Gliclazide and Heart Failure

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.

Thanks

Antje77 said:

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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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.

Bluetit1802 said:

@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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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.

ringi said:

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

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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.

kokhongw said:

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

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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.

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.

Bluetit1802 said:

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

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