Comment by Peetie on April 21, 2012 at 4:20pm

Dear Shankhdhar,
Last year I strongly suspected that one of the oral meds I was taking was causing my A1C to continually rise. I was on a very high dose of metformin and gliclazide. I was supposed to add Januvia to the mix. I stopped taking the gliclazide and did not take the Januvia. My A1C immediately decreased. By testing 8 to 10 times a day, I was also able to reduce the amount of metformin I was taking. I don't think I would have been able achieve the same results while taking the gliclazide as my numbers never ever went below 10 while I was taking it. My questions are: Why is the response to continually rising numbers following the introduction of an oral med always to simply increase the oral med. ? If the patient has no control, who is in control?
BTW my A1C is now 6.7 on the low dose of metformin. I test frequently. It has been 10 months.

Comment by Dr. L.K. Shankhdhar on April 21, 2012 at 5:34pm

Dear Peeti
Your situation is peculiar and paradoxical. Gliclazide can not increase A1c.

Comment by Peetie on April 21, 2012 at 6:36pm

Dear Shankhdhar,
Well, this is just my theory based on my own experience. I am T2 of normal (not skinny) weight. I always tested even before I took the drugs. My problem has always been fasting ie I'm in trouble if I miss a snack. My fasting numbers are always higher than my postprandials. So my liver is the problem? When I was on the high dose of metformin I had GI issues so I often skipped the snack and regular meals because I felt too sick to eat. When I reduced it by cutting the tablets in half I was able to eat normally again. So if my problem is with the liver pumping out more sugar when I fast, perhaps the gliclazide by forcing my pancreas to produce more and more insulin, stimulated my liver to produce more and more sugar? Do you think this could possibly be what happened?

Comment by Dr. L.K. Shankhdhar on April 21, 2012 at 8:25pm

Dear Preeti
No Insulin is most effective in suppressing Hepatic glucose formation, So that is not correct.

Comment by Peetie on April 22, 2012 at 4:00am

Hi Shankhdhar,
So now I'm really confused. I thought the metformin was prescribed along with the gliclazide in order to prevent the liver from dumping sugar? I also understand that there are T1 diabetics who inject insulin and also take metformin to suppress hepatic glucose formation? I have also heard that gliclazide can cause one to experience lows and this was not my experience. Intestingly, I have seen many 4's and one 3 since I stopped taking the gliclazide and reduced the metformin.
So I would say that, based solely on my own experience, that I was unable to control my blood sugar through testing while taking the oral med gliclazide. Unlike my experience prior to taking the gliclazide, I found that the numbers did not change despite changes in diet and exercise. The numbers remained consistently high despite my best efforts. I also was unable to fully understand what the drug was doing in my body. So I would agree with you that the testing was useless while I was taking the gliclazide.
The metformin is different however. I have been able to cut the pills in half and use the meter to adjust the dose. During a period of high stress, my numbers increased and I was able to use the meter to determine the time of day when I needed to take an additional half pill. So my experience has been that I'm able to use testing to adjust the metformin.
Here in Canada, the government pays for my 3-month doctor's appointments and the A1C testing so I never skip it. I am not sure whether your patients are required to pay for their appointments in India. If they do, could this be the reason why those who test tend to skip their appointments?
That was my first question this time. My second question is: If it has been determined that patients are unable to control the action of the oral meds they are taking, why are oral meds prescribed instead of or along with injected insulin for those who are willing to test and eat accordingly?
Thank you for taking the time to respond to my posts. Joanne

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