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Blood glucose too low ?

A

Adam63

Active Member
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Today when I went to my doctor to get the results of my HbA1C test, she told me that it was 40 (5.8) which
she said is too low.

I must say I was a bit surprised as I am very happy to be at that level, which is close to normal.
Back in 2013 my HbA1C test suddenly shot up to 57 (7.4) (from the mid 40s which it had been for some time.
My doctor at the time prescribed me Glyclazide and immediately my HbA1C went back to the the mid 40s.

My new doctor has taken me off the Glyclazide saying that my blood glucose was too low, and this could
give rise to health problems ! I am finding this difficult to accept. I want my blood glucose as close to normal
as possible as I don't want to experience the many complications of diabetes.

I challenged her on this, asking why she was taking me off the Glyclazide, and she told me that
diabetic experts had now come to the conclusion that type 2 diabetics should not have their blood too low.
I can see that if one got down to levels where one might be in the danger zone of a hypo then this would
not be a good situation. She said that too low a blood glucose could damage my heart.

My doctor apparently is taking her lead from diabetic experts who have come to the view that too low
a blood glucose (in my case around the normal level) can be counterproductive for type 2 diabetics.

Has anyone heard of this research? Or is it merely some nameless committee laying down guidelines,
which we poor diabetics have then to live with.
 
Hi, I am type one ,my dad told me that there is a research which proved that people with 6-7 hba1c have better health than diabetes with normal hba1c
What's glyclazide!?
 
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I don't think your GP (or Inour's Dad) are right. My latest HbA1c was 37 and my GP was thrilled about it. When it was 54 she was very concerned. I'd ask your GP to produce a copy of the research, and if she didn't produce it, and insisted on staying on this track, I'd change GPs and make a complaint about her.
 
You should be proud of your HbA1C numbers. Great management. Some docs/consultants believe that to achieve such amazing results you must be experiencing regular hypo's. They can't understand that some people can manage their diabetes without doing this. Just politely smile at your doc, explain that you appreciate their concern but you are happy with your own diabetes management.
 
@Adam63
I agree with you, I too got the HbA1c too low whilst on Insulin/Gliclazide but when I demonstrated that my tight control did not result in hypos, my consultant backed me against my practice nurse.
Ask for references for your GP's research. and compare yourself to like-situationed patients, rather than someone who has been forced down to low levels by agressive medication!

@Inour
Gliclazide is a drug for T2s which encorages the pancreas to produce more insulin (It won't work if your pancrease is already shut down)

HbA1c is an approximation of a weighted average iof BG over the last 120 days, however it isn't influenced by hypos, just highs so a widely fluctuating BG, as can be caused by over insulin use or gliclazide can produce the same hbA1c as a well controlled daiabetic. so the SD (standard Deviation) of BG values is important as well as the HbA1c
 
I think you are falling between the limits for those on Gliclazide and the lower number for those on Metformin only.
Catch 22….......
 
Adam, so are you staying on the gliclazide or wanting to gradually come off it? Just curious.
 
I wonder if your doctor was meaning your HbA1c is too low to be safe IF (and only if) you continue with Glic. ? That would sound reasonable to me due to possible hypo situations with Glic and the reason he has taken you off it. I can't think he meant it is too low without Glic. Most of us Type 2's just on Metformin or no meds at all with lower HbA1c's than 40 are praised to high heaven, and quite rightly so. I think you may have misinterpreted what he said.
 
I had similar with my doctor... his concern was that at 37 I might be having hypos through the night.

Having done testing overnight on a regular basis I could demonstrate that it didn't appear so &he was hen happy for me to continue as I was. I did have a Freestyle Libre for a few month (until it became unbearable to wear due to skin irritation) & this did indicate regular lows through the night. I'm expecting a slightly higher HB1AC next time as I've reduced my Lantus to reflect this & now wake at around 5.5 - 6 rather than 5.0 - 5.5.
 
sanguine said:
Adam, so are you staying on the gliclazide or wanting to gradually come off it? Just curious.
Click to expand...

No, I was not given the option of staying on the gliclazide. The doctor also immediately withdrew my prescription for testing strips! If she was so concerned about hypoglycemia then surely she would want me to continue testing for lows.

This situation makes me think that this is some general directive from some committee.
 

I tried arguing my case but she just withdrew the glicazide. She would not explain the basis for her decision,I wanted to know precisely the factors influencing her decision. All she would say is that there is a danger of hypos and also possible damage to the heart from so low a blood glucose. She said that the new guidelines mean that type 2 with HbA1C as low as mine should have their medication withdrawn to push up their blood glucose, to avoid hypos and heart damage.
 
OK, I don't want to get the wrong end of the stick here, and I'm not your GP, but do you think you are able to maintain good control (by diet) without the gliclazide? I'm not on any medication, but if I was my objective would be to reduce and get off them.

Are you on metformin as well?

As for test strips, if you are not on any medication apart from metformin it is typical not to get test strips on prescription.
 
Adam63 said:
Today when I went to my doctor to get the results of my HbA1C test, she told me that it was 40 (5.8) which
she said is too low.

She said that too low a blood glucose could damage my heart.

.
Click to expand...

Hmmmm, as a heart patient I would be interested in what level is considered too low. If it were me, I would send your GP a letter asking for the study/research paper associated with the "expert" claims, bullet point your concerns, politely requesting them to answer in writing to avoid confusion and miscommunication.
 

Since being diagnosed I have always tried to control my diabetes by diet, though being on Metformin. In 2013 my HbA1C shot up to 57 (9.1 mmol/L) with no change in my circumstances or diet and my doctor at the time prescribed me Gliclazide. This gradually pushed down my HbA1C to 40 (6.7 mmol/L). Now my new doctor thinks this is too low and has withdrawn the Gliclazide. I am concerned that my blood glucose will now go up again with all the consequences of damage to my sight, nervous system and other organs. I would be happier with a blood glucose as close to that of the non diabetic as possible.
 
Can I ask what your diet is? What's a typical daily menu?
 

There has been many threads on glicizide. The most on users having normal to low blood glucose levels. If you have achieved normal readings and normal hba1c, then you don't need the drug.
The difference is why!

In my opinion, you have enough control to keep your levels as good as what they are!
In the dsn and doctors opinion, they would like to see you a little higher, so the hypo threat goes away!

You will have to monitor and test after, to see what happens!
 
My last hba1c was 35 and I reduced from 88 in 6 months and all my medical team were thrilled
 
nosher8355 said:
In the dsn and doctors opinion, they would like to see you a little higher, so the hypo threat goes away
Click to expand...

It seems I am stuck in a catch 22.

I want my blood glucose as close to normal in order that no substantial damage is being done to
my eyes, nerves and other organ systems. But my doctor wants my blood glucose higher to
avoid the risk of hypo induced heart incidents.

So she is saying I have to accept the increased risk of ongoing damage from a higher blood glucose,
because of the extremely small risk of my experiencing a hypo.

This seems like defensive medicine to me, the doctor wanting to protect herself against a very
small risk. They are not willing to let me decide what to do about my own health. She is following
some government report, based on statistically managed data, which consolidate many case histories
and then tries to draw conclusions. We are all aware how the same data can be re-manipulated at
a subsequent date often to show the exact opposite. It depends often on the mindset of the
people instructing the statisticians as to what they want to massage out of the figures. It seemed
rather indicative that my doctor immediately withdrew my prescription for test strips. Perhaps
these government reports are exercise in reducing the costs of diabetes management.


I am the one assessing and taking the risk, but I am not being allowed to exercise this right.

I may be forced to go private. I have now rather lost trust in that doctor.
 
Hi Adam, I'm still not clear whether or not your ultimate objective is to come off meds anyway because of your good control. If you come off the gliclazide what's preventing you from continuing to manage your BGs by diet alone? What do you typically eat?
 


I agree with @sanguine.

Surely it is better to have better control without the meds. Than relying on them to control your blood glucose levels!
 
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