Author Topic: reducing gliclazide - bad idea?  (Read 2694 times)

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Offline Pattidevans

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Re: reducing gliclazide - bad idea?
« Reply #15 on: 03 November 2016, 01:50:28 PM »
Quote
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.
  Oooh, I'd love a trip to Paris  LOL!  Seriously I've just never heard it called that before.

Quote
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
We call it "Test, review, adjust" or "eating to your meter" i.e. testing before a meal and then at one and two hours after a meal to see what any particular food does to you.  You see we all react very individually to different foods and what may make one person's BG spike really high might be easily tolerated by someone else.  e.g. Potatoes do little to me, but bread causes huge spikes (despite bolussing insulin for the correct amount of carbs.  Other people react differently.  Lots of people also find their BGs spike at one hour and then drift down towards the two hour mark.  This is often the case in people with T2 diabetes as they do not release sufficient insulin in the first phase (i.e. as soon as they eat) but they have a good second phase insulin release (which happens later to mop up any residual sugar in the blood).

I have to reiterate though that for that particular breakfast it would seem you do need the 80mg gliclazide.  Try with a different breakfast, say bacon and an egg, you may find that doesn't spike you as much and you might get away with only a half dose of glic.
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.


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Offline peterlemer

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Re: reducing gliclazide - bad idea?
« Reply #16 on: 03 November 2016, 05:08:11 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.

This isn't something I'm clear about. Is BG control about never going above a value, and if so, what value?
OTOH. if it's about HbA1c, then I would expect that the aim is not to reduce spikes so much as maintain a good average.

Comments welcome

pete

Offline peterlemer

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Re: reducing gliclazide - bad idea?
« Reply #17 on: 03 November 2016, 05:16:02 PM »

[...]

Sounds like a tasty breakfast though!

:-). thanks sedge.

I have been using the nutritiondata website extensively and have chosen the berries as low GL, the sourdough is a bit rich but I'd run out of my favourite dense rye loaf so I took a flyer. Both breads come out relatively well within the bread range for GL, despite being quite high. Half the time I have no bread at all for breakfast, and no dairy either, but havent found a consistent pattern of results.  I am about to run a much more diligent diet chart - given that the past month had been a great improvement in readings, I want to see how far i can go within sane tasty and nutritious input.

I feel ( and I might be wrong, this is WIP) that some bonus carb has to be good - but if it turns out not to be, I can live with it :-)

pete




Offline peterlemer

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Re: reducing gliclazide - bad idea?
« Reply #18 on: 03 November 2016, 05:17:22 PM »
@peterlemer
As an ex-Gliclazide user

Thanks Fergus, How did you become an ex-gliclazide user?

pete

Offline peterlemer

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Re: reducing gliclazide - bad idea?
« Reply #19 on: 03 November 2016, 05:21:53 PM »
OT from newbie: but how do I 'like' a post?

pete

Offline Pattidevans

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Re: reducing gliclazide - bad idea?
« Reply #20 on: 03 November 2016, 06:34:37 PM »
You need to do a few more posts Pete (not many now), then a "Like" button will appear.  It's all a part of an anti-spammer thing that's on the forum.
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 nytquill17

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Re: reducing gliclazide - bad idea?
« Reply #21 on: 03 November 2016, 06:39:38 PM »
Hi Pete!

BG control can be defined as "trying to keep BGs within or as close to a normal (i.e. non-diabetic) range as possible." Bearing in mind that "as close as possible" varies from one person and one situation to another, and almost no one is able to keep their BGs in normal range all the time. Some people almost never see normal range in spite of their best efforts. In fact, I feel that "control" is a bit of a misnomer, because there is a lot that goes into BG that we don't control - but, of course, a lot that we do, too. So it's more about managing BGs, that is, making the appropriate choices about things that are within our control so that we optimise the amount of time we spend with BGs in or closer to normal range.

Normal, non-diabetic range is 4-6 (well, actually 3.5 to 6, clinically speaking, but for those of us on insulin or sulfonyureas like Gliclazide, anything below 4 can be counted as a hypo, so "4's the floor" as they say!)

However, in addition to simply "getting low numbers," the goal is also to reduce spikes as much as possible. It's much better overall for your body if your BG stays relatively level, even if it's staying level at a slightly higher BG than you wanted, than for your BG to suddenly shoot up and then come back down. The real goal then is to aim for as gentle a curve as you can get (because it's almost impossible to get NO change after eating, but usually a change of 2-3 points or so is acceptable to most people - ideal for some!), and in so doing spend as much time as possible with the numbers closest to 4-6 that you can manage.

A "good" A1c is not the goal, it is only a way of measuring. In fact, it is a very blunt instrument and is best considered as merely another tool in your arsenal of assessment, rather than the last word on the state of your diabetes. There are two main reasons for this. (1) It is not only an average, but a weighted average. That is, while technically an A1c test gives you the average glycation (exposure to glucose/sugar) going on in your blood for the last 3 months, in fact the past 2 weeks or so before the test are MUCH more heavily represented than whatever was going on 3 months ago. This is because while almost all of the red blood cells in the sample will have been around for the past week or two, only a few old, decrepit ones from 3 months ago are still left floating around. What this means, practically speaking, is that if your control the past few weeks hasn't quite been up to snuff (say you had a cold or something recently) but was excellent before that, your A1c might trend higher than a "flat average" would have (unfortunately, no "flat average" test exists, and averaging your BG readings for the past 3 months won't work, because those are spot checks - they don't measure continuously the way an A1c does). Inversely, if you had really tightened up control lately, but things weren't going so well two or three months back, your A1c will trend lower than what was actually happening inside your body.

(2) The A1c is, well, an average. Imagine that your blood sugars for the past 3 months were distributed equally across a range from 4.0 to 12.0, giving you an average BG of 8 (an A1c of 6.6% or 48.6). Imagine, on the other hand, that your blood sugars had consistently remained between 7.5 and 8.5, also giving you an average BG of 8 and the same A1c. However, the second scenario indicates much better control because BGs are more stable, if slightly above goal. So an A1c can be good for showing you general tendencies (a higher A1c necessarily means that you are having higher BGs at least some of the time, for example) but it isn't good for a fine analysis and can even mask certain problematic situations (a lower A1c doesn't automatically mean better control).


As for the breakfast issue! Just as not all carbs are created equal, neither are all the times at which you could eat them. The various hormones that regulate insulin resistance/carb sensitivity (two sides of the same coin) fluctuate as part of the normal circadian rhythm of the human body, in the same way that melatonin levels fluctuate and regulate the sleep cycle. For 80-90% of people this means that they are most carb-sensitive in the morning, least carb-sensitive in the afternoon, and somewhere in the middle in the evening. This means that you generally need more insulin for the same amount of carbs taken at breakfast than you would taken at lunch or dinner - regardless of whether that insulin is coming from an injection or from your pancreas! But if you only have the insulin your pancreas can make, and your pancreas is limited in what it can produce already, this means that taking in too many carbs at breakfast might leave it unable to keep up - and thus leave you with higher BGs than if you'd eaten the same carbs later in the day.

So I - and most others here, I think - would completely agree that it's ok and even necessary to have some carbs, and to have treats! The point of staying healthy is to enjoy life, after all ;) And you will never be able to have a zero-carb diet anyway because there's even carbs in things like lettuce and broccoli. But for most people, whatever carbs they're having in their day, breakfast is the worst possible time to choose to incorporate them! So a lot of us aim for an all-protein breakfast and save our carbs for later in the day.


p.s. to like a post, just click the "like" button at the bottom of it, once you have enough posts of your own that the system will show it to you. It should be an orange rectangle with "like" in white text. This button will not appear (for you) on any of your own posts, only on the posts of others. And if you've already liked a post, it will change to a black box that says "unlike" instead.
T1 DX 1995
Levemir + Novorapid
 
  ~-~-~-~
"If you can't ride, can you fall?"
"I suppose anyone can fall," said Shasta.
"I mean can you fall and get up again without crying, and mount again and fall again and yet not be afraid of falling?"
"I - I'll try," said Shasta.
  ~C.S. Lewis, The Horse and His Boy
  ~-~-~-~
"There is no answer; seek it lovingly."

Offline sedge

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Re: reducing gliclazide - bad idea?
« Reply #22 on: 03 November 2016, 06:44:47 PM »
There should be a red box with 'Like' in white at the bottom LH corner of posts from other people - you click it !  If it's not there it may be because you haven't got enough posts in the Forum yet - see if it appears after your count goes up to 10.  It's to prevent spammers and Trolls having a field day before anyone with the relevant permissions bans em!

Incidentally, if you wish to add a signature you should be able to now.

Now turning to the case in hand LOL - it's not only the HBA1c at all - cos you can actually swing from HI to LO on your meter multiple times daily and your HbA1c will look absolutely fine since the 33+ ones cancel out the 1.8- ones.  Two things cause diabetic complications - BG that's too high for too long - but also SPIKES !

Hence why folk try to do both - lower their BG readings overall for as long as possible and also try not to eat stuff that sends em sky high.  And everyone is flippin different what their own body's tolerances are.  In practice you can't avoid carbs totally - even lettuce and cucumber have carbs!

Alan's whole Blog is helpful for pointers and personal experience.  http://loraldiabetes.blogspot.co.uk/search?updated-min=2016-01-01T00:00:00%2B11:00&updated-max=2017-01-01T00:00:00%2B11:00&max-results=1
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 Liam

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Re: reducing gliclazide - bad idea?
« Reply #23 on: 03 November 2016, 07:17:38 PM »
Just a welcome from me right now since the things I might have posted have been covered.
DX Type I 1994.    Novorapid Animas Vibe pump
HbA1c 3/10 10.2%, 7/10 8.1%, 12/10 7.5%.
2/11 7.8%, 8/11 8.6% 9/11 8.3%.
3/12 62 (7.8%). 10/12 67 (8.3%)
4/13 63 (7.9%) 6/13 59 (7.5%)
1/14 71 (8.6%) 7/14 59 (7.5%) 11/14 (6.7%)
3/15 56 (7.3%) 12/15 49 (6.6%)
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Offline peterlemer

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Re: reducing gliclazide - bad idea?
« Reply #24 on: 04 November 2016, 01:08:05 PM »
Hi Pete!

BG control can be defined as "trying to keep BGs within or as close to a normal (i.e. non-diabetic) range as possible." Bearing in mind [...]

Thanks nytquill17 :-)

Your post has shedloads of relevant input, much of it new to me*, and I've been on a long learning curve since first diagnosed, so well done.
It matches much of what I've been coached by a succession of diabetes nurses and even GPs, and adds more that a) I definitely need to know and b) I'm a bit annoyed that an accidental posting on a forum new to me should prove so informative. Why aren't my care team as well informed?

I haven't got a 'like' button yet, so consider your post 'liked' :-)

pete

* key things I didn't know:
1. the importance of the distinction between gentle curves and spikes
2. target range
3. the accuracy and profile of the HbA1c test
4. morning carb-sensitivity

Offline nytquill17

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Re: reducing gliclazide - bad idea?
« Reply #25 on: 04 November 2016, 01:40:58 PM »
If it makes you feel any better, you're hardly alone in that. Diabetes, but especially type 2 diabetes, is really not taken very seriously by a lot of the medical establishment, kind of a "take 2 of these and call me in the morning" situation, only more like "take 2 of these and see you back in 6-12 months!"  There is also still the idea that diabetes is a disease of old people and people who are too health-illiterate to have made good choices in the first place (GRRR but that's another post) and thus it's best not to worry the patients with actual useful information, just give orders and lectures when those orders fail to accomplish anything. Although in fairness there are certainly plenty of diabetes patients who don't WANT to be involved in their own care and that must be very frustrating for an HCP to face day in and day out (although I question whether this number could be reduced if HCPs didn't instil the "there there dear just take these pills and skip dessert and you'll be fine" mentality to begin with...). But in my experience many doctors and nurses end up getting so jaded about diabetes and diabetes patients that they overlook - or simply aren't able to adequately serve - the patients who ARE invested, or who would be willing to be if given something to work with!

To manage diabetes well requires a TON of knowledge about physiology, nutrition, and pharmacology. A lot of that can only be gained by long experience because there is no one-size-fits-all approach to diabetes. GPs and the like can't possibly have this amount of specialist knowledge and they certainly don't have the 24/7 for years type of experience that diabetics "on the ground" do. There's nothing wrong with a GP not knowing this stuff, they are general practitioners, after all, they have breadth of knowledge, but not necessarily depth. What IS shameful is the fact that many GPs and GPs' nurses feel that they are perfectly capable of treating diabetic patients despite this, because "it's just diabetes, it's not so complicated" -- but it is! And that many GPs don't encourage their patients to at least educate themselves, if they can't provide appropriate education or specialist care (which is understandable, given our sheer numbers these days). The information is out there, but people don't know they need it and they aren't being told!
T1 DX 1995
Levemir + Novorapid
 
  ~-~-~-~
"If you can't ride, can you fall?"
"I suppose anyone can fall," said Shasta.
"I mean can you fall and get up again without crying, and mount again and fall again and yet not be afraid of falling?"
"I - I'll try," said Shasta.
  ~C.S. Lewis, The Horse and His Boy
  ~-~-~-~
"There is no answer; seek it lovingly."

Offline Pattidevans

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Re: reducing gliclazide - bad idea?
« Reply #26 on: 04 November 2016, 06:29:14 PM »
Well said Nytquill.  It's so true... all of it.  The number of people I know locally who take no responsibility for their diabetes and are simply not encouraged to do so is quite frightening.
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 #27 on: 04 November 2016, 09:06:24 PM »
One example: Having taken part in a national study into diabetes support groups, I had group training, attnded seminars, co-led a local group for a year. When that came to an end ( the outcome was that that particular design of support did not affect HbA1c outcomes, although it did some good for heart patients), all went quiet, and then I got a local flag that my surgery was inviting a group to form, so I leapt at it.

Imagine my feelings when, on asking the assembled participants what their latest HbA1c was, or their latest self-test level, none of them knew!

Now in retrospect, that could be taken in 2 ways:

1. they didn;t regard HbA1c as a significant part of their balancing act  ( in which case the practice nurse, who was present, might have shared that info with me) or

2. they were in a limbo of lack of motivation, support, or information

I totally get your point about what it means to be a GP, and yet our practice has a diabetes specialist GP, who I've never met!.

pete

Offline Venomous

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Re: reducing gliclazide - bad idea?
« Reply #28 on: 04 November 2016, 09:10:55 PM »
I wonder why the 'diabetes specialist GP' isn't seeing all his diabetic patients..... and how much specialist training goes into the label.

Shocking in terms of their future health that those diabetics didn't at least have the fact of their Hba1c measurement in their arsenal of knowledge.
T2 and PCOS. Just had large serous adenofibroma removed with ovary and fallopian tube. Bp is now normal!

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Offline Alan

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Re: reducing gliclazide - bad idea?
« Reply #29 on: 05 November 2016, 12:48:49 AM »
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

It seems to me that you need to reduce your time spent listening to that nurse.
Cheers, Alan, T2, Australia.
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Type 2 Diabetes - A Personal Journey (latest: Small New York Baked Low Carb Cheesecake)
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