Meds having little effect

[barrym]

Hi

I have just posted an intro http://www.diabetes.co.uk/diabetes-forum/viewtopic.php?f=20&t=42069 to give some background.

Anyway, the issue is this. I am always high in the morning, generally 8-9. I manage the levels during the day with quite a bit of exercise and have 4-5 before lunch and before tea. But again by bed time it's up to 8-9 again.

This has been the situation since I was diagnosed and I first got control and settled things down. I don't think my DN is too worried as my HbA1c was 55 at last test a few weeks ago. But it's too high for me!

I have been having two Gliclazide per day, one in the morning and one at tea time. I have just started Metformin, firstly one per day at tea time intending to get the level down at bedtime, and hopefully get over night dumping down to give a lower breakfast reading. This is in addition to the Gliclazide.

After a week absolutely no change, so I have now increased to two a day, just after breakfast and just after tea. 5 days in, guess what, no difference. I know there's scope to double the dose, and I shall discuss with the DN tomorrow, but I just wondered what you guys think.

For further background, I do do an extensive amount of exercise, although I'm still not convinced that directly relates to reduction in BG. By that I mean, sometimes I do less and the levels fall quite well, and sometimes I feel the need to do more, but the levels still generally fall the same. before I retired I was an IT techy and I like a world where tests are repeatable - this world isn't like that and I don't like it :cry:

 

[Daibell]

Hi Barry. Are you overweight or do you have a normal BMI. Did you lose weight around diagnosis time? What is your diet like? Have you restricted your level of carbs?

 

[barrym]

Hi Daibell

No I'm not overweight, BMI is 21.8, I'm 5'10 and 10st12.

Yes I did loose weight at the time I was diagnosed, that was one of the reasons I went to the docs.

To give the full picture, although never obese, a few years back, maybe 6, I had high BP and started on a low dose of Ramapril (20mg I think) and increased my exercising a lot and dropped from 13st to around 12st. That was stable for 3 or 4 of years until the diabetes when I lost a further stone to my current weight. BM now back in range and the Ramapril stopped a year or so back. Weight is good - I feel comfortable at this level.

DIet is I believe sensible. My daily carbs range from 130-180 per day, occasionally a bit higher, but BG always follows the same range. I keep a detailed record of both in a spreadsheet online that I may publish the address to - haven't decided yet :?: :think:

As I said, my HbA1c is OK, well the DNs seem happy, it's just the weird thing that the meds don't seem to have changed any thing. I've got a call in at the moment to see if I should double the Metformin again to 2 x 2 per day.

HTH. What is your thinking?

 

[barrym]

Hi nom,

Can I call you that?

I'm not sure about any correlation of carbs at tea time to bed time BG levels. Doesn't seem to make any significant difference. I don't recall know how long carbs have an influence for. I understand the low/high GI thing, and my evening meals rarely contain processed carbs. Potatoes and only a small amount of maybe 10-12 carbs is as bad as it gets.

Clearly none of this has an effect on morning levels.

Someone else said that's how merformin work, but as I understand it, it is a three prong attack. It slows digestion, it encourages the receptors (?) much like Gliclazide, to use the BG, and of course it is supposed to slow down the liver.

Well doesn't do anything for me. Did a pre and post meal test a day or two back and I was a bit low before lunch, took on probably 60g in the form of wholemeal bread, and fruit. Two hours later I was 9.9, three hours after that down to 4.8.

Normally I only test prep meals. I figure if I can't get that right the plus 2 hours is a bit irrelevant.

Sent from my Nexus 7 using Tapatalk 2

 

[Daibell]

Hi Barry. From what you say I would suspect you are similar to me in being nearer to a Type 1.5 than T2. T1.5 or LADA, Late onset T1, tends to occur when you are fairly young but that's not exclusive. After 8 years fighting rising BS levels with all the tablets I'm finally on insulin which really works. My GPs just classed me as a T2 and that was that. I had a GAD and c-peptide tests done privately to see if I had any pancreatic anti-bodies and low insulin. The GAD test was negative but the c-peptide showed I had very low insulin as I suspected. It can be difficult getting GPs to recognise that there is the middle ground of people suffering pancreatic failure for whatever reason. My GP finally reacted when my HBa1C started rocketing up despite low-carbing. A level of 55 (7.2%) is just below the level at which NICE suggests considering insulin if already on tablets. I would discuss options with the nurse and if your Hba1Cis trending upwards then insulin in the near future may help?

 

[barrym]

Hi Daibell

Thanks for that info. Certainly got me thinking and doing a bit of research on T1.5. I had a long discussion with my DN the evening before where we put in a plan of 'action'. Well a 'wait and see' plan really, with the promise or lure of an appointment with the consultant if nothing changes - why would it?

I did have a GAD test a year or more back, but I don't think they did a c-peptide test, so that would be interesting.

As a matter of interest I was a bit naughty yesterday afternoon. The wife and I went out and had a cream tea, 2 scones, jam and cream. VERY naughty I know. That was about 3.30pm, at 5.30 I did my normal pre-meal test and it was 17.2 :cry: , hasn't been that high AFAIK before, except when I was steroids during chemo treatment (another story), and right at the beginning of my diagnosis. Anyway, it is indicative of my +2 hour figures which are normally too high, 10ish, but after more modest carb intake. But weirdly, by bed time I was down to 5.4 which is as exceptional for me, I've only been that low a handful of times before bed.

This really is difficult to figure. Anyway I'm going to stick a call in to my DN and see what she says.