Change of drugs

greybags · Apr 12, 2011

I have been a type 2 for many years and have never been considered slim, but have always managed to keep my weight reasonably steady if a bit on the high side, and with a bit of management my sugars around the 5.5 to 6.3 mark

Have taken Metformin for years with the dosage slowly increasing over the years to the max 2550mg a day..

Around August last year I was also prescribed 80mg of Gliclazide a day, and now no matter what I do the weight is slowly gaining .. 10lb since last August.. Have followed my dieticians advice and eat less, and walk more, but still it seems to be gaining for no apparent reason ...
For the first time I'm beginning to get a bit fed up with this, as when ever I visit the nurse it's the same old snide remarks about weight, and I must try harder, as it's all my fault .. ... B****ks...

I know a bit of knowledge is a dangerous thing, but a bit of reading on here and other places tells me that Gliclazide can be a contributing factor to weight gain, so I am thinking I will suggest to my nurse that I would like to come off the Gliclizide and try something else ... A bit more reading tells me that Victoza may help me both with the sugars and the weight ..

Anyone have any thoughts on this idea...

sugarless sue · Apr 12, 2011

As regards the remarks from the nurse .......... :evil: You are an adult ! Don't let her treat you like a naughty child !!!

Gliclizide is a definite factor in your weight gain as it forces the Pancreas to produce Insulin and excessive Insulin produces body fat.

Have you had a good look at your diet to see if you can reduce your carbohydrate intake a bit ? By doing this you may be able to come off the Gliclizide and even reduce the Metformin plus lose some weight. Our dietary advice does not correspond with the main stream dieticians advice but many have had very good results using it on the Forum. Have a read of it and see if any of it can help you.

Here is the advice that Ken and I, as Forum Monitors, usually give to newly diagnosed Diabetics. We hope that these few ideas gained through experience help you to gain control and give you some understanding of Diabetes. This forum doesn't always follow the recommended dietary advice, you have to work out what works for you as we are all different.

It's not just 'sugars' you need to avoid, diabetes is an inability to process glucose properly. Carbohydrate converts, in the body, to glucose. So it makes sense to reduce the amount of carbohydrate that you eat which includes sugars.

For more information on CARBOHYDRATE see here:

viewtopic.php?f=3&t=20306&start=0

This is NOT a low carb diet suggestion, just a reduction in your intake of carbohydrate. You have to decide yourself how much of a reduction will keep your blood glucose levels in control.

The main carbs to avoid OR reduce are the complex or starchy carbohydrates such as bread, potatoes, pasta, rice, starchy root veg and also any flour based products. The starchy carbs all convert 100% to glucose in the body and raise the blood sugar levels significantly.

If you are on Insulin you may find that reducing the carb intake also means that you can reduce your dose of insulin. This can help you to keep weight gain down as Insulin tends to make you put on weight and eventually cause insulin resistance. This should be done slowly so as not to cause hypos.

The way to find out how different foods affect you is to do regular daily testing and keep a food diary for a couple of weeks. If you test just before eating, then two hours after eating, you will see the effect of certain foods on your blood glucose levels. Some foods, which are slow acting carbohydrates, are absorbed more slowly so you may need to test three or even four hours later to see the effect that these have on your blood glucose levels.

Buy yourself a carb counter book (you can get these on-line) and you will be able to work out how much carbs you are eating, when you test, the reading two hours after should be roughly the same as the before eating reading, if it is then that meal was fine, if it isn’t then you need to check what you have eaten and think about reducing the portion size of carbs.

When you are buying products check the total carbohydrate content, this includes the sugar content. Do not just go by the amount of sugar on the packaging as this is misleading to a diabetic.

As for a tester, try asking the nurse/doctor and explain that you want to be proactive in managing your own diabetes and therefore need to test so that you can see just how foods affect your blood sugar levels. Hopefully this will work ! Sometimes they are not keen to give Type 2’s the strips on prescription, (in the UK) but you can but try!!

For TIPS FOR STRIPS see here:

viewtopic.php?f=20&t=19002&start=0

If you are an Insulin user in theory you should have no problem getting test strips.

The latest 2010 NICE guidelines for Bg levels are as follows:
Fasting (waking and before meals).......between 4 - 7 mmol/l...(Type 1 & 2)
2 hrs after meals........................no more than 8.5 mmol/l.....( Type 2)

2hrs after meals......................... no more than 9 mmol/l ......(Type 1)

If you are able to keep the post meal numbers lower, so much the better.

It also helps if you can do at least 30 minutes moderate exercise a day, it can be split into 10 min sessions to start with. It doesn't have to be strenuous.

The above is just general advice and it is recommended that you discuss with your HCP before making any changes. You can also ask questions on the forum on anything that is not clear.

Finally a few QUESTIONS TO ASK AT DIABETES CLINIC.

viewtopic.php?f=20&t=17091&start=0

Sue/Ken.

bowell · Apr 12, 2011

We have a new nurse that looks after the diabetics at GP practice she is not a DSN
All we get is the PCT Party Line ,You don't need to test, blar blar
blar if you do test what you going to Do ? Blar Blar ect

To be Honest all do now is go and get my book stamped results filled in
and forget all and anything she had told me

Then make appointment with GP take week or two BG readings with me
I get a lot more sense out of him .
My Gp has just put me on JANUVIA to see if that works out for me

Try talking to your GP about your concerns with your BG and Gliclazide
its well know Gliclazide sometimes can promote weight gain

Extra Gliclazide benefits info

Anti-oxidant effects Gliclazide

In contrast to other currently marketed sulfonylurea drugs, gliclazide has been shown to have specific anti-oxidant properties which provide additional secondary benefits in Type 2 Diabetes patients; these anti-oxidant benefits are independent of gliclazide's effects on glycaemic control. 3 Compared with other sulfonylurea drugs, gliclazide helps to preserve pancreatic β-cells4 which may help slow the time to progression of insulin therapy. 5
Reduced mortality risks compared with Glimepride

These anti-oxidant effects may also account for observed improvements in cardiovascular disease

Reff:
http://www.bristol-labs.co.uk/pages/zicron-press-release.aspx

Daibell · Apr 13, 2011

Hi

NICE Guidelines suggest you should measure your own BS when on Gliclazide as for some people it can take you towards hypos so I should politely ignore your nurse and measure to see what food affects your BS most. I'm lucky as even with maximum dose Glic I don't get near a hypo and for me I haven't put on any weight but I gather many people do with Glic if it does make the pancreas produce more insulin. Keep up the diet with low carbs and mainly low GI ones and the exercise. There are alternative meds your GP can prescribe if needed but Glic is very popular as it works for many and is low cost

greybags · Apr 13, 2011

Hi All ..

I measure my own BG on a fairly regular basis, and have been keeping a reasonably good diet, not a full low/no carb, but a sensible diet for a diabetic for many years with no real problems, maintaing and even losing some weight over the years. Nothing spectacular, just steady and even..
It is just that since starting the Gliclizide last year and no other changes, the weight has piled on..

On the odd occasion when I get the 3rd degree from some 4ft 6" diabetic nurse, and I'm over 6ft and am made to feel like i'm naughty, becuase I've put on weight, and I dare to suggest that perhaps there might be something which is not helping the weight situation, I was told I was just making excuses for my own inadequacies, and to stop trying to blame other things for my own failings..
It is the nurse that writes all the prescription for my diabetese, so I need info so that I can make sure I can understand what she is telling me...

So I would like to try a different set of meds to rule out the Glic and see if I can lose the weight I have recently put on .. I have my 6 monthly appointment next week, and have been doing my research on what else is available..

So anyone have any experience with this problem and can offer suggestions

sugarless sue · Apr 13, 2011

This is from the BNF61 the same Formulary that the nurse will use.

Cautions
Sulfonylureas can encourage weight gain and should be prescribed only if poor control and symptoms persist despite adequate attempts at dieting; metformin (section 6.1.2.2) is considered the drug of choice in obese patients. Caution is needed in the elderly.

I'm sorry but this nurses conduct makes my blood boil ! She is bullying you and I would report her conduct to the Practice Manager ! All nurses have a clause in their Code of Conduct that they must stay up dated especially in a specialised subject. The fact that she brushes aside the well known effect of weight gain by Gliclizide shows lack of knowledge in her specialised subject. Find out if she has even done any sort of Diabetic course or is she just a standard Practice nurse ?

She should be there to encourage and help you cope with your Diabetes not berate and belittle you !

cugila · Apr 13, 2011

I totally agree with Sue (daren't disagree !! :wink: ). I too was on Gliclazide at the max dose of 3g (then) and I put on masses of weight. That started to reverse once I had better control and adopted a reduced carb eating plan. I was then later able to reduce and finally eliminate the Glic !

My Endo warned me that it can encourage weight gain.......it IS a known side effect.

However, I also found that diet changes as well as medication helped more. Many of us have found that the advice handed out by SOME Dieticians is not always the best.......it certainly wasn't for me as it advocated eating all the things which I now know raised my Bg levels and also contributed to weight gain.

greybags · May 24, 2011

I am now taking Januvia instead of the Glickasize and the weight I put on is still coming off..
Total of 7lb off already in the last 6 weeks, and I'm feeling a lot better..

Only problem is that cant seem to get the reading under 7, they seem to be hovering around the 7.4 mark, and to be honest, I feel better than I have for a long time..

Intrestingly, we have a new diabetic nurse at the surgery, who is now dealing with everything, and is quite happy to change drugs and seems to be far better natured..

I think she can see the other side of the weight problem coin, as she is not eaxctly a size zero model

Will have to wait a while now to see if they need to give me something else to help control the levels a bit more..

anna29 · May 24, 2011

Hi, it happened to me also, put 2.5 stone on in the 18months on gliclazide, then was put on victoza as januvia failed to nudge my BS down. Victoza has made just a "dip" in my high BS readings [sadly not enough] but am thrilled and so chuffed with wieght loss of almost 2stone look loads better than i was.... Went GP's and refused to take gliclazide since oct 2010 [told him to take it n be happy with the weight gain] sometimes especially when justified you do have to be firm with the HCP's. Then you can achieve more positive and productive results as we have to live with the journey of diabetes and not them! Anna.

Change of drugs

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