Prescribed metformin, worried about low blood sugar levels

[Deleted member 99312]

Hi everyone. I was recently diagnosed as type 2. Initially my intention was to try to control my BG levels with diet alone, and my GP and nurse agreed. Then I developed blurry vision, long sightedness so cannot focus easily (or at all) on things closer. Even though I read online that this is very common when first diagnosed with diabetes, and it should go back to normal after six weeks or so after you get your BG back under control, I went to see my GP anyway, just to make sure (because I admit that the rapid deterioration in my sight was rather alarming).

My GP then decided to prescribe me gliclazide (40mg, one a day).

A few days later I had my first meeting with the diabetes nurse at the surgery. She started by telling me about trying to control it with diet alone first, to see if that works. I then told her about the pills the doctor had prescribed and which I was now taking, and she hadn't been informed of this and evidently it wasn't what she would have done. Anyway she took another blood sample and it was sent off. She rang me Friday and said it was still too high so she was prescribing me metformin to take in addition to the gliclazide, it would be one a day for the first week, then two a day.

What I am concerned about is this. If my BG levels are getting back under control through my diet and/or the gliclazide, if I then in addition am taking metformin, am I at risk of my BG levels being too low? I asked the nurse this and she said if that happens come back and see her. That is fine, but what about in the immediate term if they are too low, that is dangerous right? You can feel bad or even go into a coma etc.

She gave me a blood tester and I've tested myself a few times with it. Some of the results are within the 'good' range. That is why I am worried about taking metformin as well. I did tell the nurse this over the phone but she still thinks I need metformin.

For context here are the readings I have had, both mine and from the surgery.

Initial blood test by the surgery: 27 (very high I know) - this wasn't a fasting test but still mega high.

Subsequent test, no food for 12 hours was 14.4 - it was this second high reading which prompted them to diagnose me as diabetic.

Now the readings I took myself with the machine, these are since Wednesday.

13.1 within an hour or two of eating
5.9 in the morning after no food for 12 hours or so
5.3 half hour after eating
11.9 late evening, a few hours after eating
7.7 in the morning after no food for about 12 hours
and finally last night at 9.25pm, no food for a few hours, 6.7

I am sure that someone here will know about this! Thanks in advance.

 

[Madbazoo]

Dave, Metformin is usually the first med to be prescribed and is a well tested drug for diabetics, although some people do experience stomach upsets initially. If these persist then there is an alternative slow release version which is better for some. You should not experience problems of low BG levels or hypos on that drug. Glic on the other hand can be more effective in reducing levels in some patients but can cause hypos but I don't think you will have these at the moment given your current BG levels. But keep testing and keep a log of the foods you are eating as well and you will soon learn which foods affect your levels most.

You make no mention of your 'diet' and it may be useful to post your typical meals so we can help you to refine it and get better control.

Keep asking questions. There is a lot of experience here.


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[Mazzer]

Hi Dave, I have been diagnosed with Type 2 Diabetes within the last couple of weeks, and my bg was very similar to yours, I also have blurred vision which promted me go to the doctors in the first place. I was put on Metformin 500mg twice a day and have just started my second tablet, after 7 days on one tablet and fortunately I haven't had any problems.

It might be worth asking your gp if you can just take the Metformin and drop the Gliclazide to see how you get on. Metformin is usually the first option and does not cause hypos, It takes a week or two for the Metformin to kick in before you get the full benefit.

I joined this forum about 2 week ago and I have had some very valuable advice and have managed to get my bg right down apart from the odd spike, when I have eaten somthing that affects my levels. However, I am still learning what works for me, as we are all different, but I definately take more notice of the people on this forum who have first hand experience. I am not overly impressed by my diabetic team at the moment, I have not had any dietary advice and won't get any until my next HBA1c test which is in May.

Have a good look round the forum and see how other people manage their diabetes you will be amazed at what you will learn. As Madbazoo said above keep asking questions.

Good luck and welcom to the Forum.

 

[))Denise((]

Metformin at maximum dose (2000 mg per day) lowers blood sugar levels by 1 - 2 mmols. It is usually the first diabetes drug that is given as it doesn't cause hypos. Some people do not tolerate it well and get upset stomachs (the SR version is kinder). I'm not sure why you were given gliclazide, but 40 mg a day is only a small dose and I've found that at that dose it lowers levels by 1 - 2 mmols.

You could probably get the same effect from working your way up to 2000 mg metformin as you do from 40 mg of gliclazide. Both drugs work in different ways. Do you have kidney problems? This is a reason for not prescribing metformin. Metformin prevents glucose being released by the liver and gliclazide causes the pancreas to to produce more insulin.

This is the NICE medication pathway for Type 2 https://pathways.nice.org.uk/pathwa...cose-lowering-therapy-for-type-2-diabetes.xml

If you started the metformin, it would be at 500 mg a day and as you have a meter to test, then you would see the difference quickly and prevent going hypo. If you drive a car, then the possibility of going hypo is something you need to consider.

With the levels you have mentioned, you still have some wriggle room without going hypo. If you were to start a very low carb diet, then this may be the time to review taking the gliclazide.

 

[Daibell]

Hi. I agree with the other posters that Metformin is normally the first drug to be prescribed if you are overweight. If underweight then Gliclazide may be the first drug. Being overweight implies insulin resistance which Metformin helps a bit and so does reducing your carbs. If underweight it is more likely that your pancreas islet cells are underperforming and Gliclazide helps stimulate them to produce more insulin. Don't worry about the Metformin. It's a good drug and does have other benefits apart from diabetes blood sugar. Let us know you weight and typical diet.

 

[Deleted member 99312]

Thanks a lot for the replies. I have no kidney problems and I am a couple of stone overweight according to BMI (about 15 stone and 6'2" tall). I am 41 years old. Disappointing to get diabetes at this relatively young age as I didn't think I was eating ALL that much sugar - eg. I don't sprinkle it on cereals, I have black coffee etc. and diabetes doesn't run in my family. However, after the diagnosis and after looking at what I have been eating, I realise I was eating several hundred grams of carbs a day, routinely.

A lot of that was stuff I had thought was good for me like wholemeal bread and orange juice etc. In the last six months or so I've also been eating quite a lot of chcolate biscuits and orange flavoured glucose energy drinks full of glucose fructose syrup. I had foolishly thought these were okay to drink but after my diagnosis, I've cut out stuff like biscuits and anything with glucose syrup in it, entirely. I have also decided to sharply reduce my carbs. I think that because I was eating so many carbs before, that initially I should try just cutting back a lot, rather than cutting them out entirely (or almost entirely). If that proves not to be enough, then I will review it and make further cuts if it is necessary. I think it is looking promising when my BG is a lot lower than it was already, just with the dietary changes and Gliclazide. But time will tell.

Anyway, my GP said she was giving me the Gliclazide because 'it works straight away' unlike the metformin which takes a while to take effect. It does seem odd though in light of what I've read here and elsewhere. I am glad that I am not likely to go 'hypo' once I start taking the metformin anyway because I was worried about that.