What causes elevated blood sugar level while on blood-glucose lowering medicine?

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Posted on Thu, 28 May 2015 in Diabetes
Question: My wife was diagnosed with type 2 diabetes several weeks ago. The doctor started her on a small dosage of glipizide (5mg). Her numbers went down a bit (from an average of 260 in the morning to about 190-200. After reviewing these numbers, the doctor increased the medicine slightly to 10mg. She takes 2 10mg tabs before first meal in morning. Her second day taking this new dosage, her blood sugar read 287 first thing in the morning. We took it again a few minutes later and it went to 246, then 197. (yes, I am confused). So, the question we pose is "why is the sugar level higher with more blood-sugar reducing medicine?
She has been following a sensible (low-carb/sugar) diet as well.
She currently takes trileptal, myfortic & tacrilmus. She is a recipeant of a donated kidney (3 years).
Thanks, XXXXXXX
doctor
Answered by Dr. Shehzad Topiwala 47 minutes later
Brief Answer:
Diabetes

Detailed Answer:
Diabetes can be complex to analyze many a times.

It is a complicated interplay of a myriad factors such as
Food intake
Physical activity
Stage of disease
Effects of other medications
Stress/infection/Surgery

These are only a few examples.

In your wife's case, the other medications she is on, are likely playing a role. Tacrolimus is very well known to raise blood glucose levels. There are reports of myfortic and trileptal being capable of the same.

Now oyur question is why the sugars are rising depsite medication dose increases.

As explained, there can be one or more of the above mentioned factors playing into this.
Moreover, there is a 20% variation in the meter readings compared to the real blood glucose values. So if your blood glucose (if it were taken from a blood sample from your veins, as in a laboratory blood draw) is 100, the meter may show anything between 80 to 120.
So it is best to not analyze such variations in readings from a monitoring device. It has it's limitations.
Rather, it is important to go by broad trends in the sugar values. So if it is persistently climbing, say for example over 200 and 250 for a few days then it is a worrisome pattern.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Shehzad Topiwala

Endocrinologist

Practicing since :2001

Answered : 1663 Questions

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