When low carb/keto doesn’t work

[DEBBIESCOTT]

This must be so frustrating for you. Just wondered if any medics had suggested taking the Gliclazide on alternate days, or more on one day, less the next etc? Not suggesting you do this without medical input, but a family member with type 2 ended up being told to do this by their endocrinologist, as they were having lots of hypo's, and it worked well for them until they were able to come off it completely.

DSN has told me when blood sugar keeps going up to take 20mg a day until it’s stable again, took one on Wednesday & blood sugar back to normal in 2 hours, took it Thursday & Friday just to be sure, usually it stays stable for a couple of weeks until it rises again, just seems to need to be reminded to release insulin every so often, so frustrating though trying to plan meals & getting to work & back, I carry a lunch bag of food everywhere with me

 

[LittleGreyCat]

There has been a lot of mention of MODY.
Both diabetes.co.uk and diabetes.org.uk state that this a variant of diabetes which is characterised by onset before one is 25.
Is this still the case?

 

[DEBBIESCOTT]

There has been a lot of mention of MODY.
Both diabetes.co.uk and diabetes.org.uk state that this a variant of diabetes which is characterised by onset before one is 25.
Is this still the case?

Have a read on bloodsugar101 then MODY, it’s a very interesting read.
Apparently very often misdiagnosed & can get it at any age (although genetic defect there since birth), now come to light my dad had raised blood sugar but never diagnosed as diabetic, blood sugar rose to 12.9 yesterday 20mg of gliclazide down to 3.6 within 3 hours, after eating 2 meals, can’t get a referral without seeing my gp, can’t get appointment with gp, feel sick & dizzy today not gone to work

 

[LittleGreyCat]

Have a read on bloodsugar101 then MODY, it’s a very interesting read.
Apparently very often misdiagnosed & can get it at any age (although genetic defect there since birth), now come to light my dad had raised blood sugar but never diagnosed as diabetic, blood sugar rose to 12.9 yesterday 20mg of gliclazide down to 3.6 within 3 hours, after eating 2 meals, can’t get a referral without seeing my gp, can’t get appointment with gp, feel sick & dizzy today not gone to work

From this thread you seem to be potentially an over producer of insulin with a very finely balanced Insulin Resistance (IR).
That is, when you push your pancreas to produce a bit more insulin it pushes past the IR and then you go hypo.
Perhaps an alternative might be to take a drug that makes you pee out extra sugar?
That shouldn't cause hypos (but may cause thrush).

One interesting variant of MODY is reportedly that the mechanism which controls the insulin/glucagon balance is not working properly.
I wonder how many people have that?
In your case it looks as though your system isn't reacting in time to shut off insulin production and dump glucose from your liver.
Or that when you tip over the limit and the insulin starts to work you may have so much extra insulin that a liver dump just can't stop the crash even though you aren't producing any more insulin.
Whichever way that goes, it needs a specialist endocrinologist to investigate.

Best of luck!!

 

[LittleGreyCat]

Have a read on bloodsugar101 then MODY, it’s a very interesting read.
Apparently very often misdiagnosed & can get it at any age (although genetic defect there since birth), now come to light my dad had raised blood sugar but never diagnosed as diabetic, blood sugar rose to 12.9 yesterday 20mg of gliclazide down to 3.6 within 3 hours, after eating 2 meals, can’t get a referral without seeing my gp, can’t get appointment with gp, feel sick & dizzy today not gone to work

Thanks for the pointer.
I assume that you aren't taking Metformin along with the gliclazide?

A search shows that gliclazide is a sulphonylurea.
https://diabetesupdate.blogspot.com/2010/09/diabetes-drug-interactions-can-harm-you.html
Note that I think this is for a different sulphonylurea but it does seem to strike a chord with the problems that you are having.

"Prandin is marketed with the information that it is very short acting--and is out of the body in about 3 hours. I had tried it a few years ago and this seemed to be the case.

What I didn't know--and learned the very hard way--is that this is only true if you take Prandin alone--without Metformin. If you combine the two, it turns out that the Metformin blocks the mechanism in the liver that eliminates Prandin and the drug ends up being much, much more potent."

"It is there that we learn that, over a 4-5 month period, people taking Prandin alone saw their blood fasting blood sugar rise by an of 8 mg/dl, and people taking Metformin alone saw an average drop in their fasting blood sugar of 4.5 mg/dl, but people taking both drugs simultaneously experienced an average decline in fasting blood sugar of 39.2 mg/dl--almost ten times as much as with Metformin alone!"

The whole page is well worth a read (if you haven't read it already) but it seems that over time the drug is not eliminated but keeps building up until there is a violent over reaction which is hard to control.

This feels as though it might map onto a slow increase in hypo risk then strong hypo reaction.
Then you stop the drug, and your BG slowly starts to rise.
Rinse and repeat.

Apologies if you have already covered this.
I am drowning in MODY information at the moment.

 

[DEBBIESCOTT]

Thanks for the pointer.
I assume that you aren't taking Metformin along with the gliclazide?

A search shows that gliclazide is a sulphonylurea.
https://diabetesupdate.blogspot.com/2010/09/diabetes-drug-interactions-can-harm-you.html
Note that I think this is for a different sulphonylurea but it does seem to strike a chord with the problems that you are having.

"Prandin is marketed with the information that it is very short acting--and is out of the body in about 3 hours. I had tried it a few years ago and this seemed to be the case.

What I didn't know--and learned the very hard way--is that this is only true if you take Prandin alone--without Metformin. If you combine the two, it turns out that the Metformin blocks the mechanism in the liver that eliminates Prandin and the drug ends up being much, much more potent."

"It is there that we learn that, over a 4-5 month period, people taking Prandin alone saw their blood fasting blood sugar rise by an of 8 mg/dl, and people taking Metformin alone saw an average drop in their fasting blood sugar of 4.5 mg/dl, but people taking both drugs simultaneously experienced an average decline in fasting blood sugar of 39.2 mg/dl--almost ten times as much as with Metformin alone!"

The whole page is well worth a read (if you haven't read it already) but it seems that over time the drug is not eliminated but keeps building up until there is a violent over reaction which is hard to control.

This feels as though it might map onto a slow increase in hypo risk then strong hypo reaction.
Then you stop the drug, and your BG slowly starts to rise.
Rinse and repeat.

Apologies if you have already covered this.
I am drowning in MODY information at the moment.

Thanks, I hadn’t seen that before,
When I first had gliclazide in May I was told to reduce the amount because of all the hypos, one time down to 2.4 on a glucose meter, I then had to stop it immediately & later put on metformin (I’m still taking 1000mg a day but feel it does nothing)
Now agreed with my DSN to keep taking the metformin & only have 20mg of gliclazide if blood sugar goes over 10 on my meter.
Last time I had the gliclazide I was back to forth weeing for a couple of hours then within an hour boood sugars in the 4’s again.
When I first had gliclazide in May blood sugar went from 18 to 6 in a couple of hours & just kept going down the longer I was taking it even though the dosage kept being lowered.
The DSN couldn’t believe the readings against what I was eating & kept saying something was wrong, had to keep a log & email it to her every week.
Now transpires my dad had higher blood sugar levels but not high enough to actually be classed as diabetic, maybe gliclazide is too strong for me because of my weight.
I’ve read so much about MODY I’m confused.
Thank you for replying

 

[LittleGreyCat]

I’ve read so much about MODY I’m confused.

Welcome to my world!

On the gliclazide:
The main thing I think I picked up is that sulphonylureas are usually cleared by the liver.
If they are not then they accumulate and effectively you get a bigger and bigger dose.
Slow clearance of the drug (Metformin or not) could possibly explain some of your symptoms.

 

[ianf0ster]

Forgive me, but I haven't read all the way through this thread.
However I have come across a video by Prof Jim Johnson in 2018 which may show why a Low Carb High Fat diet may not work to get T2D's into remission for up as many as 7% of people.

It's quite a long way into that video, but the Prof says that in general the way to make a mouse diabetic is to feed it a high fat diet because the mouse natural diet and their pancreas is so different from a human.
However he did an experiment on live pancreas cells (from dead donors) and found that there were 2 subject pancreas (out of around 30) where there was an insulin response to fatty acids was comparable to that of carbs.

 

[DEBBIESCOTT]

Forgive me, but I haven't read all the way through this thread.
However I have come across a video by Prof Jim Johnson in 2018 which may show why a Low Carb High Fat diet may not work to get T2D's into remission for up as many as 7% of people.

It's quite a long way into that video, but the Prof says that in general the way to make a mouse diabetic is to feed it a high fat diet because the mouse natural diet and their pancreas is so different from a human.
However he did an experiment on live pancreas cells (from dead donors) and found that there were 2 subject pancreas (out of around 30) where there was an insulin response to fatty acids was comparable to that of carbs.

Thank you for posting this, think I’m even more confused now,
Low carb/keto doesn’t work but 20mg gliclazide every 5 days does, I’ve gone from a1c of 128 in May to 47 in October on minimal tablets & I haven’t lost a llb
Just waiting now for a consultant appointment as chances of MODY are high

 

[ianf0ster]

One thing I forgot to mention is that the cases where fat caused an insulin response were in pancreatic beta cells not attached to a live human being. I don't know if it has been verified that such a response can occur in a living person.

Also just in case people think that Jim Johnson is playing down the benefits of low carb, he says that he has experience of working on drug trials and that if Virta style low carb/keto were a drug it would have a revenue in the billions of dollars per year.