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Gliclazide and Heart Failure

Discussion in 'Sulphonylureas & Prandial Glucose Regulators' started by Oldvatr, Mar 25, 2019.

  1. Oldvatr

    Oldvatr Type 2 · Expert

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    I was on Glic for over 3 years, and was successfully controlling my bgl, with an HbA1c of 42 last year. Then last month I had a blue light visit to A&E for a couple of heart attacks. I survived those, and am now waiting for surgery to improve my outlook. However, during the episodes, my bgl rocketed up into the stratosphere (32+) and my diabetic meds were stopped by the consultant. When I returned back to nearer the ground, I was told my Glic was possibly responsible for my heart failure, and that the drug is contraindicated from now on for me. I am having to get by on metformin and not much else seeing as I am still having to eat hospital food. They will not re-instate my Glic and are saying that the only drug I can take with my dicky ticker is an SGLT-2 Inhibitor, which I have immediately refused due to its reported side effects being unacceptable for me.

    I have tried to find out why my consultant has banned Glic from my future, and all I can find is a small study report in the AHA Journal that shows a weak association (0.35% increase in CVE) for those taking Glic alone, but no significant risk if Glic is taken with Metformin which is what I was taking before the excitement began. Does anyone have any info on this contraindication, since it is something that is not so far in the prescribing guidelines that I can see (NICE, BNF etc)so we may need to raise this as a new warning.

    Edit to add: The Consultant who stopped my meds did it because I no longer need it. He confirms there is no contraindication or association between Gliclazide and heart failure currently in place, and that if I find I need something in future, then I can ask my GP. Studies I have posted in this thread show that Glic may have a protective effect for CVE and may help reduce mortality.

    I have answered my own question, Thank you.
     
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    #1 Oldvatr, Mar 25, 2019 at 3:20 PM
    Last edited: Mar 28, 2019
  2. Antje77

    Antje77 LADA · Moderator
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    Glad you're still here after your casually mentioned 'couple of heart attacks'!
    Can't answer your questions as I don't know anything about hearts and Glic, but I just wanted to let you know I hope you'll be a lot better soon.
    I'm no cardiologist and no endocrinologist, but as far as I know there aren't any contra indications for insulin. Not saying you should go on insulin, but I think it's strange for them to say an SGLT-2 inhibitor is the only drug you can take. Lots of T2's take insulin, the ones with dicky tickers as well.
    All the best to you and your ticker, may it keep on ticking for a long time!
     
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  3. bulkbiker

    bulkbiker Type 2 · Oracle

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  4. Bluetit1802

    Bluetit1802 Type 2 (in remission!) · Legend

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    @Oldvatr I can't help with your quest, but wwant to send you my best wishes for a speedy recovery and a speedy escape from hospital food.

    Have you spoken to the consultant about this and asked where he gets his information about the heart failure risk from?

    Your current sky rocketing levels will surely come down once your pending surgery is over and your body is recovering. We all know what stress and illness does to our levels. Are you 100% certain you actually need glic once back home and eating properly? You are normally very well controlled on the lowest dose if I remember correctly.
     
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  5. lovinglife

    lovinglife Type 2 · Well-Known Member

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    So sorry for your troubles @Oldvatr - wishing you a good recovery (())
     
  6. zand

    zand Type 2 · Master

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    Sorry no useful info for you...just lots of love and good wishes. I had missed you and wondered if you were OK. Glad you came through all of that. :)
     
  7. Oldvatr

    Oldvatr Type 2 · Expert

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    Thanks
    Thanks for your support. I am hyperinsulinemic so for me exogenous insulin is not an answer since I clearly generate enough of my own. Glic worked for me because I had a poor Stage 1 insulin response, and by timing my dose properly I was using it to boost that initial response. So most of my insulin comes during the longer post prandial period, which is why my sugars dip during the night even when not taking any med as i am doing now. I generally drop 2 or 3 mmol.l in the night at the moment, so my morning fbg looks good. I am actually doing excellantly at the moment on just metformin with full in the face hospital food. I am generally below 7 mol/l most of the day even with 3 meals a day, and tea with biccies. Seems my 3 years on LC diets up to now has done me well. and a bit of weight loss in hospital has done wonders for my IR.

    Today my doctor declared me as being In Remission. with a second HbA1c of 46 after the 42 of a year ago. and today the hospital has stopped taking glucose readings and scrubbed out the Diabetic label on my chart above the bed.

    I consider myself to be back in control, but still diabetic and needing to regulate my lifestyle and weight to maintain this happy condition. But I have just had 2 days of birthday cake celebrations and still the meter showed good results. I can holiday again!!!!!!! I don't need to be so anal either......

    But losing my Glic will also mean I lose my GP support for SMBG test strips. so I will have to PV fund the Caresense Dual instead of the Codefree since it tracks the hospital meter closely, whereas the Codefree does its own thing and meander around the place as it does.
     
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  8. ringi

    ringi Type 2 · Well-Known Member

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    It may take sometime before your GP does a review and removes the test strips from the repeat prescription system.
     
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  9. Oldvatr

    Oldvatr Type 2 · Expert

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    Thanks for your kind thoughts. I think it is the new heart med that has a general aviso on sulfonylureas so I may get it back after my replumbing jobbie. I have agreed with consultant to revert to lifestyle only when discharged, and will see GP then if I need to. The other possibility is that the enhancing dye used during angiogram caused both my kidneys to pack up for a couple of days, so although this has repaired itself, it may be considered as a contraindication but not one the consultant spoke to me about,

    If you remember I switched off LCHF and went Pioppi diet since it was still LC but not so demanding as the LCHF or keto. The Glic allowed me leeway and this helped me share my diet with the carbophiles in the home. I was already finding I was more carb tolerant than I had been, so I was already getting ready to drop some more meds, but the Glic was supporting my teststrip habit.
     
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  10. Oldvatr

    Oldvatr Type 2 · Expert

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    The patient information sheet for the heart op says I need to keep tight control of bgl following the op, so it will need that support for a while, but maybe it is time to rationalise on only one meter now anyway. Using two was greedy, and also painful. And the Codefree was becoming unreliable so I will shed no tears.
     
    • Informative Informative x 1
  11. Juicyj

    Juicyj Type 1 · Expert
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    @Oldvatr Glad to hear your ok, just wanted to send you best wishes for a speedy recovery, sounds like you've been brought the mill, so hope your home soon.
     
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  12. Brunneria

    Brunneria Other · Guru
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    Very good to hear from you!
    Very sorry you are having a long wait for an important op, and stuck with hospital food for an indefinite period.
    Glad you have internet access, and hope we see lots more of you during the wait and your convalescence. :)
     
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  13. Jaylee

    Jaylee Type 1 · Moderator
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    Hey @Oldvatr !

    Great to see you online "me babber!"
    I'm not going to even dare a comment on affairs of the heart.

    But, you got my best from the west. :)
     
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  14. DCUKMod

    DCUKMod I reversed my Type 2 · Master
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    Jings crivvins @Oldvatr . That's all a bit of a shocker!! I'm glad you're still with us and preparations are under way to reply back you to fight another day.

    I don't have much in-depth knowledge of Gliclazide to offer you, but wish you well in unravelling the puzzle.

    Are you managing to get yourself emergency food parcels sent in or are you consigned to hospital food, although that may be doing your hospital a big disservice of course.

    From my work at the NIHR, I knew a few cardiac rehab folks, and they'd do marvellous things. I hope plans are afoot for a bit of help for you, once you get home, because from recollection it can be pretty full on for you there.

    Keep posting, and be good. We'll take your mind off things. :)
     
  15. kokhongw

    kokhongw I reversed my Type 2 · Well-Known Member

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    Perhaps this study?
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5533028/

    upload_2019-3-26_13-7-31.png


    upload_2019-3-26_13-8-6.png
     
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  16. Oldvatr

    Oldvatr Type 2 · Expert

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    Yes. That was the one I found that gives the 0.35% risk increase for glic only users. But unlikely my consultant would read that and accept it as gospel. He must have had direction from somewhere else. not in the BNF yet as far as I can see, but because I do not know what the new heart med i am being given is called I cannot follow that up for its specific instructions. We patients are not allowed to have access to the patient guidelines insert data since this is their magic art they need to keep from us mere mortals (Yes I do feel more mortal now) These secrets are kept locked up with the meds, and even these come in plain packaging so as to disguise them.

    Anyway it is slightly academic at the moment. As I said I am on full frontal hospital food, 3 meals a day, and fully carb laden to boot. But my bgl is not doing handsprings now, and I seem to be coping without a secondary diabetic med. If this persists, I am sure that I will cope when back at home on LC diet.

    I started this thread mainly to see if a new warning was in place about Glic that may affect other forum users, or even if there was a hint that Glic might actually trigger heart failure. But thanks to all for your comforting messages concerning my present predicament.
     
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  17. Oldvatr

    Oldvatr Type 2 · Expert

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    Update: I am still off the Glic. It seems to be contraindicated if the heart rejection ratio is below 40% which apparently mine was and maybe still is.

    I discussed this with another of the doctors on the ward, and told them of the two studies I had found that discussed Diabetic Med Safety, and she went away and googled it. She agrees that she cannot find anything that supports my Consultants view, and has suggested I raise it with him again,

    There is nothing in the BNF or Medscape on it, but the two reports I found both say that Glic gives protection against CVD.
     
    • Optimistic Optimistic x 1
  18. Bluetit1802

    Bluetit1802 Type 2 (in remission!) · Legend

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    Is that a typo? Do you mean "ejection rate" where 65% plus is ideal?
     
  19. Oldvatr

    Oldvatr Type 2 · Expert

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    possibly. I may be confusing it with eGFR which is kidneys.
     
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  20. PenguinMum

    PenguinMum Type 2 · Expert

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    @Oldvatr just popping in to wish you well, sorry you have had such a traumatic time. Hope the op comes sooner than later and glad your BG control is good. Re testing strips I read all the time how there are variances in the country as regards GPs prescribing them. I would try getting your Cardio Consultant and/or D consultant to sign that off in instructions to your GP. In your case it is probably as essential as any meds you are prescribed. You can but try. All best wishes.
     
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