Metformin versus Dietary Control ?

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SharonH61

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Type 2
Good evening 🙂

I have had 2 hba1c blood tests 1 month apart after a routine eye test revealed a small haemorrhage in the macular. Results of both tests were 49.I have now been told that I have diabetes. I have been advised that I need an appointment with the diabetes specialist doctor at my GP surgery.
This is going to be a telephone consultation on 15th September. With this kind of reading alongside other symptoms of itchy skin all over my body, extreme thirst, blurred vision, extreme nausea. What is the likelihood of my being started on metformin versus dietary control. Can anyone offer any ideas ?
 
It depends on how much you weigh and how diabetic friendly your diet already is?

I would expect you would be prescribed Metformin, as it is almost by default unless there are reasons not to. This would especially be the case if you are not overweight and losing it is not going to be seen as a quick solution.

But even if you are not significantly overweight and want to control by diet alone, it can be helpful to take medication in the short term just to bring your levels down whilst you make changes; loosing weight and exercising as well as changes to what you eat. Whilst it will not help with your symptoms directly, from your list of hyperglycaemia symptoms it sounds as though getting your levels down as quickly as possible will make you more comfortable.

But you are at the bottom of the diabetic range, so if you feel you can easily implement lifestyle changes and do not want to take medication then it would not be unreasonable to be allowed to try that first.

This all needs to be discussed with the doctor, as it about what you want and can do. What they will recommend is very much dependent on the individual, different doctors will see it differently. Some will think your HbA1c is low enough that you just need to put the effort in to control it yourself. Others will see medication as worthwhile regardless of what you do as well.

So the ultimate answer to your question is no one knows! But at least you will be able to speak to a specialist doctor.

Not that it should be a consideration but, in England, if you take medication for diabetes you can apply to get all you prescriptions for free. Even ones unrelated to your diabetes. If you are controlled by diet alone, though, then you still have to pay for all of them. In the rest of the U.K. they are free anyway.
 
There are things here which don't add up. Extreme thirst suggests a very high BG but the tests don't show this.

What did you do between tests? If you restricted your carb intake then there should have been a reduction in the reading even after just a month.

You might consider getting a BG meter - not very expensive and results will be of a gteat help when you talk to your GP.
 
Becka said:
It depends on how much you weigh and how diabetic friendly your diet already is?

I would expect you would be prescribed Metformin, as it is almost by default unless there are reasons not to. This would especially be the case if you are not overweight and losing it is not going to be seen as a quick solution.

But even if you are not significantly overweight and want to control by diet alone, it can be helpful to take medication in the short term just to bring your levels down whilst you make changes; loosing weight and exercising as well as changes to what you eat. Whilst it will not help with your symptoms directly, from your list of hyperglycaemia symptoms it sounds as though getting your levels down as quickly as possible will make you more comfortable.

But you are at the bottom of the diabetic range, so if you feel you can easily implement lifestyle changes and do not want to take medication then it would not be unreasonable to be allowed to try that first.

This all needs to be discussed with the doctor, as it about what you want and can do. What they will recommend is very much dependent on the individual, different doctors will see it differently. Some will think your HbA1c is low enough that you just need to put the effort in to control it yourself. Others will see medication as worthwhile regardless of what you do as well.

So the ultimate answer to your question is no one knows! But at least you will be able to speak to a specialist doctor.

Not that it should be a consideration but, in England, if you take medication for diabetes you can apply to get all you prescriptions for free. Even ones unrelated to your diabetes. If you are controlled by diet alone, though, then you still have to pay for all of them. In the rest of the U.K. they are free anyway.
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Thank you Becky, much appreciated.
 
leonS said:
There are things here which don't add up. Extreme thirst suggests a very high BG but the tests don't show this.

What did you do between tests? If you restricted your carb intake then there should have been a reduction in the reading even after just a month.

You might consider getting a BG meter - not very expensive and results will be of a gteat help when you talk to your GP.
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I wasn’t advised to do anything between the tests. Just repeat it after 1 month. I wasn’t given any information about carbs or anything else. Thanks for you advise,I will get a BG meter.
 
Anitram said:
As you are only just over the threshold I would be surprised if you aren't offered the opportunity to get your BG down through lifestyle changes first.

Martin
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I am overweight and very restricted regarding mobility due to arthritis and fibromyalgia,exercise and weight loss is going to be necessary. It will be a real challenge for me. Thanks for your response.
 
I agree it's a challenge Sharon - but the thing is ANY exercise is 100% better than NO exercise ! It absolutely doesn't have to be eg violent aerobics or weight lifting. Have you got a garden, can you walk down or across it? or eg down the hall or to the front gate. And repeat, and repeat, and repeat .....
 
trophywench said:
I agree it's a challenge Sharon - but the thing is ANY exercise is 100% better than NO exercise ! It absolutely doesn't have to be eg violent aerobics or weight lifting. Have you got a garden, can you walk down or across it? or eg down the hall or to the front gate. And repeat, and repeat, and repeat .....
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Thanks Jenny I do have a huge garden so I will be making that effort and putting it to good use
 
leonS said:
There are things here which don't add up. Extreme thirst suggests a very high BG but the tests don't show this.

What did you do between tests? If you restricted your carb intake then there should have been a reduction in the reading even after just a month.

You might consider getting a BG meter - not very expensive and results will be of a gteat help when you talk to your GP.
Click to expand...
Well we are all different and some people seem to get symptoms at lower levels than others. I personally never had any symptoms and still rarely do.
SharonH61 said:
Good evening 🙂

I have had 2 hba1c blood tests 1 month apart after a routine eye test revealed a small haemorrhage in the macular. Results of both tests were 49.I have now been told that I have diabetes. I have been advised that I need an appointment with the diabetes specialist doctor at my GP surgery.
This is going to be a telephone consultation on 15th September. With this kind of reading alongside other symptoms of itchy skin all over my body, extreme thirst, blurred vision, extreme nausea. What is the likelihood of my being started on metformin versus dietary control. Can anyone offer any ideas ?
Click to expand...
Wether you are started on Metformin or diet, can be very much dependent on your Dr.
 
Do you have a preference @SharonH61?

If you would like to try to manage your diabetes without medication to begin with you should discuss this with your Dr, and see what their suggestions are, and assess their reasoning.

As a person with diabetes, as with many long term conditions, you have the opportunity to change your relationship with your Dr to a more collaborative team effort. So you bring your individual n=1 experience of living hands-on with the condition day to day, and your Dr brings a wider perspective of medicine, scientific evidence, and physiology.

Let us know how you get on
 
Well. One year since my diagnosis. I have not managed to achieve anything positive. Partly due to my chronic illness, arthritis, fibromyalgia, degenerative disc disease, nerve damage to my left leg, all of which make exercising an extremely painful and exhausting experience. So, what do I do ? I avoid it. I know, I know. As for controlling diabetes with diet, I have no idea what I am or should be doing. My weight has increased and my Hba1c is now 50. As for my GP. No comment I am at a complete loss as to how to accept and manage this condition. I feel completely lost
 
Fortunately your HbA1C has not increased by much so you are in a good position to lose some weight and work towards getting your blood glucose level down. Although exercise will help reducing your carbohydrate intake is going to be the most powerful tool. You mentioned that you were going to buy a blood glucose monitor and that would be a good plan in enabling you to find which foods you can tolerate.
It is going to be essential for you to reduce the portions of high carb foods like potatoes, rice, pasta, bread, pastry, tropical fruits as well as cakes and biscuits.
Have a read around some of the recent posts from the new people who have been diagnosed as there is some very useful responses to them.
You need to change your mindset about what foods you can have as you are obviously already getting some symptoms caused by your blood glucose being too high. Your GP can't manage your condition it is something you have to do yourself, and yes it does take some effort.
 
Leadinglights said:
Fortunately your HbA1C has not increased by much so you are in a good position to lose some weight and work towards getting your blood glucose level down. Although exercise will help reducing your carbohydrate intake is going to be the most powerful tool. You mentioned that you were going to buy a blood glucose monitor and that would be a good plan in enabling you to find which foods you can tolerate.
It is going to be essential for you to reduce the portions of high carb foods like potatoes, rice, pasta, bread, pastry, tropical fruits as well as cakes and biscuits.
Have a read around some of the recent posts from the new people who have been diagnosed as there is some very useful responses to them.
You need to change your mindset about what foods you can have as you are obviously already getting some symptoms caused by your blood glucose being too high. Your GP can't manage your condition it is something you have to do yourself, and yes it does take some effort.
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Thank you for taking time to reply, I can see that I need to take control and make more effort. I’m going to make a start by cutting down my carb intake. Thank you again
 
SharonH61 said:
Thank you for taking time to reply, I can see that I need to take control and make more effort. I’m going to make a start by cutting down my carb intake. Thank you again
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There is lots of useful advice from a few people in the post by Jauasik for ways to cut down on carbs.
 
Hi Sharon 🙂

I had a bit of a rough start with info from GP somewhat lacking too. Simply told "diet and exercise" on diagnosis. The nurse I saw later on for blood pressure was a little more full of information but to be fair, most info was from forums and websites from people living with it themselves.

With regards to exercise, have you looked at workouts designed for elderly as they are often light and suitable to be done while sitting down. (not assuming age, rather it might be suited to your ability with your other conditions). Youtube has plenty 😉 Swimming can be a good option due to it being no impact and your local pool might be able to give you a noodle to use for some more support (and have a little float about on to relax when done lol).

With the testing your bloods on your own meter, generally one would take a test before your meal (first bite) and then test 2 hours later. A rise of 2-3mmol/L is generally okay, anything more, probs best to avoid or try with a reduced portion and retest.
Everyone is different with different tolerances to different foods which is why no one will tell you to eat and avoid specific foods apart from very common food types that set most of us off.
The issue isn't just with sugar but as folks have said, carbs as a whole so don't just look at the carbs which sugars.

I am currently trying to loose weight too and just doing regular old weight watchers but eating what my meter has shown is okay. (mostly lol). You don't need to do a special diet to loose weight as a diabetic, just fit it around what your body will or won't let you have without rising your BG too much. The lifestyle will have to be a lifelong one so bear that in mind when finding the right one for you. Sometimes the reduction in carbs alone is enough to start loosing the weight for some.

Did the GP start you on metformin in the end?

You are amongst people who live this day to day and understand how daunting is can be in working out where to start and how it likes to throw us curveballs when we think we have it down.
No question is too silly to ask.
 
gll said:
Hi Sharon 🙂

I had a bit of a rough start with info from GP somewhat lacking too. Simply told "diet and exercise" on diagnosis. The nurse I saw later on for blood pressure was a little more full of information but to be fair, most info was from forums and websites from people living with it themselves.

With regards to exercise, have you looked at workouts designed for elderly as they are often light and suitable to be done while sitting down. (not assuming age, rather it might be suited to your ability with your other conditions). Youtube has plenty 😉 Swimming can be a good option due to it being no impact and your local pool might be able to give you a noodle to use for some more support (and have a little float about on to relax when done lol).

With the testing your bloods on your own meter, generally one would take a test before your meal (first bite) and then test 2 hours later. A rise of 2-3mmol/L is generally okay, anything more, probs best to avoid or try with a reduced portion and retest.
Everyone is different with different tolerances to different foods which is why no one will tell you to eat and avoid specific foods apart from very common food types that set most of us off.
The issue isn't just with sugar but as folks have said, carbs as a whole so don't just look at the carbs which sugars..

I am currently trying to loose weight too and just doing regular old weight watchers but eating what my meter has shown is okay. (mostly lol). You don't need to do a special diet to loose weight as a diabetic, just fit it around what your body will or won't let you have without rising your BG too much. The lifestyle will have to be a lifelong one so bear that in mind when finding the right one for you. Sometimes the reduction in carbs alone is enough to start loosing the weight for some.

Did the GP start you on metformin in the end?

You are amongst people who live this day to day and understand how daunting is can be in working out where to start and how it likes to throw us curveballs when we think we have it down.
No question is too silly to ask.
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Thank you so much ! Your kind reply has made me feel so much better. I had been feeling pretty desperate. I have had no guidance from my GP at all, no metformin and not even a mention of using a blood glucose monitor to learn about my tolerance to different foods so that I know what I should and should not be eating. Should I ask my GP for a blood glucose meter or just go ahead and buy one ? How do I know which one to buy ? There are so many of them
 
@SharonH61 You need one with cheap strips - the ongoing costs mount up far faster than the cost of buying the kit - even being given one isn't that much of a bargain if the cost to use it is high.
The basic diet is easy enough - concentrate on the protein and fats - ignore 'healthy' options as they seem to be far from trustworthy.
 
The GlucoNavil has the cheapest test strips and the monitor is inexpensive, the other one is the Spirit TEE2 both available on line. You do not need to pay VAT
It is wise to buy extra strips at the outset as you only get a few in the kit. You might also want to get extra lancets although people do reuse those.
 
Drummer said:
@SharonH61 You need one with cheap strips - the ongoing costs mount up far faster than the cost of buying the kit - even being given one isn't that much of a bargain if the cost to use it is high.
The basic diet is easy enough - concentrate on the protein and fats - ignore 'healthy' options as they seem to be far from trustworthy.
Click to expand...
Thank you for your advice
 
Leadinglights said:
The GlucoNavil has the cheapest test strips and the monitor is inexpensive, the other one is the Spirit TEE2 both available on line. You do not need to pay VAT
It is wise to buy extra strips at the outset as you only get a few in the kit. You might also want to get extra lancets although people do reuse those.
Click to expand...
Thank you for your advice
 
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