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Gliclazide and normal diet.

G

Garway

Member
Messages
16
Type of diabetes
Type 2
Treatment type
Tablets (oral)
Hello everyone, I hope I am posting this in the right section,

In December I was diagnosed with steroid induced hyperglycemia. I was given a blood tester and told to take my blood sugars four times a day and no other information. The GP diabetic nurse who I didn't see wasn't able to help as she said it was outside of her experience. The GP gave me Gliclazide 80 which led to a series of hypos whilst I was waiting for the community diabetic nurse to get in touch. I was advised to set the alarm foe 4 am in case I was having hypos in the night. This went on until the end of January when I eventually saw the nurse. She reduced the Gliclazide to 40 and told me to eat a normal diet. I was by now feeling weak and tired after trying to cut down and cut out things in my diet after reading about diabetes on the web but not fully understanding any of it.

The Gliclacide 40 doesn't seem to be fully working. I am ok in the morning but if I have any carbohydrate at all my blood sugar rises and I feel ill. I drink water in an attempt to bring it down which eventually works. For example, I had plain no sugar porridge for breakfast and 6 grapes. My morning blood sugar on waking was 6.6, before my midday meal it was 5.6 and exactly two hours after it was 15.7, and once again I feel unwell. Today I had soup for lunch and two pieces of high protein bread spread with low fat Philidelphia cheese, each slice is 13.6 gm carbohydrate and 1.5 gm sugar. The soup had about 23gm of carbohydrate and 4.4gm of sugar. Any type of sandwich made with the same bread has almost the same effect.

For my evening meal, I have some kind of protien, lots of veg and say 1/2 packet of Tilda microwave brown basmati rice. Puddings are a thing of the past, Now I have Hartleys jellies with a spoonful of Fage greek yoghurt.

I am always hungry, always thirsty, still weak and tired and I haven't had a 'normal' meal in quantity or quality in months. i am at a loss, I'm obviously not understanding something and feel I am going down hill fast, I have lost over 8 lbs since this started. I am still on high steroids and likely to be for a while.

I would appreciate any advice before I contact the community nurse again. Is it the Gliclacide, is it me, and just what is a 'normal diet' in these circumstances? Many thanks for your help.

Elizabeth
 
Hi and welcome,
Well you know the steroids aren't helping as they do cause raised levels, but there isn't much you can do about that.

You seem to have a very carb-heavy low fat diet and that will definitely not be working for you. All carbs turn to glucose once in the system. The more you eat, the more glucose you will have swimming about in your blood stream. Your nurse was wrong to tell you to eat a normal diet, but sadly that's what we all get from our nurses and GPs as they just follow the NHS guidelines to eat a balanced diet containing a lot of carbs at each meal and low fat. This doesn't work for diabetics I'm afraid.

I suggest you keep a food diary including portion sizes, test before each meal and 2 hours after first bite. Record these levels alongside your food and watch for patterns emerging. You are doing the right thing in counting your carbs, but maybe its time to reduce the number of grams per meal. Less or none for breakfast, a few more for lunch, and a few more for evening meal. Avoid or cut down on the worst culprits such as bread, breakfast cereals (including porridge), rice of any colour, pasta and things containing flour (such as most tinned soups). We also need to be careful with fruit and milk.

Testing this way is how you can learn to formulate a sensible and sustainable diet for yourself. There is no need to eat low fat. In fact many low fat products are full of sugar. Eat the real thing - dairy, mayonnaise, olive oil, nuts in moderation, avocados, eggs, etc. Good fats keep you from being hungry and help with the post meal spikes.

Have a look at this for information
https://www.dietdoctor.com/low-carb/60-seconds

You will need to keep a close eye on hypo possibilities with your Gliclazide. The less carbs you eat the less Gliclazide you need. This would have to be discussed with your nurse of course.
 
I'm on 40mg of gliclizide twice a day but still have to eat low carb, I have dropped mine down over the years from max dose to this. I did try for a while without it and very low carb but my numbers rose to unacceptable levels ( for me)

I now eat between 70 - 80g. carbs a day 20- 25 breakfast 10 at lunch and 20 - 25 for dinner with a 10g carb snack before bed - this seems to be my optimal level and I have good control.

I don't eat a lot of saturated fat but I do eat full fat anything and avocado, olive oil, oily fish and a few nuts - not a lot of butter as I'm not a lover of it - not much dairy either but do eat cheese.

There is no way I could eat all the carbs you eat and keep my bs at acceptable levels - try cutting your carbs a bit but remember to test as you can hypo on gliclizide - you'll get there it just takes time to get to know what you can and can't have
 
Hi @Garway welcome to the forum. As you can see you from the advice above medicine and diet have to work together to keep your blood sugar stable.

You will need to test more than 4 times a day to help you fine tune things at first. Fasting, before bed and before and two hours after eating aiming for 5-8 blood sugar levels.

As you are loosing weight, try and get some healthy fat in your diet from things like advocado, nuts, olives etc. It will not raise your levels and can help with the hunger and replace the calories lost from sugar and high carbohydrates.

Tagging @daisy1 for some new member information for you particularly blood glucose targets. Tagging @pleinster re steroids.
 
Do not confuse the heavily touted 'healthy' high carb diet for something you can live on and remain in good condition.
You are obviously eating far more carbs than you can cope with - I can only add my encouragement that you reduce the amount of carbohydrates in your diet and eat carefully calculated amounts of low carb foods.
 

Thank you for your reply. I shall follow your advice. I actually asked the nurse if she really meant anything and she said "yes, anything", so I seem to have got myself in a right mess because I have eaten considerably less of 'anything' with a nod towards what I thought diabetics ate hence the porridge. I shall read the the link and look forward to feeling a lot stronger and feeling better.
 


Thankyou Alison for the tags and the advice on fats.
 

Thank you for the carbs targets, it gives me something to aim for.
 

I'm afraid what she said is pretty typical. This is why the NHS says T2 is progressive. Eat what you like and take a pill. A few months later, Oh that pill isn't working, have 2 pills. Then down the line, different and stronger pills. Then insulin. What they fail to tell you is that it is a diet problem, or more precisely, a carb problem. Pills can help but diet is the key. We should never just be told to rely on the pills alone. Low carb with increased fats is the way to go. There is never any need to be hungry or dissatisfied with what you eat. Low carb can be a delicious way of eating.

As for a carbs target, I am diet only so no pills to help me. I stick to around 30g a day with a few treats every so often.

Please have a read round, and do come back with any questions you may have. No question is daft if you don't know the answer.
 
@Garway

Hello Elizabeth and welcome to the forum To supplement the excellent advice you have received so far, here is the Basic Information we give to new members and I hope you will find it useful. Ask more questions when you need to and someone will be able to help.


BASIC INFORMATION FOR NEWLY DIAGNOSED DIABETICS

Diabetes is the general term to describe people who have blood that is sweeter than normal. A number of different types of diabetes exist.

A diagnosis of diabetes tends to be a big shock for most of us. It’s far from the end of the world though and on this forum you'll find well over 147,000 people who are demonstrating this.

On the forum we have found that with the number of new people being diagnosed with diabetes each day, sometimes the NHS is not being able to give all the advice it would perhaps like to deliver - particularly with regards to people with type 2 diabetes.

The role of carbohydrate

Carbohydrates are a factor in diabetes because they ultimately break down into sugar (glucose) within our blood. We then need enough insulin to either convert the blood sugar into energy for our body, or to store the blood sugar as body fat.

If the amount of carbohydrate we take in is more than our body’s own (or injected) insulin can cope with, then our blood sugar will rise.

The bad news

Research indicates that raised blood sugar levels over a period of years can lead to organ damage, commonly referred to as diabetic complications.

The good news

People on the forum here have shown that there is plenty of opportunity to keep blood sugar levels from going too high. It’s a daily task but it’s within our reach and it’s well worth the effort.

Controlling your carbs

The info below is primarily aimed at people with type 2 diabetes, however, it may also be of benefit for other types of diabetes as well.

There are two approaches to controlling your carbs:
  • Reduce your carbohydrate intake
  • Choose ‘better’ carbohydrates
Reduce your carbohydrates

A large number of people on this forum have chosen to reduce the amount of carbohydrates they eat as they have found this to be an effective way of improving (lowering) their blood sugar levels.

The carbohydrates which tend to have the most pronounced effect on blood sugar levels tend to be starchy carbohydrates such as rice, pasta, bread, potatoes and similar root vegetables, flour based products (pastry, cakes, biscuits, battered food etc) and certain fruits.

Choosing better carbohydrates

The low glycaemic index diet is often favoured by healthcare professionals but some people with diabetes find that low GI does not help their blood sugar enough and may wish to cut out these foods altogether.

Read more on carbohydrates and diabetes.

Over 145,000 people have taken part in the Low Carb Program - a free 10 week structured education course that is helping people lose weight and reduce medication dependency by explaining the science behind carbs, insulin and GI.

Eating what works for you

Different people respond differently to different types of food. What works for one person may not work so well for another. The best way to see which foods are working for you is to test your blood sugar with a glucose meter.

To be able to see what effect a particular type of food or meal has on your blood sugar is to do a test before the meal and then test after the meal. A test 2 hours after the meal gives a good idea of how your body has reacted to the meal.

The blood sugar ranges recommended by NICE are as follows:

Blood glucose ranges for type 2 diabetes
  • Before meals: 4 to 7 mmol/l
  • 2 hours after meals: under 8.5 mmol/l
Blood glucose ranges for type 1 diabetes (adults)
  • Before meals: 4 to 7 mmol/l
  • 2 hours after meals: under 9 mmol/l
Blood glucose ranges for type 1 diabetes (children)
  • Before meals: 4 to 8 mmol/l
  • 2 hours after meals: under 10 mmol/l
However, those that are able to, may wish to keep blood sugar levels below the NICE after meal targets.

Access to blood glucose test strips

The NICE guidelines suggest that people newly diagnosed with type 2 diabetes should be offered:

  • structured education to every person and/or their carer at and around the time of diagnosis, with annual reinforcement and review
  • self-monitoring of plasma glucose to a person newly diagnosed with type 2 diabetes only as an integral part of his or her self-management education

Therefore both structured education and self-monitoring of blood glucose should be offered to people with type 2 diabetes. Read more on getting access to blood glucose testing supplies.

You may also be interested to read questions to ask at a diabetic clinic.

Note: This post has been edited from Sue/Ken's post to include up to date information.

Take part in Diabetes.co.uk digital education programs and improve your understanding. They're all free.
  • Low Carb Program - it's made front-page news of the New Scientist and The Times. Developed with 20,000 people with type 2 diabetes; 96% of people who take part recommend it... find out why
  • Hypo Program - improve your understanding of hypos. There's a version for people with diabetes, parents/guardians of children with type 1, children with type 1 diabetes, teachers and HCPs.
 
Hi Elizabeth @Garway, some very good advice above. I was on Gliclazide initially but it had little to no effect...doubled it..still little effect. After keeping careful notes of what an when I was eating, what other meds I was taking and when, as well as what my meter readings were at varied times (including just before and 2.5 hrs after eating)...I soon established from the clear emerging patterns that two things alone were causing spikes in my blood sugar level - foods with carbohydrate content above 10g per 100g of product (see labels), particularly bread, cereal, potatoes, rice and pasta... and the steroid I was taking as part of my anti-rejection treatment post kidney transplant. To be clear on this....I inherited my kidney condition at birth...I got my diabetes from the subsequent long term steroid treatment (the culprit being prednisolone). So I got what's called Steroid Induced Diabetes (Type 2). Only by speaking at length with my doctors and showing them my own records to back my points up, did I get them to reduce the dosage of the steroid. I also stopped taking the Gliclazide so that I could see what was happening without the assistance of meds for diabetes....gradually, as the steroid was reduced and further reduced it became easier and easier to control my blood sugar levels. That said, I only achieved normal levels by reducing my carb intake dramatically as well as reducing the steroid to a minimum dose. It is very important to grasp what many of those medical staff advising us just don't seem to grasp - CARBS TURN TO GLUCOSE IN THE BLOOD - and that is why a "normal healthy diet" is poor advice....we don't have "normal health"!. My advice - test yourself at appropriate times and you will soon see very clearly what your levels are like without high carbs. Further, you will notice a spike after your steroid perhaps climbing up over as much as 4 maybe 5 hours before it dips again. Advice there is basic - ask your doctor and or nurse about reducing the dose of the steroid...if it is prednisolone ask about alternatives. They will know that it pushed the blood sugar up (unless they are pretty poor). My renal doctors (who monitor my blood very closely) are in total agreement with me now as is the diabetes consultant I see. You will definitely get the levels down if you successfully address these issues. Good luck. Paul
 
Thanks Paul, my problem is that I have been on high steroids for far too long. I started off at 60 and now, 20 weeks later, I am still on 45. This is causing chaos throughout my body. By now it was planned I should be on 20 and slowly reducing but any drop has been reversed by three different doctors on the occasions when I ended up in hospital with a chest infection and then PE.

I am desperate to lower the steroids, but it is going to take some time, in the meanwhile I am on Rivaroxaban for the PE which is scary in itself. Strangely, I know when my blood sugar is rising as I feel it in my feet and ears. I have peripheral neuropathy from a stem cell transplant back in 2000 and when the sugar rises my feet begin to burn and the tinnitus in my left ear gets very much worse and I feel unwell, so lowering carbs seems the way to go starting from today.

As I have been taking far too much carbohydrate it seems a bit drastic to cut them down to the Keto level in one swoop, or is it? How long did it take get to the level that suited you?
Elizabeth
 
Hi Garway, I was a long term (3 years) pred user and it caused my T2 diabetes, days after I was diagnosed I was admitted to hospital having suffered an SVT thats a superventricular tachicardia not sure if I spelled that right but as my bg levels were so high the two halves of my heart were beating out of time with each other so to get enough blood circulating my heart beat was 188 bpm! They had to chemically stop my heart to reset it to its usual rhythm.

My HbA1c was 12.6% and my bg level was 29 mmol/L and I was referred to the diabetes unit and a specialist diabetes nurse came to see me in hospital and gave me the good news that I would be going into multi daily injections (MDI) of insulin as the pred was raising my bg levels too high for oral meds to work.

I was terrified and it took me around 45 minutes to inject myself that first time as I was a needle phobic wimp, but that all changed, very quickly

Looking back on it, it was the best thing that could have happened to me for two reasons, firstly it scared the life out of me and made me determined to lose weight, get off the steroid and lose my insulin resistance enough to get off insulin, and secondly because it gave me the tool I needed to do just that.

Over the first year, a combination of insulin and a 60g of carbohydrates a day diet helped me to lose 4 stone in weight and wean myself off both the pred and the insulin soon followed but without that insulin I could not have controlled my bg levels as quickly and as effectively as I did, in effect the diet alone could not have done it.

I would definitely advise asking for a referral to a hospital diabetic unit where they understand the interaction between steroids and diabetes and can advise on insulin treatment, if I had to go back onto prednisolone for more than a couple of weeks for any reason I would have no hesitation in asking to be put back on MDI insulin as IMHO it is the only way to control bg levels when you are taking a high dose of pred.

Good luck and there can be light at the end of the tunnel.
 

Thanks Sid, I'm aiming to get hold of the community disbetic nurse on Monday and will discuss all of this with her. I was initially told that the steroid induced hyperglycemia would be temporary but extended high doses makes me worry that it may not. These steroid side effects over such a long time are killing me.
 
Garway said:
As I have been taking far too much carbohydrate it seems a bit drastic to cut them down to the Keto level in one swoop, or is it?
Click to expand...

Please go gently, one meal at a time, keeping testing and learning.
 


Certainly not temporary, how it works is like this*, the Predisolone is a corticosteroid and when you take it your body stops producing its own cortisol as your brain figures you have enough, this is why Pred has to be reduced slowly or your body can sometimes forget to reboot its own cortisol production as happened to me which is why I ended up taking it for 3 years! It was first prescribed when I suffered respiratory failure and was in intensive care and had massive doses of pred by IV.

Now as I understand it cortisol is released along with adrenal gland and is part of the flight or fight reaction we get when adrenalin is released and as Pred raises the cortisol in your body your body thinks it needs a huge dose of glucose to deal with the flight or fight response it mistakenly thinks is happening, huge releases of glucose = high blood glucose levels and why pred raises bg levels.
* Its a complicated chemical reaction and its 7 years ago that it was explained to me so I may be a bit rusty and may have got bits wrong but that is the general gist of it.

So all the time you take prednisolone or other corticosteroids your bg levels will continue to run higher and higher and insulin is the most effective way deal with it. Many doctors appear to be ignorant of this or simply assume its not a problem, the specialist hospital diabetic clinics are run by an Endocrinologist and they deal specifically with the endocrine system and diseases that are caused by problems with hormones, so are experts in corticosteroids and diabetes and will know far more than any GP or practice nurse could ever learn, I guess I was lucky to have been admitted to hospital when I was and a specialist diabetes nurse was called to see me because they had to control my bg levels with an insulin drip and the hospital consultants and doctors couldnt work out how much was needed.
 

I had no ill effects whatsoever from avoiding carbs. One day I just decided..no bread, no cereal, no pasta, chips, rice, pizza...and I gradually (ie. inside a couple of weeks) was not eating anything which was more than 10% carbohydrate. In very little time, I was eating less than 25g of carb per day...no difficulties (other than missing my shreddies and croissants). At no time did I have issues with ketones. I then gradually upped it to around 60g a day...making sure I was eating plenty of other good foods (including meat, oily fish, avocados, asparagus, and a lot, lot, lot more). Until recently, as numbers got well under control, I was back to a less strict approach very successfully - but have just had an issue with temporary steroid increase setting me back a bit. We all differ...being variations on a theme...but low carb eating has only had very, very good impact on me. By all means cut down a bit at a time, but I see no reason to take too long about it if it feels ok and is producing results. Most people seem to feel a bit dud for a few days until they adapt. My only warning would be - do it in conjunction with self testing; if you are on meds for diabetes you don't want your level going too low.
 

Well, rusty or not, for me that is the best most understandable explanation of what's going on. Thank's Sid. Now they just need to find a way to get these steroids down quickly.
 

I started yesterday. I halved the breakfast carbs, did away with rhem all together at lunch and had a moderate amount at dinner. Altogether about 60 for the day and I felt a lot better for it. My morning reading this morning was 4.8.
 
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