Changing medication for T2. A journey of horror.

[PhilC72]

After my regular hba1c showed up a rise to nearly 80 (UK terms - no idea why we use a different score method to the US, it confuses the hell out of me), she asked me if I was sticking to my Emplagloflozin regime. I said I was struggling because it was causing hideous male thrush / UTI.

She took me off it and popped me on Alogliptin, then retrested after 3 months. Hba score just the same, even she said it was functionally useless.

So now I'm testing BG twice a day and taking 40mg of Gliclazide. The tests are generally 10mmol/ml-15mmol/ml but have occasionally been 20+ mmol/ml.

I'm feeling like **** and struggling to be honest. I did notice taking bit d helped so I'm trying that.

Can't wait to see her again and get my Gliclazide upped. I realise there's a risk of hypo but I think I'm pretty far from land on that one!

 

[wes.w]

She took me off it and popped me on Alogliptin, then retrested after 3 months. Hba score just the same, even she said it was functionally useless.

But at least your Hba didn't go up even more!

So now I'm testing BG twice a day and taking 40mg of Gliclazide. The tests are generally 10mmol/ml-15mmol/ml but have occasionally been 20+ mmol/ml.

When you BG test relative to when and what you eat will give you different values. Do you test before breakfast? That is usually when you'll get your lowest value. I have peak values of 10+ after breakfast and lunch, and around 15+ after dinner. But these drop to 5-7 after meals. Try doing a few more tests to get a better idea of how you are reacting.

 

[LivingLightly]

After my regular hba1c showed up a rise to nearly 80 (UK terms - no idea why we use a different score method to the US, it confuses the hell out of me), she asked me if I was sticking to my Emplagloflozin regime. I said I was struggling because it was causing hideous male thrush / UTI.

She took me off it and popped me on Alogliptin, then retrested after 3 months. Hba score just the same, even she said it was functionally useless.

So now I'm testing BG twice a day and taking 40mg of Gliclazide. The tests are generally 10mmol/ml-15mmol/ml but have occasionally been 20+ mmol/ml.

I'm feeling like **** and struggling to be honest. I did notice taking bit d helped so I'm trying that.

Can't wait to see her again and get my Gliclazide upped. I realise there's a risk of hypo but I think I'm pretty far from land on that one!

Meanwhile, food intake and timing are the two factors you can modify.

In my view the most important blood glucose readings are those that indicate the carbohydrate impact of the food you've eaten. You’ll learn most from blood glucose levels just before you start a meal and then two hours later. Ideally, the post-meal reading should be no more than 2 mmol/l higher than the first and not higher than 8mmol/l. If that's the case, your body dealt with the arrival of glucose in your bloodstream and cleared it relatively quickly.

Armed with these data, you can modify your carbohydrate intake and you may well start to feel a lot better.

 

[PhilC72]

I'm long term diabetic and was diagnosed round about the same time I was diagnosed with fatty liver disease and I'm pretty sure fat infiltration in my pancreas is feeding into insulin resistance. While lifestyle plays a part, I believe my father's side are very prone to these problems.


I hear the bit about carb modification and undoubtedly weight loss will help, I don't doubt I need Gliclazide or similar and I appreciate the diabetic nurse is trying to get me to the right dose without flat out giving me a bunch of hypos.

I get a lot of excercise in my job, although as luck would have today I've done something to one of my Achilles tendons and can barely walk.

I suppose, look at it this way, it hurts to walk to the fridge right now, so at least it will help control my carb intake!

It's been useful to post here, like a lot of guys just getting things of my chest helps tremendously.

 

[KennyA]

Hi and welcome.

have no experience of diabetes medication so have nothing to offer there. I would however recommend low carb eating as a way both to get your blood glucose under control and to lose weight fairly quickly. There's a lot of personal accounts in the "success stories" section of the forum and it might be worth having a look there.

Testing before and +2hrs after meals allows you to identify and cut out the foods you're least able to deal with. Doing that reduces blood glucose levels, reduces the need for insulin and over time can improve insulin sensitivity.

The rest of the world changed to using mmol/mol and mmol/litre for diabetes measurements about 13 or 14 years ago. The US hasn't. There are docs and patients in the UK who are familiar with percentages and mg/dl and still use them.

 

[LivingLightly]

A low carb, healthy fat lifestyle not only plays an important role in the control of diabetes, but also weight management and, in so doing, often improves the health of patients with fatty liver disease.

 

[PhilC72]

Anyway, since I figure outright dieting is now more difficult due to taking Sulfonylureas, I have listened to your feedback and I've been reading up on the GI of foods.
In comes moderate amounts of pasta instead of chips/fries, tinned fish such as tuna, whole nuts (almonds are my favourite) and small amounts of wholemeal seeded bread instead of white bread - which it would seem, is the work of the devil.
To my delight, it appears mushy peas are surprisingly quite low GI!
This way I'll be full and not hypering like hell all day. Fingers crossed.

 

[HSSS]

Anyway, since I figure outright dieting is now more difficult due to taking Sulfonylureas, I have listened to your feedback and I've been reading up on the GI of foods.
In comes moderate amounts of pasta instead of chips/fries, tinned fish such as tuna, whole nuts (almonds are my favourite) and small amounts of wholemeal seeded bread instead of white bread - which it would seem, is the work of the devil.
To my delight, it appears mushy peas are surprisingly quite low GI!
This way I'll be full and not hypering like hell all day. Fingers crossed.

It’s a start.

But many of us type 2 find that GI doesn’t really work the way it’s claimed to. The amount of carbs is often much the same, and occasionally even higher. Eg bread has almost identical carbs regardless of its colour. The fibre content might vary a little and slow the absorption down a touch but you still absorb it all eventually and still have to produce sufficient insulin to deal with it. And that high insulin level is what makes us resistant and causes the high glucose levels.

Taking account of the carbs in the food you eat seems to get better and more consistent results. monitoring that with blood tests before and after the meal shows us what is actually happening. Try it. I doubt there’ll be much difference between brown and white bread (or wholemeal and normal pasta) at the 2hr mark and its worth it on at least once occasion for each to keep testing til you get back to the pre meal reading and see how long it takes for each

 

[PhilC72]

Lower GI makes you full for longer, as does replacing carbs with protein. So it might work.
I get the argument for low carb/paleo and so forth, because food technology has far outstripped our bodies evolution - and here we are, a lot of us diabetic.
Whatever works. I can't leave all the heavy lifting to pharmaceuticals.

 

[HSSS]

Lower GI makes you full for longer, as does replacing carbs with protein. So it might work.
I get the argument for low carb/paleo and so forth, because food technology has far outstripped our bodies evolution - and here we are, a lot of us diabetic.
Whatever works. I can't leave all the heavy lifting to pharmaceuticals.

Lower GI is about slower releasing carbs yes, but they don’t magically make you fuller though. They still invoke the same hormones and insulin reactions. The raise in glucose is a little less high but it lasts for longer overall. If you look at it like a graph the above normal area is just as big even if a slightly different shape. Long prolonged raises aren’t good anymore than shorter higher ones.

Food technology in terms of processed junk is awful and has done a lot of damage to our metabolisms and continues to do so with the excessive carbs and created fats creating a metabolic firestorm our now damaged bodies can’t deal with any longer.

But you’re right higher protein is a good move and so is doing whatever you can rather than relying entirely on medications. I’m just giving advanced warning that for many low GI simply doesn’t agree with out bodies and our meters prove that. I hope you find a way that suits your body.

 

[KennyA]

Lower GI makes you full for longer, as does replacing carbs with protein. So it might work.
I get the argument for low carb/paleo and so forth, because food technology has far outstripped our bodies evolution - and here we are, a lot of us diabetic.
Whatever works. I can't leave all the heavy lifting to pharmaceuticals.

Lower/higher GI had and has absolutely zero impact for me, either for "feeling fuller" or reduced BG. Others have different experiences. You need to find what works for you, rather than than what works (or is claimed to work) for other people.

Example: beans and legumes are quite high in carb and most people (including me initially) on keto/low carb avoid them. I've however found that they have very little impact on my BG - sure, I'll get slightly elevated levels at the +two hour mark but within acceptable range.

 

[PhilC72]

Lower GI is about slower releasing carbs yes, but they don’t magically make you fuller though. They still invoke the same hormones and insulin reactions. The raise in glucose is a little less high but it lasts for longer overall. If you look at it like a graph the above normal area is just as big even if a slightly different shape. Long prolonged raises aren’t good anymore than shorter higher ones.

Food technology in terms of processed junk is awful and has done a lot of damage to our metabolisms and continues to do so with the excessive carbs and created fats creating a metabolic firestorm our now damaged bodies can’t deal with any longer.

But you’re right higher protein is a good move and so is doing whatever you can rather than relying entirely on medications. I’m just giving advanced warning that for many low GI simply doesn’t agree with out bodies and our meters prove that. I hope you find a way that suits your body.

It seems to have shaved a few m/mol off my readings and I feel fuller in that I'm not having that snap-back feeling a while I've I've eaten.
There are political reasons your doctor will never sing the praises of low carb high protein diets.
I have my review for the strength of my Gliclazide - I've been on the lowest possible strength so hopefully that will be sorted and help too.

This is the first time in 8 years since diagnosis I've been afforded the luxury of a BG meter and it's had a profound effect on me. Why they don't give these out is beyond me, how otherwise are you supposed to know what's happening? By a 3 monthly hba1c test?!

 

[wes.w]

That's a lot more positive than your initial message, so well done!

I was given a meter on the NHS when I was first diagnosed almost 15 years ago, so I wonder why this doesn't seem to happen to everybody diagnosed as T2 under the NHS. It helped me get to a final diagnosis of Type 3C within 2 years. Meters aren't that expensive if you shop around and don't get one with all the latest gizmos (under £35 for meter and 50 tests) and you don't need to test all the time to to get some idea of what your reactions are.