High Morning Numbers With Gliclazide

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borisnatasha
Regular Member


Date Joined May 2009
Total Posts : 22
   Posted 1/12/2010 9:17 AM (GMT -7)   
I am a type 2 who was being treated with metformin and glyburide. The glyburide was working well... too well at times as I was experiencing frequent lows. But all in all I was pleased with my results and I had even got my fasting numbers down to reasonable levels (below 126). My diabetic nurse decided she didn't like my frequent lows and decided I needed to change to gliclazide in the form of diamicron MR -- 30 mg first thing in the morning.
Now I find my fasting numbers very high ( between 126 and 180), every day, even if I don't have anything to eat past supper time the night before.
And also if I eat anything which I consider bad such as a higher carb food or meal my numbers go way high and can take a long time to come back down. With the glyburide I didn't have this problem... if my numbers were high they quickly came down.
My diabetic nurse is from the school of anything up to 180 is good so I can't turn to her for advice because she would consider my numbers reasonable.

My question is does it take awhile to adjust to this drug and will I likely find my numbers come back down again to better levels in time? Is there something I can do now in regards to improving my morning numbers? I have tried eating different kinds of snacks before bed, not eating any snack and the results don't seem to vary at all. What could explain these higher numbers in the morning. I don't think I am having lows in the night causing glucose dumps.

Thanks for any and all advice!!

LanieG
Forum Moderator


Date Joined Nov 2006
Total Posts : 5393
   Posted 1/12/2010 3:16 PM (GMT -7)   
It sure sounds like you need to have your meds re-evaluated.  Fasting between 126 and 180 is very high in all diabetes literature. 
Lanie
 
forum moderator - diabetes
diabetes controlled so far by exercise and a low/no carb diet


borisnatasha
Regular Member


Date Joined May 2009
Total Posts : 22
   Posted 1/12/2010 5:11 PM (GMT -7)   
I agree that my meds should be re-evaluated but that is not likely going to happen until my next round of labs in April plus as I said previously the diabetic nurse will not think my numbers are bad. I have been on this new drug only for less than a month and Christmas and visiting screwed things up quite a bit with all the stress and eating badly. I am working at getting back into my original routine and hope that in time my levels might settle down somewhat. If not I am going to have to try to deal with the nurse and if that fails talk to my doctor who was reluctant to change my meds in the first place since they were working so well.

Thanks for your reply Lainie.

LanieG
Forum Moderator


Date Joined Nov 2006
Total Posts : 5393
   Posted 1/12/2010 6:03 PM (GMT -7)   
I understand about getting back into the routine after the holidays.  I think many of us go off a little (or a lot, depending...).   What do you normally eat at meals?  Do you have some kind of exercise that you do on a regular basis?
Lanie
 
forum moderator - diabetes
diabetes controlled so far by exercise and a low/no carb diet


borisnatasha
Regular Member


Date Joined May 2009
Total Posts : 22
   Posted 1/12/2010 8:20 PM (GMT -7)   
I normally try to watch my carbs and keep them low. I was doing what I had to in combination with my meds to keep my numbers down. I do regular exercise as well. But even with exercise and watching what I am eating
I struggle with my numbers on this new medication. I don't understand why these so called experts have to mess with what is working. I lowered my A1C from 10 down to 5.9 last year but I am sure my next one will
be quite a bit higher. I am so not impressed.

LanieG
Forum Moderator


Date Joined Nov 2006
Total Posts : 5393
   Posted 1/13/2010 7:04 AM (GMT -7)   
Gosh, this is an example of not fixing something that ain't broke!  The labs tell the story!  What's with this diabetic nurse!
Lanie
 
forum moderator - diabetes
diabetes controlled so far by exercise and a low/no carb diet


borisnatasha
Regular Member


Date Joined May 2009
Total Posts : 22
   Posted 1/13/2010 8:22 AM (GMT -7)   
I am afraid the "experts" here are either behind the times or just ignorant of the facts of diabetes. It concerns me because it is my health and I am at their mercy.
This is a small place in northern Ontario and I cannot request another health care provider so I just take what I can from their wisdom and do other research and then take
my own health into my own hands. But there isn't a lot I can do with the medications they choose to put me on. If things don't improve I will request to go back on the
glyburide... lows and all. My family doctor seems to be a little more reasonable.

In regards to my excellent lab results the nurse although pleased with my results did think I was being too strict with myself and felt I should let up a bit in my desires to improve.
She kept reminding me that any number up to 10 was good. I explained to her I like my numbers under 7 and she seemed quite frustrated with me. I get the same response from
the dietician who is the nurse's partner in crime. I tend to just listen politely and then go about my own business.

Phishbowl
Veteran Member


Date Joined May 2006
Total Posts : 547
   Posted 1/13/2010 11:42 AM (GMT -7)   
Diabetes can be like balancing on a tight rope. Between what, when and how much to eat or exercise or take medication can be a fine balancing act indeed.

We talk a lot about the ultimate goals of reaching normal-like BGLs and A1Cs and the sacrifices and efforts that go into trying to attain/maintain those goals. What we don't talk too much about is the other side of what it costs some of us in trying to achieve acceptable levels... hypoglycaemic episodes.

While high glucose levels over time will cost you any number of diabetic complications, low glucose levels over a very short period of time or a low enough immediate low, could cost you your life. This may be where your DE might be coming from. Not to play devil's advocate but, this is what my first DE told me when I was first using Rapid insulin. They'll always err on the side of caution with letting you have higher numbers vs numerous hypos. When you say frequent lows - how frequent and how low?

You've been out of routine and while your body is adjusting to a new med. Give it a bit of time being on a regular schedule and see if that doesn't see more level numbers. If your numbers don't improve soon, though, I wouldn't hesitate to make an appointment with your doc and show him the results you've had on this new drug (vs. the results you had on the previous one), and that's why you want to switch.

I'm sure if you can address the "going low" concern they have - be prepared to tell them exactly how you address one and what steps you'd take to mitigate their future occurrences (i.e. you always go low around 2-3PM so, you will always have an afternoon snack of 15-20 grams of carbs to ensure that doesn't happen or if it does, you're prepared with a quick sugar on-hand). - and I'm sure you're doc would put you back on it.
Cheers,
- Phishbowl (Type 1 since Jan'05 - Levemir, NovoRapid)
"What's Not Measured Is Not Managed"

"It is impossible for a man to learn what he thinks he already knows"-Epictetus


borisnatasha
Regular Member


Date Joined May 2009
Total Posts : 22
   Posted 1/13/2010 1:30 PM (GMT -7)   
Thank you Phishbowl for your very sound reasoning as to the reasons why perhaps my DE took this particular stance. You are totally correct in saying it was likely because of the potential harm of too many or too severe lows that I was experiencing. I did try to counteract the lows if not totally prevent them but they were happening very often... once or twice a day. I likely could have been eating more carbs per meal than I was. Another problem in connection with the lows was I was having to have too many snacks/ or candies to fix the lows or bring my sugars up high enough to go to bed at night without fear of going low overnight. This was causing weight gain plus difficulties losing weight. I did have one severe low (1.7) which I did not see coming and was in it before I realized it. Oddly enough I didn't even feel low and was able to get enough fast acting sugars into me to raise it back up to safe levels. My DE was indeed concerned that I was having any lows at all, let alone so many every week. I also am not too happy having lows and had to constantly be on guard.
But I also am not happy struggling with these high levels either. But what you have said makes sense and perhaps over time and with my routine back on line and exercise and better eating I will see some improvements. I am willing to wait it out for another few weeks to see what happens.

Thanks for your response!

Phishbowl
Veteran Member


Date Joined May 2006
Total Posts : 547
   Posted 1/14/2010 9:18 AM (GMT -7)   
OK, I understand a bit more now. Once or twice a day to have a low (under 3.9/70 is low and under 2.8/50 is a hypoglycaemic episode), is too many lows for a Type 2 on a sulfonylurea drug. I can actually see why your DE was concerned. That you could get as low as 1.7 is another cause for concern as, it's not common for Type 2's to reach this low a level without reason (i.e. missed/unbalanced meal, medication dose incorrect, etc.).

You shouldn't have to "feed the medication"; eating just to keep your blood sugars up. That's just a recipe for disaster and not a way to live in fear of lows all the time, especially over night (a whole lot of reasons why that's bad). Along with some conscientiousness towards diet and exercise, meds should help stabilize BGLs throughout the day without causing lows.

Again, it's the balancing act :-) This new drug may not be your answer but glyburide may not be either (or at least not the dose you were on). It's can be frustrating and challenging at times trying to find out what might work but patience and perseverance will eventually get you there. Keeping a daily log of food, meds, exercise and their times and amounts is the best way to see those areas you need to address and (IMHO) the only way to know what's going on.

Just to share a little and maybe give another perspective.... I'm a Type 1 (5 year anniversary yesterday), on "intensive insulin therapy" or MDI (multiple daily injections) and it took me a couple of years of trying different insulin and regimens to get me here. I test 5-7 times a day and inject 2 types of insulin 5-7 times a day. I've never had an A1C below 7.9%. I regularly have multiple daily lows and highs. I eat moderate carb (100-130/day) and have maintained my weight at 110, give or take a few up or down for short periods. This background info is mostly just to say that, despite managing my diabetes every few hours of every day and doing the best job possible according to my D-Team, I doubt I'll see my A1C ever below 7%. I'm still trying to prove them wrong but, as a "brittle" diabetic (old term but still used) the wide swings in BGLs I experience hourly, make that a difficult challenge.

Wait a few weeks, keep a logbook in the meantime (medical folks can't dispute data :-), make an appointment if you're not satisfied with your numbers, then try the next med or dose. Metformin would probably be the next most popular drug to try. But... one step at a time. Hang in there :-)
Cheers,
- Phishbowl (Type 1 since Jan'05 - Levemir, NovoRapid)
"What's Not Measured Is Not Managed"

"It is impossible for a man to learn what he thinks he already knows"-Epictetus


Phishbowl
Veteran Member


Date Joined May 2006
Total Posts : 547
   Posted 1/14/2010 12:16 PM (GMT -7)   
Ooops! Just realized you're already on Metformin, too. Sorry 'bout that - I thought you were just on the one drug. It comes to mind that it could've been the Met dose that was causing your lows along with the glyburide. There are so many different combinations of drugs and doses. Unfortunately, it does take time sometimes to find the right combo. Again, hang in there. With your efforts and your positive attitude, you'll get there :-)
Cheers,
- Phishbowl (Type 1 since Jan'05 - Levemir, NovoRapid)
"What's Not Measured Is Not Managed"

"It is impossible for a man to learn what he thinks he already knows"-Epictetus


borisnatasha
Regular Member


Date Joined May 2009
Total Posts : 22
   Posted 1/14/2010 1:26 PM (GMT -7)   
I agree that my lows were a concern. I had even cut my dosage of glyburide down quite a bit and still had lows. There was never any mention of cutting back on the metformin which I take 2 in the morning and 2 at supper.
My doctor didn't seem as concerned about my lows as the nurse and it was the nurse who recommended the gliclazide instead. The doctor didn't agree with the change because I was doing so well but reluctantly agreed to the change when I told him I was having lows. This drug might not be right for me and I guess time will tell but it is very frustrating to have found something that worked as well as it did only to change to something that is not working as well but maybe my dosage needs increasing. I will most certainly take your suggestions of creating a log book to show the nurse and doctor and hopefully they will work with me to achieve better control with a different approach.

I am sorry to read of your struggles and I sympathize with your frustrations of not being able to achieve the results that you would like to. I realize that I could be worse off than I am. I would congratulate you on your five year anniversary but sadly there isn't much to celebrate, is there?

Thank you so much for your ideas and thoughts... I really appreciate your efforts to help! You are very kind.
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