Confused about Metformin

[Silkman_Bob]

Hello Everyone,

Just a quick question regarding Metformin. I have been diet controlled for the past 6 months with the review taking place in a fortnight. During this time I have seen the odd Dr about non diabetes related matters and a couple have said that even if the HbA1C comes back as ok they would still advise to be placed back on tablets.

To be honest I would be gutted if the tests were not ok as I have maintained a good control and hammered the gym over the last 6 months ? the goal of which was to stay off tablets but to be told I may need them anyway is a bit demoralising.

If after 6 months hard graft the results aren?t what they should be then I will accept I need the tablets as there isn?t much more I could have done to avoid it ? but Im a bit confused as to why I am being told that even if the results come back as being good, I will still be pushed into taking tablets?

Any thoughts?

Thanks

Bob

 

[Caroline]

You have good control and have worked hard to get it. Perhaps you can ask for a second opinion or ask why you need medication now.

There are a number of forum users who have done very well with out medication of any kind, so perhaps they can give you some pointers, although it sounds like you have it about right already.

Having said that diabetes is progressive so at some point in the future you may well need tablets.

 

[C*5_Dodger]

Hello Everyone,

Just a quick question regarding Metformin. I have been diet controlled for the past 6 months with the review taking place in a fortnight. During this time I have seen the odd Dr about non diabetes related matters and a couple have said that even if the HbA1C comes back as ok they would still advise to be placed back on tablets.

To be honest I would be gutted if the tests were not ok as I have maintained a good control and hammered the gym over the last 6 months ? the goal of which was to stay off tablets but to be told I may need them anyway is a bit demoralising.

If after 6 months hard graft the results aren?t what they should be then I will accept I need the tablets as there isn?t much more I could have done to avoid it ? but Im a bit confused as to why I am being told that even if the results come back as being good, I will still be pushed into taking tablets?

Any thoughts?

Thanks

Bob

Dear Bob,

You are in a difficult situation, It seems superfluous to take a med if you have good control. Your doc probably thinks that Met has other benefits besides blood sugar control why not ask him. I'm diet only. When my doc asked me to take Metformin I agreed to a trial. If made no difference to my levels so I stopped it. I guess in the end you must decide after all it you who have D and may suffer the consequences of a wrong decision!

Regards Dodger

 

[Paul]

Wow spooky I was excactly the same 3 years ago working hard at the gym watching what i eat all the time being so carefull I am now on a shed load of tablets and inject every morning.
all I can say is keep up the hard work and maybe you can hold it back a bit longer than I could good luck🙂

 

[Northerner]

Hi Bob, others may know more details, but I have also read that metformin is beneficial for people with Type 2 regardless of how good their control is. As well as helping with blood glucose control, it also helps reduce LDL cholesterol and triglycerides, thus helping reduce inflammation of the arteries. 🙂

 

[Blythespirit]

Hi Bob. I'm going to agree with what Alan says about the added benefits Metformin supposedly has. You mention you have seen docs about non diabetes related matters so maybe it's these other matters that might benefit from going back on the tablets. If I were you I'd ask. I know they are prescribing it for non diabetes related conditions these days. Some that come to mind wont apply to you such as PCOS and infertility problems in women! 😛

Others that might would be be weight loss, cholesterol and heart health. I've just been reading that they're now prescribing it to obese children and pregnant women in an attempt to prevent their babies being born overweight. Odd that because a few years ago they thought Metformin would damage the unborn baby and anyone taking Metformin prior to conception were taken off it and put on insulin til after the baby was born. How times change.

Fingers crossed for your up coming review. Don't be downhearted if you do have to go back on the meds for other reasons. XXXXXX

 

[lucy123]

I was told that if my first hba1c came back below 6 I could stay off meds! I am on them now though even though my hba1c is now below 6.

 

[Silkman_Bob]

Thank you all for your help - I need to ask exactly why the Dr thinks that this is the way forward and will come back to you no doubt 🙂 x

 

[Mark T]

I?m in the opposite situation, my HbA1c is coming down and I?m worried that I might get taken off my medication. So when I have my next review I might be challenging the Dr should he try to take me off with the basis that Metformin is cardio-protective.

My basis for staying on the medication is that although my fasting and pre-meal levels are OK (sub-6 generally) my post-meal levels are not actually as good as I like (even with low GI).

Of course Metformin won?t actually help that specifically, but it will hopefully ensure that those temporary highs do slightly less damage.

 

[mcdonagh47]

Thank you all for your help - I need to ask exactly why the Dr thinks that this is the way forward and will come back to you no doubt 🙂 x

Four or five years ago a group of Medics were suggesting that the cardio protective qualities of Met were so valuable that everybody over 50 should be on Met whether or not they were diabetic.
Haven't heard that argument recently though.

 

[grufflybear]

Metformin the wonder drug eh ?.... I am working to control my BG with diet and exercise and I thought the objective was to put off the day I might need any medication, a quick look at Diabetes UK shows quite a few undesirable side effects of Metformin. So having embarked on a strict regime and now have my BMI and body fat actually slightly better than suggested ideal and my BG levels very good I too would feel disappointed if my GP gave me medication too, perhaps that is irrational ?

Isn't it better to use your bodies own mechanism if it can be made to work by the diet and exercise regime. As always I understand that needs change and everyone is different anyway. Perhaps illogical and irrational but I would fear that my natural mechanisms would become "lazy" if not made to work for themselves...

Without wishing to drag the NHS into this am I completely barking up the wrong tree to think that it is cheaper to prescribe Metformin than to supply people in my situation enough testing kit to monitor more than once or twice a day in the effort to find the best foods to eat....... ( I got 50 strips and was told they must last 3 months )

Or perhaps experience tells Gp's that Metformin is safer because too many T2 diabetics give in too often to treats and don't exercise enough....

 

[Northerner]

...Or perhaps experience tells Gp's that Metformin is safer because too many T2 diabetics give in too often to treats and don't exercise enough....

I think this last sentence is unfortunately closer to the truth - there are an awful lot of people out there who will not receive the education or motivation to do as most people do who seek out these forums. For many people, they have diabetes but they take pills for it, so that's the best they can do as far as they know/are concerned. Standard dietary advice, to eat lots of starchy carbs, probably doesn't help, and unfortunately I think this leaves many people feeling fatalistic and resigned to a steady decline rather than discovering a fuller, happier and healthier life (as in Silkman Bob's post Did Diabetes save my life?.

I'm like you, I would prefer not to be on medication and managed to reduce my intake of drugs from 11 to 2 (not including insulin, which I always think of differently!)

 

[mcdonagh47]

Metformin the wonder drug eh ?.... ....

Correct !
Type 2 diabetes is a pernicious condition that affects all the organs and functions of the body. We need to come at it with all guns blazing.

Metformin trully is a wonder drug and no, there are not a lot of bad side effects with it.

But of course, as the DUK advised in their Glasgow Spring Conference in 2009, T2s should not be put on met straight away as an immediate crutch, they should be given a 3 to 6 months trial of D&E so that they understand the absolute necessity of lifestyle changes. That has become the NICE stance also.

Unfortunately, despite the talk of D&E, there is no actual programme of Diet or of exercise for the newly T2s. Its largely a meaningless phrase.

 

[Northerner]

I was reading the other day that metformin was invented in the 1920s (or thereabouts) as a means of controlling blood sugar, but then got largely forgotten for a couple of decades after the discovery of insulin. It's certainly a drug that is pretty well known in terms of side-effects, unlike many of the more recent drugs that don't have the history to know what long-term effects might be.

 

[Mark T]

Metformin is probably the least offensive of all the diabetes drugs, even insulin is technically more dangerous because taking too much of it can be harmful. Like most drugs, people will suffer to greater or lesser extent with its side-effects.

But no one should never feel down just because you have to take medication. Sometimes the body needs a helping hand and no amount of healthy exercise and ideal diet is going to help with that. Because Type 2 can be such a varied condition, diet and exercise is not going to work for everyone and it?s not necessarily going to be because they don?t exercise enough or indulge in one too many treats.

The NHS unfortunately seems to class all Type 2?s alike despite the fact it?s quite a widely ranging condition and throws standard advice, standard diets and standard pills at you.

For me the NHS treatment plan is designed to fail and rather then trying to sort out any underlying issues it is, let?s just throw more drugs at things, let?s not bother to try tailoring diets and let?s not offer education to help the diabetic treat themselves.

 

[mcdonagh47]

and let?s not offer education to help the diabetic treat themselves.

An unfair comment. NICE states clearlyy that all T2s should have access to a

an educational course such as DESMOND. X-Pert and home-grown courses.
And PCT and hospitals are more and more committed to offering educational courses.

The major problem lies with T2s themselves. Most are only too happy to be told that they don't need to test or just take a tablet and its no big deal. The NHS invites 30 folks to go on an X-pert course and only 6 show up.

 

[Mark T]

An unfair comment. NICE states clearlyy that all T2s should have access to an educational course such as DESMOND. X-Pert and home-grown courses...

Maybe it is a little unfair, but I did ask if there were any similar courses in my area just over 6 months ago, or what support was available for education regards to self-monitoring. I didn't get a response.

Some PCT's will be better, some worse.

 

[Northerner]

Maybe it is a little unfair, but I did ask if there were any similar courses in my area just over 6 months ago, or what support was available for education regards to self-monitoring. I didn't get a response.

Some PCT's will be better, some worse.

Very true - NICE may issue guidelines, but PCTs don't always follow them if they decide priorities need to lie elsewhere - some of the advice issued to many of our members makes appalling reading, and the ones who come here are motivated. The apathy of a lot of people is also a big problem which I think we don't get to see simply because it is largely hidden from view. I have heard a lot of people relate tales of how they know relatives, work colleagues etc. who make no effort whatsoever in improving their knowledge and diabetes management.

 

[Blythespirit]

I agree with different points in all your arguments here. Most especially with Mark T's comment about a 'one size fits all' approach to treatment for Type 2's based on the cheapest and easiest course and the assumption that we don't and wont look after ourselves. Not advising us to test and not teaching us how to use the readings we get if we do and giving us antiquated diet advice. Not all Type 2's got here because we were lazy, greedy and stupid before diagnosis so not all of us will see dramatic results from adjusting our lifestyle. This is in no way meant to take away from those who do.

I agree that no one should feel that they've failed because they need meds to help keep things under control. In fact the original question posed in this thread was from Bob asking about being prescribed metformin even though his control is good and he's achieved remarkable things to get there. Following comments stated that Metformin has other benefits and shouldn't be dismissed for that reason.

I once said to one of my doctors that it was depressing having to take all the meds I do. His reply was that it would be more depressing if there was no meds he could give me. He also told me that I had been dealt a bad hand healthwise and that I was dealing with it in the best way I can. This was not diabetes related. In fact it's important to remember that many Type 2's have other conditions to deal with as well.

NICE guidlines may well state that all Type 2's SHOULD be offered DESMOND or similar but in practice that doesn't always happen. I've asked repeately over the last 7 and a half years and been told by my practice nurse that she knows nothing about it. In fact when I was finally refered to the hospital earlier this year she asked me, if I was lucky enough to get on a course, to go back and tell her about it because she didn't know anything about it and NONE of her Type 2 patients have ever been on such a course. She's been the diabetic nurse at my surgery for well over 15 years! I haven't been offered a place on a course so I have nothing to report back to her.

I'm not basing my comments on any research or anecdotes, just on my own personal experience and that of close friends, so just stating the truth as I see it.

I was put on Metformin on diagnosis. I do think this was right for me because I already had a lifestyle that was at least as good as the guidelines recommend. I remember reading the leaflet telling me 'white bread is fine and brown bread is better,' and thinking what a load of rubbish it was. I'm currently taking 500mg twice per day. Any more than that and the side effects are horrendous. Four years ago I was taking 850mg three times per day and the side effects were so debilitating I was sent for tests for bowel cancer becuase my GP didn't think the symptoms I was suffering could have been just the Metformin. The symptoms stopped when my dose was reduced.

As a lot of you know my levels spiralled out of control earlier this year, for no apparent reason. I didn't suddenly become a junk food eating couch potato. I was still eating and doing exactly the same things as I was doing when my control was excellent. As a result I'm now injecting Byetta twice per day and I'm back to the control I used to have.

So, for me, a good diet and plenty of excercise didn't stop me becoming diabetic, nor did it help me keep good control. I need meds to help me. I'm grateful that there are meds that can help me to keep this condition under control. We aren't all the same and we need to do whatever we need to do to stay well. It's finding what works for us that's the important thing. XXXXX

 

[Silkman_Bob]

Firstly thank you for all the great responses ? half the battle with Diabetes (at the start at least) is getting to grips with what it is all about and why things happen in certain situations. In this regard, the messageboard must be one of the most precious tools any diabetic can have.

One thing which is striking is that although the progression of diabetes or the lack of it can be very different in specific cases, there are some fairly broad similarities which everyone can relate to.

It is sometimes hard however to distinguish between my own diabetic journey and those of others. In some ways this is a good thing as the personal experiences relayed on this site open your eyes to things which you have never considered before, make you aware of them and you can obviously then act on this in your own battles with the big D. However, it is sometimes important to remember that Diabetes is very different from something like a broken leg for example where the treatment for such is fairly standard in each case. What I am trying to say is that even though we are all on the same path, we are all travelling on a different long term journey ? where one person passes by, another may never see.

That is the beauty of this board in that the eclectic nature of stories shows you just how diverse this disease is and also the range of ways people cope with it and attain the best life possible.

My own thoughts are surrounding Metformin at the moment as I indicated in the initial post. Since writing this I have had time to think, reflect and obviously read and digest all the helpful comments which I am truly grateful for.

From what I have learnt both through here and through my own limited research, Metformin does have other benefits to it other than those associated with blood sugar levels. In that regard, if a Dr should say to me ? I think its best you take them, I am coming round to the idea that (if they are to prove of benefit in some way) then it would be rather foolish not to.

Yet there is a part of me which is screaming the question ? why do I need tablets after pretty much changing everything about my life for the better? Maybe this is to do with the preconceived notion that you take tablets when you are ill, and don?t when you are not rather than taking essentially preventative medicine. Quite possibly this could be as a result of me not totally coming to terms with the fact that diabetes is life long and am subconsciously thinking everything is ok now ? the diabetes has gone away, hence my initial reluctance to carry on with the metformin.

The truth of the matter is that pretty much all of the above have played some part in me thinking that tablets mean that I have not succeeded in my fight against the big D yet. Reassessing matters, that is not necessarily the case and I think that should the Dr prescribe metformin then I will take them if needs be but always bear in mind how much further down the road I am now than those dark days after diagnosis.

Thank you all so much once again

Bob 🙂