Medication - is it necessary?

[bellx15]

Hello again, everyone! I thought I should start a new thread for this, as it has been a couple of weeks and I wanted to keep this separate.

OK, the situation with me has been this:

Two years ago I was found to have high BG (FBG was up to 17.1 on the first reading) but at that time I was on an inexcusably stupid and ill-conceived diet of tons of fruit juice every day. Don't even ask why.

Anyway, as soon as I received that alert I came off of the juice and started to exercise regularly. My blood pressure dropped almost immediately (2 - 3 days), and on my next FBG test I was down to 13. This continued to drop as I continued to diet and exercise. A while later (can't remember how long) it was down to 8.3 ...

At that time I just assumed from those results that I had found the way to get things back to normal and keep them there, so didn't go back to the GP.

Two years later, after being almost immobilised with sciatica over the entire winter six-months, and drinking too much beer daily, I again found that my FBG was up at 14.7.

So now I give in and agree to go on to Metformin (500x2 daily) whilst getting immediately back into the diet and exercise regime. Within a week my FBG, taken under the same conditions and at the same time as the 14.7 reading, was down to 6.1 - 6.7. Today, I took a reading at lunchtime, having had cereal for breakfast earlier, and it was 7.9.

So it seems pretty clear that I am at least improving my body's handling of glucose dramatically through diet and exercise.

My question after all of that is whether I should be on the Metformin, or should I persist with the diet and exercise alone before turning to drugs? Do the tablets in any way hinder my chance of getting back to a healthy state?

I was prompted by this http://news.bbc.co.uk/1/hi/health/7930007.stm

 

[Northerner]

Well, I would say that it is fairly clear that you are very responsive to a suitable diet and increased activity, which suggests your pancreas mainly struggles when you give it little chance and overload it. Everyone is different and for some, even a change in diet and lifestyle is insufficient to allow their pancreas to support them fully, so a helping hand from medication is necessary - there are an infinite number of 'shades of grey' really, rather than any simple answer. You need to do what works for you. If you can sustain the good diet and exercise regime then there seems a good chance that you will be able to come off the metformin - many of our members have - so it's really a decision that you must make, with advice from your doctor, whether you are willing and able to continue the good work 🙂

Some doctors, as the article suggests, do not give people the opportunity to try to improve things and put them straight on medication, but I beleive NICE say that a period of at least 3 months should be given in appropriate cases to try the D&E option.

 

[trophywench]

Of course, the problem with this is, how long is your BG staying at 7.9? Because if it's longer than just a couple of hours one morning and it keeps happening, then you (we) can be having damage caused to our internal workings already!

I'm not being pessimistic, it's a fact.

I really think you ought to get back to your docs and tell him what you've told us. I would like him to say for starters a) give me some blood and we'll get an HbA1c test done and b) come back in X days time (often they get these results the next day, but then someone has to put em on the computer blah blah blah) This test shows how much glucose, has 'stuck' to your Haemoglobin cells in the previous 12-ish weeks. In a non-diabetic the answer should be roughly 5%-ish.

And while he's getting the blood for that I'd like him to run a few more tests while he's at it. Especially Urea and Electrolytes ... and while he's on, a urine sample to test for Albumin wouldn't go amiss. All these 3 have to be sent to the lab.

There are others tests actual diabetics have as a matter of course, at least annually, but the 2nd and third ones mentioned above will show if there's anything untoward going on with your kidneys. (Kidneys and eyes are the most common two of the 'silent damage' areas. There is a specific test for eye damage but that, if it's necessary and you are diagnosed diabetic - will be arranged separately.)

So the message is basically, get to the doctors! I'd far rather be told I'm as fit as a flea and sent away with a flea in my ear than wake up one morning with unexpected diabetic complications, thanks.

 

[mcdonagh47]

So now I give in and agree to go on to Metformin (500x2 daily) whilst getting immediately back into the diet and exercise regime. Within a week my FBG, taken under the same conditions and at the same time as the 14.7 reading, was down to 6.1 - 6.7. Today, I took a reading at lunchtime, having had cereal for breakfast earlier, and it was 7.9.

So it seems pretty clear that I am at least improving my body's handling of glucose dramatically through diet and exercise.

My question after all of that is whether I should be on the Metformin, or should I persist with the diet and exercise alone before turning to drugs? Do the tablets in any way hinder my chance of getting back to a healthy state?

I was prompted by this http://news.bbc.co.uk/1/hi/health/7930007.stm

You are not getting the best out of metformin, 1500 mg is the minimum effective dose so you should probably be going up to that. 1000 is just a way-station on the way through to the effective dose.
Since you are taking Met as well as doing D&E you cannot say the changes in BGs are entirely due to D&E.
And being a Type 2 Diabetic you have zero chance of returning to a healthy state, since the diagnosis is for Life not just for Christmas. All that is on offer is control of the symptoms by various means ( metformin being tried and tested and one of the best).

 

[bellx15]

Thanks everyone!

Well, just briefly, in response to that last point, I have only been on Metformin for two weeks, and the initial improvements were monitored before I even started on it, so there is some evidence of improvement. I am not sure whether you are saying 1000mg is ineffective, or just not very effective. It would have to be the latter, presumably, if the effects of it could be getting mixed up with D&E (?)

At this stage I am not prepared to accept a life-sentence, as I truly believe that I can lick this yet. Having measurements 'at diabetic levels' (GP) on two tests two years apart is not enough to convince me that I can't change things for the better.

I'll carry on with the D&E plus meds until I see the diabetes nurse on July 3rd, and then go from there.

By the way, please don't think I am just ignoring all your advice. What I was keen to have opinions on was whether I should stay on the Metformin while I continue with the D&E. From what everyone has said, there seems at least not to be a problem with doing so.

Many thanks, all! 🙂

PS Yes, I am due to have an HbA1c test done after I see the nurse and the meds / D&E have been given a chance to work.

 

[Mark T]

I think the question here is; why would Metformin stop you from being in a healthy state?

My own view is that taking the pills isn't going to make you unhealthy. At the worst case, they are completely ineffective and might occasionally give you the runs (you'll be an Olympic class sprinter to the loo )

I believe that right now I'm at the healthiest I've probably been in 15 years, maybe even 20 (I'm 37). Metformin doesn't have an impact on that for me plus it has protective qualities.

My HbA1c was down to 5.5% at one point, so I suspect I could have justified coming off metformin if I had argued it. But, I wanted to stay on because if I had been diabetic for a year but not diagnosed then I want some protection from any future issues that may come my way.

If you believe that you can't be healthy if you are taking medicine - then I think that is psychological.

 

[Andy HB]

For me the metformin (I seem to remember I took 2 500mg tablets a day) was a stepping stone to a healthier me and I am still fortunate enough to not have to take them any more (as a personal choice). I've been off the medication for a couple of years now and my last HbA1c was 6.0% (following a bit of a carby-binge I might add!).

But as Northerner said, we are all different shades of grey when it comes to insulin production and insulin resistance and so you need to weigh things up for yourself.

Andy 🙂

 

[SimplesL]

Hi

I've been prescribed 1000g of metformin since October last year as a result of much better sugar control. (HBA1c) was 5.8%. Tested again in February it had gone to 6.5%. Still a pretty good average.

I've not heard that 1500g of metformin should be the minimum as I was told in October when metformin reduced to 1000g if average still good they would consider reducing it to 500g as it had been shown to protect your heart. So not recommended that I would come off them. But my dad also type 2 has angina & kidney failure & his mum died very young of heart problems; so foe me I am happy to stay on the meds.

Due to have a blood test (HBA1c) next Monday so if it is up from 6.5% I'll be discussing whether 1500g appropriate. My problem is high levels in the morning. I now go to gym 5 days a week; so I'm crossing my fingers I can leave meds as they are.

I recently took part in an Aspirin study & doctor thought high morning levels could be a matter of timing rather than dose. So something else I've added to my list to discuss when I see the practise nurse who runs the clinics once blood test results are in.