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Help with understanding Gliclazide (previously type 1 but now monogenic)

D

djr18

Member
Messages
7
Type of diabetes
Other
Treatment type
Insulin
Hi all,

I have a HNF4a mutation that means that my pancreas does not know when to excrete insulin even though it can produce adequate amounts of it. I have just transferred (yesterday) from insulin therapy to Gliclazide, as this is the best form of treatment for my type of diabetes. For the last 10 years I have controlled my diabetes by using Novarapid and Lantus achieving a HBA1C average of about 5.2% to 5.7%.

I just needed some real world advice about taking gliclazide and how I can reduce Blood sugar spikes as well as your general experience of the drug. With Novarapid it was actually quite flexible so I could eat what i wanted to and adjust the amount of units accordingly. On Gliclazide I am now taking 20mg before my breakfast meal but my blood sugar spiked about about 12mmol before it started to reduce. With Novarapid my spike would be about 7 - 8 mol before reducing to about 4- 6mmol after 2 hours.

In addition the half life of gliclazide is about 12 hours whilst novarapid is about a peak of 2 -3 hours and completely out of the system in 6 hours. This really is a completely new approach for me. ANY REAL WORLD advice about this drug would be extremely appreciated.

Thanks
David
 
Last edited by a moderator:
djr18 said:
Hi all,

I have a HNF4a mutation that means that my pancreas does not know when excrete insulin even though it can produce adequate amounts of it. I have just transferred (yesterday) from insulin therapy to Gliclazide, as this is the best form of treatment for my type of diabetes. For the last 10 years I have controlled my diabetes by using Novarapid and Lantus achieving a HBA1C average of about 5.2% to 5.7%.

I just needed some real world advice about taking gliclazide and how I can reduce Blood sugar spikes as well as your general experience of the drug. With Novarapid it was actually quite flexible so I could eat what i wanted to and adjust the amount of units accordingly. On Gliclazide I am now taking 20mg before my breakfast meal but my blood sugar spiked about about 12mmol before it started to reduce. With Novarapid my spike would be about 7 - 8 mol before reducing to about 4- 6mmol after 2 hours.

In addition the half life of gliclazide is about 12 hours whilst novarapid is about a peak of 2 -3 hours and completely out of the system in 6 hours. This really is a completely new approach for me. ANY REAL WORLD advice about this drug would be extremely appreciated.

Thanks
David
Click to expand...

Hi. Like you I'm MODY and on gliclazide. I certainly find it takes a while to have an impact. To avoid spikes I'm afraid you will have to adjust your diet. The advice to new members on this forum should give you some good pointers. Reducing carb intake is a must (especially refined carbs like white bread, white rice, etc) -- generally, you will need to eat to your meter, but presumably you already know what spiked your system from when you had to adjust your insulin dosage. 'Think like a T2' would be my advice.
 
I'm afraid I can't comment on your prescription, but congratulations on finally getting the correct diagnosis!

You can now get your head around a permanent diet and lifestyle that actually works for you.

:)
 
Yep Gliclazide gives very little control so the control will need to come from you via carbs in your diet. I have gone from Glic to novorapid and levemir and it is so much easier to control things, although I am low carbing too, aiming for 30g a day.

Ali
 
Thanks for all of your replies.

I am now being extremely careful with what I eat. On insulin, I could eat what I liked (within reason) and then adjust my units accordingly but with Gliclazide I am now eating smaller portions and avoiding any products with refined sugar in it (harder said than done). It definitely helps.

One quick question. Since I have only been taking tablets since Monday this week I am still testing how my body reacts to it. This morning I took my 20mg of Gliclazide and did not eat anything for about 2 2/2 hours. I tested my blood sugar before 4.8mmol and after 2 1/2 hours. My blood sugar was 4.7mmol. NO CHANGE.

However, when I eat food my blood sugar rises to about 8.5 and then gradually falls over 2 hours to about 6mmol, so the Gliclazide is actually working. My question is this, do I have to eat food for Gliclazide to work?????? It seems a silly question but I really cannot find the answer to it and my DSN is currently not available.

Many Thanks!
 
I am on 40mg of gliclizide twice a day, you should eat within 30 minutes of taking it for it to be most effective, you risk going too low and hypoing if you don't eat with it, depending on how tight your numbers are.

Others are correct gliclizide helps a little but diet and watching your carbs is the key. I can still only tolerate about 20 - 25g carbs for breakfast and dinner (when I take my meds) and about 10 - 15g for lunch, I also have a supper of about 10g carbs, my most carbs days usually the weekend add up to 90g for the day.

You need to test to get your threshold for carbs per meal and what you personally want your numbers to be, keep going it's a learning curve and you will get there

:):)​
 
Oops don't know what happened at the end of my post there must have pressed something that reallined it???
 
I want my numbers to be as tight as possible but on my current dose of Gliclazide I do not seem to go low. It just seems to stabilise at about 5.8mmol after about 2 - 4 hours. Today I ate quite a lot and after 1 1/2 hours it was 5.7mmol. It then just seems to stay at about that level. At least with Novarapid I could make a reasonable guess what my sugars were. With Gliclazide after I have eaten I have no idea what to expect 11.3/ 8.5/6.5/5.7 mmol

How can it be that I take Gliclazide, not eat anything for over 2 hours and my blood sugar is just 0.1mmol lower (4.8mmol to 4.7mmol). I then eat food and the Gliclazide seems kick in and keep my blood sugar in check???????????
 
Maybe your liver dumped glucose to compensate, when the Gliclazide made your level drop?
That's a guess - but it is a similar mechanism to what happens to type 2s who hypo - and it can happen with no symptoms at all, so you won't know it has happened.
 
It is a possibility, but I am very sensitive to low blood sugar levels and would more than likely have recognised that 'low' feeling before my liver dumped the glucose but I possibly did not. However, being on insulin for 10 years plus, I really do recognise a hypo. As I have only been on these tablets for a few days now I really really want to get in contact with my DSN but I will have to wait until next Monday to see what might be happening.

Tomorrow I will wake up and take 20mg, not eat anything and test my sugars every 10 - 15 minutes. If my liver is dumping glucose then I should see a gradual decline in my blood sugar levels to below 4.0mmol and then a rise as my liver dumps. Obviously if my sugars continue to drop I will have a handful of Glucose tablets on hand.

I just want to get to the bottom of this.
 
Here are today's blood sugar readings

06_45 4.8mmol

07.00 17.5mg gliclazide

09.40 4.7mmol

09.45 Mango 2/3 45g bowl of all bran

10.45 6.8mmol

11.55 6.2mmol 20mg Gliclazide

12.30 chilli con carne (added cheese) with small jacket / small home cooked bread, I felt this was a medium to large meal

14.00 5.7mmol

15.00 6.9mmol

16.14 5.7mmol
 
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