Advice for a newbie re meds

H

Happyhippy23

New Member
Relationship to Diabetes
Type 2
Hi all, had what I felt was a body blow of a diagnosis beginning of July following a routine blood test for BP review. Got sent sharp-ish to DN.
My HB? Number was 89! From then, I have been following the 8 week blood sugar diet, very little carbs and sugar, haven’t deviated- lost just about 2 stone to date with another 4 stone to get to healthy bmi.
I bought a monitoring kit- first couple of weeks it was 13, then 11 and the last 2 weeks it’s been between 6.3-7.1 at random times of the day.
I had a tel call from DN, she asked how metformin going (2 a day), bit nausea but ok, she said she thinks I need to be on insulin, I told her of weight loss and numbers, she said my 89 number suggests insulin? Does my own monitoring get taken into account - are these numbers ok? I feel quite down as I’ve made loads of changes and not getting new bloods taken till October.
 
Happyhippy23 said:
Hi all, had what I felt was a body blow of a diagnosis beginning of July following a routine blood test for BP review. Got sent sharp-ish to DN.
My HB? Number was 89! From then, I have been following the 8 week blood sugar diet, very little carbs and sugar, haven’t deviated- lost just about 2 stone to date with another 4 stone to get to healthy bmi.
I bought a monitoring kit- first couple of weeks it was 13, then 11 and the last 2 weeks it’s been between 6.3-7.1 at random times of the day.
I had a tel call from DN, she asked how metformin going (2 a day), bit nausea but ok, she said she thinks I need to be on insulin, I told her of weight loss and numbers, she said my 89 number suggests insulin? Does my own monitoring get taken into account - are these numbers ok? I feel quite down as I’ve made loads of changes and not getting new bloods taken till October.
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You will find many people find the initial diagnosis a body blow. The first time I collected my prescription and testing kit I sat down and had tears down my face. There is plenty of information on this site to help.
The HbA1C was high but it seems as if the changes you made have had a result. The nurse is only suggesting that the high results suggested insulin but I don't think anything would be done until after the next blood test. As the HbA1C test looks at the average blood sugar over the last two to three months, I would have thought that October would be a good time to have the next test. It will allow the test to show the effects of what you have achieved. Too soon and it will pick up in the average some of the time before the weight loss and diet change. Rather then test at random times, I would be inclined to test at a regular time, say before and two hours after eating.
 
Mine was 83 and insulin has never been mentioned.

The NICE process is for lifestyle changes and a single medication initially (usually metformin, if there are no other issues like kidney problems), and if they does not bring it down, maybe another medication added. I know people on 3 medications to keep levels under control. If this fails then the next step may be insulin.

Well done, though, looks like good progress!
 
I agree with Jim and suggest you keep a record of all the readings so you can show your DN. I also suggest you politely refuse insulin until your next HbA1c and review in October. With the readings you have been getting, I'm confident your glucose levels will have dropped by then.
 
mine was 87 when I was diagnosed just over a year ago, I was in hospital when diagnosed with kidney infection and several other problems I was put straight on Insulin and still remain on it, I was never offered any other meds on the rare visit to the doctors, and to be honest if I had been offered metformin I wouldn't have been happy to take it, now my HbA1C is 39. congratulations on your progress.
 
Treatment plans do seem to vary depending on your GP or diabetic nurse but with an HbA1C of 89 mmol/mol which is indeed high there are many other oral medication that are usually tried before insulin and only then if those medications and dietary changes are not working would insulin normally be considered.
There is no reason why you should not succeed with the action you are taking and if you are able to tolerate the metformin then that will help. The weight loss is fantastic so carry on.
You should get another HbA1C 3 months after diagnosis to monitor progress so don't be pushed into insulin before seeing how you are doing.
Some useful ideas in this link for suitable dietary changes. https://lowcarbfreshwell.com/
 
Happyhippy23 said:
Hi all, had what I felt was a body blow of a diagnosis beginning of July following a routine blood test for BP review. Got sent sharp-ish to DN.
My HB? Number was 89! From then, I have been following the 8 week blood sugar diet, very little carbs and sugar, haven’t deviated- lost just about 2 stone to date with another 4 stone to get to healthy bmi.
I bought a monitoring kit- first couple of weeks it was 13, then 11 and the last 2 weeks it’s been between 6.3-7.1 at random times of the day.
I had a tel call from DN, she asked how metformin going (2 a day), bit nausea but ok, she said she thinks I need to be on insulin, I told her of weight loss and numbers, she said my 89 number suggests insulin? Does my own monitoring get taken into account - are these numbers ok? I feel quite down as I’ve made loads of changes and not getting new bloods taken till October.
Click to expand...
I started off with a HbA1c of 91 and have been at the top end of normal eating a low carb diet for over 7 years. Insulin was never even on the horizon, nor any other treatment for diabetes once I had a second test and had HbA1c of 47.
 
My hbA1c was 104.
- GP ordered me to ramp up to 2000 Metformin/day.
- GPs were also concerned about my liver and arranged a ultrascan.
- I did not want to risk the side effects of Metformin.
- One of Michael Mosley's books introduced Prof Roy Taylor.
- Prof Taylor's book said a rapid weight loss diet, without medication, could bring BG down to a normal level in 7 days.
- I informed my GP that I intended to follow Prof Taylor's advice. She advised taking Metformin, rather half-heartedly.
- The next day, a radiologist found I had a fatty liver (as most newly diagnosed T2Ds do) and said 'treat it by diet'. I did

I could not possibly comment on your need for insulin, your GP/DN should know what is best for you. If I were you, I'd carry with your diet until you have reached your target with or without medication.

Looking back there was no real need for my 600-800 calorie regime, and some significant downsides. If there were to be a next time I'd follow a diet something like this:
- What should we eat? https://www.zoeharcombe.com/2021/08/what-should-we-eat/
 
Happyhippy23 said:
I bought a monitoring kit- first couple of weeks it was 13, then 11 and the last 2 weeks it’s been between 6.3-7.1 at random times of the day.
I had a tel call from DN, she asked how metformin going (2 a day), bit nausea but ok, she said she thinks I need to be on insulin, I told her of weight loss and numbers, she said my 89 number suggests insulin?
Click to expand...

Congratulations on the huge efforts you have been making already Sorry you weren’t given much encouragement for the progress you’ve observed so far (which does look encouraging).

I think many HCPs get rather jaded by their suggestions falling on deaf ears, and folks just not being prepared to make even the most basic changes to their routine. The forum is full of dramatic success stories which can come as a shock to many nurses and GPs. Hopefully yours will be one of those!

Getting an HbA1c 3-4 months after your diagnosis seems like a good bet. As a marker, it is far less prone to daily variation, and should provide you with a solid evaluation of how your metabolism is currently coping, and whether any additional meds might be worth considering.
 
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