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BSL and other medications

P

plantae

Well-Known Member
Messages
828
Type of diabetes
Type 1
Treatment type
Insulin
About a month ago my Dr increased the dosage of one of my other medications (not diabetes related) and my blood sugars went out of control. For example, 15-20 minutes after taking the tablet my BSL would jump up to 3 mmol/L higher from the level I was before taking it. This elevated level would stay elevated all night. I, not very scientifically, confirmed that it was the increased dosage of this unrelated medication that was causing all this by dropping back to my lower dose after a phone call to my Dr. Has anyone had a similar experience or had to increase their diabetes medication (in my case probably basal insulin) to account for blood sugar rising medications? Or maybe things settle down by themselves after a while? I’m not asking for advice, just curious about other peoples’ experiences
 
15-20 minutes seems very quick for a tablet to increase blood sugar (unless it's a chewable one or dissolves in your mouth), but in answer to your question when I have to take a course of oral steroids, then I definitely need more insulin.
 
Hopeful34 said:
15-20 minutes seems very quick for a tablet to increase blood sugar (unless it's a chewable one or dissolves in your mouth), but in answer to your question when I have to take a course of oral steroids, then I definitely need more insulin.
Click to expand...
Possibly it‘s acting so quickly because to increase the dose I was splitting one 30mg tablet in half to get to the 45mg new dose? Or maybe it just dissolves quickly… some up my other tablets that don’t effect BSL but do things I can feel work in 15 mins… but looking back on my graphs it (the sudden rise) is definetely there... the dose is a night 5 hour after dinner/novorapid and with no food since dinner

Thanks for replying. So, I guess when I recommence my increased dose I need to speak to my endo or DE nurse to work out how to deal with the increase. The medication has a half life of 4 days or more I think so I’m not sure if that makes things easier (increase insulin) or harder (wait for peak plasma concentration and then try to adjust insulin if necessary). Either way I need to speak with GP, endo and DE because although I’m now allowed to adjust my insulin based on carb counting and for sick days I still have a cap on my max total daily insulin. The medicine is mirtazipine for reference. It’s a bit confusing because some scientific literature says it can have a positive effect on hyperglycemia… positive in the sense it might help control/avoid it. Other papers suggest what I experienced: i.e. Hyperglyceamia, but maybe it settles down after a while, so maybe insulin adjustment would be temporary. The main reason I rang the Dr to go back onto the lower dose was because my vision became very blurry and I need to be able to drive, and I want to discuss with endo and DE about any insulin adjustments. I do feel I need the higher dose, but not the higher BSL I’ve only just, after 6/7 months got to the point where my TIR is most days 100% (touch wood) so I’m reluctant to mess with things. On the other hand I guess similar circumstances will require adjustments for the rest of my life (?) so I should try and get used to it…
 
I am not an insulin user. I take a fistful of tablets in the morning for my many comorbidities but I do not test BSL until my evening mealtime. I found that on days when I forgot to take my meds, then my BSL waa always 2 to 3 mmol/l lower than usual. So like you I did a very non-scientific experiment to identify what was pushing up my BSL. Turns out it was my BP med and my prostate med. The one diabetic med I take in the morning was neutral - it neither raised nor lowered my BSL and did nothing for me.
 
Well I did the experiment again last night and convinced it’s the mirtazipine. I feel like I need the increased dose so will bring it up again next meeting. My experiment of n=1 and only 14 hours into it seems to show that it’s not a high that lasts just a few hours… my fasting BSL this morning was 2 mmol/L higher than it has been for the last 2 weeks. So many things to consider…
 
Probably not relevant, but I found I can get a 2mmol/l difference after changing packs of strips. Low batteries in the tester can also give a shift in readings. So perhaps you need to do the hokey cokey (eliminate as many other confounders that you can, then re introduce them and log results to see how the trends change and more importantly that reintroducing them causes the effect). Changing the Med once may be a fluke Repeated and it becomes believable This is a tenet of Science in that it nust be repeatable..
 
Absolutely. The confounding factors are quite tricky to account for sometimes, though. E.g. I can’t think of a way to account for sensor and CGM tolerable error except for statistically and that would require more data than I have or have the capacity to collect. I do know that both the CGM and finger pricks collaborated each other in this single test. I do plan on going back to the higher dose so there is a chance there to at least reproduce the result (or not). The only reason I ‘rushed’ to get back down to the lower dose is that I was doing field work that week and needed to be able to drive; with blurry vision and sustained high readings I didn’t feel comfortable driving. Now that I’m back working at home the blurry vision, even if it lasts awhile, isn’t so much of an issue (blurry in the distance, not close so it doesn’t effect my computer work, just driving). I have an appointment with the GP on Friday and will be telling him I’ll be doing some more tests. When I spoke to him last he said it (unstable BSL) wasn’t a known side effect for mirtazipine but I can find studies on Google Scholar saying different. I haven’t had time to properly read and assess the studies yet, though. Even if it turns out that they’re low quality studies, or studies not done on humans doesn’t mean that it doesn’t effect me in that way or it’s a very rare side effect. Or maybe it was all just coincidence
 
One of the sude effets of the Mirtazipine is increas
One of the reported side effects of Mirtazapine is increased pressure in the eyeball. similar to Glaucoma. Have you had a glaucoma test since starting this med? That may explain the visual problems. it does seem that the med can interefere with diabetes blood sugar control and make it less stable. These effects of the med are acknowledged by NHS UK and are listed on their website. Apparently it seems to lower blood sodium levels too.
 
I had a complete eye examination in December 2022 and was on the 30mg of mirtazipine (not 45mg though)… have been on in for over 10 years. That’s interesting regarding the blood sodium levels as well

Thanks for mentioning the NHS UK, I hadn’t even thought of looking there as I’m not in the UK. I’ve got it open and reading now
 
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