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Low Blood Glucose Levels

Discussion in 'Type 2 Diabetes' started by Terrytiddy, Jun 15, 2018.

  1. Terrytiddy

    Terrytiddy Type 2 (in remission!) · Well-Known Member

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    Hi all been on LCHF since 30th April with great results. I do 18/6 fasting 20.00 -14.00 every day and only have black tea, coffee and water during fast. Bg was 16.6. I started off on 15 - 20% carbs. I then reduced to less than 10% carbs on 4th June and then down to less than 5% carbs on 11th June. My Bg has come right down. From Monday I have had a FBG of 4.4, 4.3, 3.7, 3.7 and 3.5 today (Friday) I feel great and no problems with being so low. I'm still on 1000mg Metformin and 160mg Gliclazide twice a day. As of today I'm going to reduce that to 500mg Metformin and 80mg Gliclazide twice a day.
    I will be seeing my Dn in 2 weeks for a weigh in, should I mention the reduction of Metformin and Gliclazide to her? Its going to be another 6 weeks before I have my bloods done.
    Look forward to your replies and advice. :)
     
    #1 Terrytiddy, Jun 15, 2018 at 3:01 PM
    Last edited: Jun 15, 2018
  2. Kalobe

    Kalobe Type 1 · Well-Known Member

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    I'd let them know what you are doing as they might be able to help with the reduction in dosing. (Beware that they may not like it!)
     
  3. xfieldok

    xfieldok Type 2 · Well-Known Member

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    I would be cautious about reducing your meds without medical advice. Your numbers are fantastic but it is over a very short period of time.

    Metformin moves your blood glucose out of your blood stream , where it can be seen, into your organs where it can't.

    I don't have any experience of glicazide.
     
  4. Rachox

    Rachox Type 2 (in remission!) · Moderator
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    I personally think you need to speak to your Dr sooner rather than later. You are at risk of going hypo on Gliclazide but even so you should consult your medical team about changing doses.
     
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  5. Bluetit1802

    Bluetit1802 Type 2 (in remission!) · Legend

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    I agree. You need to speak to your GP/nurse about reducing the gliclazide. The Metformin is far less important and does very little. The Gliclazide does a lot.

    Brilliant numbers!
     
  6. Terrytiddy

    Terrytiddy Type 2 (in remission!) · Well-Known Member

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    Thanks for advice guys, will stay on full dose until I see Dn in two weeks. It was just seeing that having very low Bg and on Gliclazide could cause hypo's. :)
     
  7. Fruitella

    Fruitella Type 2 · Well-Known Member

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    Hi. I would be wary of staying on the full dose of gliclazide if you are getting 3.7s. Can you contact the nurse with your figures? Ask their advice sooner than 2 weeks. When I was that low on the Gliclazide I thought I was fully functioning - work colleagues would have disagreed.
     
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  8. Ziggy2017

    Ziggy2017 Type 3 · Well-Known Member

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    Maybe see your doctor the fact your at 3.7 and feeling fine could mean you risk becoming hypo unaware
     
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  9. Bluetit1802

    Bluetit1802 Type 2 (in remission!) · Legend

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    I don't think we were meaning stay on the dose - with numbers that low you could easily hypo and must be very careful not to drive if you are under 5. I think we were meaning let your doctor/nurse know (by telephone if necessary) what you are doing rather than wait for weeks to your next appointment. Please, be VERY careful, and have some jelly babies or glucose tablets with you at all times.

    I think @Oldvatr was on Glic and dropped it because his numbers were low. (Sorry if I got that wrong) Maybe he can suggest.
     
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  10. Oldvatr

    Oldvatr Type 2 · Expert

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    Correct. I did have mild hypo's while I adjusted my Glic dose from 4 x 80 mg a day down to 1 x 40mg in the morning. Because I was testing 3 or 4 times a day (more if driving) then I had a reasonable view on how things were progressing while I dropped my carb intake relatively slowly. I kept to a regular pattern so things became stable and repeatable before I changed any med treatment, and thus I quickly got an indication of how any such changes either to diet or meds or their timing affected me ( a day or two to see a change in averages) So as I approached hypo land, I became aware of what symptoms I got with low bgl, and thus became hypo aware. I had a rule that I had to be 5 or higher both when driving, and also at bedtime which was always 4 hours after my last meal and last Glic dose, so that it was unlikely that I would go any lower in the night. If my 4hr PP reading was below my pre meal reading then I would eat some carbs just to make sure I was safe in the night.

    When I was happy that a dose level was working ok, then I sent a letter to my GP requesting that the change become officially entered in my records and in my prescription. I have a good GP and he is supportive, so I have demonstrated by graphs in the letter what level of control I was getting, and there was never a problem.

    One thing I did was to collect the unused pills so that I have a bottle to hand in case I need to bolus for a bad meal choice, and take an extra Glic to compensate on a temporary basis. I do not need to do that now, as I rarely get low bgl. I seem to be in the range 4.5 to 8 mmol/l with a medium carb intake so no longer going keto by choice. My HbA1c this month was 42, and my daily average today is 6.8 which I am happy with. I went softly softly catchee monkey, and I avoided keto flu, and my hypo's were always manageable on my own. Also the hypo's were shallow and naturally self correcting as the glic is excreted, so I never needed the massive sugar hit that someone on insulin might need. I never felt in danger.

    PS: as my FBG dropped, I benefitted not only from lower diabetes meds, but also had to reduce my BP and heart meds too, and drop my statins off the scrip. So my LC journey has significantly reduced my NHS footprint.
     
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  11. Terrytiddy

    Terrytiddy Type 2 (in remission!) · Well-Known Member

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    Thanks for that @Oldvatr great info. I will give nurse/doctor a ring next week to see what they say. Thanks again for advice. :)
     
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  12. EllieM

    EllieM Type 1 · Well-Known Member

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    Just a comment on the driving. As you're clearly at risk of hypos (measured blood sugar under 4) I would strongly recommend doing a blood test before you drive a car. If you hypo while driving you not only risk killing yourself but also others. (Standard practice for T1 diabetics on insulin, not 100% sure of the rules for those on glicazide.) And make sure to always carry glucose tablets or equivalent. Congrats on the awesome blood sugar results.
     
  13. Oldvatr

    Oldvatr Type 2 · Expert

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    U R Welcome. Hope it helps you find a good solution. I found HCP's can be persuaded if you have pretty pictures. graphs to show. I personally use EXCEL spreadsheet for my log, and it is available as an online version - but be aware that it uses the cloud for storage, and you may need to consider your privacy settings before using it. There are other logging apps that others use, but as an engineer I found Excel to be most adaptable, and I can do many different trending analysis and projections with it.

    I get GP support for test strips etc, and this is due to (A) using Glic, and (B) being a driver needing to meet DVLA rules, and finally and most important, I used it to fine tune my meds and treatment, and because I have affected my treatmenr in a a positive direction. then this has given my GP the excuse to fund my testing habit. He is using s loophole in that Glic can lead to hypo's, so that is why I keep up with my one Glic tab a day, since it keeps that door open for him to justify it.

    Bon voyage.
     
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  14. Oldvatr

    Oldvatr Type 2 · Expert

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    It can be used against you if you cannot produce the meter evidence after an incident, and may invalidate your insurance if you drive without following the guidelines, I am re-applying for my licence [being an oldfarty], and I have had to sign a formal doc from DVLA that I am hypo aware, and that I agree to test myself according to the guidelines. Since I already do that anyway, it is no sweat. As a T2D not using insulin you do not need to inform DVLA, and they do not currently to my knowledge mandate adherence on an existing licence. However it seems that licence renewal at 70 leads to medical assessment being carried out and then they may ask for your compliance.

    If you have hypo's where you need assistance (eg paramedic or hospital) then you need to inform DVLA. You are allowed one such event in a year, but two strikes and you are out. That is why I went cautiously into LCHF.
     
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  15. Bluetit1802

    Bluetit1802 Type 2 (in remission!) · Legend

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    I'm not sure that is correct, at least it wasn't for me, my husband, and several of my friends. I simply renewed it on line. No medical assessment.
     
  16. Bluetit1802

    Bluetit1802 Type 2 (in remission!) · Legend

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  17. Oldvatr

    Oldvatr Type 2 · Expert

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    The medical assessment is triggered when you tick the diabetes option, and this should trigger the DIAB1 form. This in turn leads to the DVLA making enquiries at your GP, and this is a paperwork exercise that goes on behind closed doors. I am still awaiting my licence decision after 3 months since surrendering my licence, and am permitted to drive under Section 88 so I was able to renew my car insurance as well.

    The DVLA has a duty to make sure that as we age, we maintain full control of our vehicles. It is possible to get round it by not declaring any medical issues, as was demonstrated so sadly by the Glasgow Bin Lorry incident. The onus for declaring a condition that may affect our ability to control a vehicle such as eyesight, laser eye surgery etc is on us. I presume you declared Diabetes on orals, as I did, but they dug deep on mine. It may be random sampling.

    I have been informed last week by DVLA that it can take 12 months to reach a decision. If it goes over the 12 months then everything resets to = NO Licence condition, and I will have to make a fresh application from scratch.
     
  18. Bluetit1802

    Bluetit1802 Type 2 (in remission!) · Legend

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    I did tick the diabetes box, and also any other boxes that applied, but I am not on any meds, so maybe that makes it different. I completed the on-line renewal and received my new licence within a week.
     
  19. Terrytiddy

    Terrytiddy Type 2 (in remission!) · Well-Known Member

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    Hi @Oldvatr I do log everything and have been producing graphs for my Dn. It looks so much better and it gives you motivation and inspiration to carry on. :)
     
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  20. Oldvatr

    Oldvatr Type 2 · Expert

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    The DVLA used to provide guidance notes for drivers which advised a level of 5 mmol/l but it seems to have been withdrawn in the latest revision. Now the mandatory requirements say the onus is on us not to drive while impaired, so presumably they must have lost a law case where a limit was used against a driver without success thus setting a precedent that it is not a simple case of using the meter result as clearance, since meters are not calibrated and are capable of giving wrong results. The new licence application I have had to fill in has required me to state and sign a declaration that I am hypo aware, and the notes say that unaware drivers are likely to lose their licence. This seems to be a recent addition that has been added to DIAB1 for all diabetics, not just insulin users. (i.e. there was no skip option on the form.)

    Edit to add. The following ammendment occurred to DIAB1 form in Jan 2018
    1 January 2018 As a consequence of changes in European legislation amendments have been required to the applicable standards for: diabetes mellitus managed by insulin; and diabetes mellitus managed by medication which has a risk of causing hypoglycaemia (low blood sugar).
     
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    #20 Oldvatr, Jun 16, 2018 at 12:11 PM
    Last edited: Jun 16, 2018
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