Gliclazide

[RichBromiley]

Hello everyone-
Could I ask for some advice please?

My consultant last week suggested that Gliclazide might be a possible medication to help even out some spikes that I see after eating. I'm currently on 2x500mg metformin and last HBA1C is down to 43 (6.1%) from 91 at diagnosis. So he said that we could do nothing, but Gliclazide is also an option to consider to give me easier control and is writing to the GP to that effect.

For days on end my BG readings can be fine-ish but sometimes spike to 10+ (2hrs post-prandial)for a while and even 13s very rarely and I'd like to avoid that. Fasting BG is also 6+, with 7+ normally 2-3 times a week as well. I'm relatively low-carb, 100ish grams per day and slower release carbs.

I've done some reading about Gliclazide- seems that the most probable side effect is the chance of hypoglycemia with exercise. Also there are possible complications from driving if I have an accident without testing first.

Does anyone have any experience of using it as a type 1.5/LADA?

[I'm still assuming that I am Type 1.5/LADA- possible/probable diagnosis- GAD results yet to be returned from lab, but thin body shape, aged 38, do plenty of exercise]

If anyone has any experiences that they would like to share I'd really appreciate it!

Thanks,
Rich

 

[smidge]

Hi Rich!

I've had LADA for around 4 years. I was put on Glic for a short while - about a week - but it didn't work for me at all, so they took me off it again and put me straight on insulin. Glic gave me very bad headaches, but didn't reduce my BG one bit! Anyway, some people with LADA use it very successfully, but a lot depends on how much insulin-producing capacity you have left. It makes your pancreas work harder and produce more insulin, but if you don't have sufficient beta cells, it won't work. Have you had a c-peptide test to measure your insulin production? If not, ask for one as there is no point using Glic if you don't have the capacity to produce enough insulin.

Another issue with Glic for LADA is that as you progress (and Glic might speed that progression along) your capacity for producing insulin will diminish and Glic will become less effective to the point it won't work at all, so it is only a temporary measure really.
You also can't adjust Glic in the way you can insulin, so on your 'good pancreas' days you might get hypos - LADA is a bit unpredictable day-to-day as you're finding - so getting the dose right and getting consistency might not be very easy.

Finally, Glic can cause weight gain just as insulin can - and this is especially true if you keep having hypos and having to treat with carb. You do need to avoid 'feeding the Glic', but that's the same with insulin too.

As for driving, I told the DVLA when I went onto Glic, but they weren't interested until I went onto insulin. However, Glic can cause hypos, so testing before driving is a sensible measure - although I don't know if it's compulsory as it is with insulin.

Take care

Smidge

 

[hanadr]

RB
when I was first diagnoed over 10 years ago, I was put on Gliclazide. I read up what I could about it and dcided it wasn't what I wanted to use. With the agreement of my gp, I dropped it in preference for a low carb diet. I'm still on 2 x 500mg Metformin [now the SR form, because I'd developed irritable bowel] My last HbA1c was 40 and I have no signs of "progression"! I have also reduced the retinopathy, which was there on diagnosis. My BG is staying at around 5 - 5.4 throughout the day and may be as low as 4.2 on fasting.
As I've recently written, I eat very sparingly, basing my meals around veggies. I've just had fried grated home-grown courgette for lunch with bacon and a cup of coffee. Atasty wholesome meal with lots of vitamins and minerals and virtually no digestible carbs.
I'd always rather turn to diet than to medicines for anything. there seem to be fewer side effects.
Hana

 

[desidiabulum]

Hi. Smidge is the expert on LADA, and you should definitely follow her advice. But there is a chance that you might (like me) be MODY. Depending on the gene involved, this can lead to erratic sugars, but not as volatile as LADA, and gliclazide is therefore less likely to lead to hypos than it would with LADA. I've been taking glic for nearly two years and have been fine with it, and have almost been able to remove hypos entirely from life, which has been an enormous relief (an added bonus is that if you get the 40mg pills you can cut them down to 20mg, which means that you can control dosage far better than with, say, glipizide).
Like Smidge, I found DVLA weren't interested in gliclazide, but I test before driving.
Good luck -- let us know how you manage with the new medication.

 

[paul-1976]

it's a tricky one as both MODY and LADA fall under the Type 1.5 umbrella but both conditions,as Desidiabulum says,have a difference in how they behave in terms of control and their treatment..I can only give you my anecdotal experience as a LADA who tried Gliclazide and I too,suffered with headaches,constant hunger BUT no positive effect on my BG's whatsoever although that may not be the case with you.

Best of luck whatever you decide to do. :wink:

Paul

 

[elaine77]

Hi I'm with smidge!

I was put on gliclazide and told my GP I wanted off them ASAP as they made no difference to my BS whatsoever. I didn't get any illness or side effects they literally just had no effect at all.

When I went to see my consultant and confirmed my diagnosis he said it was a good idea to have come off the gliclazide as a type 1.5 because, like smidge said, it forces ur pancreas to produce more insulin but if u don't have enough beta cells that's impossible and it can do more damage than good because it can exhaust your pancreas and destroy beta cells quicker!

This is why it is so important to get a correct diagnosis in the first instance as there are differences between the types of diabetes that need to be considered at all times


Diagnosed with GD in 2010, Completely disappeared postpartum. Re-diagnosed December 2012 with type 1.5 diabetes, age 26, BMI 22 currently controlled by only Metformin, 500mg twice a day.

 

[RichBromiley]

Thanks everyone for your thoughtful replies- and some good info. It's really reassuring to know that there are other people in the same situation or with the same experiences. Your stories will definitely make me a little more cautious about Gliclazide.

I didn't realise that Gliclazide could cause further depletion of beta cells/insulin production but I guess that makes sense (I had assumed it might be more likely to help in that it would 'support' any insulin production). I certainly don't want to speed progression if I can help it, but would that not be the case anyway if I have higher BGs that were stressing my pancreas as well?

Annoyingly I haven't had a c-peptide test- I asked the consultant and he was quite dismissive of it, seeming to suggest that the reaction to Gliclazide will be a good marker of the insulin production. Have I been fobbed off???? (I think I now know the answer to this one...)

It's likely that I'll be put on a small (20mg/day) dose so I think I'll give it a go for 2 weeks, monitor it very closely and then re-assess. I'll keep you all posted.

Thanks again for your support,

Rich

 

[elaine77]

Hi Rich, I get where you're coming from.

The way I look at it to get my head around it is this:

Your in a very very heavy cart loaded with weight and u have 8 horses pulling u along and you whip them from time to time to get them to go quicker, faster, further.... And they do... They can manage the weight with a bit of a push now and again.

Now imagine this but with only 2 horses.... Ur whipping and whipping but its not working.. it won't make a difference because there is just not enough horses to deal with the weight no matter how hard you try to push them.... The horses will just end up getting exhausted to the point where they no longer work anymore.

Ur right in thinking that if there aren't enough horses to pull the weight then regardless of the whipping the horses will get exhausted anyway.. BUT.. without u constantly whipping them and trying to force them to go harder they would be able to last a little longer as they won't be exerted quite as much (because even when running high BS ur not too high constantly, there will always be dips.)

The gliclazide is the whip.

The horses are your beta cells.

Imagine the weight is carbs.... Get rid of some of the (weights)carbs and it means a lower number of horses will be sufficient to carry the load.

This is where type 1.5s are at the minute, or at least where I am.

I'm not insulin dependent but I am insulin deficient so at the moment I don't need insulin because I have enough horses (beta cells!) to deal with a low GI diet (lower weights)..... When some more of my horses get unscrupulously murdered by King GAD well...il have to either get rid of more weights or buy some new horses (insulin)!

Haha I think the diabetes has now made me delusional making up diabetic stories in my head... Apologies for this!


Diagnosed with GD in 2010, Completely disappeared postpartum. Re-diagnosed December 2012 with type 1.5 diabetes, age 26, BMI 22 currently controlled by only Metformin, 500mg twice a day.

 

[netty01]

hi I was on Gliclazide for a while did not work
for me to help with my sugar levels but it did start to put
weight on me so they stopped it

 

[RichBromiley]

Hi Elaine and Netty- thanks for your replies.

Elaine- I know exactly what you are saying so I'm keen to avoid that. I just wasn't sure if Glicalzide would be a 'whip' as you described it (to ccontinue the analogy) or as some 'oil' for the cart to make it run more smoothly and put less strain on the horses. If it's the 'whip' then I don't want to go onto it if it's avoidable; the 'oil' then I can see no harm.

If it is the 'whip' effect, then I have to balance the damage that it might do to my beta cells vs the potential damage from occasionally higher BG readings. Or I go even lower carb and potentially lose more weight ( that's a bad thing for me). I suspect it will be a question of shorter term vs longer term impacts.

Decisions.....

I'll try for 2 weeks as I have a GP appointment in mid-sept. If it doesn't reduce blood sugars- no harm done and I'll ask to come off them.

If it does have a significant impact- that will be the real decision time.

 

[elaine77]

I know what u mean about losing weight, im not really low carb just low GI carb and despite being high fat diet im still losing weight :-/ I think its safe to say low fat diets are not the best and its the carbs that are the unecessary evil!

Sent from the Diabetes Forum App

 

[Daibell]

Hi Rich. I was put onto full dose (320mg) Gliclazide a good few years ago and at first it helped a bit but in the recent years before I finally went onto insulin it had no effect whatsoever. I think in some ways your GP is right in saying that if Glic doesn't work at anywhere near full dose then your pancreas just hasn't many beta cells left. I did have a c-peptide done privately last year as my GP wasn't taking things seriously and it showed I had very low natural insulin. I've read some discussions about c-peptide tests and views differ on whether it should be fasting or not to give the most useful result; mine was fasting. I've never seen any conclusive research on whether Glic does further damage the pancreas so the jury is out as they say. Glic should only make you put on weight if it is working well as a result of the increased insulin production. In my case because my pancreas is knackered I continued to lose weight even on the full dose. So, I'd say give it a try and see what happens.

 

[Clarabella]

I was put on gliclazide when I was diagnosed with LADA in February. It gave me a splitting head ache, I tolerated it for a week and had to stop taking it.

 

[RichBromiley]

Hello everyone- a quick update on the Gliclazide experiment. I've been taking just 20mg per day, in the morning before breakfast for 2 weeks. It's lower than the recommended dose but the GP is ok with it.

So far, so good- at such a low dose I didn't expect it to have much of an effect- but all my 2hr+ BG readings have been under 8 so that's a bit more controlled than it was. I have been pretty good with eating this last couple of weeks (and found the joy of being able to do scrambled eggs in the microwave for lunch) so that will help to explain it. But at least there aren't any really unexplainable highs so it's making me feel a bit more confident.

Fasting BGs aren't really much different- slightly lower, with most in the 6s rather than the previously more frequent 7s and occasional 8s but I'm happier with that. I think Glicalizide has a half life of 11hrs or so which could explain less impact 24 hours after taking it in the morning.

So all in all it has been positive, so far. I'll keep going with it for a while and see what happens. The test will be if/when the readings start to rise and it's not as controlled any more.

Thanks for all your replies earlier- it was much appreciated!

Rich

 

[desidiabulum]

Hi -- that's really good news that such a small dose is proving so effective. Hope this persists for you :thumbup: