF ALL OF YOUR READINGS YOU MAY BE STUNNED BY THE SWING BETWEEN READINGS BEFORE AND AFTER EATING AND TAKING GLICLAZIDE YOU WILL COME TO REALISE HOW DOCTORS USE IT UNSCIENTIFICALLY TO SMASH DOWN YOUR B.S. WHILST YOU MAY BE BLINDLY RAISING IT WITH THE FOOD YOU EAT. GOOD LUCK ---- TAKE CARE WITH ANYTHING I HAVE WRITTEN --- MONITOR EVERYTHING ------

 

[terryhalford]

Reading the comments listed here some of you seem unaware of the action of Metformin and Gliclazide.Metformin only works if your BS is above a certain level. Gliclazide will reduce BS no matter how much sugar is in the blood. Taking 2 Gliclazide in one dose could reduce BS by as much as 10%. Therefore you could 1. have a hypo 2. drop your BS to what seems a 'good' level but the action from your food will allow it to rise from this low level once achieved. to understand BS readings therefore needs to take this into account . 6 months ago I was on 4 Gliclazide, 4 Metformin and 1 Sitaglyptin a day. Using Dietary control and finger prick readings I was able to prevent Hypos, lose 4 stone in 4 months ( a secondary effect of sugar intake reduction) and no longer need any Gliclazide or Sitaglyptin I only take one Metformin every few days if I have been unable to resist eating rounds of sourdough bread with 'low' sugar jam on it. Recent tests show E.C.G. on my heart - perfect, lungs - perfect, cholesterol levels - perfect, blood pressure - perfect, hgba1c test dropped from 11.1 to 6.1 (I am expecting much lower results at next test) This can be done by anyone BUT I MUST STRESS THAT YOU NEED TO UNDERSTAND THE ACTION OF GLICLAZIDE ON ANYONE UNDERTAKING A LOW SUGAR DIET. IF YOU REDUCE YOUR SUGAR INTAKE YOU MUST REDUCE YOUR GLICLAZIDE TO PREVENT HYPOs !
I used the G.L. glycaemic level of foods to keep my sugar low and reduced my GLICLAZIDE tablets until I no longer needed them, then began to reduce my Metformin. I MUST ALSO STRESS THAT AS MY B.S. BEGAN TO STABILISE THE SIDE EFFECTS FROM OTHER TABLETS BECAME MORE PROMINENT, SO LIAISE WITH YOUR DOCTOR FREQUENTLY - ALSO BE AWARE THAT MY OWN DOCTOR FAILED TO RECOGNISE THE EFFECTS OF A LOW SUGAR DIET. IF YOU HAVE TROUBLE SWALLOWING IT IS CAUSED BY SITAGLYPTIN.
THIS CAN BE VERY SERIOUS AS IT CAN RESULT IN YOU BEING UNABLE TO GET AIR INTO YOUR LUNGS UNTIL THE FOOD OR WATER CAN REACH YOUR STOMACH. In short if you are serious about a low sugar diet YOU MUST REDUCE YOUR SUGAR REDUCTION TABLETS - TAKE FINGER PRICK TESTS BEFORE AND AFTER YOUR MEALS AND IF NECESSARY REDUCE THE QUANTITIES UNTIL THE G.L. GIVES YOU READINGS THAT YOU FIND SATISFACTORY (G.L. 10 = LOW. G.L. 11-19 = MED. ABOVE = HIGH) GOOGLE GLSHREDDED WHEAT WILL GIVE YOU GL OF 22(high) ETC. YOU WILL FIND THAT 30g (two heaped tablespoons) SCOTS PORRIDGE OATS gives a G.L. of 8 o.k. to have as breakfast. Once you do this to all of your food you can reduce your finger prick testing to very occasionally. KEEP A GRAPH OF ALL OF YOUR READINGS YOU MAY BE STUNNED BY THE SWING BETWEEN READINGS BEFORE AND AFTER EATING AND TAKING GLICLAZIDE YOU WILL COME TO REALISE HOW DOCTORS USE IT UNSCIENTIFICALLY TO SMASH DOWN YOUR B.S. WHILST YOU MAY BE BLINDLY RAISING IT WITH THE FOOD YOU EAT. GOOD LUCK ---- TAKE CARE WITH ANYTHING I HAVE WRITTEN --- MONITOR EVERYTHING ------

 

[sujeet]

Does Metformin HCL cause increase in hyper acidity. Though my BG is within control but Metformin causing problems.

 

[terryhalford]

I am not aware that metformin may be responsible for hyper acid reflex, I am not really aware of what this is, but at one time I suffered from what I called bile being brought up from my stomach into my throat. i NOW RECALL THAT IT WAS DUE TO A REACTION AGAINST ME GIVING UP EATING BREAD MADE FROM WHEAT AND EATING ONLY TESCO's RYE BREAD. WHEN I STOPPED EATING RYE BREAD THE PROBLEM DISAPPEARED. i NOW EAT ONLY SOURDOUGH BREAD -- SO FAR NO PROBLEM

 

[johnoo]

Hi. It could certainly be worth trying to adjust your Gliclazide. Apart from your overnight highs, which could be the Dawn Phenomenon, your figures tend to be quite good and I wonder whether reducing from 3 to 2 Gliclazide a day might be worth trying? One other thought is that there is a variant of diabetes called MODY where sugars fluctuate wildly. I wonder whether it's worth suggesting this to your Doc?

Again thanks, am going away for short break, on return I will undertake a trial with Glicazide timings, will post results.

As stated in a previous post I was going to experiment with taking Gliclazide at different times & in different dosages.

The trial Timings & dosages were as follows
a) 1.5 tablets with Breakfast & 1.5 tablets with Supper
b) 1 tablet with Breakfast & 2 Tablets with Supper
c) 1 tablet with Breakfast, 1 tablet with Supper & 1 tablet late at night
d) 0 tablets at Breakfast, 1 Tablet with Supper & 2 tablets late at night.
Any comments?
Any comments?
The following are the average BS results before Breakfast & Supper for these trials, 4 tests were taken for each trial
a) Average 10.88 6.68
b) Average 10.10 5.90
c) Average 8.95 5.40
d) Trial stopped as I had Hypo in early hours of morning

Therefore I am keeping to taking the tablets as shown in trial c) which seems to give the best results

 

[terryhalford]

GLICLAZIDE IS A SUGAR DESTROYER AND SHOULD NOT BE TAKEN LATE IN THE DAY, AS YOU HAVE FOUND OUT YOU ARE ALMOST CERTAIN TO GET A HYPO DURING THE NIGHT THIS IS CONSIDERED TO BE DANGEROUS. SEE MY COMMENTS ELSEWHERE ON THIS SUBJECT. For further information METFORMIN & GLICLAZIDE are designed to control sugar levels raised by eating carbohydrates when the PANCREAS is no longer able to handle it. The effect of the tablets on sugar levels therefore depends how much you eat and the starting point of the sugar peak when you take the tablets. Blood sugar levels cannot be seen as a smooth running controllable river, you will get severe peaks and troughs caused by food (highs) and tablets (lows) The only way to be certain is to take B.S. readings before and two hours after meals to understand the effect of the food you are eating, even this can be difficult as you have to understand the effect of the tablets you are taking on the sugar levels when you take the tests. However it can be done! Common sense should tell you therefore that METFORMIN & GLICLAZIDE should be taken at the same time as taking food. Also you should come to realise that the only way to control sugar levels is to reduce the amount of sugars that you eat. The prescribing of GLICLAZIDE should be seen as a desperate act by a doctor to reduce your sugar levels. The more you have to take only shows that you are failing to control your intake effectively. You may eventually end up having to inject insulin if you do not. sugar sources are :- 1. STARCH (WHEATFLOUR { bread, cakes, biscuits, potatoes, rice,] I eat only SOURDOUGH BREAD (ASDA - SAINSBURY's - TESCO)and only scots porridge oats (ASDA 65p per 500 gms NOT QUAKER OR OTHER PORRIDGE OATS) The description Scots or Irish is important 2. SUGAR ( grapes, raisins, confectionery - I eat only low calorie granulated sweetener which is made from sugar but has only 2 calories and NO SUGAR ( ASDA) 3 CARBOHYDRATES ARE THE SOURCE OF SUGAR SO MUST BE TAKEN INTO CONSIDERATION 4 Fruit contains fructose a form of sugar considered to be 'safe' as it is slow acting and gives the pancreas time to deal with it, However if you are on GLICLAZIDE it is unlikely that your pancreas CAN deal with it (an Apple has a Glycaemic Load of 6 = low, O.K. to eat but two = 12 = medium and has to be taken into account if your body cannot deal with it as your B.S. will be raised by it. Some of this may seem drastic to some of you BUT IT IS OF COURSE FOR YOU TO DECIDE WHAT YOU WANT AS YOUR FUTURE. Two days ago I stood behind a YOUNG woman buying a cup of coffee, who had also bought a sticky, delicious looking, iced bun who told me that she was now on insulin injections. - Was I surprised by this - no. If you decide to reduce your sugar intake you do not have to stop eating all of the above immediately as this may be difficult and DANGEROUS. Your body needs sugar, especially your brain,so you cannot stop taking sugar completely. A HYPO Is your brains way of shutting down your body so that it can take whatever sugar is available. IT IS NOT OVERLY DRAMATIC TO SAY THAT YOUR BRAIN IS SAYING 'HELP ME I'M DYING'. - The comments I have posted are all based on my personal experience and the many books I have read on the subject. I'm sorry that they are disjointed but I hope that you are able to use any information carefully. - I WILL REPEAT - TAKE CARE - FOR SAFE RESULTS USE A BLOOD SUGAR MONITOR - ONCE YOU COME TO UNDERSTAND WHAT YOU ARE DOING IT IS EASY --

 

[johnoo]

GLICLAZIDE IS A SUGAR DESTROYER AND SHOULD NOT BE TAKEN LATE IN THE DAY, AS YOU HAVE FOUND OUT YOU ARE ALMOST CERTAIN TO GET A HYPO DURING THE NIGHT THIS IS CONSIDERED TO BE DANGEROUS. SEE MY COMMENTS ELSEWHERE ON THIS SUBJECT

Would you please direct me to your comments, thanks J

 

[pav]

GLICLAZIDE IS A SUGAR DESTROYER AND SHOULD NOT BE TAKEN LATE IN THE DAY, AS YOU HAVE FOUND OUT YOU ARE ALMOST CERTAIN TO GET A HYPO DURING THE NIGHT THIS IS CONSIDERED TO BE DANGEROUS. SEE MY COMMENTS ELSEWHERE ON THIS SUBJECT

Would you please direct me to your comments, thanks J

You can see all the posts that terry has made here, search.php?author_id=69048&sr=posts

 

[Neil Walters]

I take my 2no 80mg gliclazide 2 hours before my breakfast and since I have been doing that (nearly two weeks) there has been a transformation on my BS control.


Diagnosed type II 1998 2 x 80 mg Gliclazide, 4 x 500mg Metformin and 1 x 100mg Sitagliptin