Gliclazide and "skipping" meals

[debs248]

Rambly thoughts from a newbie, will try to stick to the point above...

I'm used to eating only 1 meal somewhere between 4-8 pm, then a snack before bed.

This week I was diagnosed with diabetes (HbA1c 113), the GP tested my blood glucose (20.1) and ketones, and prescribed Gliclazide and Metformin. I'm supposed to take 40mg Gliclazide once per day for 4 days, then twice per day for 3 days, then add the metformin in gradually increasing doses. She insisted that I must start eating another meal every day, NO EXCUSES, even though I had explained to her that this would be extremely difficult to arrange in my current situation.

She also gave me a blood glucose meter and told me to check first thing, before or after a meal (can't remember which so I plan to do both) and before bed.

As you might know if you've seen my other thread, I haven't been able to get a decent blood drop so no testing yet. So far I've taken Gliclazide once per day with my first or only meal and am supposed to up it to twice today. I haven't had much in the way of side effects so far - I had a bit of a weird wibbly feeling an hour or two after taking it on Friday but as I'd had a reasonably carby pub lunch I reckon it wasn't a hypo, just exhaustion after a stupidly busy week.

I'm trying to find a balance - obviously bringing down my blood glucose to sensible levels is high priority but I don't want to either eat extra food unnecessarily or risk a hypo. Not being able to test blood glucose means I'm flying blind here.

I'm sort of thinking that if I can't fit in a 2nd meal and don't take the 2nd dose of Gliclazide, that's better than taking it on an empty stomach? The meals are supposed to be 10-12 hours apart which would mean eating the 2nd one between 2-6am which is a bit ridiculous!

I could just try taking it without a meal today and see what happens. Or delay the snack to 2am and take it then. Has anyone had a similar experience? (unlikely for I am very "special" )

 

[lovinglife]

We can’t advise on how and when you take your meds as forum rules don’t allow it, when I was on Gliclizide I definitely had to eat after taking it. It’s a hypo inducing medication so it can be dangerous if you don’t, especially if you drive, so your nurse does have a valid point.

I haven’t been on it for a long time now but if I didn’t eat after I’d taken it I would get serious hypo in the mid 2s. I know you’re struggling testing so won’t go into that but the sooner you can get the hang of that the better as you are taking Gliclizide.

Maybe you could speak to your nurse again and ask if you could try staying on the one dose for a while to see if that’s enough to bring your BG down?

I used to take mine with my breakfast & evening meal - usually 8 hrs apart, can you change to having your snack as your breakfast and take one then and then the other with your evening meal as you are doing now?

 

[JoKalsbeek]

Rambly thoughts from a newbie, will try to stick to the point above...

I'm used to eating only 1 meal somewhere between 4-8 pm, then a snack before bed.

This week I was diagnosed with diabetes (HbA1c 113), the GP tested my blood glucose (20.1) and ketones, and prescribed Gliclazide and Metformin. I'm supposed to take 40mg Gliclazide once per day for 4 days, then twice per day for 3 days, then add the metformin in gradually increasing doses. She insisted that I must start eating another meal every day, NO EXCUSES, even though I had explained to her that this would be extremely difficult to arrange in my current situation.

She also gave me a blood glucose meter and told me to check first thing, before or after a meal (can't remember which so I plan to do both) and before bed.

As you might know if you've seen my other thread, I haven't been able to get a decent blood drop so no testing yet. So far I've taken Gliclazide once per day with my first or only meal and am supposed to up it to twice today. I haven't had much in the way of side effects so far - I had a bit of a weird wibbly feeling an hour or two after taking it on Friday but as I'd had a reasonably carby pub lunch I reckon it wasn't a hypo, just exhaustion after a stupidly busy week.

I'm trying to find a balance - obviously bringing down my blood glucose to sensible levels is high priority but I don't want to either eat extra food unnecessarily or risk a hypo. Not being able to test blood glucose means I'm flying blind here.

I'm sort of thinking that if I can't fit in a 2nd meal and don't take the 2nd dose of Gliclazide, that's better than taking it on an empty stomach? The meals are supposed to be 10-12 hours apart which would mean eating the 2nd one between 2-6am which is a bit ridiculous!

I could just try taking it without a meal today and see what happens. Or delay the snack to 2am and take it then. Has anyone had a similar experience? (unlikely for I am very "special" )

Gliclazide forces your pancreas to produce more insulin to deal with the food you eat. If you don't eat, and your system gets flooded with insulin, you get the same thing someone shooting insulin on an empty stomach would: you'd likely get a hypo. With metformin limiting the glucose the liver releases, there's a failsafe that potentially won't work to bring your numbers back up if you go too low. And as long as you can't properly test for hypo's, it's NOT a good idea to experiment. Though I have to say it is an experiment I can't get behind whatever way you turn it. I didn't know low carbing and fasting weren't a good idea when on glic, and I had several hypo's, regularly. Not fun. And in my case, I got combative, and would refuse to eat. I didn't want help, even knowing full well I was in trouble. Different for everyone though.

A hypo can make you incapable/unwilling to take care of yourself, so if you're unable to bring yourself out of it, you have a very real, very dangerous problem.

If the meter is an issue, try a libre sensor (free on trial for two weeks), to see whether that works for you? Just, you know... Be careful.

...Maybe look at what you're eating when you do eat, see whether you can being your levels down without glic? You're already on one meal a day, which a lot of us use as (part of a method) to bring blood glucose under control. If your one meal is carb-laden, you might be able to switch it to protein/fats, so it won't spike you. What do you eat and drink in a day?

Not saying to go against the doc's advice, but the medication you've been put on does require you to eat... If you're not going to, for whatever reason, this regime isn't quite right for you and needs further discussion with your GP...?

Good luck eh,
Jo

 

[debs248]

We can’t advise on how and when you take your meds as forum rules don’t allow it, when I was on Gliclizide I definitely had to eat after taking it. It’s a hypo inducing medication so it can be dangerous if you don’t, especially if you drive, so your nurse does have a valid point.

I haven’t been on it for a long time now but if I didn’t eat after I’d taken it I would get serious hypo in the mid 2s. I know you’re struggling testing so won’t go into that but the sooner you can get the hang of that the better as you are taking Gliclizide.

Maybe you could speak to your nurse again and ask if you could try staying on the one dose for a while to see if that’s enough to bring your BG down?

I used to take mine with my breakfast & evening meal - usually 8 hrs apart, can you change to having your snack as your breakfast and take one then and then the other with your evening meal as you are doing now?

Oh if only I'd seen a nurse maybe I wouldn't have these problems!

(Sorry, very frustrated that I have been dealing with bureaucracy and poorly trained people all week)

I *might* get to see one on Friday but I'm not getting my hopes up. GP surgery's online system pretty **** and can't face ringing them today as I need to eat and order supermarket delivery as well.

I decided to risk adding the 2nd dose this morning despite no testing - hubby kindly volunteered to get up early and fry eggs (Side question, I've not been given any guidance as to what is in the meal I take with gliclazide, how does it prevent hypos if there are no carbs?)

No obvious symptoms/ side effects so far, I did manage to get a blood drop from a finger pad 7 hours after taking gliclazide with BG 15.3 so probably nowhere near hypo levels in the meantime!

I thought I needed to space the doses out by 10-12 hours, 8 sounds far more doable, thanks!

 

[debs248]

...Maybe look at what you're eating when you do eat, see whether you can being your levels down without glic? You're already on one meal a day, which a lot of us use as (part of a method) to bring blood glucose under control. If your one meal is carb-laden, you might be able to switch it to protein/fats, so it won't spike you. What do you eat and drink in a day?

I've been used to eating mostly low carb for nearly 10 years now and never liked eating in the mornings, so just slipped into this pattern. While every day is different, I'd typically go for 20-30g protein (more if available) with 1-3 portions of low-carb veg. I don't measure fat but I don't generally add extra fat apart from olive oil on a salad.

The snack could be almost anything, but usually less than 30g carbs. It's often leftovers from a previous meal, or a piece of cheese, sometimes pork rinds or lentil chips.

I'm trying very hard to ignore my love of crisps but do indulge perhaps once or twice a week. Fortunately I don't drink alcohol any more (perhaps half a unit twice a year) and trained my childhood sweet tooth into submission in my teens. Might drink a small glass of juice or Coke on special occasions but never fancy cakes any more thank goodness. My biggest difficulty is all my family are carb monsters so they cook unsuitable meals and eat terrible snacks all the time. Even my T2D mother keeps trying to give me cake I don't want.

Drinks - 3-4 large (500ml) mugs of tea with a splash of skimmed milk, sparkling water if stil thirsty.

Not saying to go against the doc's advice, but the medication you've been put on does require you to eat... If you're not going to, for whatever reason, this regime isn't quite right for you and needs further discussion with your GP...?

I did point this out to the GP at the time but her rather unhelpful response was "welll you'll just have to eat a second meal" as if there was no alternative. Fortunately they only want me to take it for 3 months until my next HbA1c but this summer is going to be a right pain foodwise.

I think when I finally see a diabetic nurse I might request slow release tablets. Fingers crossed!

Thanks for the support, it's really helping

 

[debs248]

I don't really want to reduce my carb intake as

I like vegetables.
Financial and family constraints mean keto is not currently feasible.
I'd rather eat less often and really enjoy what I *do* eat.

I'm aiming for <35g carbs per meal in general, with the occasional <50g "feast", and only eating once or twice per day. Surely that ought to be enough? It's already way below what the GP (female btw) probably thinks I'm eating.

 

[debs248]

Definitely going to ask about slow release gliclazide (the metformin is slow release anyway), can't believe they'd rather force me to eat more than I want to. Mind you I'm not ruling anything out these days, crazy times are upon us lol.

The gliclazide is only supposed to be a 3 month rescue treatment but things are difficult enough at the moment without adding an additional, unnecessary challenge. I seriously think 3 months of trying to "eat to the meds" might be the straw that broke the camel's back.

 

[JoKalsbeek]

Your HbA1c, if I did the math right, means you're basically hovering around 12 mmol/l all the time... That's more than the occasional coke-or-crisps spike. And you might not be managing keto, your current intake is fairly low carb and consistent with intermittent fasting or even One Meal A Day/OMAD... I think you might want to ask your GP for a GAD and a C-peptide test. Just to check whether you're actually, truly a T2. We're just diagnosed T2 on a guess, if there's nothing else there to indicate a different type of diabetes. They don't look for other types, as the tests are expensive and T2's are in the majority. If I were you, I'd want to be 100% sure of the diagnosis, unless you can find some explanation for your bloods being so high all the time. Maybe wear a CGM for a bit and keep a food diary, so you can show the doc your numbers (I am guessing) remain high even when fasting for most of the day. That might make them a little more cooperative and less dismissive. GP's like numbers, generally speaking.

Hang in there eh.
Jo

 

[JoKalsbeek]

PS: Other things can drive blood sugars up, too. Stress, other medications (statins, steroids), illnesses, so something else might be going on. We tend to look at foods a lot because there's much to be gained there, and fast, but you're covering most of that already. It'd be good to know where the high blood glucose is coming from, because it doesn't seem to be your food intake, unless I read it all wrong. And if it's something like steroid use for something that is with you for life, a "three month thing" isn't going to fix it. Maybe an endo would be able to step in, if your GP can't be bothered?

 

[debs248]

No steroids, but stress levels have been ridiculously high for the last 6 months so I have a strong hunch that may be to blame. I've been insulin resistant for over 20 years (I have PCOS) so assumed I'd be Type 2 one day given family history...

Now I'm more able to test, I'm getting lower readings, presumably due to the gliclazide, so at least something's going right.

 

[Melgar]

Stress can certainly drive up your blood sugars @debs248 . Is there anyway you can reduce those stress levels? I know sometimes life just puts us in that position. Sustained stress is detrimental to health. There is a lot of focus on diet, because diet has a big impact on blood sugars, however, if your body is revved up all the time, in that flight or fight mode, your body is responding readying itself for a fight or a flight away from something dangerous , hence the expression. Your body releases adrenaline and cortisol. Cortisol is a steroid hormone. When it is used as a medicine it's called hydrocortisone.

My suggestion, if I may, is to look for ways of releasing that stress, a brisk walk fir instance. I would also suggest meditation techniques too. The best option is to get yourself out of that stressful situation, but I know that isn't always possible.

Edited to add link about stress

https://www.apa.org/topics/stress/body

 

[debs248]

Stress can certainly drive up your blood sugars @debs248 . Is there anyway you can reduce those stress levels? I know sometimes life just puts us in that position. Sustained stress is detrimental to health.

My suggestion, if I may, is to look for ways of releasing that stress, a brisk walk fir instance. I would also suggest meditation techniques too. The best option is to get yourself out of that stressful situation, but I know that isn't always possible.

Life is currently full of stress, has been for decades but particularly bad the last 6 months. Unfortunately I'm mostly bedbound so can't physically work off the stress any more, and can't escape when it's other members of the household stressing me out. Playing computer games or reading when I'm well enough are my two main distractions nowadays.

 

[searley]

It's very much user dependant

I've only ever had 2 meals even on insulin, and even then I may skip the odd meal

The main think is keeping an eye on your BG your level either will or will not allow a meal to be skipped

If your bg is getting low then you have no option except to eat something