When to seek hypo help?

[rach]

Hi!

I'm on gliclazide modified release once a day for a while now and have mostly found it totally fine except for a period of debilitating hypos. I never went totally unconscious, always able to self treat, however they were long-lasting and relentless (lasted about 5 days with me having to eat every 3 hours). I eventually landed up in hospital, as I was so sick of them. At my last appointment I asked what I should do if this happened again but didn't really get a reply. At what stage would you go to hospital? Or would you not bother unless you became unconscious? I just got to the stage where I thought there might be something else they could give me, but as there wasn't I wonder if it was the right move. Help would be much appreciated in case I ever experience this again...

Thank you!

 

[hanadr]

Trouble with a slow release Gliclazide is that the effect lasts a long time. You need quite a big dose of Glucose to counteract it.
If you are totally alone, I would report to the hospital just to be safe.( call a taxi, don't drive!) If you have someone with you who can hand you bottles of lucozade regularly until the BG comes back up, that would be enough.
I stopped taking Gliclazide and went low carb, because I didn't like its effects and I was on the ordinary one.
Are you on Metformin too?
Most T2s on low carb can manage with just Metformin. It doesn't cause hypos and once you adapt to it it stops the upset stomach effect.
It's worth considering if the hypos are really nasty and/or frequent

 

[Trinkwasser]

Sounds like you are now overmedicated, I'd be seeing my doctor ASAP about a dose reduction.

Here's a good way to find out what's happening throughout the day

http://www.alt-support-diabetes.org/NewlyDiagnosed.htm

This is not so common inthe UK due to the usual lackadaisical approach to diabetes treatment but it's not uncommon in the States where more doctors take an aggressive initial approach that patients actually improve faster than was expected through dietary control and exercise and the medics are not reducing the medication doses fast enough.

The B answer is to feed the medication with more carbs, it may be in the meantime you can improve things by changing the time of day you take the drug and moving some carbs from one part of the day to another, which the testing protocol may help you determine by showing you when you are going low and if you are still getting highs.

Standard hypo treatment is 15g fast carbs (glucose tabs or orange juice or similar) and test again in 15 minutes. For Type 2s some slow carbs mixed with fat are a good plan as a followup, but at the end of the day it's better to adjust the meds to the diet rather than the other way round.

 

[rach]

Thank you for your help - I just realised I said it lasted 5 hours... meant 5 days. I live in a communal flat so there were people around for parts but no-one I could have asked to spend multiple nights/days with me. I was treating it with short then long acting carbs, getting up to about 6 then falling by 2 hours later back to 2. It was by the 3rd day of this I figured surely something was wrong...

I did try metformin hana - it really didn't agree with me! Also my condition is sensitive to sulphonyureas apparently so they want to keep me on that if possible. I'm not sure there is a lower dose, and the rest of the time I'm getting good readings on it 5-7 fasting, 6-10 post meals so not keen on changing if can help it. Doctor did mention if it happens again perhaps switch to short acting more frequently.

Thank you!

 

[hanadr]

Short acting medication taken moe frequently might be an answer. Ask about Starlix. It's not used often and I'm not sure whetther it would be right for you, but it has a short life of only an hour or so.

 

[rach]

Starlix? Thanks Hana, I'll look that up.

I quite like the gliclazide if I can keep it (it certainly does the job - my HbA1c now down to 6.2 and no longer getting massive post prandial peaks) although not the hypo period, especially as I'm mostly alone, extremely scary. Hopefully the dose I'm on now might do the trick and avoid repeats of the situation!