Newly diagnosed T2 - meds or not?!

Mike d said:

Completely wrong. That's EXACTLY what you should be shooting for. The vision is not an issue as that's common when your blood sugars come down quickly. Nurse is right about a new HBA1C test in 3 months to see where you're at,

Welcome by the way

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glicazide with low carb can cause hypos so has to be carefully monitored. So as a whole yes low carb is an option but it’s not completely wrong to not recommend both

there has also been discussion that too rapid blood drop can cause vision issues. I know little about it, just saw some posts elsewhere in forums. So wise to question and get it checked. Given my family history I am very concerned about any vision changes so I do yearly tests even though we only get a free optician test every 2 generally

Well you have to be careful with gliclazide and low carb, cos you might get hypo's.
So care does need to be taken and dosages lowered if you start getting hypos

Magneto2009 said:

Thanks for the quick response. That's interesting - I thought the risk of hypos was too high with low carbs and glyclazide. My main frustration is understanding whether the meds are totally needed. I seem to be sitting at a BG level of 9ish throughout the day at the moment (it was obviously higher several days ago) so I'm worried the meds might be too much?! Equally, I don't want to do any more damage by not taking the medication if it is indeed really needed.

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Have you spoken to your doctor? You could ask to do 3 month diet approach and then revisit the need for meds then.

9s would be too high for me, but you are very new to low carb, it took me many months to get a lower hba1c with that approach.

Mike d said:

Then first I''ve heard of that as a T2. I stand corrected

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I’ve been T2 since 2008 and have learnt more in the last months being on this forum than in the preceding years

Magneto2009 said:

Hi, Yes, spoke to the diabetic nurse and she basically said meds are what's needed. I asked the doctor about low carb diet when he prescribed the drugs and he said not to do that at the moment, just to reduce sugar intake. 9s are definitely too high, but it's only been a week, so I'd like to try diet before drugs. It's really been the last couple of days that it's stayed at 9s, before that it fell each day from 17-12 ish, and seems to have plateaued a bit for the last 2 days in the 9s. I know it's early days.

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In your shoes I'd do the same... monitor blood glucose closely and try without the meds for a while by going ultra low carb. You'll start to see if it works for you pretty soon through your bloods and if they start to go up you have the meds in reserve.
Did they give you metformin too or just Glic?

Edit to add your 101 mmol/m HbA1c implies and average BG of 15 so if you are currently seeing 9's then it has dropped significantly already.
See above..

@Magneto2009,

Welcome to the forum and well done on getting blood sugars down so quickly. By the way, I have started at a very similar level as yours (my HbA1c was 100 at diagnosis) and have dropped back to normal levels quite quickly and have stayed there for the last 5 years. So, it definitely can be done and it sounds as if you are well on your way.

Many T2s on this have observed that blood sugars tend to lower in a stepwise fashion rather than gradually. This might be because your body has gotten used to the higher levels and kind of "panics" when you go lower than your usual levels -- the liver then starts to help out by turning glycogen into glucose (and also by gluconeogenis -- i.e. making new glucose). After a while however, as the glycogen in the liver is depleted, you often see another significant lowering of general glucose levels. So, it just takes a little bit of patience and equinamity -- I'm sure you'll eventually get there, though.

Maybe you could ask your GP to give you a three-month trial on diet alone and then reassess -- as other have suggested. Failing this, maybe suggest to switch to metformin rather than gliclazide. Metformin generally doesn't cause any problems when on a low-carb diet (but may cause gastrointestinal distress -- either just for a few days or also longer term -- so watch out for this) and has a much better track record overall (e.g., with respect to cardiovascular problems). However, it is ultimately you who are in charge of whether you want to take specific medications or not, the only thing GPs and nurses can do is advise.

Btw, often blood lipids tend to also fall into place once your blood sugars normalize and you have stopped losing wait. So, it might be worthwhile to give it a little time.

Good luck on your journey -- we all will be curious how you fare. So, keep posting and again welcome to the forum.

Magneto2009 said:

Thanks, that's really useful. I'm slightly worried about high cholestrol and being told to reduce fat - that would affect my low card diet, but I guess they may want to medicate for that too. The dr said he wouldn't suggest Metformin as my level was too high at 101, so it's just glyclazide I've been prescribed.

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I would suggest doing your own research about cholesterol. It not just about total numbers but ratios.
I wouldn’t worry about it right now it’s much more important to concentrate on BG levels and you seem to be doing well with that.

Magneto2009 said:

Hi,
I was diagnosed with T2 last Friday with an HBa1c of 101. The doc has prescribed 30mg of Glyclazide (once daily). I've collected the prescription but not started it yet as I'm not keen to take it. Immediately on diagnosis I came on here and got lots of useful information and therefore made some quick changes to my diet (reducing carbs to 50-100g a day). I've got a meter, as advised by the doctor, and have been testing. Initially my BG reading was 23, but that has come down steadily over the week, with changes in my diet. It's come down to around 12 in the morning and between 8-9 throughout the day (testing before and 2 hours after a meal) and doesn't move above 2 points after eating. I've been exercising too, but have a foot injury which is now making that very challenging. I initially had symptoms of extreme thirst/needing to pee. That has got much better, but I now have some concerns about blurry vision/floaters (I've booked an eye test).

I'm not keen to take the pills unless necessary, but I'm unsure if diet alone is appropriate, or if my levels will fall any lower than they currently are (which is obviously still too high). I suspect my cholestrol is also high (tested yesterday and dr wants to discuss results) so I'm not sure if low carb/higher fat diet will help that.
I've had a call with the diabetic nurse, and tried to express my concerns about the medication, but was told not to worry and to take it and come back in 3 months! I know if I do take the medication then a low carb diet isn't recommended. It seems that I'm making progress though through diet, so I'm really unsure what's best.

Any guidance would be very gratefully recieved! Thank you

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Hi and welcome
When I was diagnosed 9 months ago with an HbA1c of 90 I was prescribed Glimepiride which is similar to glyclazide .
Even at the lowest dose which was 1mg , with me low carbing it dropped my BG level very quickly.
This drug makes your pancreas increase insulin production whilst metformin helps your sensitivity to insulin.
When taking Glimepiride my levels dropped below 4 a few times so after 1st month I got my doctor to change my medication to metformin Sr extended release and since then I have reduced my metformin dosage from 1000 mg to 500 .
The extended release is a bit easier on your stomach.
If you take the glyclazide make sure you test regularly especially just before you drive, and keep glucose tablets or some jelly babies with you just in case you need to get sugar level up quickly.
Because I was initially prescribed Glimepiride I got a meter and testing strips on prescription and even now I am not taking it I still get the strips on prescription. So ask doctor to prescribe strips for you.
The glyclazide will definitely get your sugar level down.
After been diagnosed 4 months later HbA1c down to 40 and it’s stopped at that up to date

Magneto2009 said:

Thank you - I'll do some reading!

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There is much information about cholesterol on this site.
I know there is a thread about it.
But I can’t seem to find it.
@bulkbiker might have it.

It took me around 4 months to go from 121 to 35 by going keto, under 20 carbs per day.

Magneto2009 said:

Thanks, that's really useful. I'm slightly worried about high cholestrol and being told to reduce fat - that would affect my low card diet, but I guess they may want to medicate for that too. The dr said he wouldn't suggest Metformin as my level was too high at 101, so it's just glyclazide I've been prescribed.

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Any idea what your cholesterol level was?
Ideally full lipid panel results.. most GP's just look at the total which is pretty meaningless in isolation.
If you are getting readings in the 9's after a short period without meds then I wouldn't worry about fat in the diet whatsoever providing it's from animal sources and not processed seed oils. Your cholesterol will do all sorts of things while in weight loss and blood sugar reduction mode wait until your weight stabilises and you get decent blood glucose levels before worrying about cholesterol.

@Magneto2009

Here's the statins thread at @Hotpepper20000 mentioned for when you get bored...it's long and detailed.

https://www.diabetes.co.uk/forum/threads/cholesterol-and-statins.156985/

Hi. I'm slightly surprised the Dr didn't start with Metformin and then add some Glic if needed. If you have excess weight that would be the normal approach plus the low-carb diet. The 40mg dose of Glic is very low and almost certainly wouldn't cause a hypo. If someone has a hypo with Glic then the dose needs reducing as it implies the beta cells are working quite well and don't need much stimulating with the Glic. A T2 with excess weight is unlikely to benefit from Glic as the problem will be insulin resistance and Metformin can be more useful. You could try a low-carb diet at first without any meds. As for statins, see what your lipids ratios are and if needed have the minimum statins dose needed to get them right.

Great results for a week, but don't get disheartened. Getting bg down is a marathon not a sprint. Think months rather than weeks.
Yes I got very blurry eyes in the first few weeks and panicked as I have eye issues anyway but it did clear. I think its where the body is releasing sugar from the fat cells and you can actually see it in your eye fluids. At times I could almost feel the fat melting out of my cells too. I had a few other odd symptoms too, I think its like the body going cold turkey on sugar. Very staring and odd but it didn't last long. I just kept being guided by my meter and ate enough so I wasn't hungry.
I can't advise whether to take the medication or not, but I did it diet alone.