Advice on medications for Type 2

[Jan1956]

I'm almost a year into a T2 diagnosis.
Hba1c was 57 on diagnosis.
History of t2 in family.
I soon got my Hba1c consistently down to 31 . I've never had meds so was delighted - I've been serious about a strict low carb diet and also invested in a BS monitor and have had used Dexcom one ( privately paid)
However, I've discovered as a result of a number of glucose fasting tests which report around 7.3 mmol /l ( every time )that my HBa1c has not been an accurate reflection of my blood sugar. This is also the evidence on my Dexcom monitor and my BS readings they consistently average 7.6 . So despite low Hba1c I am "an anomaly" in that Hba1c not accurate and my fasting levels place me in diabetic range.
I also struggle with Dawn Phenomenon and often have early morning spike readings around 10 remaining high until lunch time
My question is does anyone else have a similar experience to me??
Secondly do you think I now need to consider meds to control this - it's just not improving ?
The nurse mentioned that I could have slow release metformin ? Are there any other meds I could consider? Would metformin be suitable? I worry it could drop my levels too low

 

[Leadinglights]

I'm almost a year into a T2 diagnosis.
Hba1c was 57 on diagnosis.
History of t2 in family.
I soon got my Hba1c consistently down to 31 . I've never had meds so was delighted - I've been serious about a strict low carb diet and also invested in a BS monitor and have had used Dexcom one ( privately paid)
However, I've discovered as a result of a number of glucose fasting tests which report around 7.3 mmol /l ( every time )that my HBa1c has not been an accurate reflection of my blood sugar. This is also the evidence on my Dexcom monitor and my BS readings they consistently average 7.6 . So despite low Hba1c I am "an anomaly" in that Hba1c not accurate and my fasting levels place me in diabetic range.
I also struggle with Dawn Phenomenon and often have early morning spike readings around 10 remaining high until lunch time
My question is does anyone else have a similar experience to me??
Secondly do you think I now need to consider meds to control this - it's just not improving ?
The nurse mentioned that I could have slow release metformin ? Are there any other meds I could consider? Would metformin be suitable? I worry it could drop my levels too low

Welcome to the forum, you are right to question the correlation between the readings you are getting and try to look for an explanation. Various conditions where your red blood cells are either high or low or other types of haemoglobinopathies can influence HbA1C results in which case there is another blood test that would be more accurate so you could ask for a fructosamine test.
Many do get Dawn Phenomenon or Foot on the floor syndrome depending on when it happens, which is your liver being super helpful in releasing glucose in the absence of food, some find testing in bed will help or eating breakfast as soon as possible.
The rule of thumb if Type 2 is 4-7mmol/l fasting and before meals and no more than 8mmol/l 2 hours post meal and if that is maintained for most of the time in the 3 months before the HbA1C then that is likely to be below 42 mmol/mol so in normal range.
Metformin is often prescribed when diet is not sufficient as it helps the body use the insulin it produces more effectively and reduces the release of glucose by the liver, it is not a medication likely to cause hypos.
If you are following a very low carb or Keto diet then your slightly elevated blood glucose shown by finger prick could be your liver releasing glucose which would be a normal process when not diabetic.
Given your HbA1C if OK would indicate you would be in remission as you are not taking medication and have several results in normal range.
I would be inclined to ask for the fructosamine test before considering metformin or any other medication. Do you need to lose weight? What are you actually having for meals.

 

[Jan1956]

Welcome to the forum, you are right to question the correlation between the readings you are getting and try to look for an explanation. Various conditions where your red blood cells are either high or low or other types of haemoglobinopathies can influence HbA1C results in which case there is another blood test that would be more accurate so you could ask for a fructosamine test.
Many do get Dawn Phenomenon or Foot on the floor syndrome depending on when it happens, which is your liver being super helpful in releasing glucose in the absence of food, some find testing in bed will help or eating breakfast as soon as possible.
The rule of thumb if Type 2 is 4-7mmol/l fasting and before meals and no more than 8mmol/l 2 hours post meal and if that is maintained for most of the time in the 3 months before the HbA1C then that is likely to be below 42 mmol/mol so in normal range.
Metformin is often prescribed when diet is not sufficient as it helps the body use the insulin it produces more effectively and reduces the release of glucose by the liver, it is not a medication likely to cause hypos.
If you are following a very low carb or Keto diet then your slightly elevated blood glucose shown by finger prick could be your liver releasing glucose which would be a normal process when not diabetic.
Given your HbA1C if OK would indicate you would be in remission as you are not taking medication and have several results in normal range.
I would be inclined to ask for the fructosamine test before considering metformin or any other medication. Do you need to lose weight? What are you actually having for meals.

Thank you for your advice and information. I’m seeing the GP shortly so I will definitely ask for this test
Do you know much about the BC effectiveness of Slow release metformin? This was suggested for me at a low dose but I don't want it to lower my afternoon levels too much so they go too low below 4
Regarding weight and what I eat. My BMI is at the top of the normal range. I feel my weight is maintaining and I don't think I would naturally find it easier to lose any more weight. I've been the same weight for some months.
I eat only protein veg and salads. Barely any carbs. No potatoes and only ann occasional am portion sweet potatoes I only eat hi protein wraps and low carb crackers occasionally. I use almond flour for baking I have lots of fish and chicken. Also steak and lamb occasionally.
If I want something sweet I make a dessert with 75 % or higher dark chocolate and double cream and cocoa. Or a lemon mousse with cream cheese and cream
I’m rarely tempted these days to eat what I shouldn't though I do eat fruit. Really struggle without apples raspberries oranges ( occasional) and apricots. Not ideal but if I eat cheese first I minimise a spike.

 

[Leadinglights]

Thank you for your advice and information. I’m seeing the GP shortly so I will definitely ask for this test
Do you know much about the BC effectiveness of Slow release metformin? This was suggested for me at a low dose but I don't want it to lower my afternoon levels too much so they go too low below 4
Regarding weight and what I eat. My BMI is at the top of the normal range. I feel my weight is maintaining and I don't think I would naturally find it easier to lose any more weight. I've been the same weight for some months.
I eat only protein veg and salads. Barely any carbs. No potatoes and only ann occasional am portion sweet potatoes I only eat hi protein wraps and low carb crackers occasionally. I use almond flour for baking I have lots of fish and chicken. Also steak and lamb occasionally.
If I want something sweet I make a dessert with 75 % or higher dark chocolate and double cream and cocoa. Or a lemon mousse with cream cheese and cream
I’m rarely tempted these days to eat what I shouldn't though I do eat fruit. Really struggle without apples raspberries oranges ( occasional) and apricots. Not ideal but if I eat cheese first I minimise a spike.

People are prescribed slow release metformin as it is often kinder on the stomach than the other version, it does not really act differently in reducing blood glucose alongside diet, but you are really following a pretty low carb diet anyway which would for many reduce blood glucose without medication.
This link has suggestions for low carb approach https://lowcarbfreshwell.com/ but I think that is going to be pretty much if not rather more carbs than you currently are having anyway. I would have thought than if you are within the suggested levels for those with Type 2 4-7 before meals and no more than 8mmol/l 2 hours after eating you are doing fine.
Sometimes having the technology like a CGM can cause people to over react to what is just normal body metabolism.
But yes mention the other test to your GP but don't be surprised if they have never heard about it

 

[Jan1956]

People are prescribed slow release metformin as it is often kinder on the stomach than the other version, it does not really act differently in reducing blood glucose alongside diet, but you are really following a pretty low carb diet anyway which would for many reduce blood glucose without medication.
This link has suggestions for low carb approach https://lowcarbfreshwell.com/ but I think that is going to be pretty much if not rather more carbs than you currently are having anyway. I would have thought than if you are within the suggested levels for those with Type 2 4-7 before meals and no more than 8mmol/l 2 hours after eating you are doing fine.
Sometimes having the technology like a CGM can cause people to over react to what is just normal body metabolism.
But yes mention the other test to your GP but don't be surprised if they have never heard about it

Thanks. No I won't be surprised if they haven't but I'll go armed with information lol. I agree with everything you say, however in my case my blood sugars are elevated much higher than this 2 hours after eating. This elevation starts from about 4am to 6 am when it often ( but not always?) rises from 7.5
to 9 and 10 and remains high until about 1 pm. Even if I eat breakfast it doesn't help. My BS can raise up to 12 - 2 hours after breakfast but oddly after my main meal around 6 pm it will go down to 7.5 after 2 hours.

 

[Leadinglights]

Thanks. No I won't be surprised if they haven't but I'll go armed with information lol. I agree with everything you say, however in my case my blood sugars are elevated much higher than this 2 hours after eating. This elevation starts from about 4am to 6 am when it often ( but not always?) rises from 7.5
to 9 and 10 and remains high until about 1 pm. Even if I eat breakfast it doesn't help. My BS can raise up to 12 - 2 hours after breakfast but oddly after my main meal around 6 pm it will go down to 7.5 after 2 hours.

Out of interest what are you having for breakfast?
It does seem as if something odd is going on.

 

[everydayupsanddowns]

Interesting that your own glucose monitoring would seem to align with a higher HbA1c - hope you can find out why that might be with some further checks (eg to rule out anaemia).

I think some people are considered to be ‘high glycators’ and others to be ‘low glycators’, in that two individuals with identical glucose profiles may get slightly different HbA1c results. Though I’m not sure if there is a test they can do for that.

Metformin generally works gently in the background, reducing glucose output from the liver, and improving insulin sensitivity. It isn’t designed to work directly on meals, but just to pootle along in the background helping out a little. It’s generally felt to have a low to no risk of causing hypoglycaemia, so hopefully a low dose wouldn’t unduly affect your afternoon readings?