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Dr. David
Dr. David, Board Certified MD
Category: Medical
Satisfied Customers: 43414
Experience:  Board Certified Physician
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I am a hypertensive diabetic (typeII) and have been since 1998.

Customer Question

I am a hypertensive diabetic (typeII) and have been since 1998. I take the following medication to try to control it.
AM Felodipine 1 x 5
Indapamide 1 x 1.5
Candesartan Cilexetil 1 x 32
Metformin Hydrochrolide 2 x 500
Gliclazide 2x30
Pioglitazone 1x30
Evening
Metformin Hydrochrolide 2 x 500
Simvastatin 1 x 20
Gliclazide 2x30

I don't smoke. I only drink red wine occasionally -- mostly around Christmas.

Lately i have managed to work out an exercise regime and diet that seems to be working quite well.

Unfortunately, as a side effect, i have begun to feel hypo most of the time -- sometimes it has gotten so bad that i get up in the around 0400am to try to get some food in me.

My last HBA1c was measured at 54 (equivalent to 7.1 mmol/l, apparently). And BP was 130/80.

My question is whether there is a reliable and safe method to reduce my intake of tablets (specifically the diabetes ones) so that i can start to rely more and more on exercise and diet. I am of course aware that i cannot simply change medication without doctors advice, but i sense my primary care doctor is too busy to really spend some time working out an optimal tablet regime that is consistent with a good diet and fairly intensive gym about 3 times a week (1hr sessions).

If there is a safe and reliable way to reconfigure the blood sugar tablets, then i would be very grateful to know it so i can share this with my primary heath doctor.

I am in the UK by the way.

Thanks for your help in advance.

Rgds
Ken
Submitted: 2 years ago.
Category: Medical
Expert:  Dr. David replied 2 years ago.

Dr. David :

This is Dr. David

Dr. David :

yes, if you are exercising more, you should have less dose of your medication

Dr. David :

you and your doctor should be working together on this.

Dr. David :

your metformin can be cut down

Dr. David :

your gliclazide can be cut down.

Dr. David :

but you and your doctor have to do this together.

Dr. David :

when is your next appointment with your doctor.

Dr. David :

does your doctor know you are exercising more recently?

Dr. David :

your pioglitazone can also be cut as well

Dr. David :

but I would not cut all of them at the same time.

Dr. David :

I would cut the gliclazide in 1/2 dose first and get repeat a1c testing in 2-3 months

Dr. David :

and then see.

Dr. David :

and continue to monitor your glucose levels.

Customer:

yes, i am in full consultation with my doctor, but as i said, this is within the NHS scheme and there is never enough time to assess the situation in detail. That is what i am asking here so that i can discuss with her next time i see her in 2 months time unfortunately!

Dr. David :

I see.

Dr. David :

your doctor might suggest you cut the metformin dose in 1/2 or possibly the gliclazide dose in 1/2

Dr. David :

I would cut your gliclazide dose

Customer:

so i see, the safe sequence is (a) cut the gliclazide by 50% (b) retest in a couple of months.

Dr. David :

that would be one way to go

Dr. David :

there is no one safest way to go.

Dr. David :

but cutting it down slowly is safest and resting.

Dr. David :

and continuing to monitor your glucose level to show your doctors your levels are well controlled and sometimes low.

Customer:

So i guess what you are saying is that i more or less have to accept the almost constant hypo which lasts well into the next day after exercise.

Dr. David :

this would be good evidence that your dose can be cut.

Dr. David :

and your a1c is really good.

Dr. David :

you have to try to eat more at this point

Dr. David :

until you can talk to your doctor about cutting your dose.

Dr. David :

and as soon as you cut your dose, then your levels will be better.

Customer:

sometimes my glucose levels when i measure at home fall to 3.5 mmol/l especially after exercise and stays low for quite some time, even after eating.

Dr. David :

I would try to call your doctor on the phone and let him know of your low glucose levels as well

Dr. David :

or get a sooner appointment than 2 months.

Dr. David :

you can also see one of his partners if possible.

Dr. David :

the sooner you can see or talk to one of the doctors, the sooner you can cut your dose and get your levels better.

Dr. David :

does this help?

Customer:

Having been diabetic since 1998, is it possible through change of lifestyle (such as i have done) to completely be free of the disease?

Dr. David :

if you loose weight and improve your health and eat a good vegitarian diet, you can reverse or highly improve type 2 diabetes.

Dr. David :

so it is possible to improve.

Dr. David :

and it looks like you are improving your health and being to reverse your diabetes

Dr. David :

continue to burn calories by exercising and you will need less and less medication

Customer:

and is the only way of knowing this to gradually reduce medication while monitoring a1c? in other words there is method that is more definitive and somewhat less 'empirical'?

Dr. David :

and there can be a time when you might not need any blood pressure or diabetes medication.

Dr. David :

if your fasting glucose becomes normal and your a1c is normal without any diabetes medication, can reverse your diabetes and make it go away.

Dr. David :

so it can go away.

Dr. David :

keep up your exercise and eating healthy.

Dr. David :

do you have any other questions?

Customer:

No, that is all for now. Thank you very much. can i mail you if i have any other followup questions?

Dr. David :

yes, you can always reach me in the future

Dr. David :

http://www.justanswer.com/medical/expert-dr-david/

Dr. David :

is my webpage if you need to reach me again.

Dr. David :

if done for now, please leave positive feedback below

Dr. David :

you might have to scroll down to see the ratings area

Dr. David :

we only get credit with positive feedback

Dr. David :

thanks for using JustAnswer.com

Dr. David :

do you see the ratings area below?

Customer:

OK thanks.

Dr. David :

thanks for using JustAnswer.com

Dr. David :

do you have other questions

Dr. David :

hello?

Dr. David, Board Certified MD
Category: Medical
Satisfied Customers: 43414
Experience: Board Certified Physician
Dr. David and 3 other Medical Specialists are ready to help you

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