Glicazide or Insulin

[scarred]

HbA1c has risen to 70mmol/mol and the doctors want to put me on glicazide. I get the impression that this may make my pancreas wear out quicker.

Should I ask for insulin? Or am I getting ahead of myself?

*Edited to clarify I'm type 1.5

 

[Diakat]

I would go for the insulin. As you point out it is better for the beta cells.
You nèed to talk to the doc and weigh up the options.

 

[Oldvatr]

HbA1c has risen to 70mmol/mol and the doctors want to put me on glicazide. I get the impression that this may make my pancreas wear out quicker.

Should I ask for insulin? Or am I getting ahead of myself?

I had an HbA1c of 99 and faced insulin therapy PDQ, and that was with max dose Gliclazide already on board (320 mg a day), but then I discovered LC dieting, mainly LCHF at that time, and started eating to meter. Within 3 months I was reducing my Glic dose and my BP meds and kicking my statins into touch. I did not need insulin therapy and still don't. I have reduced my glic dose down to 40 mg a day now, and halved my Metformin, and last week my GP declared me Normal. So for me the choice seems to have been well worth it.

I have as a result of the LC diet changes managed to reduce my weight, my girth, my wardrobe contents, and consequently my Insulin Resistance. This latter means that I am no longer caning my beta cells, and although I use 1x glic tab still, I am comfortable with that and I now have a vastly improved insulin response that allows me to eat a more carby diet than I was, and not put on weight. So I do not fear burnout myself, but time will tell. I have been T2D for over 15 years now, and feel much better

Either therapy is viable. I find using glic allows me to be more relaxed.

 

[Tennisplayer]

I have come across conflicting information regarding the use of glic in type 1.5. When misdiagnosed as t2, I was using met and glic. My doc d/c'd both after antibody test results came back and started me on Tresiba 1/day. With carb restricted diet (around 10-30 per meal), I am able to maintain weight, bloods are within range and I do not have to bolus. Research exists regarding the "protective" role early insulin use can provide 1.5's beta cells although there are also some conflicting studies as well. I definitely think a discussion with your provider regarding insulin would be useful.

 

[Daibell]

I've been down the same route. I would go for insulin if you can as you have much better control and reduce the possibility that Glic will shorten your beta cell life although this isn't really proven.

 

[Energize]

Would the same theory apply to a Type 2?

I'm on Glipizide 5mgs twice a day but I'm finding it difficult to anticipate when the effect will kick in, so when to prepare meal and eat etc. First thing in the mornings is the worst as, as soon as my feet touch the floor, my glucose levels shoot up (I use Freestyle Libre - extravagant but my best motivator I've found )

So, currently, as I normally wake up around 4am (only 3 hrs sleep - normal for me), I've been taking my Glipizide at that time, as it takes around 3 hrs, or more, to have any effect. So, I then have been getting up around 7am. This strategy seems to have helped initially but, once downstairs, levels start rising again, not getting back down until around 12md. Also, before my evening meal, I try to take Glipizide around 5pm, and eat around 8pm

By the way, I'm on LCHF, so cheese, eggs or ham for breakfast. Any activity will send my BG levels up, too. I'm thinking I need to see the GP to discuss this and see what he has to suggest. I don't mind injections - I do my own Vit B12 injctions, subcut/orange needle so insulin, at low dose, might give me more control, to my thinking. I'll be interested to read how this thread progresses.

 

[Diakat]

Would the same theory apply to a type 2.

Possibly not. Depends on level of insulin resistance.

 

[Antje77]

I had an HbA1c of 99 and faced insulin therapy PDQ, and that was with max dose Gliclazide already on board (320 mg a day), but then I discovered LC dieting, mainly LCHF at that time, and started eating to meter. Within 3 months I was reducing my Glic dose and my BP meds and kicking my statins into touch. I did not need insulin therapy and still don't. I have reduced my glic dose down to 40 mg a day now, and halved my Metformin, and last week my GP declared me Normal. So for me the choice seems to have been well worth it.

I have as a result of the LC diet changes managed to reduce my weight, my girth, my wardrobe contents, and consequently my Insulin Resistance. This latter means that I am no longer caning my beta cells, and although I use 1x glic tab still, I am comfortable with that and I now have a vastly improved insulin response that allows me to eat a more carby diet than I was, and not put on weight. So I do not fear burnout myself, but time will tell. I have been T2D for over 15 years now, and feel much better

Either therapy is viable. I find using glic allows me to be more relaxed.

Very sound advice - to a type2. @scarred is LADA, however. Their immune system kills their insulin producing cells. Eating low carb makes you need less insulin, no matter if it comes from your body or from the fridge, but you still need insulin. Gliclazide can squeeze out your pancreas to force it to give you insulin, but for a LADA it comes to an end eventually, at which point they definitely need insulin from the fridge, as there's nothing left in the body.

 

[Bluetit1802]

@Energize Because you are experiencing liver dumps in the mornings and during/after exercise, you most likely have a lot of insulin resistance. If this is the case, and if your pancreas is producing enough insulin of its own, in my opinion neither injected insulin nor Gliclazide is the right medication. However, I am not a doctor. This is just my opinion.

In my opinion, and after reading stuff about it, There is no point in forcing your pancreas to produce extra insulin (This is what Glipizide does) if you already have enough of your own but it doesn't work properly due to the resistance. All that will happen is you will end up with more insulin than you need circulating in your blood stream, which will make the insulin resistance worse and may lead to weight gain or inability to lose weight. Have you any idea what your insulin levels are like?

 

[Oldvatr]

Would the same theory apply to a Type 2?

I'm on Glipizide 5mgs twice a day but I'm finding it difficult to anticipate when the effect will kick in, so when to prepare meal and eat etc. First thing in the mornings is the worst as, as soon as my feet touch the floor, my glucose levels shoot up (I use Freestyle Libre - extravagant but my best motivator I've found )

So, currently, as I normally wake up around 4am (only 3 hrs sleep - normal for me), I've been taking my Glipizide at that time, as it takes around 3 hrs, or more, to have any effect. So, I then have been getting up around 7am. This strategy seems to have helped initially but, once downstairs, levels start rising again, not getting back down until around 12md. Also, before my evening meal, I try to take Glipizide around 5pm, and eat around 8pm

By the way, I'm on LCHF, so cheese, eggs or ham for breakfast. Any activity will send my BG levels up, too. I'm thinking I need to see the GP to discuss this and see what he has to suggest. I don't mind injections - I do my own Vit B12 injctions, subcut/orange needle so insulin, at low dose, might give me more control, to my thinking. I'll be interested to read how this thread progresses.

The OP is being offered Gliclazide, which is similar to but not the same as Glipizide.
https://www.wsh.nhs.uk/CMS-Document.../6071-1-Diabetes-Gliclazide-and-Glipizide.pdf

Glic is I believe more agressive than Glip, which is an older drug. The dosage of Glic is usually higher than Glip/

Since both drugs amplify the insulin reponse, then IMO they need carbs to trigger that response, so I take mine about 30 mins before a meal as a sort of T2D bolus. I do not think either drug does much for us if there is no meal to start the ball rolling, so is no use to combat Dawn Phenomenon.

Keeping glucogen stores low by following proper LCHF diet to deplete these stores will eventually reduce the DP since the liver has limited ability to dump glucose. Snacking at night will top up the liver stores and undo the good work LCHF does. I found it took something like 5 months while I lost weight and adipose fat before my DP subsided.

So to recap. My experience with Glic shows that it does nothing as a morning after pill, so will not clear glucose from the blood if there is no insulin demand. It is not the same as exogenous insulin, which is injected into the blood and which will act without needing any stimulus from a meal.

 

[Oldvatr]

Very sound advice - to a type2. @scarred is LADA, however. Their immune system kills their insulin producing cells. Eating low carb makes you need less insulin, no matter if it comes from your body or from the fridge, but you still need insulin. Gliclazide can squeeze out your pancreas to force it to give you insulin, but for a LADA it comes to an end eventually, at which point they definitely need insulin from the fridge, as there's nothing left in the body.

I agree, my advice is as a T2D and not so relevant to someone with LADA. I wonder why they were prescribed this drug if their progression is more strongly mapped out than mine.

I must assume that the LADA dx is only recently been confirmed by the lab tests for GAD and c-peptide, and that the use of an oral med is a temporary stopgap to bring high sugars down quickly before the proper ID training and support could be arranged. The worry from burnout from this drug is probably not going to have much impact in the timescale.

 

[ickihun]

I can only speak for myself but I always feel well on metformin and insulin or just insulin. I can lose weight healthily on these meds but Gliclizide just made me gain weight.
However insulin without low carb can cause some people weight gain.

 

[scarred]

I agree, my advice is as a T2D and not so relevant to someone with LADA. I wonder why they were prescribed this drug if their progression is more strongly mapped out than mine.

I must assume that the LADA dx is only recently been confirmed by the lab tests for GAD and c-peptide, and that the use of an oral med is a temporary stopgap to bring high sugars down quickly before the proper ID training and support could be arranged. The worry from burnout from this drug is probably not going to have much impact in the timescale.

I've had LADA for a couple of years now and I've had all the tests. The progression to insulin is inevitable as the beta cells stop working.

To squeeze the beta cells with glicazide or not is the question. What is the benefit of protecting the few remaining producing cells? Prolonging the honeymoon phase?

And yes I'll be discussing this with a professional too.

 

[ickihun]

I've had LADA for a couple of years now and I've had all the tests. The progression to insulin is inevitable as the beta cells stop working.

To squeeze the beta cells with glicazide or not is the question. What is the benefit of protecting the few remaining producing cells? Prolonging the honeymoon phase?

And yes I'll be discussing this with a professional too.

Well it depends if no cells and with insulin gives overall better control than the mad on/off honeymoon phase stress on the tablet. Also if some cells then more adventurous if a cure to be developed as at least some life to help rather than none if killed off by Gliclizide?

 

[Jenny15]

I have T2 and have just started on insulin after 9 years of low carb success then major burnout and needing the helping hand of insulin.

So I'm biased. Here is some info on the pros and cons of insulin for T2 (I realise you are LADA not T2 but some of the info is still accurate):
http://www.phlaunt.com/diabetes/15478720.php

I have only ever taken Metformin and I hope to come off it eventually because I don't think the benefits are worth it, But I will ask my doctor and nurse.

I don't want to ever take the other meds as I'm sure they will cause even more weight gain as well as some serious side effects and risks. To me, insulin just makes more sense.

 

[Oldvatr]

Does anyone actually have a proper study report that confirms sulphonylureal drugs kill beta cells or lead to progressive loss of insulin secretion? I have done a load of searches on this subject, and all I can find is forum discussion and blogger spiel and some very biassed reporting in the press. There has certainly been folklore discussion on this matter, but there seems to be no study that actually confirms it. I can find the likes of Bernstein, Mercola, and Jenny Ruhl expounding this hypothesis, but none of them actully refer to evidential proof of the assertions. It seems that the hypothesis relies on the assumption that the drugs force or squeeze more insulin out of the pancreas so must be making the cells work harder thus depeleting their lifespan. But there are many other things that damage and destroy these cells. This is what I found

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3900074/

1. Zhang et al. Second-Line Agents for Glycemic Control for Type 2 Diabetes: Are Newer Agents Better? Diabetes Care 2014;37:1338–1345

https://www.ncbi.nlm.nih.gov/pubmed/1425152

I suspect that until recently the progression of T2D towards insulin therpy being necessary was something that was inevitable and so a scapegoat had to be discovered to hang the blame on. This is the 'T2D is a progressive disease' mantra, which many of us here can now challenge.

The recent discoveries into the effect of NAFLD on insulin resistance show that this is a major stress on the pancreas, and now that it seems to be potentially reversible, then this may remove the progessive march of T2D towards self destruction (according to the media and Panorama).

To me NAFLD is far more harmful than my drugs, and hyperglycemia is also potentially fatal, so using glic to fight both these conditions makes sense to me, and in the absence of proof otherwise, I am content to continue using them.

 

[Jenny15]

Does anyone actually have a proper study report that confirms sulphonylureal drugs kill beta cells or lead to progressive loss of insulin secretion? I have done a load of searches on this subject, and all I can find is forum discussion and blogger spiel and some very biassed reporting in the press. There has certainly been folklore discussion on this matter, but there seems to be no study that actually confirms it. I can find the likes of Bernstein, Mercola, and Jenny Ruhl expounding this hypothesis, but none of them actully refer to evidential proof of the assertions. It seems that the hypothesis relies on the assumption that the drugs force or squeeze more insulin out of the pancreas so must be making the cells work harder thus depeleting their lifespan. But there are many other things that damage and destroy these cells. This is what I found

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3900074/

1. Zhang et al. Second-Line Agents for Glycemic Control for Type 2 Diabetes: Are Newer Agents Better? Diabetes Care 2014;37:1338–1345

https://www.ncbi.nlm.nih.gov/pubmed/1425152

I suspect that until recently the progression of T2D towards insulin therpy being necessary was something that was inevitable and so a scapegoat had to be discovered to hang the blame on. This is the 'T2D is a progressive disease' mantra, which many of us here can now challenge.

The recent discoveries into the effect of NAFLD on insulin resistance show that this is a major stress on the pancreas, and now that it seems to be potentially reversible, then this may remove the progessive march of T2D towards self destruction (according to the media and Panorama).

To me NAFLD is far more harmful than my drugs, and hyperglycemia is also potentially fatal, so using glic to fight both these conditions makes sense to me, and in the absence of proof otherwise, I am content to continue using them.

We are all different. I provided some info and my own experience to help the thread author make their decision. I'm glad you have found a method that works for you.

 

[Oldvatr]

We are all different. I provided some info and my own experience to help the thread author make their decision. I'm glad you have found a method that works for you.

There is a general rule of thumb that thread questions like the OP posted will evoke certain predictable responses. Those forum members who use insulin therapy will urge the OP to ask for insulin treatment, and those like me who use orals successfully will bang the drum for orals. At the end of the day, the OP has a choice for their near future since both treatments are viable at reducing hyperglycemia, but it is almost certain that in time they face an ID future. I do too, but hopefully not for some time to come. I am also of the opinion that either treatment regimes can be used to extend the beta cell production for some time and it comes down to the OP choosing which way of treatment suits them best in terms of quality of life. The current use of orals as offered by GP buys time for proper treatment training to take place which is a temporary benefit,

I think that one aspect tht the OP needs to take into consideration is to find out if they have Insulin Resistance present, which is apparently possible for LADA. If so then exogenous insulin will not be helping that condition, and I would auggest that whichever treatment is chosen, then an LC diet become part of either treatment to combat any IR to reduce insulin needs and to reduce any NAFLD if present.

 

[Jenny15]

At the end of the day, the OP has a choice for their near future since both treatments are viable at reducing hyperglycemia, but it is almost certain that in time they face an ID future.

I agree with everything you are saying but I would just add that everyone is different. It's impossible to know enough about a person on a forum to know which option will be more effective, sustainable, practical and affordable for that person. They know, though. All we can do is provide the info then respect them enough to decide for themselves.

I admit my understanding of the issue is limited to T2. I know little about LADA, so I noted that in my post. I know I have spent the last 9 years trying to manage T2 along with several other health issues and fairly tumultuous life events. So I try to keep in mind that a poster may also have a lot going on.

The art and science of medicine is that a doctor can find out as much as possible about their patient's physical and lifestyle factors, and help them decide, based on that. Words on a screen are often a poor substitute. But at least they're here 24/7 and cost nothing.

 

[Daibell]

I have T2 and have just started on insulin after 9 years of low carb success then major burnout and needing the helping hand of insulin.

So I'm biased. Here is some info on the pros and cons of insulin for T2 (I realise you are LADA not T2 but some of the info is still accurate):
http://www.phlaunt.com/diabetes/15478720.php

I have only ever taken Metformin and I hope to come off it eventually because I don't think the benefits are worth it, But I will ask my doctor and nurse.

I don't want to ever take the other meds as I'm sure they will cause even more weight gain as well as some serious side effects and risks. To me, insulin just makes more sense.

Hi. Neither insulin nor the typical diabetes tablets such as Glic or Glip cause weight gain but the carbs you eat may do if you eat too many. The meds enable the body to metabolise the carbs which it couldn't do otherwise.