Weight loss and getting off oral agents
| Author: Judy Kohn, RN, BSN, CDE |
| Last Updated: Thursday, May 15, 2008 |
Q: "I used to be on Glucophage® and Amaryl®. Since I lost 50 pounds over the past 2 years, my doctor tapered me off of the Amaryl because I was getting too low, and now he said he might consider stopping my Glucophage. My glucose runs around 80-110 before meals and under 140 after meals. I have several questions: What glucose level is too low? At what glucose level is it ok to stop oral medication? If my glucose levels are all normal, then does that mean I don’t have diabetes anymore?"
A: Congratulations on your successful weight loss and your great progress!
What glucose level is too low:
First, certain medications can cause hypoglycemia, while others do not. The Amaryl is a sulfonylurea which stimulates your pancreas to produce more insulin. If the dosage is more than you need, (or if you do not eat enough, miss or delay a meal, or do unexpected activity), your glucose can get too low—i.e. to hypoglycemic levels which are usually defined as being below 70 mg/dL-- if you take medication that can cause hypoglycemia. However, if you are on no medication, or if you take a medication that does not cause hypoglycemia (such as Glucophage), then technically you cannot get too low.
When do you stop oral medication:
For economic and practical reasons, if your glucose levels were frequently running below 110 mg/dL and often in the 70-80 mg/dL range, (and under 140 mg/dL after meals) then many healthcare professionals would consider that it is time to try to taper off the medication to see if you still needed it.
- In some situations, after the medication is out of the system (it can take up to 2 weeks after stopping some medication), I have seen blood glucose levels rise back up to unacceptable levels (i.e. over 130 mg/dL before meals, or over 180 mg/dL after meals), meaning that the person still required the medication to keep their glucose levels in target range.
- In other instances, the glucose levels remained in the same range, indicating that the medication was no longer needed. In this situation, the excess weight had contributed to insulin resistance, so losing the weight reduced the insulin resistance.
Do you still have diabetes:
This is a common question. Most experts would say that technically yes, you still have diabetes, but you are considered a very well-controlled person with diabetes. The reasons are:
- If you regain the weight, your glucose levels would most surely go up again and you would again require medication.
- If you have a serious illness or surgery, or receive a medication that can raise blood glucose (such as cortisone), your glucose may rise.
- Even if you don’t regain the weight, diabetes usually progresses over time, so while it is possible that you may never need medication, it is also possible that you may require medication again later as you age. Because of this, your healthcare team will most likely tell you to continue testing your glucose; however, if all the readings are in the normal range, your team may reduce the frequency of your blood glucose testing.
Please read the related questions below as they will elaborate on the points in this answer.
Related Questions
Q: Glucose goals
"What is a good blood glucose reading?"
Q: Hypoglycemia without diabetes medication
"Your answers have been a great help, and now my question is about low
blood glucose with non-medicated diabetic patients as myself. Is there ever too
low of a blood glucose reading?"
Q: Insulin resistance
"Could you explain insulin resistance so that I can understand it? This
term seems confusing to me."
Q: Type 2 and diabetes medication
"As a person with type 2 diabetes, I have worked hard to bring down my
weight and I also exercise regularly, so why are my blood sugars rising? Does
this mean I will need to start taking medication?"
Q: Infection can raise blood glucose
"I am taking amoxicillin for an infection and my blood sugar readings have
suddenly gone up a lot, 172 this morning and 202 this afternoon. Can the
antibiotic cause false readings or raise blood sugar?"
Important Notice: The responses provided by the team of Diabetes Educators are based on their personal experiences and expertise as practicing diabetes healthcare professionals, and are not to be considered diabetes management advice from Abbott Laboratories. Remember that information provided by the team of Diabetes Educators is for general background purposes and is not intended as a substitute for medical diagnosis or treatment by a trained professional. You should always consult your physician about any healthcare questions you may have, especially before trying a new medication, diet, fitness program, or approach to healthcare issues.
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