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Consultant/ raising BG/ dopping Glics

CollieBoy

CollieBoy

Well-Known Member
Messages
2,974
Location
Lancashire
Type of diabetes
Type 2
Treatment type
Diet only
Dislikes
Hi carb Foods
Last week I had a meeting with my Consultant and agreed to try taking my Gliclazide down to 20mg @ breakfast and stopping my 20mg @ evening meal.
My results this week have raised my fasting to ~5.1 and my 2hr post brekkies to 5.9 (from 5.4), and my 2hrs post evening meal to 6.9 :shock: from 6.1.
DSN repoted that this was all very good and spouted all the NHS bovine excreta about up to 9, 2hrs post being OK.
Told her we will agree to differ on control, as i want to keep my feet and eyes,
but question is, am I being too paranoid on my BG.
Also said big danger is hypos, but only had one in last 12 months, when doing heavy physicals, no faint/weak only sense that going low which was nipped at 3.9 with glucose & biscuit.
Generally feel better at <6.5 so this weeks levels making me feel eugh :sick:
Perhaps keep evening glic & lose morning?
Metaformin not available due to CKD, so restricted in drugs.
 
Hi. You ask your consultant to change the Gliclazide to Sitagliptin? No hypos, no weight change and less possible long-term impact on the pancreas. It just controls spikes.
 
Daibell,
Sitaglipin is contraindicated with CKD so probably wouldn't get it ! :cry:
 
A completely gut feel Fergus nothing medical at all but I would probably go for the 6.9 and drop the Gliclazide simply because I would feel that way probably delays the chance of progression the most. Like you I would find that a very tough decision and one I don't envy you making.

Are all the Sitagliptin type ones rules out what about Galvus and Onglyza? Can you cut your carbs further or is that risky with CKD? The logic says with your cholesterol and as long as you are reasonable fit and not overweight then a slightly higher hBA1c should be ok especially if you keep spikes to the minimum. Logic is one thing but the psychology of your own control method is another!
 
Fergus... just using the examples you have posted above to work out some averages (a very small sample I am sure we will all agree!).. but the change will increase your HbA1c by around 0.4%... to probably looking at your previous results to somewhere back in the high 5's..

It may be worth taking a reduced dose till your next HbA1c and seeing what the actual difference is.. then make a decision from there.
 
Thanks all,
I admit the sample size is rather small :lol: (4 days on new regimen) but I have decided to sitch my Glic dose to the evening meal to allow it to cover the higher carb/ spike laden period of the day. will try this for next few days.
after all all my improvements have been initiated from "our side" and why should I expect any useful input from the blinkered "fishnet condom" DSNs :lol: :lol:
 
I want to ditch my gliclazide (40 mg a day), but don't have the confidence to do so as I like the figures I get with it. I get prescribed the 80 mg tablets (I know there are 40 mg ones available but can't get them prescribed). Which ones do you get Fergus? As surely a 20 mg dose would mean cutting an 80 mg tablet in 4 and getting very small imprecise bits.
 
I knew they were available in 40 mg, its a pain to have to take the pill cutters with me when I go away (which I do quite a bit). The thought of cutting the 80 mg in 4 and getting tiny bits is putting me off cutting the dose. Will have to go back to doc and talk to him about getting the 40 mg version, although have a feeling they are more expensive.
 
From NHS Electronic drug tarrif (June 2012)

Gliclazide 40mg tablets for 28, £3.36 Zicron

Gliclazide 80mg tablets for 28, £1.06

so a bit more expensive!
 
I can see that cutting down to 20mg would be easier with the 40mg tablets. I'm sure I'm going to get the line of just give them up altogether as your levels will be fine on just metformin.
 
sitagliptin is now licensed for people with CKD but at half or quarter dose. Also a drug called linagliptin licensed for CKD
 
Update:
Switched 20mg Gliclazide to p.m. to cover evening meal needs. seems to be working O.K.
Fasting B.G. high 4s to low 5s 2 hr post brekkies low 5s 2 hrs post eve meal low 6s :thumbup:
Common sense as my carb loadings are evening meal centred.
Why couldn't DSN have suggested this rather than her NHS death bleatings :shock:
Confidence in their common sense severely shattered :shock: Can i trust them in a Real Crisis!! :think: :think:
 
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