I’m T2, on metformin (no insulin). I’ve been on & off glyburide–right now I’m taking a very small dose (1.25 mg). Many mornings, I’m at 80 or below 2 hours after a good breakfast (incl 3 carb exchanges). My bg is at healthy levels otherwise during the day; that leads me to want to stick with the glyburide. My medical team seems to be warning me off the glyburide for this reason, yet won’t say so clearly. (My endo actually tossed my concern back to my primary care physician–a 3rd year resident!)
It is certainly a pain to worry about the possibility of the lows, but I’m testing and carrying snacks. Normally I eat nothing between breakfast & lunch. Maybe I should just add in a small carb snack 2 hrs after breakfast everyday?
You didn’t say what your morning fasting BG is and if the metformin is taken only in the morning. If you’re start with a BG that is at 130 or less, take the glyburide and the metformin, assuming you eat right away, the glyburide is working on that 130 BG reading more quickly than it is on your food because the food takes an average of 1 hour before it starts to increase your BG. If you delay eating then your BG is going to drop even more quickly. If your BG is higher and your BG is still low, you definitely don’t need the glyburide, because that drops your BG quickly not the metformin.
Your BG is on target during the day, I’m assuming, because of the AM metformin. If your taking metformin only at night (this would be unusual), then it is indeed due to the glyburide. I’m assuming this is not the case, so agree with your medical team that you don’t need glyburide because that definitely lowers your BG. If you’ve lost weight, are more active, or watching your carb intake, or any combination of these, it isn’t unusual to wean off medications…it’s a good thing!!
Taking snacks to correct a low when it’s easier to just discontinue the glybuide justifies even more stopping the glyburide.
Hope this makes sense! If it doesn’t, I’ll try to clarify. ( - :
As one who has been here - done that both stralex and glyburide; I have the following comments as it applies to me not the appropriate medical opinion that you may need - that has to come from your caregiver.
Fisrt off, your pancreas may still be working quite well but could use a little assist.
Gylburide and starlex are like taking sledgehammer to fliues.
Glyburide is big pain in ■■■ as it lasts 10 and one-half hours waiting to kick your ■■■.
Starlix only works 4 to 5 hours - one meal cycle.
I found that if small variable assist is needed, I am on 1 to 3 units of hmalog lispro that works 4 to 5 hhours giving one opportunity to adjust each meal and also take boost after eating meal when digestion starts kicking out glucose and when you add boost - preventing a low - race to basement…
Taking insulin/pills before meals on a non working or very low output pancreas as is traditionaly done - a type 1 strategy, I might add; usually guranatees a low when both the bolus from a working pancreas add to the ingested pills/insulin shot.
Watch out for the 75/25; 70/30 combo crap insulin that has 12 hours lurking in your veins ready to jump on you at a moment’s notice. That along with working pancreas can send your BG values all over the map.
The biggest farce here is that 15 to 20 per cent of the diabetics are type 1 and type 2 make up the other 80 per cent.
Current pill/ insulin strategies take no notice nor work in complement of a type 2 insulin resistant diabetic to complement a in place working pancreas to prevent hyperglycemic lows.
because the food takes an average of 1 hour before it starts to increase your BG
Man I sure wish i was part of the average because food (depending on fat and protein intake) will start spiking my blood sugar in 15-20 minutes tops with it usually beginning within 5 minutes of eating. Even with very high fat meals I tend to get a spike this quick it is just smaller and over a wide period of time. I would say on average my “peak” influx of glucose is around 1-1.5 hours or so though.
Deborah- I would try stopping the Glyburide for a few days and then test to see if when you stop the Glyburide whether you blood sugar readings the rest of the day (not when your usual hypo’s occur) are in an acceptable range for you. If you notice that they are higher than you want when stopping Glyburide then your strategy of a little carb at that time of day when you get your lows on Glyburide is good. If you do decide to snack I would suggest trying to take those calories out of later in the day (dinner?) so you do not gain weight with the addition of the snack.
Depending on your financial situation you may look into trying different meds too. Januvia or Onglyza may help with your numbers with less lows. If you are ok with an injection you may try Byetta or Victoza (although these are sometimes associated with lows too). All these meds are usually quite expensive. One other thought is that Glyburide is a longer acting med. If you have persistent problems with lows in the morning but you need something for later on during the day you could try to switch to a med similar to Glyburide called Glipizide. Glipizide tends to be in the system for a slightly shorter time than Glyburide. You could try glipizide at lunch maybe?
Well, I can’t really say I am a fan of the sulfonylurea drugs like glyburide. They have historically been associated with side effects and risks and studies seem to show that on average they are not durable (they last a year, or a couple years). But of most concern is that while it is good to come down to a normal fasting after a meal, we also must be concerned about our surges of blood sugars after our meals. And having an A1c of 6.5% suggests an average blood sugar of about 140 mg/dl. If you have relatively normal fastings, that suggests large blood sugar swings.
I actually would support the idea of dropping the glyburide and seeing how you do on a lower carb diet. With lower carbs you may even find you need little or no medication.
Maria–
Very helpful. Between you and the other posts (& another ridiculously fast low yesterday), I’ll go back to metformin only.
My FBG on only metformin are usually ~20 pts above target range . . . I gues I’ll stick with this til I see my next A1C.
Based upon my own experience only and not to be confused with medical advice to you that should only come from your caregiver.
The fact that you are getting the bad lows suggests:
Your own pancreas insulin is working and assisting your body.
The Glburide/Starlix are too big of a hammer and you have some choices:
carefully reduce some carbs, and/or up the hearty exercise. Energy balance is the key. Carbs eaten should equal energy burnt by body and exercise and be at a balance.
Once one gets to T2 it usually means one needs to exercise a little heavier and hearty to get the balance in place.
If you want some insulin, the needle and liquid insulin are far more adjustable and can work nicely with your pancreas by not having to hammer with hormone glyburide to hammer out insulin in large uncontrolled batches.
That is where I found myself and ended up on 2 to 4 units of humalog lispro at each meal without creating a nasty low. If you do not have CGMS it is a pain to catch these lows caused by the starlix/glyburide pills. 3768-DiabetesMellitus_paper_williams_wilkins.doc (607 KB)
Those are healthy subjects. Notice that the BGs start rising immediately and peak well before one hour. In myself and most of the other type 2s I have corresponded with the only difference is the timing and the size of the peak, not when BGs start to increase.
Cheers, Alan, T2, Australia Everything in Moderation - Except laughter
I'm T2, on metformin (no insulin). I've been on & off glyburide--right now I'm taking a very small dose (1.25 mg). Many mornings, I'm at 80 or below 2 hours after a good breakfast (incl 3 carb exchanges). My bg is at healthy levels otherwise during the day; that leads me to want to stick with the glyburide. My medical team seems to be warning me off the glyburide for this reason, yet won't say so clearly. (My endo actually tossed my concern back to my primary care physician--a 3rd year resident!)
Would you define two things for me please:
What do you consider a good breakfast with three carb exchanges?
What do you consider "healthy BG levels"?
I suspect that you are having a reactive hypo at your 2-hour post-breakfast point exacerbated when you take the glyburide. But I could easily be wrong, so try doing some testing at one hour after breakfast to show me I am. I think you may get a surprise at the size of your spike at that time.
Alan:
My breakfast: 1 ww toast or .5 C beans; egg; 1 C milk; fruit
Healthy BG during the day: never above 180, usually 110-150
All of the feedback has led me off the glyburide. I’m thinking about trimming my carbs. I have been following my dietician’s advice (3 carb exchange meals + a couple 1 carb snacks) but perhaps it’s time to try less.
Alan-- Your replies got me (re)thinking my doctors' recommendations about carbs & numbers. (And I got off the damn glyburide.) I have reduced my carb intake by about 20%. This seemed impossible at first, but I've done it. Got my new A1C today: 6.3 & no lows. Feeling good--thank you for your input. :)
Jim-- Your comments in November re glyburide also motivated me to get off the drug. (My endo would not opine either way!) I'm doing very well on just metformin & closer carb watch. I appreciate that you shared your experience.
In this case I got a more well-rounded perspective/approach from my fellow d-posters than my medical professionals.
