Possible Drug combinations

[CMDG]

I've been a well controlled type 2 diabetic for over 20 years. Alas I'm now in heart failure at 73. It seems as if a couple of the cardiology drugs are making my blood sugar worse. For the first time in my life, I'm a perfect diabetic diet wise. No sneaky sweet things, carbohydrate consumption low.

I'm now taking Metformin and Dapaglifozin, having dropped Gliclazide for the Dapa. My Blood glucose is running high between 7 and 14, with periodic highs, largely if I'm eating out and not in control of what I eat. My GP is happy with this, suggesting it's better than a hypo. The cardiologist isn't. A recent letter from my last appointment says so.

I've lost 9 kilos of weight, ok some of that was fluid due to HF. I'm trying hard to loose weight so not being able to bring the scores down is driving me nuts.
Are any of you on a triple drug therapy? And if so which drugs? Can Gliclazide be added to the Metformin and Dapagliflozin?

Caught between the devil and deep blue sea here!

 

[Oldvatr]

I was doing well on Metformin and Gliclazide, when I too got the bothersome HF and had the triple BP. When they did an angiogram on me they flooded me with contrast dye which has clobbered my kidney function and so the Metformin had to go. Got substituted with dapagliflozin and glic on minimum doses. My bgl has risen by 2 mmol.l and it seems that the Dapagliflozin is not doing much for me. I did recently discover that when I missed my meds, my BGL dropped by 2 mmol, and it was repeatable. I roo suspected my heart meds but managed to isolate the 2 meds that were doing it. Tamsulosin and Furusomide. Since I need both of these I will have to consider upping one of my meds to cover the morning. The Dapa is giving me grief and I have no desire to increase it, so I will opt to take a small tab (40mg) of Glic in my morning meds. I was on 80 mg fairly recently and it worked well for me.

From your reported readings, it may be that Dapagloflozin is not working for you either. May be worth experimenting a bit, but Dapa is being prscribed to all HF patients for non diabetic reasons.
Speak with your doctor first.

[Mod amendment.]

 

[CMDG]

I was doing well on Metformin and Gliclazide, when I too got the bothersome HF and had the triple BP. When they did an angiogram on me they flooded me with contrast dye which has clobbered my kidney function and so the Metformin had to go. Got substituted with dapagliflozin and glic on minimum doses. My bgl has risen by 2 mmol.l and it seems that the Dapagliflozin is not doing much for me. I did recently discover that when I missed my meds, my BGL dropped by 2 mmol, and it was repeatable. I roo suspected my heart meds but managed to isolate the 2 meds that were doing it. Tamsulosin and Furusomide. Since I need both of these I will have to consider upping one of my meds to cover the morning. The Dapa is giving me grief and I have no desire to increase it, so I will opt to take a small tab (40mg) of Glic in my morning meds. I was on 80 mg fairly recently and it worked well for me.

From your reported readings, it may be that Dapagloflozin is not working for you either. May be worth experimenting a bit, but Dapa is being prscribed to all HF patients for non diabetic reasons.
Speak with your doctor first.

[Mod amendment.]

Cardiologist was very keen on it, gave me my first prescription but the GPs could not cope with what they called a new medicine. Not so new! Methinks the pandemic has interrupted their continuing education! It is recognised that some of my medications raise Blood Glucose. I like you took a sneaky Gliclazide 40g after a bad carbohydrate day one evening as my morning BG readings are often 14. It worked, halved the score to 7.4. Still rather high. GP has apparently referred me to the Community Diabetic Service. Last time a GP did that a couple of months ago over Dapagliflozin, the referral was rejected as inappropriate! I'm on Butamedine not frusomide, plus Eplenerone, Ivrabradine, Forxiga and Sacubril/Valsarten - all maximum doses. I've been told that I'm heading towards cardiac resynchronisation therapy - probaly with a defibrillator

GP Practice not in a good state here...rural, aging population, lost medical and admin staff during pandemic. I'm told Gliclazide and driving can be a problem with potential hypos so be wary of increasing your dose.

Sorry about the angiogram doing your kidneys in! Do you know why you are in heart failure? Problem valves?

 

[Oldvatr]

Cardiologist was very keen on it, gave me my first prescription but the GPs could not cope with what they called a new medicine. Not so new! Methinks the pandemic has interrupted their continuing education! It is recognised that some of my medications raise Blood Glucose. I like you took a sneaky Gliclazide 40g after a bad carbohydrate day one evening as my morning BG readings are often 14. It worked, halved the score to 7.4. Still rather high. GP has apparently referred me to the Community Diabetic Service. Last time a GP did that a couple of months ago over Dapagliflozin, the referral was rejected as inappropriate! I'm on Butamedine not frusomide, plus Eplenerone, Ivrabradine, Forxiga and Sacubril/Valsarten - all maximum doses. I've been told that I'm heading towards cardiac resynchronisation therapy - probaly with a defibrillator

GP Practice not in a good state here...rural, aging population, lost medical and admin staff during pandemic. I'm told Gliclazide and driving can be a problem with potential hypos so be wary of increasing your dose.

Sorry about the angiogram doing your kidneys in! Do you know why you are in heart failure? Problem valves?

Like you my advance.retard mechanism is not working. I too was being considered for pacemaker with a go faster stripe(defibrillator) but kidneys say No. I see you are on the Entresto too. Very expensive med. I am finding it has trashed my electolytes, with sodium deep diving and my potassium scaling Everest. But cardio wants to double the dose and give me extra meds to counteract sodium and potassium problems. I suspect I am part of a trial being conducted, and definitely a guinea pig since cardio team swear Entresto does not alter electolytes even though the trial data confirms it.

I am hypo aware, so that is not a problem for me. I used to be on 320 mg dose but only 40mg at the moment. I have just renewed my licence being over 70 and I had no quibble.

How are you doing on Forxiga? I find it is giving me gyp. I remember one day following a Wartburg car up a hill, and it was blowing perfect smoke rings every ten feet. Well, that is me on forxiga. That and the furusomide is creating fatbergs that block the loo. Never been a problem before. And the trial on Dapagliflozin that the Cardio references was conducted and paid for by the manufacturer. Easy to be sceptical about that.

 

[CMDG]

What do you mean advance/ retard? Not a term I'm familiar with?
Sitting in the early morning sun while it was still cool, I was reflecting on how well I felt compared to even 2 months ago.
So for me the maximum doses of Eplenerone, Forxiga, Ivravradine and Sacubril/ valsarten plus Bumetanide as the diurectic are working well for Heart Failure. The Sacubril ++ was a bit dodgy to begin with at the lower dose but side effects rapidly wore off. I even have a date for a pacemaker insertion! So I'm sorry you have not achieved the same results.

As I have posted elsewhere, I've just been prescribed Trulicity/ dulaglutide by the Community Diabetes Service. A weekly injectable / GLP-1 category drug. Cant be prescribed by GPs. Now I know why the GP referred me! Weight loss is a feature of the drug. Doubling of the gliclazide dose brought my weight loss to an abrupt halt so this is very welcome. Other potential side effects not so good. I'm hoping they dont afflict me or only last a short time! I get to stop the Gliclazide!

 

[Oldvatr]

What do you mean advance/ retard? Not a term I'm familiar with?
Sitting in the early morning sun while it was still cool, I was reflecting on how well I felt compared to even 2 months ago.
So for me the maximum doses of Eplenerone, Forxiga, Ivravradine and Sacubril/ valsarten plus Bumetanide as the diurectic are working well for Heart Failure. The Sacubril ++ was a bit dodgy to begin with at the lower dose but side effects rapidly wore off. I even have a date for a pacemaker insertion! So I'm sorry you have not achieved the same results.

As I have posted elsewhere, I've just been prescribed Trulicity/ dulaglutide by the Community Diabetes Service. A weekly injectable / GLP-1 category drug. Cant be prescribed by GPs. Now I know why the GP referred me! Weight loss is a feature of the drug. Doubling of the gliclazide dose brought my weight loss to an abrupt halt so this is very welcome. Other potential side effects not so good. I'm hoping they dont afflict me or only last a short time! I get to stop the Gliclazide!

Advance/retard means changing the timings of the heartbeat, as in forwards/backwards.

I became aware that my Entresto BP med (Sacubril/ valsartan) is both hyperkalemic and hyponatremic and as a result it inceases blood potassium, and reduces sodium levels, My diuretic also does the same. My Forxiga before I dropped it also made me wee a lot more. As a consequence, this hot weather has made these problems worse, and I am reaching a dangerous elecrolyte imbalance. I drink more, I wee more and I sweat. So I have been forced to endure a low potassium diet and increase my salt intake because I have started getting heart related issues that I do not want.

As I say, I have dropped my Forxiga, and I have halved both my diuretic dose and the Entresto while the hot weather persists. The hot weather is enlarging my vascular pethways so I do not need such a high dose of BP control at the moment.

 

[lessci]

I've been a well controlled type 2 diabetic for over 20 years. Alas I'm now in heart failure at 73. It seems as if a couple of the cardiology drugs are making my blood sugar worse. For the first time in my life, I'm a perfect diabetic diet wise. No sneaky sweet things, carbohydrate consumption low.

I'm now taking Metformin and Dapaglifozin, having dropped Gliclazide for the Dapa. My Blood glucose is running high between 7 and 14, with periodic highs, largely if I'm eating out and not in control of what I eat. My GP is happy with this, suggesting it's better than a hypo. The cardiologist isn't. A recent letter from my last appointment says so.

I've lost 9 kilos of weight, ok some of that was fluid due to HF. I'm trying hard to loose weight so not being able to bring the scores down is driving me nuts.
Are any of you on a triple drug therapy? And if so which drugs? Can Gliclazide be added to the Metformin and Dapagliflozin?

Caught between the devil and deep blue sea here!

Currently - Metformin, dapagliflozin, gliclazide and Trulicity was on sitagliptin, but taken off of that for the trulicity

 

[Oldvatr]

Cardiologist was very keen on it, gave me my first prescription but the GPs could not cope with what they called a new medicine. Not so new! Methinks the pandemic has interrupted their continuing education! It is recognised that some of my medications raise Blood Glucose. I like you took a sneaky Gliclazide 40g after a bad carbohydrate day one evening as my morning BG readings are often 14. It worked, halved the score to 7.4. Still rather high. GP has apparently referred me to the Community Diabetic Service. Last time a GP did that a couple of months ago over Dapagliflozin, the referral was rejected as inappropriate! I'm on Butamedine not frusomide, plus Eplenerone, Ivrabradine, Forxiga and Sacubril/Valsarten - all maximum doses. I've been told that I'm heading towards cardiac resynchronisation therapy - probaly with a defibrillator

GP Practice not in a good state here...rural, aging population, lost medical and admin staff during pandemic. I'm told Gliclazide and driving can be a problem with potential hypos so be wary of increasing your dose.

Sorry about the angiogram doing your kidneys in! Do you know why you are in heart failure? Problem valves?

Yep a valve problem. Pacemaker was in line to correct this, but dropped when kidneys reacted to contrast dye, which they would use in the new op to sight the electrodes. Had a triple bypass three years ago, but they refused to fit a zip at the time. So facing open heart surgery possibly, but age and condition probably not up to it, They intend to review next June if I am still in the land of the living. I was a heavy smoker and a drinker, amongst other nefarious activities, so diabetes is not the cause.