Can anyone tell me please if Metformin specifically reduces spikes rather than reducing overall numbers. I am not on medication and usually pre meal figures are 6 and below but 2 hours post meal can go up to 10/12. This happens about four times a week. I would ask to go on Metformin if it helps spikes. Doctor reluctant to prescribe previously because of other medication but would probably do it. I can’t see any point in starting if it doesn’t reduce spikes. My diet is good. I’m not sure what acceptable figures are as when I was in hospital (not diabetes)in February and on steroids I was told to aim for under 12 but looking at websites post meal seems to be under 8.5. I was diagnosed in February in hospital so am still quite confused and would love some advice.
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Metformin
- Thread starter Hilary M
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Leadinglights
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My understanding is that metformin works in combination with a reduced carbohydrate diet to improve the way the body utilises the insulin you are producing so wouldn't have an immediate effect on any one particular meal.
The best way would be to keep a food diary so you can see if it is any particular foods or activities which are causing those spikes you are seeing.
It could be you have become more sensitive to something in particular if a post meal is going up by that much it would indicate something you have eaten is too high in carb for your body to tolerate as a increase of 2-3mmol/l is what people look for.
Steroids do have a reputation for affecting blood glucose levels.
The best way would be to keep a food diary so you can see if it is any particular foods or activities which are causing those spikes you are seeing.
It could be you have become more sensitive to something in particular if a post meal is going up by that much it would indicate something you have eaten is too high in carb for your body to tolerate as a increase of 2-3mmol/l is what people look for.
Steroids do have a reputation for affecting blood glucose levels.
rebrascora
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Metformin doesn't work in the way you are hoping. It works to reduce insulin resistance and it also inhibits the liver from outputting so much glucose in between meals.
To tackle your spike problem you would be best to keep a food diary with your readings and try to figure out which foods are causing the spikes and then reduce the portion size of that food or avoid it or perhaps eat it at a different time of day.
Most people find they are most insulin resistant on a morning, so breakfast cereals can be problematic then, even "healthy" foods like porridge but their system can (edited to add).... "perhaps".... cope with it in the evening or even lunchtime. If you are seeing these spikes mostly in the morning, then finding a lower carb breakfast option (Greek style natural yoghurt with berries and seeds perhaps or eggs) should sort the problem.
To tackle your spike problem you would be best to keep a food diary with your readings and try to figure out which foods are causing the spikes and then reduce the portion size of that food or avoid it or perhaps eat it at a different time of day.
Most people find they are most insulin resistant on a morning, so breakfast cereals can be problematic then, even "healthy" foods like porridge but their system can (edited to add).... "perhaps".... cope with it in the evening or even lunchtime. If you are seeing these spikes mostly in the morning, then finding a lower carb breakfast option (Greek style natural yoghurt with berries and seeds perhaps or eggs) should sort the problem.
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D
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Metformin mostly reduces the amount of glucose your liver releases, and helps decrease insulin resistance.
I don't believe any diet alters how metformin actually works.
In theory, with metformin your overall BG will reduce, and because of that, you should be able to deal with spikes slightly better as your body is now performimg with a bit more capacity.
It's not a get out of jail free though, so have a talk to your doctor about pro's and con's.
As said check your BG after a meal and see if it is any particular food is causing a spike.
Then you can modify your diet accordingly, and see what your BG is like then.
Leadinglights
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Just a thought but what are your post meal results like when you don't see the 10/12 levels.
As you are fairly new to your situation and still learning have a read around the forum and learning zone for ideas.
What was your HbA1C on diagnosis as that will help people to tailor advice for you.
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Welcome to the forum @Hilary M
Steroids have a reputation for playing havoc with BG levels, which may explain why you were given a higher target while taking them.
General advice for T2s used to be to aim for 4-7 pre meals and no higher than 8.5 by 2 hours after meals.
Many folks on the forum use ‘before’ and ‘2hrs after’ meal checks to aim for a meal-rise of no more than 2-3mmol/L, reducing carbohydrate portions or swapping types of carbs for meals which cause bigger rises. It is the total carbohydrate (not just ’of which sugars’) which you need to keep an eye on.
Good luck, and let us know how you get on 🙂
Steroids have a reputation for playing havoc with BG levels, which may explain why you were given a higher target while taking them.
General advice for T2s used to be to aim for 4-7 pre meals and no higher than 8.5 by 2 hours after meals.
Many folks on the forum use ‘before’ and ‘2hrs after’ meal checks to aim for a meal-rise of no more than 2-3mmol/L, reducing carbohydrate portions or swapping types of carbs for meals which cause bigger rises. It is the total carbohydrate (not just ’of which sugars’) which you need to keep an eye on.
Good luck, and let us know how you get on 🙂
Thank you to everyone who replied. I really appreciate all the knowledge and suggestions. Interestingly I had a routine tel appointment with my diabetes nurse today and gave her yesterday’s figures. She says I’m fine and not to worry about spikes as everyone has them and I won’t be going on tablets which ties in with all advice that Metformin won’t reduce spikes. I’m sure there’s room for improvement though. I monitored what I ate yesterday and if anyone can make any suggestions about my readings/diet that would be good. Waking 6.4, Porridge (22carbs)with a few blueberries, 2strawberries, dessert spoon of yoghurt. (2 hours after BG 9). Morning snack - egg, small slice toast, coffee with cream.( Pre lunch BG 5.8.). Lunch 2 ladle fulls of sweet potato and carrot soup, dessert spoon hummus, 1 oatcake, square 85%dark chocolate , BG 2 hours after 10.2. Afternoon snack cappuccino (no chocolate), quarter of a chocolate tiffin biscuit. (Pre eve meal) BG 7, (2 hours after 8.9).Evening snack small slice multigrain brown toast with peanut butter . (2 hours after 10.8). Did a 12 hour fast and BG this morning 6. Please don’t tell me to eat less as I’ve always been thin and currently am 46.5kg, 5’4 “ in height and really need to eat more to bring me up to my normal weight of 50kg. I read if I up the protein that’s like a diet and I would lose more weight. Also recently been put on Atorvastatin. Am I worrying unnecessarily if nurse saying everything ok? When I was reduced to a low dose of Prednisone (5mg) and on a reducing Gliclazide dose after coming out of hospital (not related to diabetes)my HbA1c was 57.
My only comment on your meal yesterday is for you to try and work out what caused the massive spike after lunch - my money is on the sweet potato in the soup. You want to see a rise of 2-3 mmol in your readings pre- and post-prandial. So that jump of 4.4 means that there is something your system is reacting to, and you're best avoiding it apart from rare occasions. Your other readings all look pretty good.
Ironing out the big spikes will help your base BG level to lower over time and you'll see your fasting levels fall eventually.
Well done though!
Ironing out the big spikes will help your base BG level to lower over time and you'll see your fasting levels fall eventually.
Well done though!
rebrascora
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Hi. I think it likely your post lunch spike was due to more than one component of the meal ie having too many carb elements all adding up to more than your system could cope rather than specifically saying the sweet potato was to blame but obviously as the biggest carb element, it will have had more impact, but there are carbs in the carrots, hummus, oatcake and chocolate. It is also possible that there was delayed release from the toast with the egg depending upon what type of bread and how close to lunchtime you had it. If it was a low GI bread and you had it within an hour of lunch, it might have contributed to the after lunch spike.
Is your diabetes steroid induced or were you diagnosed before the steroid use started? The reason I ask is that it sounds like you are underweight which suggests you may not be Type 2. Whilst there are Thin Outside Fat Inside Type 2 diabetics, it is very rare for a Type 2 to be underweight and struggling to put weight on. Whereas Type 1 diabetics often experience unexpected weight loss at diagnosis and it is often muscle wastage as well as fat. I was shocked at how skinny my thighs and forearms and even wrists became and I am a muscular build.
As regards putting on weight, many of us increase our fat intake when we reduce our carbohydrate intake. Fat is calorie dense so you don't need a lot to increase your daily calorie intake. It also helps to keep you feeling full (less hungry) and it slows the release of glucose from the carbs you do eat and best of all it tastes good. So for your menu you could have double cream in your porridge instead of yoghurt. Plenty of butter on your toast with the egg and/or have 2 eggs. Full fat Creme Fraiche or cream cheese in your soup instead of hummus (more fat and less carbs) but maybe have a smaller portion of the soup itself or try a lower carb veg soup as root veg like sweet potato, carrot, parsnip and potatoes are all quite high carb. Cauliflower, broccoli, celeriac and leeks etc are better choices.
As far as I am aware it is not true about eating more protein putting your body into diet mode, so I would certainly look at increasing your protein too but I think the key is not to be frightened of fat, particularly if you need to gain weight.
I see they have put you on a statin.... Was your cholesterol particularly high and do you know the numbers and ratios of the specific elements of the cholesterol readings ie HDL, LDL and triglycerides? Many GPs are too keen to dish out statins without looking at the overall picture for an individual including the ratios and risk factors. If you are underweight and reasonably active then those factors should be taken into consideration when considering statins even if your cholesterol is above the recommended 4 for diabetics. Obviously I don't know your readings or family history or personal circumstances but there is a lot of debate about cholesterol and statins and a lot of the long standing science and the advice based on it about cholesterol and dietary fat is now being reconsidered. The NHS is a bit behind the curve with this and still mostly promotes low fat dietary advice which is not always helpful particularly for diabetics who are lowering their carb intake to manage their diabetes.
..... Anyway, just some things to consider.
Is your diabetes steroid induced or were you diagnosed before the steroid use started? The reason I ask is that it sounds like you are underweight which suggests you may not be Type 2. Whilst there are Thin Outside Fat Inside Type 2 diabetics, it is very rare for a Type 2 to be underweight and struggling to put weight on. Whereas Type 1 diabetics often experience unexpected weight loss at diagnosis and it is often muscle wastage as well as fat. I was shocked at how skinny my thighs and forearms and even wrists became and I am a muscular build.
As regards putting on weight, many of us increase our fat intake when we reduce our carbohydrate intake. Fat is calorie dense so you don't need a lot to increase your daily calorie intake. It also helps to keep you feeling full (less hungry) and it slows the release of glucose from the carbs you do eat and best of all it tastes good. So for your menu you could have double cream in your porridge instead of yoghurt. Plenty of butter on your toast with the egg and/or have 2 eggs. Full fat Creme Fraiche or cream cheese in your soup instead of hummus (more fat and less carbs) but maybe have a smaller portion of the soup itself or try a lower carb veg soup as root veg like sweet potato, carrot, parsnip and potatoes are all quite high carb. Cauliflower, broccoli, celeriac and leeks etc are better choices.
As far as I am aware it is not true about eating more protein putting your body into diet mode, so I would certainly look at increasing your protein too but I think the key is not to be frightened of fat, particularly if you need to gain weight.
I see they have put you on a statin.... Was your cholesterol particularly high and do you know the numbers and ratios of the specific elements of the cholesterol readings ie HDL, LDL and triglycerides? Many GPs are too keen to dish out statins without looking at the overall picture for an individual including the ratios and risk factors. If you are underweight and reasonably active then those factors should be taken into consideration when considering statins even if your cholesterol is above the recommended 4 for diabetics. Obviously I don't know your readings or family history or personal circumstances but there is a lot of debate about cholesterol and statins and a lot of the long standing science and the advice based on it about cholesterol and dietary fat is now being reconsidered. The NHS is a bit behind the curve with this and still mostly promotes low fat dietary advice which is not always helpful particularly for diabetics who are lowering their carb intake to manage their diabetes.
..... Anyway, just some things to consider.
Drummer
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From your menu I would not eat the porridge the toast the sweet potato and carrot soup, the hummus the oatcake the biscuit the toast - I would have eaten two low carb meals - no snacks, but I am wondering if you don't eat meat or fish?
Thank you for suggestions. I did wonder myself if I could be type 1 because of the weight loss but I was diagnosed when I was in hospital because of ulcerative colitis (which has never caused me any weight loss over the past 30 years).I did see doctors from the diabetes team and I specifically asked if it was type 1 or 2 and they said steroid induced. When I was in hospital I had readings in the 20s and was put on a reducing dose of Gliclazide to coincide with reduction in steroids. My first reading when I went onto home monitoring (9/2/21) (still on reducing steroids and Gliclazide) was pre lunch 11.5, pre evening meal 20.7. Post meal measurements were never taken in hospital. Why do all medical people seem to concentrate on pre meal measurements? I am on no diabetes or steroid medication now and over the past 3 months my BG levels have gradually come down to a pre lunch of and same for pre dinner unless I occasionally eat a scone and cappuccino between meals when it will go up to 10. I would go crazy if I didn’t have an occasional treat.
I think what I am trying to say is if it is type 1 would things not have got worse rather than better when I stopped the steroids and Gliclazide on 30 March? And as I had many BG, ketone (always ok)measurements ,blood tests in hospital would this not have shown up if it was type 1? And would I not have continued to lose weight? I am low weight but it does seem quite stable.
Have switched to double cream on your suggestion.
As always would appreciate any ideas.
I think what I am trying to say is if it is type 1 would things not have got worse rather than better when I stopped the steroids and Gliclazide on 30 March? And as I had many BG, ketone (always ok)measurements ,blood tests in hospital would this not have shown up if it was type 1? And would I not have continued to lose weight? I am low weight but it does seem quite stable.
Have switched to double cream on your suggestion.
As always would appreciate any ideas.
Maca44
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I had to cut porridge out as that spiked my BG sweet potato and lots of carrots I would cut back on. With regards to eating less I am actually eating more and never get really hungry now I know what I can eat and to be honest the food I eat now has never been so good it's better not worse than before and I don't feel I'm missing out.
It takes time to adjust foods but very easy once you see what you can eat without spikes.
It takes time to adjust foods but very easy once you see what you can eat without spikes.
rebrascora
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The thing is that you have changed your diet since you came home from hospital to lower carb (hospital food is notoriously high carb and not diabetic friendly.... maybe that is why they don't do post prandial testing!!) and stopped the Gliclazide. Both of those things will take the strain off struggling/failing insulin production and give the pancreas a bit of a breather enabling it to cope better for a while.... that might be weeks, months or years. Type 1 onset in more mature people tends to be slower which is why it is often mistaken for Type2 and many health care professionals seem to be misinformed that it is a condition which only exhibits in children and young adults. It is certainly possible to get Type 1 in your 70s or even 80s and I understand the consultants in my area used to have a bit of a competition between themselves to see who could get the oldest newly diagnosed patient each year.... at least that made them much more open to looking for Type 1 in older people, so a positive benefit.... so many people are misdiagnosed Type 2 and it takes years to eventually get the correct diagnosis and I suspect never in many cases.... It may be one of the reasons why diabetes is considered progressive... because those misdiagnosed Type 1s eventually progress to needing insulin.... as well as poor dietary advice and support for Type 2 diabetics.... Anyway, I digress...
You should not be too concerned about the odd treat taking you up to 10 as log as it comes back down again. Do keep monitoring the situation and find ways to increase your calorie intake without increasing the carbs to help build you up a bit. Increasing fat intake is so alien to us after years of being told to eat low fat that it takes quite a bit of thought to find ways of incorporating it into our meals but it really does make all the difference when you are eating low carb as it makes it so much more filling and enjoyable.... I had belly pork with cauliflower mash (big dollop of cream cheese in that) and broccoli last night. Yum!
I am learning so much from these posts. It’s all really beneficial so thank you everyone. Its also very reassuring communicating with people who have the illness.
I found it interesting that type 1 in older people tends to be slower so does that mean it could remain diet controlled and not give me problems for a little while even if it is type 1? The fact it tends to be slower does give me reassurance as I just imagined collapsing suddenly very ill if type 1 diagnosis had been missed. I just don’t have the nerve to ask my gp anything at the moment having just been discharged by a team at endocrinology who would only categorise it as steroid induced. One doctor did say no one know how long I might really have had it as I have had three courses of steroids over the past 18 months, but no mention of type 1 from him either.
I would speak to the surgery if my weight loss started again.
I have bought a book Carb and Calorie Counter so that should help me look for low carb, high calorie food and I’m enjoying my coffee with cream now!
Regarding statins I was put on them because of both diabetes and family history. I read that statins can affect BG and I wondered if there is particular type I should ask for (no saying I would get but worth a try).
I found it interesting that type 1 in older people tends to be slower so does that mean it could remain diet controlled and not give me problems for a little while even if it is type 1? The fact it tends to be slower does give me reassurance as I just imagined collapsing suddenly very ill if type 1 diagnosis had been missed. I just don’t have the nerve to ask my gp anything at the moment having just been discharged by a team at endocrinology who would only categorise it as steroid induced. One doctor did say no one know how long I might really have had it as I have had three courses of steroids over the past 18 months, but no mention of type 1 from him either.
I would speak to the surgery if my weight loss started again.
I have bought a book Carb and Calorie Counter so that should help me look for low carb, high calorie food and I’m enjoying my coffee with cream now!
Regarding statins I was put on them because of both diabetes and family history. I read that statins can affect BG and I wondered if there is particular type I should ask for (no saying I would get but worth a try).
Leadinglights
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The choice of statin is very much down to your G P as some are not compatible with other medications if you take them. I would ask why they think it necessary for you to take statins, as it does seem to be the automatic thing for them to prescribe. The body needs cholesterol for all sorts of metabolic functions, production of hormones, vitamin D, tissue repair amongst others. Dietary fats do not directly convert to cholesterol but the ration of LDL. HDL and triglycerides are just as important as the total
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