harbottle
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- Relationship to Diabetes
- Type 2
So you are saying the research is wrong and your statement backed with nothing is true?
There are many reasons why T2s end up with more medication.
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Cutting down Metformin?
- Thread starter RJN123
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So you are saying the research is wrong and your statement backed with nothing is true?
There are many reasons why T2s end up with more medication.
Lucyr
Well-Known Member
- Relationship to Diabetes
- Type 1
The studies aren’t accessible for me to read but the summary says “Sitagliptin improved beta-cell function” which means makes the pancreas produce more insulin, as I stated.
snowball12
Well-Known Member
- Relationship to Diabetes
- Type 2
- Pronouns
- She/Her
Which I find the most depressing thing of all
BMI
Roland (still learning!)
- Whipple + total panc'y, 5 Feb 20=T3c, as if T1.
- MDI: Tresiba & NovoRapid + G7 (07/23). HbA1c=55, 07/23.
- I eat what I want + lots of cream. BMI=23=happy.
My approach would be to drop all the T2 medication and adjust my diet to get A1c down into the 30s by attention to diet. That's totally conditional on your other medication, AI and so on.
Congratulations on your progress.
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Proud to be erratic
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- Type 3c
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Hello @JITR,
I think you might be getting my remarks to @RJN123 mixed up with the original question raised in this thread ie "Cutting down metformin". I am Roland, an insulin dependent T3c and freely admit to quite a limited knowledge of T2 (although there is a lot of it in my wider family, at all ages and my late brother lost both legs to T2); I do have some background knowledge and connection with this dreadful disease.
If I have totally misunderstood your comment above and you are in fact just acknowledging that you unwittingly commented because you had scanned through forum posts too quickly - then please ignore this response from me and let's park this bit of dialogue. There must be lots of other things we could productively exchange views on!
Best regards
Drummer
Well-Known Member
- Relationship to Diabetes
- Type 2
I suspect that bad advice is involved in the need for more medication - I really can't understand why there is so much pressure to eat 'healthy' carbs and get ever worsening results.
Hello @Proud to be erratic
Thank you for you kind message. Yes, I was acknowledging that mix up.
As it happens RJN123 also said he had limited knowledge of T2, I frankly haven’t gone into the scientific specifics too much given all my other medical issues which have taken up a lot of my research and energy, so I would really appreciate some thoughts from you well-researched folks.
My comments were about the efficacy of diet and medication for treating T2. All I know about your T3 and T1 is that insulin treats the condition. In contrast T2 medications main aim is to reduce peak levels of blood glucose. Since Professor Taylor's Counterpoint study in c.2008 proved 'standard' T2 was reversible, we have known a suitable weight loss and maintenance diet can reduce blood glucose and reverse the underlying condition, "too much fat", especially in the liver and pancreas. In other words, matching diet with insulin (and glucagon) seems to be main thing, with medication in support as and when necessary.
I agree with you with T2 is a dreadful disease. That's why I was keen to put it behind me as soon as I could, not least because I was diagnosed at the same time with hemochromatosis. I see that can lead to T3c
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trophywench
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- Relationship to Diabetes
- Type 1
My reply directly to @TJN123 is that the adrenal glands themselves have any amount of input to the glucose in the blood. Those jolly old 'fight or flight' hormones, notably the cortisol produced have the effect of increasing that blood glucose so is never great once diabetes rears its head - and long term use of steroids has exactly the same effect so folk who need to take steroids (which includes my husband for his COPD) always need to have at least annual (if not more frequent) HbA1c blood tests to check nowt else has been sent awry. Hence to me it's unlikely that you have Type 2 diabetes, you more likely have one of the Type 3 diabetes varieties - thought I'm not certain it's the usual form of 3c which as far as I'm aware is only applicable when it's cancer of the pancreas/chronic acute pancreatitis - neither of which you appear to have actually had. Even 3c is not automatically designated 'as if Type 1' since some 3c patients can be treated with tablets and @eggyg was one of those folk to begin with, but her Beta cells also packed up after a while so she's now treated as if Type 1. Even if you are classed as 'more like Type 2' to begin with - No Way Jose can it be reversed or treated with 'diet & exercise' so please don't get side tracked by people trying to be helpful by suggesting yours can.
All hospital diabetes consultants first qualify as fully fledged endocrinologists before deciding to specialise in their area of choice which might be diabetes, andrenal probs, thyroid probs, not sure what else. Hence your hospital endo will only know a certain amount about the finer points of your diabetes and won't actually be 'the expert' in it, employed full time in that specialism.
All hospital diabetes consultants first qualify as fully fledged endocrinologists before deciding to specialise in their area of choice which might be diabetes, andrenal probs, thyroid probs, not sure what else. Hence your hospital endo will only know a certain amount about the finer points of your diabetes and won't actually be 'the expert' in it, employed full time in that specialism.
trophywench
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- Type 1
@Lucyr - you just have to remember though, that internet diabetes forums are not places where PWD 'generally' gather, let alone visit for advice or to debate some aspect. 🙂
Lucyr
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- Relationship to Diabetes
- Type 1
Sorry I’m not sure what this means. I included the people that don’t use forums when I said what generally happens.
Please note I wrote:
My view is to drop all the T2 medication and adjust your diet to get your A1c down into the 30s by attention to diet. That's totally conditional on your other medication, AI and so on.
I have no idea how any lay member of this forum can be expected to spot what type of diabetes anyone has, if it is beyond many endocrinologists to do so.
Precisely.
T2 medications such as Metformin can have 'hidden' side effects. A least one recent study has shown Metformin works by acting on mitochondria and reducing the amount of food ingested. Reportedly it also reduces the volume of mitochondria (as compared with a control group not on Metformin).
Moderator note: This study is not identified, and cannot be checked. However readers should be reassured that there are also studies demonstrating that Metformin improves mitochondrial function in T2 diabetes. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9124713/
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trophywench
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- Relationship to Diabetes
- Type 1
The whole point is Lucy that there are many people who when they ask their GP or the GP surgery nurse a question they're not told the right answer, so instead of spending a few extra minutes enquiring how or what or when someone's eating or whether they actually DO any exercise regularly just say Oh your HbA1c blood test tells me you need more help with diabetes so I'll increase your metformin prescription to 2 with every meal instead of one. Patient then says OK and does it because the Dr is right and knows what he's doing better than me.
There are still many many people who would simply never consider even asking if there's anything they can do instead or as well as, taking more medication, to try and help themselves too.
trophywench
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- Relationship to Diabetes
- Type 1
@JITR - I appreciate what you say to me and it's true that I'm now ancient and during my life have gradually got a far greater understanding of the inner and therefore normally unnoticeable workings of the human body than the average man on the Clapham omnibus - which is precisely why I addressed my reply precisely to the precise person affected, ie the OP of this thread.
Lucyr
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- Relationship to Diabetes
- Type 1
Sorry but I still don’t understand how this makes my answer wrong?
Insulin production can reduce over time if your pancreas is overworked, that was the point I made, and explains why the average t2 needs more medication over time. Taking medications that stimulate the pancreas to produce more insulin can have the same result and that’s why I suggested that if I had a choice between dropping sitagliptin or metformin I’d drop sitagliptin and keep metformin.
Proud to be erratic
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- Type 3c
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@JITR thanks for your reply. I don't want to take this dialogue with you too far and thus away from the original post and question. I personally think, partly from many remarks by members of this forum and partly from family I see (or saw in the case of my late brother), that T2 as a diagnosis can be oversimplified. The diversity of the symptoms shown are sometimes not recognised leading to standard (broad brush) treatment options that aren't necessarily fully appropriate.
I particularly feel this when a treatment plan claims 95% remission success. If that remission lasts a great deal longer than the criterion of 3 months for 95% of those who follow that plan - I would be amazed. If it is so I believe the NHS should pay the creator at least £1m (tax paid) for so comprehensively solving such a massive cost burden to the NHS; as well of course for the constant relief to those diagnosed with T2 and now in remission. I'm not convinced the claims are quite so clear cut.
It's a tricky balance between wanting to help from the knowledge we do have but neither overwhelming or just confusing the original poster, nor not realising there are very different extra (invisible to us) factors in play.
Happily none of this conversation seems to apply to the poster @RJN123 who seems very comfortable with his D management and strong medical support. Long may that continue for him. I intend to step out of this thread now and only return if very specifically asked by the poster. You and I are adding to the potential high-jacking of this thread! But I'd be happy to dialogue with you either by a PM or within a different thread, if an appropriate topic arises.
I particularly feel this when a treatment plan claims 95% remission success. If that remission lasts a great deal longer than the criterion of 3 months for 95% of those who follow that plan - I would be amazed. If it is so I believe the NHS should pay the creator at least £1m (tax paid) for so comprehensively solving such a massive cost burden to the NHS; as well of course for the constant relief to those diagnosed with T2 and now in remission. I'm not convinced the claims are quite so clear cut.
Precisely @JITR, but all the more reason to be cautious aboutt getting entangled in things of which we can't see the fuller picture. You certainly didn't say anything wrong and you did caveat your remarks. But precisely as @trophywench has said the additional aspect is that the diabetes of @RJN123 is so much more complex and a long way from being a standard T2.
It's a tricky balance between wanting to help from the knowledge we do have but neither overwhelming or just confusing the original poster, nor not realising there are very different extra (invisible to us) factors in play.
Happily none of this conversation seems to apply to the poster @RJN123 who seems very comfortable with his D management and strong medical support. Long may that continue for him. I intend to step out of this thread now and only return if very specifically asked by the poster. You and I are adding to the potential high-jacking of this thread! But I'd be happy to dialogue with you either by a PM or within a different thread, if an appropriate topic arises.
To bring this thread back to where it started, one answer is a good discussion with your endocrinologist about phasing out sitagliptin and metformin, either or both, in the context of finding the best way forward.
Hello all, despite the somewhat heated tenor above, I have actually found the discussion very helpful as it gives me a starting point of discussion with my medical team, as well as given me some ideas of what type of medical papers to look up.
Just as an aside, saying that I hadn’t done a deep dive into T2 is not the equivalent if not knowing what I consider the basics (diet, steroid interactions, T2 vs T3 etc). What I was referring to was that I haven’t quite understood the pharmalogical properties of different medications and how they work, so some of the discussions here have been enlightening. In the longer term I WILL need to read up on this, but getting my head around my complex cancer treatment and Addisons seemed more urgent. But you have given me a starting point. Thank you.
Just as an aside, saying that I hadn’t done a deep dive into T2 is not the equivalent if not knowing what I consider the basics (diet, steroid interactions, T2 vs T3 etc). What I was referring to was that I haven’t quite understood the pharmalogical properties of different medications and how they work, so some of the discussions here have been enlightening. In the longer term I WILL need to read up on this, but getting my head around my complex cancer treatment and Addisons seemed more urgent. But you have given me a starting point. Thank you.
Update in case anybody follows this thread. I met with my endo yesterday (who I feel is taking a holistic and thorough approach to my care). He was happy with my last three HBA1C results of 39, 43 and 41, and suggested I try to drop Sitagliptin which he felt wasn’t necessary in my case and probably didn’t do much. He was, however, adamant that metformin has a huge amount of benefits and he sees a better prognosis for patients who take this. So testing the metformin-only regimen for the next six months to see if my numbers hold. I am free to go back on sitagliptin if I feel it necessary.
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