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Metformin Vs Gliclazide or others??

Discussion in 'Metformin/Biguanides' started by warrenlmilton, Sep 27, 2012.

  1. warrenlmilton

    warrenlmilton · Newbie

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    Greeting all

    I have recently been diagnosed with Type 2 and a reading of 7.9% (A!c level of 63mmol/mol) over a few months of readings (Nov and then Jun) plus an slightly high cholesterol reading so what I am looking for is guidance on medication. I was originally offered Metformin and then through discussion we agreed on Metformin SR, however, a friend as been on both and had bowl issues and so suggested Gliclazide which is her drug.

    About me: weight is slightly over but GP not worried, regular walking of dog and weekly bike rides and with a healthy diet with a little naughtiness - gotta live a little.

    What meds would be the best for me?

    Thanks in advance
     
  2. paragliderpete

    paragliderpete · Well-Known Member

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    Hi. You don't give much information about diet. Whilst medication will help, you will still need to be strict with the types of food that you eat, as about 80% of control is by food , usually you will have to modify your carb intake to lower your bm's.
    With regards to your meds, Metformin and gliclazide are used ot assist in two different problems. Metformin is used to lower insulin resistance,is normally the primary medication, and in the majority of cases is very effective after the early stomach upsets are overcome. Gliclazide works by stimulating insulin release, and is known to cause hypoglcemia, but is effective if your insulin levels are low.
    You need to work with your doctor to establish what meds would be most appropriate for you, for example in the early stages of T2 diabetes you could actually be producing more insulin than a normal person, but insulin resistance makes it ineffective, to take a drug like gliclazide increasing insulin production further would only make matters worse.
    How well do you control your diet, do you think it may be possible to control by diet only. Come back to the forum with details of a typical days diet, and there will be plenty of members to advise you.
     
  3. Daibell

    Daibell LADA · Master

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    Hi. It's not for me to try to be the GP, but my understanding is:

    Metformin SR does suit most people stomach wise, but sadly it doesn't suit your friend but may suit you. Met is optimal for T2's who are overweight with insulin resistance. Gliclazide works by stimulating the pancreas and is the more preferred option for those of normal weight. Then there is Sitagliptin which works by suppressing an ezyme that in turn suppresses the pancreas producing insulin a certain time after meals. I'm on all three tablets! Gliclazide can cause hypos if your pancreas still has enough cells left and can cause some weight gain. Sitagliptin is neutral ref weight gain and can't cause hypos; it's the most expensive and newest drug of the three. As you may be aware the first thing to do with T2 is always to get the diet right thru reducing carbs then go on to medication. Which medication depends on your T2 causes and there are no real tests to separate out the causes so it really is trial and error
     
  4. warrenlmilton

    warrenlmilton · Newbie

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    Okay, first of all thank you both for your comments.

    Typical diet as follows:

    7am - cup of tea and first 250ml of water started and breakfast bar (natural nuts and seeds with ginger yum yum!)
    12pm - Bag of crisps (normally baked), some fruit (apple or satsuma), more water usually 2nd or 3rd 250ml bottle
    6pm - Chicken or fish with fresh vegs and tats, or rice or pasta
    cuppa tea and maybe some peanuts IF wife and I after a snack but usually nothing.

    Doctor was happy with weight and diet although I think i'm maybe a stone over weight but i have a big frame - no that's not a joke 5'9" and broad shoulders!!

    I notice you are on Metformin SR who do you find it, am i worried about nothing?

    This is all new to me so its like a different language!

    Warren
     
  5. Daibell

    Daibell LADA · Master

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    Hi. I've never had any issues with my Met SR in 8 years but we are all different. In general though most people on the forum who are on the SR version seem happy.
     
  6. Fraddycat

    Fraddycat · Well-Known Member

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    Hi Warren, I think you can gain a lot of control by making some changes to your diet. Some of the things you are eating are ringing alarm bells, I would take a close look at the packaging on your breakfast bar, I am almost certain it will be full of sugar and carbohydrates which will shoot up your blood sugars and then they will drop a while later when you will feel hungry again. Take a look at the carbohydrates in your bar, I think you will be shocked.

    Next - fruit and crisps (sorry) both are high in carbohydrates, it would be better if you can avoid both. Perfect snack foods are ... slices of ham, cheese, pepperami, hard boiled egg, cherry tomatoes, cold chicken drumsticks etc. It also looks like you are not eating a lot early in the day, it might be better to balance your food over the day.

    Suggestions for brekkie - yoghurt with berries. I normally get a full fat greek yoghurt, and stir in about 10 raspberries. Its really luxurious and quite filling. OR ... omelette, or bacon and eggs, or cold leftovers from last nights dinner.

    Suggestions for lunch - ham salad, or cheese or chicken or hard boiled egg (you're getting the idea right) or if you didn't have one for brekkie, omelette, or any protein with veg if you are not a big fan of salad.

    If you can I would cut in half your portions of potatoes, rice or pasta, these will make your blood sugar rise dramatically and controlling those ingredients will really help you to maintain control.

    Have a read around the forum, particularly the low carb section, its quite an eye opener! Good luck
     
  7. paragliderpete

    paragliderpete · Well-Known Member

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    hi Warren I agree with fraddycat, It would appear that your carb intake is quite high, I get a feeling that you could achieve great results by reducing your daily carb content. There are loads of members who will be able to help you with your diet , together with a strategy for testing, I'm just about to go on holiday so won't be around for a few days. All the best and I'll look up how you're getting on when I return
     
  8. Grazer

    Grazer · Well-Known Member

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    Agree with the others. Sort out the diet before you worry about the meds
    With meds, metformin is a good safe drug, but most people prefer to stay of the more serious drugs like Gliclazide etc if they can. As said, Glic can cause hypos and also puts extra strain on our already weakened pancreas.
    With diet, cut back on the starchy carbs like the rice, pasta, flour products and potatos. Doctors like to talk about "healthy diets", but what's healthy for non diabetics isn't necessarily healthy for us. Make up the food with more dairy, meat, fish and leafy veg. It's the carbs that raise your BGs, and you need to reduce them to a level you can tolerate. Test two hours after eating, and if you're above 7.8, reduce the carbs in that meal the next time you have similar. You'll soon work out what you can and can't eat.
     
  9. xyzzy

    xyzzy Other · Well-Known Member

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    Hi Warren

    I agree with what everyone else is telling you. The best approach is to sort your diet as it works ten times better than any diabetic medication in my opinion. I got diagnosed in December last year with an HbA1c of 100 (11.3%) so higher than yours. Within 6 months I reduced it down to 30 (4.9%) simply by changing diet and reducing my carbohydrate intake. I have also normalised my cholesterol and blood pressure levels too. Not cured as if I eat something high in carbs or sugar my levels go through the roof but so long as I mostly keep to my new healthy diet my levels are fine. I do all of this with my gp's full backing. A lot of people on this forum have achieved similar results to myself in fact it was people on this forum who told me what to do when I joined.

    Basically to get control involves two things. First accept you are going to have to make some long term lifestyle changes. You won't need to be "good" all the time but you will need to be good for the vast majority of the time. Diet wise first cut out all forms of natural sugar so the obvious cakes, biscuits, sugar in tea and coffee, non diet sodas and even pure fruit juices as they have loads of sugar. Next and just as importantly at least halve your intake of rice, pasta, bread, potatoes, cereals and other flour based products. Replace with extra meat, fish, cheese, eggs and especially green veg. Things like yoghurt are generally fine. If you want a small amount of fruit then "berries" are best and I find they won't raise your levels as high if you eat them as a pudding after your main meal. On the rice, pasta and bread you have left in your diet swap to brown basmati rice, brown or tri-colour pasta and the best bread by far is Burgen Soya bread that you can get from most supermarkets.

    Try to do some exercise even if it is just walking. My exercise is simply walking the dogs each day.

    Part two involves getting yourself a blood levels meter. If the gp won't give you one (some are really really anti and will give you a load of rubbish why you shouldn't use one) then get one called an SD CodeFree from the healthcare.co.uk shop on eBay. They also sell them on Amazon. It will cost less than £20 with test strips at around £5 for 50. This is by far the cheapest meter and loads of members have them in fact the majority of forum members will tell you a meter is essential especially in the first few weeks and months as you learn what is safe to eat and what is not. To be frank it's pretty obvious you are not using a meter by what you have given as your average diet!

    Start testing 2 hours after you eat. You need to aim to be under 8 mmol/l as regularly exceeding 8 is where you start to risk complications such as blindness and amputations. With your HBA1c of 7.9% your levels are averaging at 11.4 mmol/l so well above the safe level of 8. The NICE guidelines say under 8 mmol/l two hours after eating and between 4 and 7 at all other times.

    At the beginning you may find getting under 8 to be really difficult if your levels have been running high for a while. If it is then also test before you eat and aim for the two hour after eating reading to be back at roughly the level of the before eating reading. If you do that then you should see a gradual day by day improvement until all your two hour readings come out safe.

    If you can't stop the readings spiking high after two hours then you have a stark choice. Either reduce the rice, pasta, bread, potatoes, cereals and other flour based products some more until your levels respond or if you really can't change your diet further then go back to the gp and ask for stronger meds.

    The disadvantage of the extra meds route is many of the stronger meds that stimulate insulin production will make you gain weight as that is one of the primary things insulin does, it lays down fat. Remember that as T2 you are likely to be producing a good deal of insulin but it is not working properly (called insulin resistance). Any fat you put on will make what insulin you produce work even less efficiently as it will raise your insulin resistance further so you can end up in a loop of having to take stronger and stronger medication which in the end will lead you to insulin dependency as while your levels remain unsafe they are also killing of the very cells that actually produce insulin. In the end you end up as an insulin resistant T2 who needs to inject large doses of insulin because their pancreas has completely stopped and that is not a good place to arrive. People on the forum call this the drugs escalator.

    The important thing is to recognize that which ever way you choose you need safe blood levels to stop you developing some pretty awful diabetic complications down the line.
     
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  10. Grazer

    Grazer · Well-Known Member

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    By the way, you'll need a meter and testing strips! Cheapest option is the SDcodefree from Amazon or eBay. You can get meters free from manufacturers like Bayer, but the strips cost far too much. Cheaper to buy the codefree
    Sorry, posted this same time as xyzzy as follow up to my post! Same message fortunately!
     
  11. frankweir

    frankweir · Member

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    thx to xzzy...i have been considering a more aggresive approach even tho my a1c is 5.6...id like to get to 5.0...but i hadnt heard of drugs escalator. sounds counter productive for sure!
     
  12. Vixonangelica

    Vixonangelica · Newbie

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    Hi Warren, I was diagnosed with T2 about 11 years ago - I totally controlled it successfully for over 8 years by diet alone - so do listen to these guys advice won't you. Looking at your diet (apart ftom what else has been said) I think you need to eat more often as you seem you seem to have many hours between your meals. If you do this you will keep your BGL at a more stable level (remember be very careful about carbs) eat smaller meals with small 'legal' snacks - I eat 6 times a day - it also means I am not starving say at
    lunch time and I don't eat a large lunch. I agree you must get a BGL monitor asap to get to
    know what food spikes your sugar levels and what doesn't - so good luck and most of all good health.
     
  13. Al112

    Al112 Type 2 · Newbie

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    Hi all. New to all this myself. Really struggling with my diet. But after reading all these post gonna really give it a go. What I really want to know, and this might sound silly. But I have one arm so taking a blood reading from my finger is impossible. Can I prick a toe and get a reading


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  14. eveshamgal

    eveshamgal · Well-Known Member

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    Regarding the side effect of metformin, I never used to take mine because if them. Then I started taking anti diarrhea tablets with them but since cutting out carbs I have to say these side effects have lessened significantly. It appears to me it's the carbs that do not work well with metformin, not the person

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