Testing on alogliptin

[Rutheluned]

Hi
I had my diabetes review last week and the nurse seqemed surprised that i wasnt testing my blood sugar- ssid if imnon alogliptin i should test within 2 hours of driving. Ivr nevef been toldcto test before,am just learning to use the kit , bug csnt find anythkng about alogliptin that mentions testing like this- is thisx advice correct?

 

[aylalake]

That’s interesting! Most, if not all, nurses don’t encourage Type 2S who are not on insulin to test. They say there is no point, which is ridiculous!
I have been on Alogliptin for a few years, seen several different doctors and nurses and never been told to test. I wish they would because then I wouldn’t have to self fund my strips and CGMs.

 

[HSSS]

This comes up now and again because the leaflets are a bit vague. Usually it’s in relation to gliclizide but it seems to apply to any diabetes medication that can cause hypoglycaemia. The standard leaflets are https://assets.publishing.service.g...e-to-insulin-treated-diabetes-and-driving.pdf for insulin users which also does explain when to test in relation to driving and https://assets.publishing.service.g...vers-with-diabetes-treated-by-non-insulin.pdf for everyone else

If you are on gliclazide or other meds that carry a risk of hypos you should have testing equipment provided as it’s necessary for driving within the law as well as the direct risks of the hypo. Look at NICE NG28 https://www.nice.org.uk/guidance/ng28 and in there is guidance for drs https://assets.publishing.service.g...84397/assessing-fitness-to-drive-may-2022.pdf which says (the bold is mine to highlight the relevant parts)

Managed by tablets carrying hypoglycaemia risk- Including sulphonylureas and glinides (for example Repaglinide, Nateglinide)
May drive and need not notify DVLA, provided:
■ no more than 1 episode of severe hypoglycaemia while awake in the last 12 months and the most recent episode occurred more than 3 months ago
■ should practise appropriate glucose monitoring at times relevant to driving
■ under regular review
It is appropriate to offer self monitoring of blood glucose at times relevant to driving to enable the detection of hypoglycaemia.
If the above requirements and those set out in Appendix D (page 127) are met, DVLA need not be informed.
DVLA must be notified if clinical information indicates the agency may need to undertake medical enquiries.

The below official documents also say you should test before driving on hypo causing medications. Should you have a driving incident and be found to be hypoglycaemic then you are potentially liable for driving whilst unfit due to drugs (the diabetes prescribed ones), careless or dangerous driving as a result. It could and should be clearer on the usual leaflet for non insulin users but that makes no mention of testing one way or other.

https://www.diabetes.org.uk/guide-to-diabetes/life-with-diabetes/driving/driving-licence#hypomeds (says to ask your medics if you are at risk of hypos and they are advised to tell you to test as above)

https://www.diabetes.org.uk/guide-to-diabetes/life-with-diabetes/driving/driving-licence. Scroll half way down the page to rules for group 1 and “Other medication that can cause hypos (like sulphonylureas)

https://gpnotebook.com/en-GB/pages/paediatrics/non-insulin-diabetes-mellitus-and-driving is a guide for drs which has in their bold for hypo causing drugs “should practise appropriate glucose monitoring at times relevant to driving”

 

[HSSS]

So I suggest anyone on these medications discuss testing equipment with their DN or dr and produce these guidances to support their case. Shockingly few seem to know about this. @Rutheluned seems to have a nurse on the ball.

 

[Lamont D]

I endorse as @HSSS has posted.
The gliptin family of drugs are used to stimulate first phase insulin response, because of either insulin resistance or because like me, my first phase response is very weak, due to other issues. You may have high circulating insulin and this effects the response.
This is why, testing is important, as the dosage may be too high and stimulate too much insulin which may result in a hypo. And if you are finding yourself improving your diabetic results, your insulin resistance and levels of useless insulin has lowered, the need to use the drug, the dosage needs to be lowered or you may need to be taken off it altogether.