Type 2 Advice on reducing insulin and or Glicaside first

[poemagraphic]

My question is about reducing my insulin intake and or reducing my Glicaside tablets.

I first started taking insulin 4 weeks ago after being admitted to hospital with a virus.

The consultant noted my highly elevated BG levels and was aware that I was taking 1000mg Metformin twice a day = 2000mg
He told me he was taking me off Metformin with immediate effect and replaced it with 10 units of insulin once a day at 22:00
Plus 80mg of Glicaside twice a day, one in the morning and one in the evening.

Within the first couple of weeks I was getting readings regularly during the day of below 4.
As I drive for a living I was concerned that at these levels I would have to keep on stopping and eating 4 jelly babies then wait 20mins then eat a couple of Rich tea biscuits... Mmmmm Jelly babies!

Also 2 hours after my evening meal (Almost time for bed) ... I was constantly getting readings below 8. I WAS TOLD...
"You MUST be above 8 before going to bed if you are below 8 You should eat 2 or 3 Rich Tea Biscuits and wait until your readings have risen above 8"

WHAT? This seemed counter productive.

I dropped my insulin to 8 on the second week and again to 7 on the third week. So a 30% reduction in 3 weeks!

I am still hitting low readings at night 5-6 often.... After reading several threads on this 'great site' by helpful, knowledgeable experienced, and informative posters. I now 'just' go to bed. I always wake up for a wee at some point so I take another reading to see how low I have dropped. As a rule I have not dropped at all.

NOW! My the reason for my question about what to reduce; Insulin and or Glicaside is to see if any members have any insight
about dropping their meds/insulin levels.

I am reluctant to ask the DN as she has said that I should be aiming for 60 - 80 gm of carbs per meal. I am eating half that amount, aiming currently for around 100gm per day.

However I am thinking more and more that I will begin a stricter LCHF diet ASAP.

The results many members have achieved here is testament enough to the positive effects and benefits of a low carb diet.

Any and all insight, links, advice would most gratefully received.

Thank you for reading

Po

 

[DCUKMod]

@poemagraphic - I hate quoting rules, but our Rule A11, here https://www.diabetes.co.uk/forum/threads/community-ethos-forum-rules.50278/ , states the following:

"11. Important: Members are generally not Health Care Professionals, and those who are participate on the Forum as Members, not Health Care Professionals. Members are unable to diagnose any condition, or instruct in the alteration of medication, irrespective of personal or professional standing or experience."

I appreciate sometimes that rule can lead to frustration, but it is there for member safety and to ensure such important changes are appropriately supported.

In terms of how each of those meds work, in its simplest form, your Gliclazide stimlates your pancreas to produce more natural insulin to cope with what you eat and drink. Your injected insulin is effectively an injected top-up for what your body can naturally produce.

If I apply simplistic logic, I know which I would reduce, but I've never taken either of those meds, so it's my feeling only.

 

[Jaylee]

Hi @poemagraphic ,

You would need to discuss this with your DSN.

Basically from what I understand your night readings are in safe parameters when you wake & test?

I'm a Lantus user for many years giving my dose at 11pm. The danger zones for a drop (hypo.) for me can be twix 2&3 am or 5&6am.? If it happens.

Now I don't take Glic
But I do "bolus" for meals with novorapid (another insulin, fast acting.) to the amount of carbs consumed. (To simplify my situation.)
Logically your pancreas would do this job for the meals you eat with the help of Glic increasing insulin response & sensitivity regarding the carbs you consume.

You appear to have also changed your diet drastically from what was initially advised by your health care team.
You need to note/log your diet change reduction in carbs, resulting BGs & the dosage you take, then consult you HCPs (at the earliest opportunity.) regarding your medication, only they can advise in regards on what you clearly intend to do with a med reduction.

We don't all have the same metabolism. So caution & avid meter use is always expressed when doing a change.

Good luck!

 

[poemagraphic]

@poemagraphic - I hate quoting rules, but our Rule A11, here https://www.diabetes.co.uk/forum/threads/community-ethos-forum-rules.50278/ , states the following:

"11. Important: Members are generally not Health Care Professionals, and those who are participate on the Forum as Members, not Health Care Professionals. Members are unable to diagnose any condition, or instruct in the alteration of medication, irrespective of personal or professional standing or experience."

I appreciate sometimes that rule can lead to frustration, but it is there for member safety and to ensure such important changes are appropriately supported.

In terms of how each of those meds work, in its simplest form, your Gliclazide stimlates your pancreas to produce more natural insulin to cope with what you eat and drink. Your injected insulin is effectively an injected top-up for what your body can naturally produce.

If I apply simplistic logic, I know which I would reduce, but I've never taken either of those meds, so it's my feeling only.

Thank for posting the above response... Duly noted.
I can understand fully why that rule applies. I need to brush up on the ethos-forum-rules. Sorry if I transgressed.

Your simplistic logic is sound.
Po

 

[poemagraphic]

Hi @poemagraphic ,

You would need to discuss this with your DSN.

Basically from what I understand your night readings are in safe parameters when you wake & test?

I'm a Lantus user for many years giving my dose at 11pm. The danger zones for a drop (hypo.) for me can be twix 2&3 am or 5&6am.? If it happens.

Now I don't take Glic
But I do "bolus" for meals with novorapid (another insulin, fast acting.) to the amount of carbs consumed. (To simplify my situation.)
Logically your pancreas would do this job for the meals you eat with the help of Glic increasing insulin response & sensitivity regarding the carbs you consume.

You appear to have also changed your diet drastically from what was initially advised by your health care team.
You need to note/log your diet change reduction in carbs, resulting BGs & the dosage you take, then consult you HCPs (at the earliest opportunity.) regarding your medication, only they can advise in regards on what you clearly intend to do with a med reduction.

We don't all have the same metabolism. So caution & avid meter use is always expressed when doing a change.

Good luck!

Hi Jaylee

Thank you so much for replying.

I keep an almost hourly log of everything I eat and take by way of meds and insulin.
On my first visit to the diabetes dietitian, they said they were pleased with my grasp of the situation and happy with my meter readings.

The nurse I first saw (a month ago) said that the '10 dose' was a starting point, as we are all individual and had to start somewhere, and that I could drop the dose (I also use a Lantus) myself depending on my readings. She said that she would be happy for me to drop to 7 if I continued to get low readings... below 4 during the day.

I feel that my 'new' way of eating ie. staying around the 100g a day mark has had a major impact on how well I feel... Of course the meds are playing a huge part in the reduced BG levels and the increased energy and well-being I am experiencing.

That said I really would like to reduce the dose of insulin and feel that when I reduce my carb intake again, that 7 units will result in low readings which I MUST avoid to do my job (Logistics).

"Above 5 to drive" DVLA set the numbers we all must follow and abide by.

Most days I am testing around 10 times. Excessive perhaps, however I am still finding out how my body responds to different foods, any exercise or manual work I undertake... Plus my body is still in the process of recovering from a virulent virus.

I am normally very fit and healthy and my BMI is perfect.

Having so many posts here about so many things that we really 'need' to know and understand is a god send.
Thanks again for replying and your "Good luck" comment is most welcomed.

Po

 

[Jaylee]

Hi @poemagraphic ,

I understand your position regarding balancing the BGs with the job. (& of course staying on the right side with the DVLA.)
I've worked in a similar role in the past.
Your testing isn't excessive, & the logging of everything helps the HCPs to help you.
The recovery from the virus may well be helping with the lower BGs along with the diet.

I also understand you're recently diagnosed?
But this is where it gets tricky with the medication combo you are prescribed. (Which is way beyond me.)

If it was a T1 "MDI" situation? I'd be looking at what the basal insulin is doing first. (Get the foundations solid.)
Then work out what's happening with the bolus to carb timing & ratios..

You will have to work closely with your health care team, continuing a pragmatic aproach to resolve your conundrum with the medication.
They can help, once there is a further reference to what's happening..

All the best.

 

[DCUKMod]

Thank for posting the above response... Duly noted.
I can understand fully why that rule applies. I need to brush up on the ethos-forum-rules. Sorry if I transgressed.

Your simplistic logic is sound.
Po

Worry not. Sometimes we all get a bit enthusiastic about what the forum can, and can't do, and sometimes those responding feel sure they know the answer and want to help.

Quite clearly it is inappropriate for any of us to make a diganosis for anyone, and similarly, some medications, such as insulin, are very powerful indeed to the extent they can miraculously improve and preserve lives, but abused or used inappropriately can kill too, so we must be safe. DCUK takes member safety very seriously.

 

[poemagraphic]

Worry not. Sometimes we all get a bit enthusiastic about what the forum can, and can't do, and sometimes those responding feel sure they know the answer and want to help.

Quite clearly it is inappropriate for any of us to make a diganosis for anyone, and similarly, some medications, such as insulin, are very powerful indeed to the extent they can miraculously improve and preserve lives, but abused or used inappropriately can kill too, so we must be safe. DCUK takes member safety very seriously.

I agree 100%

I am quite surprised that some people do not fully understand how crucial this whole situation is to understanding how serious things can get.. We all have the power to greatly change our lives if we know what can be achieved by often simple changes to ones diet and lifestyle. It can seem daunting for some which is where this site comes in.

 

[Daibell]

Hi. It is unusual to take both insulin and Gliclazide as they effectively do the same thing, but I can see that your situation is a changing one. I would see the DN at some point and suggest that taking both may not make sense and to agree the best action including any dose adjustment. Your DN's advice to have so-many carbs at each meal is very out-dated whereas my lovely DN has said for me to continue to reduce my carbs to help control my BS. I would try to avoid the subject when you see her and just nod if necessary to avoid conflict. Obviously your medication dosage does need to take account of your carb intake so you may need to be tactful in talking about the carb level you prefer but it is your choice.

 

[poemagraphic]

Hi. It is unusual to take both insulin and Gliclazide as they effectively do the same thing, but I can see that your situation is a changing one. I would see the DN at some point and suggest that taking both may not make sense and to agree the best action including any dose adjustment. Your DN's advice to have so-many carbs at each meal is very out-dated whereas my lovely DN has said for me to continue to reduce my carbs to help control my BS. I would try to avoid the subject when you see her and just nod if necessary to avoid conflict. Obviously your medication dosage does need to take account of your carb intake so you may need to be tactful in talking about the carb level you prefer but it is your choice.

I have ticked the smile face because I am laughing to myself as that is actually exactly what I did/do.
Thank you for replying and giving me such great advice.

If we stepped back a couple of hundred years (well a lot less actually) Low carb would have been the only choice that was taken seriously. Now we have to smile and nod whilst we are inwardly thinking.... well you know what we are thinking lol

 

[Daibell]

I have ticked the smile face because I am laughing to myself as that is actually exactly what I did/do.
Thank you for replying and giving me such great advice.

If we stepped back a couple of hundred years (well a lot less actually) Low carb would have been the only choice that was taken seriously. Now we have to smile and nod whilst we are inwardly thinking.... well you know what we are thinking lol

Yes, it's interesting how far off the rails all the diet experts have gone (and globally) since before the war. Thye seem oblivious to the fact that they are ignoring the knowledge of hundreds of years. I've still got the media article somewhere on file where a medical 'expert' in the 70s or so wrote a paper proclaiming that carbs were the obvious food for diabetics to eat. Since then I've been very cautious about research papers and who funds the research.. I am extremely critical of PHE (Public Health England) who have been promulgating the high carb/low fat nonsense based on food company funded research.