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BG increase after med reduction?

Mr Hairyman

Well-Known Member
Messages
57
Type of diabetes
Treatment type
Diet only
In May, my HBA1C was 80, when I was diagnosed with T2D. Was given 2000mg of Metformin and Canagiflozin and I began low carbs and exercise.

In August, I my HBA1C was 36. Nurse dropped me down to 1000mg of Metformin and Canagiflozin.

My October HBA1C was 34, so the Metformin is now 500mg and I've come off Canagiflozin.

I do a morning finger prick test most mornings before eating, and it's normally around 5.8, which is consistent with my HBA1C scores. However, for the last week or so, just after my meds adjustment, it's been around 7.5

I know it's early days, but it does seem to suggest the meds (Canagiflozin in particular) were having an effect. I was wondering if people had experiences of increases in Blood Glucose after coming off meds, and if there is a chance it will 'settle down' of it's own accord? I'm certain I haven't been letting Carbs creep back in and am either in the gym or swimming 4 times a week.

My goal really is to be in remission and to be med free. I could go full Keto if that's what it takes, but I think this would be much more challenging.

Appreciate peoples thoughts
 
Unfortunately, the body adapts to the continued presence of a drug and IME stopping it altogether seldom proceeds smoothly at first. It's so disappointing when the delicate balance that we strive so hard to achieve is disrupted.

We're all different, but if you keep to a low carb, healthy fat lifestyle [LCHF], your BG levels will gradually start to improve. Sometimes it takes a while.
 
You're doing great!

You are making more progress, though you're used to seeing lower readings. Since reducing the meds you are now handling the same glucose but with less meds.

Your body hasn't changed overnight since coming off the meds so the readings will be higher for a while. You haven't lost any progress. And you will continue to make progress from here.

Keep an eye on it, all being well the readings will gradually creep down. and speak to your diabetes nurse if you're unhappy.

And, increasing the dose again for a bit isn't failure.

But don't do what I did...

When I came off Empagliflozin the first time I got pretty down about the higher readings and I let that throw me off my diet (stupid). So ended up back on the tablets, piled all the weight back on, and eventually insulin.
 
When I came of Gliclizide a few years ago my numbers did rise a little bit, I went full out keto and they did go down but not to the levels that I got when I was on meds. But I’m happy with that, for me I’d rather have a HbA1c of 49 with no meds than one of 42 on meds. Plus I was having a lot of hypos so was feeding the hypos rather than my body.

Do you have any wriggle room to reduce your carbs a bit more? If you do that may help
 
Yeah, I try to stay under 50g of carbs a day, so I'm not full keto. If I dont return to lower levels in a few weeks, I'll give this a go I think.
 
Mr Hairyman said:
Yeah, I try to stay under 50g of carbs a day, so I'm not full keto. If I dont return to lower levels in a few weeks, I'll give this a go I think.
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It’s worth a try, give yourself time to plan what you would decrease carb wise from your diet as it has to be sustainable for you
 
I’m on 2000mg of Metformin and 10mg dapagliflozin which keeps my BG in single figures but if I don’t take this combination it soon creeps into the teens. I’m eating low carb, high fat but as I’ve been lazy in the past couple of years, not recording my carb intake, I’m probably having more than 20g a day. I know keto definitely works for me if I stick to it.
 
Hi, welcome and great work on getting your hba1c down!

From a quick read on canafiglozin, seems like a good medication to drop due to some of the longer term risks:

Invokana is an oral medication for type 2 diabetes that helps to lower blood glucose levels by encouraging the body to filter out glucose from the blood.

Invokana is an oral medication for type 2 diabetes that helps to lower blood glucose levels by encouraging the body to filter out glucose from the blood.
www.diabetes.co.uk

The reason your blood glucose has increased slightly is that the canafiglozin blocks SGLT2 inhibitors in the kidney, causing less glucose to be absorbed and increasing the amount that's excreted through urine. Without it, you're now absorbing more glucose than you were when you took it.

However, you're doing great. I haven't taken any medication since diagnosis and reduced my hba1c from 83 to 32 in 15 weeks since July. Without medication, my "on waking" reading is now 6 to 7 on a good morning, 7 to 8 on an occasional bad morning. However, for the first couple of months after diagnosis, I was mostly in the 7-8 range first thing. This morning result is the one you can't really influence without medication, it's caused by your liver dumping glucose into your system to wake you up, and T2 diabetics generally don't handle the glucose dump as efficiently as non-diabetics. If you have weight to lose and do so, that will help, especially if you also have a fatty liver (many diabetics are prone to this, even ones with perfect BMI).

My advice would be to keep an eye on it following the medication change, but don't stress too much. The changes you've made in diet and lifestyle will have a lot of benefits. If you're comfortable dropping carb intake a bit lower, that will help too, but you might not need to go full keto. I have done, but that was to compensate for no medication at all in my case. Might be worth trying keto though if you're able to.

What are your blood glucose readings like before a meal and 2 hours after?
 
Thanks for that - really helpful to know. Definitely still have weight to lose and am working on it. My tests in May said I had a fatty liver, but subsequent tests have shown that to have improved significantly.
I haven't really done blood glucose readings before and 2 hours after meals - mostly because I'm not organised enough to remember. It was something I was looking at doing if/when I got to the point where I was off my meds completely. Perhaps I'll give it a go sooner.
 
I'd definitely recommend the additional testing, if you're able to. Two reasons for doing so in your case are:

1) You've already made significant diet changes. With the change in medication, your before and after meal readings will show whether your diet can sustain being off that medication, or if you need to drop carb intake a little more.

2) With low carb dieting, many here find that their first reading of the day in the morning is their highest. If this is the case, you can worry less about that morning reading, as your hba1c is all about maximising your time in better ranges. If you're aiming for no meds and remission, these before and 2 hour after meal readings help by giving you regular feedback on how your diet is doing with supporting those goals and ensures you're not eating something that's causing your blood glucose to spike high for long durations.

Don't get me wrong, based on what you've said, hopefully you won't need to make massive changes to what you're already doing. You've done the hard part in just getting started and reducing your hba1c, so the above would just help to tighten up any areas and hopefully reduce the need for medication.
 
@Mr Hairyman I agree with both @lovinglife and @Paul_ . I have been in non-medicated remission for over 3yrs now and have never had an HbA1C as low as 34.
While I would like to keep mine below 42, I know that external factors (injury, infection, medications, stress, lack of sleep) could all push me above 42 if they happen at the 'wrong time' related to an HbA1C test. I don't worry about this because I control the one thing I can control, which is what I eat. So I don't bother with fasting BG tests, almost never testing in a morning. I eat 2 meals per day (just 1 at weekends) and sometimes test them (i.e. before first bite and then 2hrs after 1st bite) to see that I am maintaining control of my BG. I used to test every meal (looking for no more than a 2 mmol rise) when first striving for remission, but soon found I could predict the results - so no longer needed that amount of testing.
 
@ianf0ster raises a good point there about testing regularity. Following diagnosis, I took readings every morning, then before and after every meal. I continued this until my recent follow up blood tests. Now I know what I've been doing is working and had it confirmed with an updated hba1c result, I only test my morning levels once a week (more out of curiosity than anything else) and there are many meals I don't bother testing after because I know they're safe. I still test before lunch and dinner each day, just to check, but this is more for reassurance/confidence in my diabetes management than any concern. Other than that, only new foods/meals get the full works from testing now.

It's a bit of effort and expense on test strips when starting it, but it really helped shape my diet very quickly.
 
I am 7 years from diagnosis and things are still changing.
My Thyroxine prescription is down from 200 to 175micrograms, but I am not taking it every day now - I can't get an appointment with my GP as even now my supplementation is considered 'adequate'
My winter coat is hanging off me and I have a pile of garments to reknit in smaller sizes, having gone through my store of garments recently they are mostly too large now and need remaking.
After so many decades of being pushed to eat carbs as they are healthy, it is not going to be an overnight recovery even with good levels of glucose and almost normal HbA1c after diagnosis at the age of 65 I feel better and am stronger, certainly, but change is still ongoing, though I dropped my maximum intake of carbs per day from 50 to 40 thinking that would push down my HbA1c from 42 into the 30s - after a year of lower intake my HbA1c was 42, so it seems that there is more going on than a simple response to what we swallow.
I notice that you test before eating - I gave up on that quite early on and only tested afterwards, as that it the most significant reading, surely?
 
Resurgam said:
I notice that you test before eating - I gave up on that quite early on and only tested afterwards, as that it the most significant reading, surely?
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Personally, as my progress continues since diagnosis, I'm less bothered about meal responses as I'm pretty confident on most of what I eat now having tested it numerous times previously. However, a reading before lunch gives an indication as to how my morning has affected my blood glucose, then my reading before dinner does that for the afternoon. As you said, so many things affect BG levels, so at my early stage a before meal reading just provides some reassurance that nothing outside of food has caused an undesirable BG level. Would I change anything in future if I got an undesirable reading? Maybe, maybe not, but I at least have the data to make that decision on.

The other reason for me is that I'm changing quite a lot of variables at once. Although my food is fairly consistent, I'm losing weight, my fatty liver is improving, and in 15 weeks my cells have gone from drowning in insulin to not. With all that change, I just like to see how my BG levels track from a data perspective because, well, I'm a massive data and stats nerd!
 
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