Type 2 Spiking and dropping

Redeye313 said:

Hello.

I posted a couple of weeks back and got some great advice off some of the members here about keeping a food diary and regular testing as well as before meals and 2 hours after. As I’ve been testing regular I have noticed that some foods will spike my bg really high to 11 or 12 then an hour or so after will drop to about 3 or 4 where I would then feel a hypo coming on and have to grab for the jelly babies and tell my boss I’m going for a sit down. I was on 500mg of slow release metformin and 40mg of gliclazide and that wasn’t having any affect on my bg.
I’m now on 1000mg sr metformin and 80mg gliclazide.
My dbn has told me she is referring me to the community specialist nurse and to be prepared to be put on insulin. As I have no idea (2years diagnosed and still not really a clue what I’m doing) does this sound like it could benefit me in the long run.
I have no issue with taking any medication or possible insulin I just want to be at a more constant steady bg level.

Thanks

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Hi @Redeye313

I recently made the decision to try insulin after 9 years, 7 of which were spent controlling my BGs with lifestyle (mainly food) changes and 1000mg of metformin. In the past two years a lot has happened with my health; I have "multiple co-morbidities" which in English means I have lots of disorders I'm trying to manage, most of them for life. So that complicated things a bit.

I'm not familiar with having such big swings in BG... I assume it's either due to a particular type of diabetes you have and.or the gliclazide. It must be a real pain for you.

I'm glad your nurse is willing to refer you and not just sit back and say everything will be OK.

I'm happy to answer any questions you may have about insulin either here or by PM. The injections don't hurt (me)... I find fingerprick testing 100 times worse.

What has your HbA1c been like over the 2 years since your diagnosis? Thanks.

Redeye313 said:

My HbA1c for my last 3 tests has been around 74.9 and hasn’t really changed, lowest being 69.5 in the last 2 years.
The finger prick testing I don’t find to bad so I guess I would find injections ok. Reading around the forum I see a lot of people using terms like bolus and basal for insulin and not sure what that means. Also do you have to work out how much to take yourself or does your dbn tell you? I know I’m not on insulin yet but it would help to have a bit more info so I understand better.
Thank you

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Basal means a long acting insulin that you take once or twice a day. This one works on getting your fasting BG down and acts as a background insulin all the time.

Bolus means a short acting insulin that you take with each meal. You may or may not need to add this in. If you do, they teach you how to calculate how much to inject just before eating the meal, based on how many grams of carbohydrate you estimate are in the meal. There is a mobile app for this or you can use a book with charts, I think.

Since your numbers have been fairly high for quite a long time, you may wish to give insulin some serious thought. My plan is to reassess it once my BGs are back where they should be and if I can go off it, I will. But if I can't, I won't.

There's a writer in the US who has diabetes and she has written a couple of books and an excellent website, Blood Sugar 101. I found her explanations about the pros and cons of insulin for T2 really helpful, especially since my A1c has been over 65 for a long time. I need to get it down within a couple of months, not another year.

http://www.phlaunt.com/diabetes/15478720.php

Has Reactive Hypoglycemia ever been mentioned to you?

Really consider all the options before accepting insulin. Maybe ask to go on a daphne course to help with the spiking and dropping, although I'm experiencing this also and think it is the gliclizide. I have been type 2 for years, insulin was the worst experience, its hard to get a grasp of exactly what to inject unless carb counting, and even then, lots of hypos occurred due to other things affecting my body. Eg/ exercise, heat, hormones. I would honestly try to find the right combo of pills, have you tried dapagliflozin? I also reacted to metaphormin. Keep a food diary and try to see dietician or nurse as much as possible. Hope this helps.

All I can say is, hypos and sudden drop in blood glucose are because there is too much insulin circulating. IF this is the case for you, then you need to consider if injected insulin is the right choice for you. Similarly any other drug that stimulates the pancreas to produce extra insulin, as Gliclazide does. Yes, they will help with the highs, but may also cause even more lows. I believe less carbs would be more beneficial for you - the fewer the carbs, the less highs there will be, and the less lows.

Disclaimer - I am not a doctor.

Bluetit1802 said:

Has Reactive Hypoglycemia ever been mentioned to you?

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I believe that the high Hba1c levels would likely rule that out.
But it would need a fasting Hba1c test.
I believe it could be the Glicizide, but the drug might not have a good effect because of what the ops dietary intake is.
I would like to believe that insulin would be last resort.

Redeye313 said:

As for dapagliflozin I have never heard of it nor has it been offered to me so I will enquire next week at my review.

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Before you do anything, please Google dapagliflozin and side effects. It has many, and is not the safest medication long term. It works by getting rid of glucose through the urinary system.

Redeye313 said:

I have been talking to my practice nurse and she thinks that the medication I’m on isn’t going to improve my levels as I’ve only had a 0.1 drop on my HbA1c in the last 12 months and that is with cutting down carbs and swapping and changing medication and doses.
As for dapagliflozin I have never heard of it nor has it been offered to me so I will enquire next week at my review. I have recently been on a DESMOND course for my diet and that has helped me with counting carbs and keeping portion sizes down to help manage my bg. Nothing seems to keep my levels consistent so that is why my practice nurse has suggested insulin. As I have discussed with her she thinks it could be time because if the big swings in numbers.

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You have said that you have cut down on carbs.
How low have you actually gone?
The reason I ask is because, it could be relevant to why your hba1c levels won't drop despite taking Glicizide.
If your dietary advice is still too carb laden, and you get the typical advice on diet on these courses, reducing may not be enough. You probably are in that viscous circle, where you eat, that produces a spike of glucose which your trigger to over produce too much insulin, you have insulin resistance, you create too much insulin which doesn't get used, your blood glucose levels stay too high, then you eat again a few hours later, the circle starts again. The drug will have little effect over time because of the high spikes.
You may have an intolerance to certain foods, which only testing appropriately will discover.
But then again, I might be wrong!
But it is worth a thought about what you might try before relying on insulin.

Best wishes

Redeye313 said:

I’ve already settled on the fact I want insulin. After 2 years of really high bg enough is enough. I am quite disappointed by the way my diagnosis has been handled. When I was first diagnosed I went to the hospital because I was having really bad stomach problems and they found that my levels were high so they gave me metformin, and just said take 2 of these twice a day which caused my stomach problems to get worse. Eventually I was sent to a diabetes consultant who took me off the metformin and put me on gliclazide. After that I found out I had got ibs so coming off the metformin was a real relief for my stomach but not for my levels. It took the consultant and his team a year to decide I was t2 and now they are unsure if I am. Someone on the forum said it was more likely to be LADA which given my symptoms sounds like it could be. The consultant at the hospital didn’t send me for retinal screening or check my feet or ask about my diet. It wasn’t until I saw my practice nurse that all this was sorted and she was mad at the consultant. I have now had retinal screening and I need laser treatment to correct my eyes as the high bg has damaged the blood vessels behind my eye. My practice nurse has helped me with my diet, my eyes and my feet in just over 6 months while my consultant had just done the bare minimum.
Sorry for going a bit off topic but good to know people on here listen and try and help more than the so called professionals do at times.

Thanks

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On reading that, I'm also mad at the consultant, and I'm sure you were/are too.

Shocking dereliction of duty and possible legally actionable, but that's another story. The urgent need right now is for you to get your BGs down.

Despite what others may say, insulin is an option for people to *consider* in situations like yours, but if I were you I would keep an open mind for another couple of weeks or so, just in case you do have a less common form of blood glucose regulation problem such as reactive hypoglycaemia (RH) or LADA just as examples.

I don't have RH but with your spiking and dropping it would pay to find out about it. @Bluetit1802 is really knowledgeable about it and there are some others here that also know a lot and can help you.

Whether someone with high BGs over a long period of time has T2 or LADA the basic approach is the same: To reduce carbs and consider some of the available medication options. I'm not recommending any medication, or insulin, just saying it is something to consider. The first priority is to reduce carbs. This forum is an excellent place for info on how to do that easily and safely.

Redeye313 said:

Just googled the side effects for dapagliflozin and doesn’t sound like something I would like to take. Thanks for the suggestion though. I will ask if there are any other options available before insulin. I just want to get it sorted as the length of time I’ve had high bg I don’t want to develop any more problems through bad control.

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This website has info about all the groups of diabetes medications that are available (in the US and I assume most are also available elsewhere too).

You can probably find the same info by googling but I like the fact that they are shown in a table with pros and cons.

There are links to detailed info about the meds at the bottom of the page.
http://www.phlaunt.com/diabetes/17977284.php

Lamont D said:

I believe that the high Hba1c levels would likely rule that out.
But it would need a fasting Hba1c test.
I believe it could be the Glicizide, but the drug might not have a good effect because of what the ops dietary intake is.
I would like to believe that insulin would be last resort.

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I am starting to think the hypos could just be an effect of the Glicizide.

@Redeye313, when you were started on Glicizide, were you told much about the increased risk of hypos? Did you get them when you were on 40mg?

I've never taken Glicizide but on starting insulin I was told to treat hypos with a short-acting sugar source like jelly babies AND a longer acting sugar source like a biscuit or small sandwich. I haven't had a hypo yet so I don't know much about them.

Were you told at what level to treat hypos? Do you keep a record of what your BG was at the time, and what it was on re-testing shortly after? How many hypos are you having?

It looks like your nurse has increased the Glic from 40mg to 80mg because it wasn't doing enough, but my concern is that it still isn't doing enough, and now your risk of hypos is even greater.

If you were to discuss with your nurse then give this a try, I wonder if stopping the Glic for (I don't know, a week?) then seeing what your numbers do will help the two of you figure out what's going on.

Hypothetically, if you (with nurse agreement) stopped your Glic and worked really hard on low carbing for a few weeks (I find that safely increasing fats a little bit makes it easy) you might see an improvement and decide to keep doing it.

No matter what meds you decide to try in the future, low carbing will benefit you.

I know nothing about statins except that I don't want to take them and thankfully don't need to for now. If you could tell us your recent lipid results breakdown (HDL, LDLs etc not just total cholesterol) that would help us to help you. Often doctors and nurses prescribe statins when they are not needed and they then cause nasty side effects that don't help you manage your BGs well.