Dapagliflozin v Gliclazide

[tigerlily72]

I'm struggling at the moment following my annual review and the results of my Hba1c.

A little about me:

Female, early 50's
(Very) Overweight
Multiple other health conditions inc Atrial Fibrillation, Fibromyalgia, CFS, Anxiety, High Blood Pressure
Current Meds (diabetes and blood pressure) include - Sukkarto 2x daily, Alogliptin, Bisoprolol, Indapamide, Irbesartan

In Sept 2022 my Hba1c was 66 and now it's increased to 76! However, my total cholesterol has reduced to 4.4 and LDL cholesterol to 3.4. I was told the target for LDL was 2.5.

My blood pressure is too high although my kidneys, liver and urine were all "ok".

I admit that my lifestyle and diet isn't great. I like the things I shouldn't such as bread, mashed potato/comfort food at this time of year as well as chocolate and cake. Due to having fibromyalgia I hardly have the energy to go to work and I don't exercise. I try to use the stairs rather than the lift at work unless I'm having a bad pain day.

The DSN has recommended increasing Sukkarto to 3x 500mg pills daily (I'm currently taking 2 per day). The Alogliptin was introduced around Sept last year. I've also got to try and lose weight and make some lifestyle changes.

I'll be recalled in about 3 months time and if no significant change then she wants to put me on Gliclazide or Dapagliflozin.

I'm really worried about the side effects of both of these and despite reading up a little, am still confused as to which would be "best". She doesn't seem too keen regarding the Gliclazide. Also, would I be given a blood glucose monitor with either of these as I understand there's a risk of hypo's with Gliclazide.

Any advice at all would be really welcome.

 

[Deleted member 571965]

I'm struggling at the moment following my annual review and the results of my Hba1c.

A little about me:

Female, early 50's
(Very) Overweight
Multiple other health conditions inc Atrial Fibrillation, Fibromyalgia, CFS, Anxiety, High Blood Pressure
Current Meds (diabetes and blood pressure) include - Sukkarto 2x daily, Alogliptin, Bisoprolol, Indapamide, Irbesartan

In Sept 2022 my Hba1c was 66 and now it's increased to 76! However, my total cholesterol has reduced to 4.4 and LDL cholesterol to 3.4. I was told the target for LDL was 2.5.

My blood pressure is too high although my kidneys, liver and urine were all "ok".

I admit that my lifestyle and diet isn't great. I like the things I shouldn't such as bread, mashed potato/comfort food at this time of year as well as chocolate and cake. Due to having fibromyalgia I hardly have the energy to go to work and I don't exercise. I try to use the stairs rather than the lift at work unless I'm having a bad pain day.

The DSN has recommended increasing Sukkarto to 3x 500mg pills daily (I'm currently taking 2 per day). The Alogliptin was introduced around Sept last year. I've also got to try and lose weight and make some lifestyle changes.

I'll be recalled in about 3 months time and if no significant change then she wants to put me on Gliclazide or Dapagliflozin.

I'm really worried about the side effects of both of these and despite reading up a little, am still confused as to which would be "best". She doesn't seem too keen regarding the Gliclazide. Also, would I be given a blood glucose monitor with either of these as I understand there's a risk of hypo's with Gliclazide.

Any advice at all would be really welcome.

Gliclazide is very good at improving BGLs/reducing HBA1c, especially those naive to it. The problem is there's a requirement for you to monitor BGLs due to the risk of hypoglycaemia.
Also, gliclazide can increase your weight, something as you said might not be appropriate.

I hate the fact that you aren't given a BGL meter at point of diagnosis. If you are prescribed dapagliflozin then there is no ''reason'' for them to give you one as per NICE guidelines. However I try to give my patients one because it's important they see the high numbers and it helps with accountability - for example you might reconsider that large piece of cake if you see your pre/post-prandial BGLs elevated.

Dapagliflozin might be a good option as you have hypertension and dapagliflozin has both cardiovascular and renal benefits. This is really important as there is a **** load of data showing a tight link between uncontrolled DM, hypertension and CKD.

Most importantly, it's really important you look at your diet. You're describing foods that are high in sugar/carbohydrate which will have a considerable impact on your BGLs. This is what is likely driving your HBA1c to deteriorate.