Gliclazide on a low carb diet

[Numan]

Hi everyone, so I need some help understanding Gliclazide. I’m on Metformin and have just been put on Gliclazide just over a week ago. Previously I controlled by diet only, low carb (60 Grammes a day spread equally over three meals) but since I had covid jab, an operation, wound infection, then covid my sugars went high and I couldn’t get them down. To complicate things, two days after starting on G I went on holiday and have been trying to eat as low carb as possible, but without my usual staples. Readings haven’t really changed since starting G. Then yesterday I got sick of sitting opposite my wife eating cakes and all the naughty stuff, so I had a low carb day off, not mad but I had bread, potato, ice cream. This morning my fasting reading is 3.0 below what I’ve kept having for the last week. Does G need carbs to work? I’m still on holiday so can’t contact my DN, so
I thought I’d ask for advice. Fasting readings have been 14 since November, and very stable, this mornings was 11

 

[NicoleC1971]

Hi everyone, so I need some help understanding Gliclazide. I’m on Metformin and have just been put on Gliclazide just over a week ago. Previously I controlled by diet only, low carb (60 Grammes a day spread equally over three meals) but since I had covid jab, an operation, wound infection, then covid my sugars went high and I couldn’t get them down. To complicate things, two days after starting on G I went on holiday and have been trying to eat as low carb as possible, but without my usual staples. Readings haven’t really changed since starting G. Then yesterday I got sick of sitting opposite my wife eating cakes and all the naughty stuff, so I had a low carb day off, not mad but I had bread, potato, ice cream. This morning my fasting reading is 3.0 below what I’ve kept having for the last week. Does G need carbs to work? I’m still on holiday so can’t contact my DN, so
I thought I’d ask for advice. Fasting readings have been 14 since November, and very stable, this mornings was 11

Glicazide stimulates insulin when it is needed i.e when carbs are eaten.
It isn't in a list of meds which would cause a problem on a low carb diet e.g. either low blood sugar or ketoacidosis.
If you continue with low carb you may find you no longer require it because you should improve your sensitivity to insulin and not require those additional pulses of insulin to keep blood sugars normal when you do eat carbs.
Did you feel bad on a 3.) btw? A normal range is about 4-7 fasting and within 2-4 hours of a meal.
There s a handy short paper here should you wish to discuss the implications of your diet with diabetes meds here. I would not assume your gp or nurse is necessarily aware of the implications!
https://bjgp.org/content/69/684/360/tab-article-info

 

[DEBBIESCOTT]

I’m on 20mg gliclazide
It can & does make me hypo

 

[Numan]

Glicazide stimulates insulin when it is needed i.e when carbs are eaten.
It isn't in a list of meds which would cause a problem on a low carb diet e.g. either low blood sugar or ketoacidosis.
If you continue with low carb you may find you no longer require it because you should improve your sensitivity to insulin and not require those additional pulses of insulin to keep blood sugars normal when you do eat carbs.
Did you feel bad on a 3.) btw? A normal range is about 4-7 fasting and within 2-4 hours of a meal.
There s a handy short paper here should you wish to discuss the implications of your diet with diabetes meds here. I would not assume your gp or nurse is necessarily aware of the implications!
https://bjgp.org/content/69/684/360/tab-article-info

Thanks for replying, to make it clear my figures are normally 14.0 but today they were 11.0 down 3.0 from the usual. Prior to November I had been on low carb for 3 years or so and generally fasting figures were 6 to 7. Then they just doubled overnight and have stayed high ever since. The lowest I’ve been this week was 6.1 after a 25 mile bike ride, normally this would stay low for a reasonable time but even without eating it went up to 11.5 within a few hours of stopping exercising

 

[Bittern]

Low carb and gliclazide can and do work together but it is a drug that can and will make you hypo. You need a meter and need to test before and after meals and at any time you feel a little funky. You also need to carry glucose tabs., jelly babies or something similar to take you out of a hypo if you get one at least until you get to know how low carb and gliclazide work for you. If you are around 3 in the morning, with your nurses consent, change any dose you take before bed, the other alternative is to have a slightly more carb heavy evening meal and reduce carbs during the rest of the day to stay within your carb target.

 

[NicoleC1971]

I’m on 20mg gliclazide
It can & does make me hypo

That's interesting . Are you looking to reduce it if that's happening a lot?

 

[NicoleC1971]

Thanks for replying, to make it clear my figures are normally 14.0 but today they were 11.0 down 3.0 from the usual. Prior to November I had been on low carb for 3 years or so and generally fasting figures were 6 to 7. Then they just doubled overnight and have stayed high ever since. The lowest I’ve been this week was 6.1 after a 25 mile bike ride, normally this would stay low for a reasonable time but even without eating it went up to 11.5 within a few hours of stopping exercising

Sounds as if your own insulin isn't keeping up. I hope the dietary changes help to restore supply/increase sensitivity if that's the issue.
Not eating causes your body to make its own glucose which sh0uld then normally be balanced by your own insulin. Obviously cycling 25 miles isn't an everyday solution but does show that you've still got some of your own insulin as this is needed to take glucose into cells!

 

[Oldvatr]

Thanks for replying, to make it clear my figures are normally 14.0 but today they were 11.0 down 3.0 from the usual. Prior to November I had been on low carb for 3 years or so and generally fasting figures were 6 to 7. Then they just doubled overnight and have stayed high ever since. The lowest I’ve been this week was 6.1 after a 25 mile bike ride, normally this would stay low for a reasonable time but even without eating it went up to 11.5 within a few hours of stopping exercising

I am confused. Your avatar says insulin dependant so is that correct since gliclazide requires a functioning pancreas to do its stuff.

I am a glic user. I was on 350mg a day before I went low carb. Now I am on 40mg per day and still low carbing (actually medium carb to be true) and I find that one tab can drop my sugars by about 4 mmol/l, but less if it was a high protein _+ fat meal. I do not hypo on that dose and am currently running with average readings of between 5 and 6.

Yes glic does need a glucose hit to work. The glucose triggers an insulin response, and glic only seems to work when there is a demand for insulin from glucose. It does not seem to respond as much to a protein or lipid insulin demand. It may be that my meals generally trigger a glucose hit, but by the time the protein and fat hit arrives, then the glic is already used up or filtered out. I have not tried a protein only meal.
@DEBBIESCOTT how do you get your 20mg dose? The BNF shows 40mg as the lowest tablet dose available so are you splitting 40mg tabs?

 

[DEBBIESCOTT]

That's interesting . Are you looking to reduce it if that's happening a lot?[/
No, without it blood sugar keeps rising with it it plummets, it’s a balancing act every day, the joy of having MODY (only take 1/2 of the lowest therapeutic dose)

 

[DEBBIESCOTT]

I am confused. Your avatar says insulin dependant so is that correct since gliclazide requires a functioning pancreas to do its stuff.

I am a glic user. I was on 350mg a day before I went low carb. Now I am on 40mg per day and still low carbing (actually medium carb to be true) and I find that one tab can drop my sugars by about 4 mmol/l, but less if it was a high protein _+ fat meal. I do not hypo on that dose and am currently running with average readings of between 5 and 6.

Yes glic does need a glucose hit to work. The glucose triggers an insulin response, and glic only seems to work when there is a demand for insulin from glucose. It does not seem to respond as much to a protein or lipid insulin demand. It may be that my meals generally trigger a glucose hit, but by the time the protein and fat hit arrives, then the glic is already used up or filtered out. I have not tried a protein only meal.
@DEBBIESCOTT how do you get your 20mg dose? The BNF shows 40mg as the lowest tablet dose available so are you splitting 40mg tabs?

Yes, have a pill cutter & cut the 40mg in half as instructed by the hospital

 

[DEBBIESCOTT]

Sounds as if your own insulin isn't keeping up. I hope the dietary changes help to restore supply/increase sensitivity if that's the issue.
Not eating causes your body to make its own glucose which sh0uld then normally be balanced by your own insulin. Obviously cycling 25 miles isn't an everyday solution but does show that you've still got some of your own insulin as this is needed to take glucose into cells!

No without it blood sugar keeps rising, with it it plummets, balancing act every day, the joy of MODY

 

[Oldvatr]

No without it blood sugar keeps rising, with it it plummets, balancing act every day, the joy of MODY

I take it you are HNF4-alpha, and this explains the sulfonyl requirement. As you say, MODY is unlike trad diabetes and comes with its own challenges.

PS I have a pill bottle full of split glic tabs which I gathered while progresssing in my Low Carb journey. The 80mg tabs have a score mark that makes them easy to split without the cutter. The 40 mg ones dont have the score line, being smaller.

 

[NicoleC1971]

No without it blood sugar keeps rising, with it it plummets, balancing act every day, the joy of MODY

Sorry Debbie. I know MODY is very different and you do make insulin and I am feeling dumb because I mis spelt glic and had it down as a different class of drug whereas its a Sulphourea hence can cause hypo. I will shut up now.

 

[DEBBIESCOTT]

I take it you are HNF4-alpha, and this explains the sulfonyl requirement. As you say, MODY is unlike trad diabetes and comes with its own challenges.

PS I have a pill bottle full of split glic tabs which I gathered while progresssing in my Low Carb journey. The 80mg tabs have a score mark that makes them easy to split without the cutter. The 40 mg ones dont have the score line, being smaller.

Yes HNF4A, took 25 years to get proper diagnosis
(Never heard of it until some kind person on here suggested it) nobody else in family have ever been diagnosed with diabetes either

 

[Numan]

So I’ve had a very confusing day, 20 Grammes of carbs for breakfast, 20 grammes for lunch, fasting reading this morning was 11.0. I ran out of test strips at work so couldn’t test until I got home. 6.0 at 6:30pm. Had salad and some chilli mince for dinner. Just tested and I’m 13.7, Why is it gone so high? it’s driving me crazy

 

[Oldvatr]

So I’ve had a very confusing day, 20 Grammes of carbs for breakfast, 20 grammes for lunch, fasting reading this morning was 11.0. I ran out of test strips at work so couldn’t test until I got home. 6.0 at 6:30pm. Had salad and some chilli mince for dinner. Just tested and I’m 13.7, Why is it gone so high? it’s driving me crazy

I am still confused. Your details state you are Insulin dependant T2, but your treatment is diet only. I must assume you are not using insulin since you have not posted anything to that effect. So, your chilli mince with salad bounced you. Well, protein does convert to glucose (about 50% the effect of carbs so I am led to believe from those T1D that have to bolus for it.)
Did you use any gravy powder or stock cube - some of these have added sugars. did you buy the mince from a butcher - I found one popular supermarket was injecting dextrose into their meat, and washing their chickens in sugared water to make the meat taste sweeter. Or was it a TV dinner or frozen ready made?

Your morning fasting level of 11 ia comparable to the post meal 13 so maybe your system is running at that level, and the surprise would then be the 6 after work. What was your recent HbA1c?

 

[Numan]

HbA1c was 109, not insulin dependent, can’t see where you found that or how to check. Mince from a supermarket. Tested the 6.0 on two different meters as was surprised myself

 

[HSSS]

I am still confused. Your details state you are Insulin dependant T2,

you’ve had this a few times lately. Have you got the old status glitch back? Numan is listed as plain type 2 to me, diet only if I hunt in the profile.

 

[Oldvatr]

you’ve had this a few times lately. Have you got the old status glitch back? Numan is listed as plain type 2 to me, diet only if I hunt in the profile.

Never mind. He has confirmed his status in his reply. My screen still shows ID in his profile page.

Numan Insulin-dependent Type 2 · Well-Known Member
Updated: the problem is now fixed.

 

[Numan]

So my fasting figure this morning (tested twice on two different testers) was 8.2. Which is the lowest fasting figure I’ve had for 6 months. My frustration is due to the complete unpredictably of my results, the only common aspect is my figures seem to be higher in the evening after my main meal, and I am watching tv relaxing after a day at work. Maybe I will try some exercise after my meal. Diabetes is so frustrating