annual review - after 3 months

[indigorblue]

I was diagnosed with diabetes at the end of January this year. I'm 65, not overweight exercise regularly I eat a largely healthy diet.
there is a lot of diabetes in my family (no obesity) mostly type 2 but some type 1 too. because of this I was tested for T1
which took ages for the result to come back as negative. in the meantime I have been on metformin, then metformin and insulin
then reduced insulin and same metformin then no insulin same amount metform now recently increased to 4 metformin a day.
this has caused fluctuations in my glucose - although I have stayed pretty much between 6.5-9 so hopefully given a bit more time
that will come down and be a bit more consistent. am wondering how long that is likely to take in other folks experience?
I am being monitored/advised/prescribed by the regional diabetic team but I have had a phone call to make an appointment for
an annual review with the local diabetic team in my GP practice. I appreciate it's because that's the way they work but am not
sure how useful/accurate this is as my medication is not yet "fixed" and feel I would like to put that off until that's all sorted out
and given a chance to work it's magic! anyone else been through similar ..

 

[gail2]

good be they want to book it well in advance

 

[silver minion]

It could just be an interim review to see how you are doing and to check the medication is working without causing unwanted side effects.
I have had several interim reviews by the local practice nurse who looks after type 2s. I think this was because my HbA1c was so high at diagnosis. I am now on annual reviews but as they like to do them on your birthday month at our practice it will be in roughly 5 months time.
Hope it all goes well and you are happy with treatment plan going forward.

 

[debs248]

I have similarly been told to book an "annual" review after 3 months, I think it's just the name they use regardless of actual frequency.

 

[JimmyBlue]

@indigorblue hi I was diagnosed back in October 2024 and had my first annual review in January 2025. However, at the review they said that my surgery normally aligns the annual review with birthday months so I am due a second annual review in June. I think the first review after a few months is to allow them to establish the baseline position for their future checks. Letting you wait twelve months after diagnosis to do the annual checks would be a bit off, especially if any of the things they check are actually causing you issues.

 

[indigorblue]

thank you - yes the nurse had said it would usually be around the time of my birthday which would have been
around 6 weeks after initial diagnosis. If you don't mind me asking did you have lots of changes to your medication in the first few months? I think it's just there have been so many changes with my meds and that
is possibly still ongoing so wondered how useful any tests would be at this point. I am in regular contact with the regional team/ every couple of weeks

 

[saffron15]

I had a blood test at my request at end of June which was 69 second test for confirmation end of July 64 saw Diabetes nursemid August and started metformin. Put on dapaglifozin mid September and a statin end of September. 51. Had annual review in December which I thought was early but the surgery had decided to align annual reviews to birthday. Hba1c 44. Diabetes nurse was ill. I saw her in February and should have made an appointment this month for hba1c.

What was your original hba1c? Did you have a second test? Most type 2s in your age group are overweight or have belly fat. I have lost over 2 stone. I did it by watching carbs and moving more. I still eat some bread and occasional potatoes but have cut out most sweet items though had a piece of cake today and if I have a pie I have a small one with extra veg.

Keep a food diary perhaps add in motions if on metformin and exercise can be housework gardening stair climbing.

I haven't seen a Doctor but depends on your surgery.
Hba1c are usually done with a three month gap. Now you are said to be type 2 your surgery wants to have a chat as to how effective your medication has been. You will probably be seen 6 months after that then on annual reviews.
At some stage you will have your feet checked and eye screening


Freshwell app is a good guide. I have previously posted a Web site in the NewForest which has links to lots of sites.



Take things steadily.

 

[indigorblue]

it was 96 I'm an active vegetarian 5'5 weighing in at 9 stone 7 pretty good with my diet.
I've had so many changes to my meds I wondered how it worked with others

 

[silver minion]

My medication was increased over several months, both the metformin and gliclazide which was introduced in July to help reduce the blood glucose down to under a hundred. I am niw on the maximum dise for both. I was offered dapagliflozin in Feb but opted to increase the gliclazide instead. I was tolerating it well and didn't want the possible side effects of the flozin due to previous bouts of UTIs and thrush pre diagnosis.

 

[saffron15]

@indigorblue I can see given your physique and how high the reading was that they wanted to rule out or in type 1. I started on metformin in mid August. The slow release. Increased each week. When I got to 4 I was put on dapaglifozin. The metformin went down to twice a day. Dapaglifozin was on basis it is good for cardiovascular health and I have high blood pressure. Two weeks later a statin was added. I wasn't happy with dapaglifozin as I peed more and thought I had to eat more carbs. I was given opportunity in February to drop a tablet. I chose metformin as I was due a cataract op so thought it was easier to have one of each. @silver minion is closer to your profile than I am.

 

[JimmyBlue]

Hi @indigorblue, I don't currently take medication. I did take metformin, reluctantly, between mid November and mid February but as I am trying to get to remission and feel I can address things through diet and exercise, we agreed in March that I would have until my next review in June to do this without medication.
My original test as an HbA1c of 92 which was 86 on the second test two weeks later (I had also upped my exercise) and following changes to my diet and despite a serious bout of ill health in November, I managed to get the HbA1c down to 47 in January. My cholesterol had increased and my triglycerides but I am trying to address those through my diet and exercise as well. I did increase my exercise following the conversation about cholesterol.
My exercise regime per week is now:
2 x 4 mile runs
1 x 6 mile run
3 x weight session; and
a minimum of 1 x 9 holes of golf if not 1 x 18 holes.
I am 64 in June and walk a lot as well as reading, baking and trying to get third parties to let me do how not to get scammed presentations to help people in my local community I retired at the end of 2024.

 

[indigorblue]

Hi @indigorblue, I don't currently take medication. I did take metformin, reluctantly, between mid November and mid February but as I am trying to get to remission and feel I can address things through diet and exercise, we agreed in March that I would have until my next review in June to do this without medication.
My original test as an HbA1c of 92 which was 86 on the second test two weeks later (I had also upped my exercise) and following changes to my diet and despite a serious bout of ill health in November, I managed to get the HbA1c down to 47 in January. My cholesterol had increased and my triglycerides but I am trying to address those through my diet and exercise as well. I did increase my exercise following the conversation about cholesterol.
My exercise regime per week is now:
2 x 4 mile runs
1 x 6 mile run
3 x weight session; and
a minimum of 1 x 9 holes of golf if not 1 x 18 holes.
I am 64 in June and walk a lot as well as reading, baking and trying to get third parties to let me do how not to get scammed presentations to help people in my local community I retired at the end of 2024.

I struggle with things like diet and exercise - I do several fitness classes (for over 55s) week including weights plus pilates & yoga. walk dog
for 1-1.5hrs day any starchy carb are wholegrain have never eaten much in way of cakes biscuits sweets fizzy drinks or alcohol. don't eat meat. have never been up for high intensity/aerobics but apart from that I'm stuck. I was also diagnosed with high cholesterol so have reduced any high fat treats and switched to low fat cheese, yoghurt and spreads. consultant put me on statins BP good at 108/71/64 first thing. rarely unwell can't remember last time I had a cold even.
feel like being diet controlled only an overwhelming challenge

 

[indigorblue]

@indigorblue I can see given your physique and how high the reading was that they wanted to rule out or in type 1. I started on metformin in mid August. The slow release. Increased each week. When I got to 4 I was put on dapaglifozin. The metformin went down to twice a day. Dapaglifozin was on basis it is good for cardiovascular health and I have high blood pressure. Two weeks later a statin was added. I wasn't happy with dapaglifozin as I peed more and thought I had to eat more carbs. I was given opportunity in February to drop a tablet. I chose metformin as I was due a cataract op so thought it was easier to have one of each. @silver minion is closer to your profile than I

thanks for that. how long did it take for the metformin to kick in? my glucose went up initially I went up to 4 metformin
a day about 10 days ago but that was on the back of coming off insulin a couple of weeks before

 

[JimmyBlue]

starchy carb are wholegrain

@indigorblue I don't eat very much in the way of carbs. I am supposed to be eating about 120g per day but if I hit 90 I am feeling good. I do eat plenty of fat and protein and the former is probably part of my cholesterol issue. I use full fat greek yoghurt every morning and eat significant amounts of nuts (circa 100-150g/day) these all push up my saturated fat amounts and I am now using Benecol to reduce them if possible.
My target diet each day is to eat as close to 3000 calories to cover the exercise and to try and put a bit of weight back on. I was between 86 & 84kg when diagnosed and am now 75.8kg or thereabouts. My wife would like to see a bit more meat on the top half as my legs are not so bad as the running has added muscle back on. I have managed to put a 1kg back on over the past six weeks so not to bad I think.
I never got above 1 x 500mg tablet of metformin when I was taking it. I also tried something called berberine for a day, it seemed to work in a similar fashion to metformin, with consequent reductions in BG. I have checked out other supplements and found that some do have risks if too much is consumed.

Edited to remove suggestion that Berberine has toxicity risks.

 

[Leadinglights]

thanks for that. how long did it take for the metformin to kick in? my glucose went up initially I went up to 4 metformin
a day about 10 days ago but that was on the back of coming off insulin a couple of weeks before

It seems a bit unusual to be given insulin without trying metformin and diet initially then adding other oral meds if that didn't work so there must have been something that directed their decision to prescribe insulin. Usually before changing meds then they would do another HbA1C.
Often although people feel they eat healthily, what is for someone not diabetic is not so when the body struggles with carbohydrates and it is not just sweet stuff but all carbs. Bread, rice, pasta, even if wholemeal and starchy veg are all high carb.
This link has a vegetarian meal plan which is low carb which if you are only on metformin should be suitable.
https://lowcarbfreshwell.com/

 

[indigorblue]

It seems a bit unusual to be given insulin without trying metformin and diet initially then adding other oral meds if that didn't work so there must have been something that directed their decision to prescribe insulin. Usually before changing meds then they would do another HbA1C.
Often although people feel they eat healthily, what is for someone not diabetic is not so when the body struggles with carbohydrates and it is not just sweet stuff but all carbs. Bread, rice, pasta, even if wholemeal and starchy veg are all high carb.
This link has a vegetarian meal plan which is low carb which if you are only on metformin should be suitable.
https://lowcarbfreshwell.com/

I was given insulin and metformin initially as GP felt my profile did not fit a T2 and there is a history of T1 in family. I do keep a diary of what I eat and yes agree there is always room for improvement. try to keep the carbs to a minimum but
mindful of the need for fibre so today flaxseed barley and oatcakes have been my carbs. dietician advised a little protein with them to slow down digestion

 

[Leadinglights]

I was given insulin and metformin initially as GP felt my profile did not fit a T2 and there is a history of T1 in family. I do keep a diary of what I eat and yes agree there is always room for improvement. try to keep the carbs to a minimum but
mindful of the need for fibre so today flaxseed barley and oatcakes have been my carbs. dietician advised a little protein with them to slow down digestion

OK that makes sense, did they do the tests for Type 1.
I use edamame or black bean pasta which is low carb and a good substitute for wheat based pasta.

 

[indigorblue]

OK that makes sense, did they do the tests for Type 1.
I use edamame or black bean pasta which is low carb and a good substitute for wheat based pasta.

they did - it took ages for the results to come back. love edamame beans always keep a bag in the freezer did not realise
was available as a pasta. tried a beetroot one I think but afraid did not like very much. funny wholemeal pasta tonight
with courgette + lo fat mozarella. guess that is my main carb of the day. hot and cold with bread

 

[Leadinglights]

they did - it took ages for the results to come back. love edamame beans always keep a bag in the freezer did not realise
was available as a pasta. tried a beetroot one I think but afraid did not like very much. funny wholemeal pasta tonight
with courgette + lo fat mozarella. guess that is my main carb of the day. hot and cold with bread

You can usually find it in H & B, spaghetti, fettuccini, noodles. Obviously more expensive but I usually cook about 25g dry weight, best with a strongly flavoured sauce and it only needs 5ish minutes cooking.
Unless you need to for other reasons there is no need to have low fat.

 

[indigorblue]

I do. high cholesterol consultant suspects genetic, also why fibre in my case important too.
will check out Holland and Barrett next time I go to town in a couple of weeks. if I can add chilli & garlic
I'm happy with that!