Author Topic: reducing gliclazide - bad idea?  (Read 2709 times)

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Offline peterlemer

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reducing gliclazide - bad idea?
« on: 01 November 2016, 02:32:15 PM »
Following a more aggressive diet regime, my morning bloods have been falling and a couple of times, when <6, I've broken my morning 80mg glic tab and only had half.
My reasoning is that my nurse has been trying to convince me that, since I'm on glic, I need to test 2 hours before I drive a car, even though I've never had a hypo.
Putting that issue to one side, it seems clear that glic is notorious among both DVLA and diabetic nurses for lowering BG enough to cause hypos.

It seems to me obvious then, that if my BG is 'normal' before breakfast, it wouldn;t hurt to reduce my glic since I don;t want to thrust it below normal.

My nurse was horrified when i told her, and said I must never reduce my meds.

Any comments?

pete

Offline sedge

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Re: reducing gliclazide - bad idea?
« Reply #1 on: 01 November 2016, 02:49:48 PM »
Hi Peter - and first off, welcome to DSF !

I'd stress the bit about not giving medical advice cos we aren't qualified - but were you talking about insulin rather than Glic, I'd absolutely agree with you.  ie - it sounds like perfect sense to me!  What was her actual reasoning for being horrified?  If she didn't give one I'd be suspicious myself if I were you - after all, don't they also make 40mg Glic tablets, and if you've changed your diet and are getting better BGs - then yes - the whole thing about that is to try and eat more so your own pancreas can do the job for you - could be you do need to drop the dose!

And the testing - no it's immediately before driving and every 2 hours thereafter supposing it's a long drive, cos Glic causes the pancreas to push out more insulin BUT nobody knows how much it will emit, or when!  So it is completely and utterly sensible to tell us to do it!

How are tests after other meals going - is it time to see the doc (not the Nurse) about a review of your meds?
Jenny

T1 DX 1972, pumping Novorapid 24/05/11

HbA1c - 7/07 8.7, 1/08 7.8, 9/08 8.4, 3/09 7.3, 7/09 7.2, 12/09 7.3, 11/10 8.1, 2/11 8.6, 9/11 6.5 2/12 6.4  5/12 50/6.7  11/12 52/6.9  01/13 46/6.4  06/16 46/6.4  12/16 45/6.4

Offline Pattidevans

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Re: reducing gliclazide - bad idea?
« Reply #2 on: 01 November 2016, 04:35:59 PM »
Hi Peter and welcome to the forum.

You say that if your BG is under 6 you have been reducing your gliclazide by half, however have you tested at one and two hours after your breakfast to see what it is then?  If your nurse is stressing that you should test before driving (and as Sedge says, the law specifies right before driving, not 2 hours before) then you have the means to test and can do that.  I am not going to tell you what to do regarding your gliclazide, but I suggest you see what your meter says about how high you spike after the meal a. with the full dose of gliclazide and b. with the half dose.  Because sure as eggs are eggs your BG WILL rise after you eat.  So it's not the pre-meal level that matters so much, it's the post meal numbers.

Test strips are an important tool in our armoury to see what's going on not just before meals or in the morning, but after meals to see what different foods do to you.  So I would experiment as above before reaching any other decisions. Hope this helps  :)
Patti


Type 1.  Mis-diagnosed T2 May 2003, finally had CPeptide test 15/7/11 and proper diagnosis 1/9/11.  Now pumping Apidra with Roche Spirit Combo pump. Hba1c 6.1 April 2016.


© 2015 Patti Evans

Offline sedge

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Re: reducing gliclazide - bad idea?
« Reply #3 on: 01 November 2016, 06:14:00 PM »
Aaah - very good point Patti, well made.  Apologies, Peter, if I started leading you up the garden path.
Jenny

T1 DX 1972, pumping Novorapid 24/05/11

HbA1c - 7/07 8.7, 1/08 7.8, 9/08 8.4, 3/09 7.3, 7/09 7.2, 12/09 7.3, 11/10 8.1, 2/11 8.6, 9/11 6.5 2/12 6.4  5/12 50/6.7  11/12 52/6.9  01/13 46/6.4  06/16 46/6.4  12/16 45/6.4

Offline Venomous

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Re: reducing gliclazide - bad idea?
« Reply #4 on: 02 November 2016, 07:52:24 AM »
Hi and welcome. Patti has covered the issues around reducing the gliclazide.

I think testing before you drive is a good idea anyway, don't you? Though as sedge says not two hours before, but immediately before and every two hours if you're driving for an extended period.
T2 and PCOS. Just had large serous adenofibroma removed with ovary and fallopian tube. Bp is now normal!

Novorapid, levemir, trulicity, metformin.

Offline Fergus

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Re: reducing gliclazide - bad idea?
« Reply #5 on: 02 November 2016, 09:47:15 AM »
@peterlemer
Welcome to the forum.  As an ex-Gliclazide user I would agree that in order to be safe you should :
1) test before driving and every 2 hrs.
2) check the effects of 80mg and 40mg on your post meal BG.
On Jenny(Sedge)'s assertion that you dont get 40mg Gliclazide then this is not true. I sourced 2 diferent brands through my pharmacist, despite Boots being adamant that it didn't exist (Zicron by Bristol & by Actavis)
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Offline Pattidevans

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Re: reducing gliclazide - bad idea?
« Reply #6 on: 02 November 2016, 09:51:59 AM »
@peterlemer
Welcome to the forum.  As an ex-Gliclazide user I would agree that in order to be safe you should :
1) test before driving and every 2 hrs.
2) check the effects of 80mg and 40mg on your post meal BG.
On Jenny(Sedge)'s assertion that you dont get 40mg Gliclazide then this is not true. I sourced 2 diferent brands through my pharmacist, despite Boots being adamant that it didn't exist (Zicron by Bristol & by Actavis)


Jenny (Sedge) said "don't they also make 40mg gliclazide tablets" meaning she thought they did make them.   Easy to misread!

Patti


Type 1.  Mis-diagnosed T2 May 2003, finally had CPeptide test 15/7/11 and proper diagnosis 1/9/11.  Now pumping Apidra with Roche Spirit Combo pump. Hba1c 6.1 April 2016.


© 2015 Patti Evans

Offline himtoo

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Re: reducing gliclazide - bad idea?
« Reply #7 on: 02 November 2016, 11:16:18 AM »
Hi Pete
welcome to the forum

agree with everyone so far on testing immediately before driving.

no knowledge of Glic so can't help there.
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Offline sedge

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Re: reducing gliclazide - bad idea?
« Reply #8 on: 02 November 2016, 12:32:14 PM »
No Fergus - I said 'Surely they DO make 40mg' LOL
Jenny

T1 DX 1972, pumping Novorapid 24/05/11

HbA1c - 7/07 8.7, 1/08 7.8, 9/08 8.4, 3/09 7.3, 7/09 7.2, 12/09 7.3, 11/10 8.1, 2/11 8.6, 9/11 6.5 2/12 6.4  5/12 50/6.7  11/12 52/6.9  01/13 46/6.4  06/16 46/6.4  12/16 45/6.4

Offline peterlemer

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Re: reducing gliclazide - bad idea?
« Reply #9 on: 02 November 2016, 03:58:54 PM »
Wow, fabulous bunch of replies! Thanks :-)

To asnwer the points in turn:

I am not insulin dependent, I manage on meds, diet and exercise.

The nurse didn't say why i shouldn't reduce my meds, just that I shouldn't
I intend to continue my experiment, and not mention it again unless it shows good results.
I am double-testing avery day ( as per mendosa)

Today, my pre-brekfast BG was <6 so I took a half-glic. 2 hours after breakfast, I was >9 so I took the other half. Before lunch I was <6 again.
( at that point I routinely take a Januvia tab)

As for the driving issue, in the 12 years of testing I have only ever had one reading <4, and had no hypo symptoms. So I don;t feel that I'm a risk
My nurse said that the police would want to see that I'd taken a reading within 2 hrs prior to an incident but the DVLA says:

" By law you must tell us if any of the following applies:
You suffer more than one episode of severe hypoglycaemia within the last 12 months. You must also tell us if you or your medical team feel you are at high risk of developing severe hypoglycaemia."

I couldn't find any other law - perhaps the panel can help?

cheers

pete

Offline Venomous

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Re: reducing gliclazide - bad idea?
« Reply #10 on: 02 November 2016, 05:17:03 PM »
My take on this is....I think nurses generally don't like for a person to think for themselves, if you have a 'condition' and are told to take meds for it by a doctor (read God) then you should never ever alter that med by yourself because 'what do you know', you're 'just a patient'. However the doctors and nurses aren't with us during the night when we wake up hypo or whenever else, it isn't their life on the line, it's ours, so it's OUR diabetes and up to us to care for it as best we can with the medical profession as our guidance and helpers (and prescription writers, thank you very much). However, when sitting in a car you're in charge of a lethal weapon, I don't see the problem with testing your bg to see if you're at a comfortable level before starting out, that's basic self care (and care towards every other motorist on the road also) and it's not like it's difficult to do or anything so why wouldn't you?

Also if I were in a hypothetical accident (which hopefully none of us will be) how awful it would be to be held responsible for that if there was no evidence as to the level of blood glucose in the blood. And that's not even going as far as considering the possibility of being hypo and actually being responsible for it. It's a legal argument, take your blood sugar reading, it ensures you know you're good, it means that if in (worse case scenario) there's an awful accident you have evidence that it wasn't down to being diabetic and being hypo, that you took due care of yourself, your passengers and anyone else on the road around you.

I know the feeling when the medical profession goes into a tizz about a possible hypo (that hasn't happened for years and isn't even likely to happen in the near future) but also you do need to cover your own self too in all senses. Seems like a no-brainer to me.
T2 and PCOS. Just had large serous adenofibroma removed with ovary and fallopian tube. Bp is now normal!

Novorapid, levemir, trulicity, metformin.

Offline Pattidevans

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Re: reducing gliclazide - bad idea?
« Reply #11 on: 02 November 2016, 06:03:09 PM »
Quote
I am not insulin dependent, I manage on meds, diet and exercise.
No, I don't think anyone thought you were, but the action of gliclazide is to push your pancreas to produce more of your own insulin and it can be very imprecise and no one can say how much your pancreas will produce.  Ergo at any time unknown amounts of insulin can be circulating in your blood.  However, looking further into your response I would say you aren't producing that much.

Quote
I am double-testing avery day ( as per mendosa)
I am unfamiliar with that regime.  Could you explain or give a link please Peter.
Quote
Today, my pre-brekfast BG was <6 so I took a half-glic. 2 hours after breakfast, I was >9 so I took the other half. Before lunch I was <6 again.
( at that point I routinely take a Januvia tab)

With due respect, that was why I suggested you tested after your meals (in this case breakfast) before making a decision as to whether to halve your gliclazide.  It would appear on this occasion that in fact you may have been better off taking the whole tablet before breakfast.  May I ask what that breakfast consisted of?

Patti


Type 1.  Mis-diagnosed T2 May 2003, finally had CPeptide test 15/7/11 and proper diagnosis 1/9/11.  Now pumping Apidra with Roche Spirit Combo pump. Hba1c 6.1 April 2016.


© 2015 Patti Evans

Offline peterlemer

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Re: reducing gliclazide - bad idea?
« Reply #12 on: 02 November 2016, 07:39:30 PM »
I can't find my original source for what i call 'double-testing' but I can confirm that it is usually called 'testing in paris' and is what has already been suggested here, which is before a meal and 2 hours after.

Accuchek have a video that I've just found and might get the tool. I'm not permitted to post a URL here, so search accuchek, pair-testing tool


My breakfast consisted of a slice of low-salt back bacon on a thin slice of sourdough toast.
I also had a small bowl of raspberries, blueberries and beansprouts in a stir of plain set yoghurt and plain kefir.
and a coffee :-)

pete

Offline sedge

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Re: reducing gliclazide - bad idea?
« Reply #13 on: 02 November 2016, 09:34:21 PM »
Just idly wondering how many grams of carb are in the brekky - http://www.fatsecret.com/calories-nutrition/generic/bread-sour-dough?portionid=10109&portionamount=1.000

Obviously yours was a thin slice, but I wouldn't have a clue as to the dimensions and therefore the carb value - but you have a good idea so what d'you reckon?

Then add the carbs in the fruits and the yoghurt - see http://nutritiondata.self.com/facts/fruits-and-fruit-juices/1851/2 and  kefir - and see how many grams in total it was, cos you can see from that how much X grams of carb increases your BG, for which you need the full 80g to deal with it.

And then consider whether you want to stay on the 80g - or if you could reduce the carbs and possibly then only need 40g, or whether you really need the carbs (which are not necessary actually for nutrition itself) at all, in which case you most likely could do without the glic. too !

Sounds like a tasty breakfast though!
Jenny

T1 DX 1972, pumping Novorapid 24/05/11

HbA1c - 7/07 8.7, 1/08 7.8, 9/08 8.4, 3/09 7.3, 7/09 7.2, 12/09 7.3, 11/10 8.1, 2/11 8.6, 9/11 6.5 2/12 6.4  5/12 50/6.7  11/12 52/6.9  01/13 46/6.4  06/16 46/6.4  12/16 45/6.4

Offline Lucy

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Re: reducing gliclazide - bad idea?
« Reply #14 on: 02 November 2016, 11:03:23 PM »
If it was your 2 hour reading that was over 9, then your actual peak bg would likely ave been much higher so i'd say you do need the whole tablet.
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