Hba1c raised from 6.8 to 8.8

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StveB

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Type 2
Hi all.
At my last review with our Db nurse, about 4 weeks ago, she increased my Slow Release Metformin from 500mg/day (been on for last 12 years without problem) to 1000mg/day, which my has caused stomach problems and diarrhoea.
She was going to increase this by another 1000mg/day but has said to hold off on that.
Does anybody take a different medication as an alternative to Metformin or is the next step Insulin as she has suggested?
By the way bmi of 23, get regular exercise, eat very little carbs, hi on fruit and fibre. Nothing has changed for the last 12 years except Metformin
Any advice would be helpful.
Thanks Steve
 
Hi Steve that's quite a rise, if nothing exercise and diet wise haven't change then other things need to be looked at. For instance are you a slow (very slow) onset type1? If this is the case then insulin would eventually be needed.

Depending on the fruit you eat some of that can be very high carb so have a look at what you are actually eating carb wise and perhaps look at a lower carb alternative if you can.
 
Over the years your sensitivity to carbs may have changed and /or your intake has crept up so you may need to re-evaluate your carb intake.
Making a food diary for a few days just to check what you are having.
 
Most of us would recommend restricting fruit to a daily small portion of berries for a Type 2 diabetic, so I wonder if your understanding of which foods are high is carbs is incorrect and perhaps you are eating more than you think in other food groups too ie sweet potatoes, parsnips etc. Maybe you are following NHS dietary advice and eating wholemeal bread and pasta and whole grains as well?

I also wonder if you might be LADA (Latent Autoimmune Diabetes in Adults).... a slow onset Type 1 diabetes, as @Pumper_Sue suggests. The sudden deterioration may have been triggered by a Covid infection or even the Covid vaccine if it is LADA.
Do you test your BG levels at home so that you can see how your body is responding to the food that you eat as this is the approach which most Type 2 diabetics here on the forum find successful.

Yes there are many alternative medications between Metformin and insulin, one being Gliclazide which works by stimulating your pancreas to produce more insulin but if you are LADA/Type 1 then it will likely not work or possibly a short term improvement followed by a crash as your remaining insulin producing beta cells are effectively flogged to death in which case insulin would become essential.

Perhaps asking for some testing (C-peptide and GAD antibody tests) for Type 1 might be in order or a referral to a specialist diabetes clinic although waiting times are pretty huge these days due to Covid. Anyway, those would be things to discuss with the nurse. Might be a good idea to make a list because I am aware that most of what I am saying will probably be unfamiliar to you.

Good luck and let us know how you get on.
 
There are many more drugs before you get to Insulin for Type 2. I personally over the years had to adjust what I eat several times.
 
Hi @StveB I have recently had to re-evaluate my diet after years of successful control, having had gradual increases in HbA1c above the level my GP is happy with.
This included a food diary, actually weighing stuff, and checking the carb and GI values of the foods.
Consequently, I have altered both the amounts and types of carbs, and tried to spread my intake more across the day. Apparently, as we age, our digestive ability decreases, so eating smaller amounts more often can help, especially if you're losing weight. In my case, with low BMI, I have chosen to get more of my calories from protein and fats, substituting these for carbs. It seems to be working, as my HbA1c was down at the last test, which for me meant medication avoided for a bit longer. We're all different - you may find a different solution.
I agree with others that you also need to discuss with your medical team the possibility that you are other than Type 2.
Hope this helps. Nick.
 
If they straight up replace metformin it would probs be a sulphonylurea (gliclazide) and that would be your first line treatment instead of metformin.

They will adjust you to the highest dose you can tolerate before moving onto a new stage of treatment.
The link below gives a bit of info about each drug.
https://www.diabetes.org.uk/guide-t...treating-your-diabetes/tablets-and-medication

Nice Guideline Links for prescribing:
Nice guidelines: https://www.nice.org.uk/guidance/ng28/chapter/Recommendations#first-line-drug-treatment
Easier to read guidelines in a pretty table: https://www.sign.ac.uk/assets/diabetes_algorithm.pdf

I'm not sure why they keep waving insulin around like it is a threat. There are many steps to go through before getting to insulin and even then, if you need it you need it. They shouldn't make patients fear it because if they do get to there, it will just make things harder if you aren't keen on using it by that point.

Realistic view of type testing or seeing anyone other than your gp team - reach the end of 2nd line and have a hba1c over 75/9% (which averages bg fingerpicks of 11.8 mmol/l) or have other major red flags to suspect t1 (weight loss, thirst, frequent peeing all with ketones present).
 
Excellent responses thanks everybody.
Yes I'm certain I've brought this on myself. My evening alcohol intake crept up (wine & Brandy, about 35 units a week) which I've stopped. I do enjoy fruit having, Half Grapefruit, Medium Apple, slice of Cantaloupe, 2 plums, and a pear every day. 1 medium potato, cous cous or brown rice with my evening meal, 2 Slices of Burgen Soya & Linseed bread a day, a small slice of home made cake which includes flour of course. Knock that on the head.
I don't test as I'd been stable for so long I let the meter lapse. Where does everybody get their strips from?
More comments are welcome
 
StveB said:
Excellent responses thanks everybody.
Yes I'm certain I've brought this on myself. My evening alcohol intake crept up (wine & Brandy, about 35 units a week) which I've stopped. I do enjoy fruit having, Half Grapefruit, Medium Apple, slice of Cantaloupe, 2 plums, and a pear every day. 1 medium potato, cous cous or brown rice with my evening meal, 2 Slices of Burgen Soya & Linseed bread a day, a small slice of home made cake which includes flour of course. Knock that on the head.
I don't test as I'd been stable for so long I let the meter lapse. Where does everybody get their strips from?
More comments are welcome
Click to expand...
I'm afraid your answer is there in that list of foods you are having, all high carb.
The GlucoNavil is a monitor with the cheapest test strips, Amazon or on line. Monitor about £10 strips £13 for 100.
 
The alcohol itself is unlikely to be causing the problem as those are very low carb options unless it is sweet wine, but it is of course a healthy decision to reduce that intake or knock it on the head altogether if you can easily do that. I am sure we all enjoy fruit but that is a lot in a day, so limit it to one or two items per day and choose lower carb options like berries and grapefruit rather than an apple and pear. You can use ground almonds and artificial sweetener to make cakes instead of regular flour, so that would be something you could adjust but still keep your afternoon cake. One of our members @Martin62 has taken up baking a low carb cake each week with tremendous results and posts each week to show what he has produced and where the recipe can be found. this is one of his creations... https://forum.diabetes.org.uk/boards/threads/keto-gingerbread-cake.99403/

Anyway, good luck making some improvements to your diet and here's hoping you can get things back into order again whilst still findig treats that you can enjoy.
 
Is there a recommend daily carb intake for type 2's or is it like other things it depends on the person?
 
StveB said:
Is there a recommend daily carb intake for type 2's or is it like other things it depends on the person?
Click to expand...
It depends on the person 🙂
Grapefruit is fine as that's quite low carb. Your diet is quite carby for a type2 so I think that's where your answer is.
 
StveB said:
Is there a recommend daily carb intake for type 2's or is it like other things it depends on the person?
Click to expand...
Yes, it depends!! 🙄
Low carb is considered less than 130g per day but most Type 2s need to go a bit lower than that to about 70-100g, others lower still. This is why a BG meter and appropriate testing strategy is so important when trying to use dietary control because it will guide you as to what your individual body can cope with rather than general advice which may or may not work for you.
 
Well I've had a very useful day. Some excellent advice from you good people, I've worked out my daily carbs add up to about 150grms and I can see where I can make changes to bring that down to about 100 and if I'm really strict down to about 80. I've phoned Accu Chek and they're sending a new meter with test strips free of charge, now all I have to do is try and remember when to test and how to understand the results, I've got it all somewhere from doing it before just need to find it. Not on Statins or Thyroid meds yet, my total cholesterol was 4.8 at the review but the LDL,Triglycis where at the wrong ratio to HDL so hoping that will sort itself once Db is better under control.
Not sure how I can reduce bad cholesterol and increase good? Fat wise my diet is very good.
So thanks again everybody, all advise gratefully received.
 
If you are going to test the effect your meal has on your blood glucose level then you test just before you eat and 2 hours after the first bite. If the increase is more than 2-3mmol/l then your meal is too carb heavy, you would also aim for no more than 8.5mmol/l or even 8mmol/l 2 hours post meal. Obviously you should not have anything more to ear or drink other than water during those 2 hours.
Reducing carbs can help improve those cholesterol ratios.
 
Update. The new meter came yesterday, first fasting test this morning was 9.1, 2 hours after first bite, 9.0,
and that was after eating 1/2 red grapefruit, grilled tomato and bacon, 1 slice of 9grm carb bread , cup of tea.
Spoke to nurse yesterday changing meds back to 1 metformin as more causes gastric problems but adding in Alogliptin.
Any thoughts anyone on all of the above?
 
To get normal Hba1c results I stay under 7 after eating - which means breakfast is usually meat and stir fry, or fish and salad or eggs and cheese with a tomato, or mushroom omelette for breakfast, then a cup of coffee with cream, and then I am good for 12 hours until dinner. I am very sensitive to carbs so eat very few, but find it no bother to stick to low carb - I am happier eating this way than when on the GPs high carb low fat diet. I suppose it is what you get used to.
 
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