How to approach reducing/removing meds to a doctor?

[zoombapup]

Hi guys,

Trying to think through a problem and could use some advice.

My situation is that I was diagnosed about 10 weeks ago, and by diagnosed I mean "rushed into hospital with ketoacidosis and kept in for 4 days".

At the hospital, the doctor and diabetic nurse were having a bit of an argument about what to do with me, in the end the nurse convinced the doctor and they put me on basal insulin (8 units) and 2 metformin a day, plus Ozempic once a week.

Since then, I've come down quite a significant amount BG wise, from 20+ at the hospital to averaging around 5.5 for the last 8 weeks.

Now the issue is that I really need to be able to drive, so I have to maintain a BG level above 5 to do that safely. Because I'm on the various drugs, if I don't I could go hypo and you all know the score there.

Now here's the thing, I need to lose a lot of weight. In order to do that, I'm going to have to reduce my calorie intake a fair bit, which isn't a problem as I've done that before and lost 5.5-6 stone. But with the meds I'm on, reducing calories is going to drop me below the 5.0 that is safe to drive.

So I guess the question is, how do you get your doctor on board with removing medications? I'm not in the position where I've slowly gone through the pre-diabetic range. In fact last year my hba1c was considered normal before diagnosis (i.e. a year previously when tested it was normal), so I've gone from nothing to insulin/metformin/ozempic. But I want to try out control via diet so in order to do that safely it seems like I'll have to undo the medication somehow.

I get the feeling that the doctor at the hospital is a bit of a "lets just put em on meds" kind of guy, but the nurse was far more of a "lets try out some different approaches" kind of guy. In fact the nurse was far more informative than the doctor.

So how do you broach the subject of medication reduction? I mean ultimately they can't exactly stop you doing whatever you want. But I'd rather have them on board and supportive.

 

[Kaylz]

basal insulin shouldn't really drop you, its designed to keep things steady while you aren't consuming carbs etc, if it drops you then it means there is too much in your system and it should be reviewed and adjusted as necessary, metformin is supposed to help the insulin you produce work better, there are even some Type 1's on a basal/bolus regime that need the help of metformin due to insulin resistance, insulin isn't generally a hand out kind of medication though so I cant imagine anyone would add that unless they thought it was absolutely necessary, have they actually done tests to confirm if you are Type 1 or Type 2?

I know this doesn't answer your question but you may see a very sharp rise in levels should you come off the medication

 

[everydayupsanddowns]

I think the best approach is to have exactly the conversation with your Drs that you are outlining here.

Like @Kaylz - I think there are still some questions about classification that need answering. And the answer to those isn’t ‘well you’d be on insulin either way so it doesn’t matter whether we say T2 or T1...’ because clinical research results (and therefore access to appropriate tech and meds) are divided by type, so it you really are LADA you need to be flagged as such.

It’s perfectly possible to drive while being on insulin, and to lose weight too. But at the moment it sounds like you are ‘feeding’ your meds (which is never a good idea), rather than them just supporting your metabolism and BGs.

I think if you explain your reasons for wanting to reduce meds like you have here you will have a very positive appointment. But it’s important to go in with an open mind, and try to understands your Drs perspective too 🙂

 

[zoombapup]

I know this doesn't answer your question but you may see a very sharp rise in levels should you come off the medication

I think the way I see it currently, is that the insulin I'm taking is keeping me lower than I would be otherwise as expected. But I've noticed that when I reduce portion size I go under the 5.0 level considered by DVLA as safe for driving, which means that if I'm going to go on a diet, I'll be unable to drive, which seems counterproductive.

Now that I can monitor the situation and actually know what effects my BG levels, I can at least have a go at trying to control via diet and exercise in a more natural way. I think the meds were prescribed because at the time I was in considerable danger. So this is more of a longer term control issue than anything. Not to say that I can't maintain the current regime, it just seems a bit silly because I need to lose considerable weight and the way to do that is to cut the calorific intake whilst maintaining low carb. I just figure that the "rapid weight loss" of the 800 cal diet approach seems reasonable if I can do that for a period and then go back to a better maintenance regime post diet.

Interestingly there have been a few people here doing the Newcastle diet 800 cal thing and they have achieved the weight loss, but as with everything it's definitely situational and personal and there have been people who revert to a "normal" diet of carbs and balloon back up again.

Thanks for the feedback though guys, it's only 10 days away so I guess I'll see what they say at the appointment. My main concern was that the Doctor seemed a bit too quick to instantly start medication, but given that was in an emergency situation maybe he was just having an abundance of caution.

 

[DaveB]

Hi. First I would try to come off the Ozempic as you lose weight and after discussion with the GP. It's role is to help weight reduction but can have side effects so worth stopping when it has achieved the aim. Metformin is not a problem so don't worry about continuing to take it. You need to think Carbs and not Calories as Calories have no role for us; they are not a food group whereas carbs are the biggest culprit food group for weight and blood sugar gain. If you reduce both calorie count and carbs you will end up reducing fats which is not good. Do keep the carbs down and that should help with your weight.

 

[zoombapup]

You need to think Carbs and not Calories as Calories have no role for us

I'd generally agree with you Dave, but I've got a considerable amount of weight to lose and just reducing carbs isn't going to cut it. I need to cut down on overall calorific intake temporarily. Once I've lost my target, I'll go back to the current low carb eating, as that is also slowly dropping my weight too, but the difference is that I can either lose it quickly or lose it slowly and in this case I prefer to lose quickly as I've done that in the past, according to the research it seems to be pretty much a wash on which way to go, so this is more of my preference than anything. I just want to do it safely and with the Doctors on board with the approach really.

Thanks all for the advice, I didn't realize my appointment was only 10 days away, so I guess it will come soon enough that it's not worth thinking too much about.

 

[grovesy]

I think the way I see it currently, is that the insulin I'm taking is keeping me lower than I would be otherwise as expected. But I've noticed that when I reduce portion size I go under the 5.0 level considered by DVLA as safe for driving, which means that if I'm going to go on a diet, I'll be unable to drive, which seems counterproductive.

Now that I can monitor the situation and actually know what effects my BG levels, I can at least have a go at trying to control via diet and exercise in a more natural way. I think the meds were prescribed because at the time I was in considerable danger. So this is more of a longer term control issue than anything. Not to say that I can't maintain the current regime, it just seems a bit silly because I need to lose considerable weight and the way to do that is to cut the calorific intake whilst maintaining low carb. I just figure that the "rapid weight loss" of the 800 cal diet approach seems reasonable if I can do that for a period and then go back to a better maintenance regime post diet.

Interestingly there have been a few people here doing the Newcastle diet 800 cal thing and they have achieved the weight loss, but as with everything it's definitely situational and personal and there have been people who revert to a "normal" diet of carbs and balloon back up again.

Thanks for the feedback though guys, it's only 10 days away so I guess I'll see what they say at the appointment. My main concern was that the Doctor seemed a bit too quick to instantly start medication, but given that was in an emergency situation maybe he was just having an abundance of caution.

Newcastle Diet according to Professor Taylor is for those who are a definite Type 2.

 

[Deleted member 25429]

I'd generally agree with you Dave, but I've got a considerable amount of weight to lose and just reducing carbs isn't going to cut it. I need to cut down on overall calorific intake temporarily. Once I've lost my target, I'll go back to the current low carb eating, as that is also slowly dropping my weight too, but the difference is that I can either lose it quickly or lose it slowly and in this case I prefer to lose quickly as I've done that in the past, according to the research it seems to be pretty much a wash on which way to go, so this is more of my preference than anything. I just want to do it safely and with the Doctors on board with the approach really.

Thanks all for the advice, I didn't realize my appointment was only 10 days away, so I guess it will come soon enough that it's not worth thinking too much about.

I am type 1 but have massively reduced my carbs. I take insulin and drive and have lost 71/2stone over the course of the last eighteen months . I just use low fat with low carbs and walk a lot . When I was first diagnosed I was on higher doses of insulin and I ended up feeding the insulin . But with trial and error you get to the levels you actually need

 

[ianf0ster]

Hi zoombapup,
Going from the below 'pre-diabetic' range for Hba1C to Ketoacidosis is not normal for a real Type 2. So despite your weight there is a chance you are LADA or Type 1.
So I suggest you press your GP for the tests to confirm which it is.

Then you seem to think that a Low Carb 'Way Of Eating' won't reduce your weight. - Most people who try it lose moderately and controllably (even without consciously cutting Calories at all). I'm a Type 2 TOFI (never overweight) so Low Carb appealed to me more than a Low Calorie diet. I still lost between 1 and a half to 2 lbs per week without any hunger. In fact I lost weight gradually over the 4 months to my next HbA1c which confirmed that my Diabetes was in remission. My weight has since stabilised.

 

[zoombapup]

Then you seem to think that a Low Carb 'Way Of Eating' won't reduce your weight.

Hi Ian,

I'm definitely going to follow up on the type 1/2 thing. I'm honestly surprised they haven't done anything about that yet. Unless they have and simply haven't told me, or I didn't hear it at the time. Anyway, it's not like I don't think I'm losing weight on the low carb diet I'm currently eating, because I am. It's more that the rate of weight loss is I think a bit too low for the amount I've got to lose, plus there seems to be no evidence for either rapid weight loss or slower being particularly better. So I figure I might as well go for the rapid method just because of my own motivation being high right now.

As I've said, I've done this kind of thing before and had it work OK, now I've got a method of testing my BG levels I think I can do the same again but with the BG in mind. But you're right, if I'm not type 2 then that does change the outlook somewhat. I'll ask the doctor about that for sure.