Drug Question

Type 1 and LADA
1

I finally went to see a specialist here in Ontario and had a good visit. The Dr looked at me and told me I'm more than likely not Type 2 but LADA. After 3 1/2 years of being told I was Type 2 by my GP this is a big relief for me. He sent me for blood work and told me he would have other tests done after he gets the results. He also told me he thinks I will probably be on insulin within a year. I told him I have no problem starting insulin and think it would be the best option in controlling my BS.

Here is my question: He wants me to try a different drug, I'm currently taking 2x500mg Met but wants me to add 1 30mg of Gliclazide. I know nothing about this drug so just asking for thoughts/input etc....

Thanks as always!

Paul

2

It was about 3 years into before I was re diagnosed as T1 but mine was a lot more dramatic. .lol I have been on glipizide which doesn’t really work on me at all. And Metaphorman can cause some serious stomach side effects so watch out for that one. Good luck!

3

Hi Paul: Sorry, I don't know anything about Gliclazide. If I were in your shoes, I would go over the test results with the doctor and then really push to be on exogenous insulin; I would push in a way that doesn't put the doctor on the defensive, but that makes it clear that for my health I want insulin. Just my two cents. Best of luck, good that you finally got a doctor to listen and pay attention.

4

After all these years, you finally get a doctor who actually questions your diagnosis. I do hope your doctor orders a full antibody panel (GAD, ICA and IA2) as well as a c-peptide. Even if they come back all negative, that does prove you are not LADA. My understanding is that 85-90% of T1/LADA test negative for all three antibodies.

The drug that your doctor has prescribed (Gliclazide)is the same as the drug formerly known as Diamicron. It is a Sulfonylurea. It works by stimulating your pancreas to constantly excrete insulin. The action that you should observe is a lowered fasting blood sugar. In practice, many people find that they go low from this drug between meals or overnight. I actually don't like sulfonylureas, many authorities believe that they burn out your remaining beta cell function and I always refused to consider them as an option. And I really support what Melitta has said, push for insulin. And a sulfonylurea is contraindicated for LADA/T1.

Do let us know how things work out.

1 Like
5

Some people feel that drugs in the the class as Gliclazide (Sulfonylureas) might burn out insulin producing beta cells by making them produce more insulin. Google "Sulfonylurea burnout." I personally avoided it. My attitude back when I had a T2 diagnosis was that if going low carb and taking metformin wasn't enough, then I needed insulin. Second, get the bloodwork done to test for LADA. If you are, you should get on insulin quickly. The thing with LADA is that eventually your body probably wont produce insulin and bad things happen if you don't have any in your system.

Eventually, I was diagnosed LADA (tested positive for everything and had low C-peptide. Should have been diagnosed as diabetic years ago. Got a T2 diagnosis Jan 1, 2010, and then LADA July 2013, but I've been on insulin for close to 2 years.

6

Using insulin is really not fun. I have been on it for over 50 years, and it is just hard on so many fronts. Do all the tests, go low carb--in my book anything you can do to avoid insulin and protect your health is good.

7

If it were me I would get all the tests done and then go on insulin.. you may only need low doses at this point.. also go low carb, I do 50g per day now, this makes managing insulin much easier. Insulin is not fun but as a type 1 you're in more danger to go to dka and that won't happen on insulin most likely. In addition a lot of the other diabetes drugs except for metformin have caused bad side effects on beta cell health and in other areas.

8

Thanks for all the input guys :) I'm going to start the new drug and monitor if it helps. When I go for my next visit I'll discuss if it would be better to save whatever natural production I have left and go straight to insulin injections. At least I can tell the Dr I gave the medication a try...

Paul

9

T2 here... going on insulin was the best thing I ever did to manage my diabetes. Started beginning of June after ending up in the ER.

Exogenous insulin gives you so much control and flexibility in terms of when to eat, what you eat, when you exercise, and much more.

MDI got me from insanely out of control to better than tight control. While the downsides to injections is there, the non-diabetic bg is worth it.

In two months I've gone from oral meds, to MDI, to wearing a Dexcom G4 CGM (one week), and slapped on my first Omnipod yesterday. I love being a cyborg. Based on my BG patterns over the last week I set up a basal program that worked right out of the gate... For the first time I had flatlined sugars last night, past my usual 4am Dawn Phenomena, and at 10:45am I'm still stable at 107.

I can't advocate enough for Borgifying oneself. I feel like I can manage this disease effectively, and live a real life.

10

Wow, love your sense of humor :)

And, wow, 2 months from oral meds, MDI to pump... Why so quick to get on the pump?

Paul

11

Reasons in order of importance:

  • Control.
    Having that cannula in you all the time gives you the flexibility to control your dosing much more like a pancreas, giving many smaller boluses as you eat. Less planning/forecasting is necessary, and you don't have to eat more than you want to to cover a large bolus injection when you thought you were going to shove an entire Angus Hereford in your maw because, well, you were really hungry when you planned your bolus injection. Didn't plan for that double Sambuca after dinner? With a pump it's almost like not having diabetes (press a few buttons on your "cellphone" (Omnipod PDM) and you're covered). On MDI, well, another trip to the restaurant bathroom, for -- what is it now? -- injection #12 of the day in your super-tight control program.
  • Convenience.
    As I said above, when I need to juice it because I'm indulging and having mud pie for dessert, I can just check that text on my "cellphone", then get back to protecting my precious dessert from my wife's fork. With MDI? After I get back from the bathroom, half the mud pie's gone, and no one at the table saw anything!
  • Toys.
    I'm an engineer by training, and love technology and tech toys. Now that I'm Borg, my affinity for this stuff has mysteriously increased :-) Anyway, just because of my nature, I love messing with the Omnipod and the Dexcom G4. I'm fascinated with what they can do. What I can do with them to be as close to non-diabetic, at least in terms of BG, as I possibly can. My biggest problem right now is leaving these devices alone!

Pumps are not for everyone. What I find fun and entertaining, many others (like my wife) find boring to tears. I read the Omnipod manual cover to cover and think it's really cool. My wife couldn't get past the safety warning at the beginning before glazing over.

That said, if you like cool tech gadgets, checking out a pump and a CGM is a really good move. As much for a T2 as for a T1. The fact that T2s are not in as much immediate DANGER as type 1's, uh, we'd still like to keep our feet and legs into old age, be able to see, digest food normally, feel the soft skin of our first grandchildren on our fingertips, and much more.

Simply avoid killing yourself with acute glycemic excursions should not be the criteria for access to treatment technology. Getting as close to not having the condition in the first place should be the standard.

Imagine the health care industry telling men with ED that 1/16 of a Viagra is all you can have because, well, that gets you from a floppy to a squishy. So now you don't have as much dysfunction.

That's what they're doing to us T2 who want to aggressively treat our condition. I can't guarantee I won't have complications. What I can do is minimize the risk/change as much as possible.

From what I can tell, a pump is the best bet. I tried tight control (actually, I was and am trying for normal blood sugar levels, much tighter than the ADA "tight control" guidelines) with MDI and fingersticks, and it was brutal. 8-12 injections a day, 1-15 fingersticks.

With the pump, I have a cannula insertion every two days, and with the G4 about 4 fingersticks a day.

And BG in my target range 90-110 most of the day, occasional excursion to 150 or so after a meal if I didn't plan ahead well enough on the meal bolus.

On June 1, 2013 I was over 400; how much, we don't know... the doctor's office "professional" meter didn't read any higher.

It can be done. It can be enjoyable. It can be fun. It can be interesting.

JUST DO IT!

12

Wow, sounds like you have a good handle on your management of D... If I'm on insulin in the hear future I'll probably come asking the Cyborg questions :)

Paul

13

I’m putting in my 25 cents worth. The oral drug have tooooo many side effects… The insulin is the best way to go then your really in control it’s a bit of fine tuning at first but you will get it. I speak from seeing what happens when the dr just keeps adding oral meds. My type 2 husband at 56 is in renal failure due to one not controlling his t2 and two taking 3 oral meds for 20 years and still not helping control his sugars . Having said that insulin in my opinion is the safer medication . Remember you are in charge of you if your doc and you don’t have the same mindset find another, I know it is a different kind of system up there in Canada but try a different doc if he is unwilling to try the insulin as the first line of defense. Hope my big opinion was helpful. :slight_smile: