New A1C level

[NewdiabeticRo]

Hi
I was diagnosed with T2 in may with a level of 109. I have had a blood test last week and it is now down to 75 which has been a result of diet - I have not been super strict - I eat out once a week, grab snacks sometimes etc. I have been prescribed Metformin 500mg sustained release, twice a day at diagnosis but I have been very bad with taking my meds. Is this a good improvement? I have recently started exercising 4 days a week and am meeting with my GP soon to discuss the results but they've given me an impression they want to put me on more meds - can I refuse?

 

[Inka]

That’s a good improvement @NewdiabeticRo However, 75 is still high and well into the diabetes zone. If dietary changes can’t bring your levels down enough then sometimes medication is needed. Obviously you can refuse any medication, any surgery, anything medical as that’s your right, but you should weigh up whether you’ll be able to further improve your blood sugar with diet alone. Perhaps you could ask for a brief delay before starting any more meds in order to try to improve your HbA1C further?

 

[NewdiabeticRo]

Hi inka, thank you for your reply - my issue with medication is that I'm really bad at taking it. Diet only has brought it down with around 3.5-4 kgs of weightloss - I have started exercising these last two weeks and lost 0.5 kgs more - I want to ask for more time to lose weight and see where I go from there. I'm only 25 so I think I'm capable of it is all

That’s a good improvement @NewdiabeticRo However, 75 is still high and well into the diabetes zone. If dietary changes can’t bring your levels down enough then sometimes medication is needed. Obviously you can refuse any medication, any surgery, anything medical as that’s your right, but you should weigh up whether you’ll be able to further improve your blood sugar with diet alone. Perhaps you could ask for a brief delay before starting any more meds in order to try to improve your HbA1C further?

 

[Eddy Edson]

FWIW, my view: 75 is high, at the level where there is real risk of complications, and the risks seem to be higher for younger people. I'd seriously consider taking whatever meds are on offer to get levels down quickly, after which you can try reducing/dropping them. It can go hand-in-hand with weight loss for long term remission, but IMO there would be real benefits to cutting the amount of time you are exposed to high BG levels.

 

[Leadinglights]

As you say you haven't been particularly strict with your diet, now might be the time to review what you are doing as that is going to have more impact that the metformin which does not act directly on the food you eat but gives the body a helping hand to use the insulin you are producing more effectively.
There is no reason why you can't eat out, have snacks etc as long as those are good choices.
This link may help you do just that. https://lowcarbfreshwell.co.uk/

 

[everydayupsanddowns]

Well done on your steady progress so far @NewdiabeticRo

The work you’ve put in so far is clearly paying off, and it’s great to hear that you’ve been upping your exercise too.

If you’d prefer to slow any increase in meds, I guess the first thing to do is to make sure you are taking the ones you’ve already been prescribed diligently - so you can maximise their effect.

It also sounds like you might have a little wiggle room in your diet left too. Cutting back on carby snacks, and perhaps changing your choices when you eat out so that they are a bit more BG friendly?

At an A1c of 75mmol/mol you’ve still got increased risk of various things, so aiming to gradually reduce that down to the target your Dr has given you over the coming months would be well worthwhile.

No effort is wasted in diabetes management. Even small changes can have a substantial impact on risk - so it’s all worthwhile.

Keep going! And let us know how you get on 🙂

 

[42istheanswer]

Hi inka, thank you for your reply - my issue with medication is that I'm really bad at taking it. Diet only has brought it down with around 3.5-4 kgs of weightloss - I have started exercising these last two weeks and lost 0.5 kgs more - I want to ask for more time to lose weight and see where I go from there. I'm only 25 so I think I'm capable of it is all

If your reason for not taking medication is forgetting it, then you need strategies to help you remember until it becomes routine. E.g. if you have a hot drink with your breakfast, put a note or a pack of your medication by the kettle to help you remember the morning dose. Set yourself alarms on your phone. If your reduction so far is without taking the Metformin properly, then if you were even more careful about diet and took the Metformin, you might get a better reduction

 

[NewdiabeticRo]

If your reason for not taking medication is forgetting it, then you need strategies to help you remember until it becomes routine. E.g. if you have a hot drink with your breakfast, put a note or a pack of your medication by the kettle to help you remember the morning dose. Set yourself alarms on your phone. If your reduction so far is without taking the Metformin properly, then if you were even more careful about diet and took the Metformin, you might get a better reduction

I hope so, trying to be better with it.
Had my eye screening today and so far been told it's all good so that's one small win I guess

 

[Drummer]

I hope so, trying to be better with it.
Had my eye screening today and so far been told it's all good so that's one small win I guess

That is still a goodly decrease in Hba1c which I'd have thought should be acceptable as going down very quickly can result in problems such as false hypos and even problems with eyesight.
If more medication is suggested, perhaps if you point out just how far you have come in the short while since diagnosis you can then ask for another three months to continue in the same way - the same reduction would take you down to 41 - which is just at the top of the normal range and not even prediabetic.
I suspect that you might need to be a little stricter in your diet to get down that far, but having done so well in the first few months you know what you need to do now.

 

[Drummer]

You could be cheeky and ask for a blood glucose tester to assist in your quest for lower blood glucose levels instead of more medication, should it be pushed.

 

[NewdiabeticRo]

You could be cheeky and ask for a blood glucose tester to assist in your quest for lower blood glucose levels instead of more medication, should it be pushed.

Hi, so since I was last here I have seen my GP this week who's confirmed my eyes are all okay, and increased my Metformin to 1000mg twice a day (and explicitly said it should have been done within back in June, Oh well). She also put me on empagliflozin 10mg twice a day. They will re-do the A1C sometime in November and cut back meds if they're happy with the results.
My current issue is that I have a breakfast meal replacement shake that doesn't seem to be enough with my new meds as I was at a hypo within 3 hours so I was wondering if anyone had any suggestions for breakfast options - I'm currently considering overnight oats or overnight chia seed pudding. Any recommendations would be helpful. My lunch and dinner is recipes from the 800 calorie cook book by Dr. Michael Moseley

 

[Leadinglights]

Hi, so since I was last here I have seen my GP this week who's confirmed my eyes are all okay, and increased my Metformin to 1000mg twice a day (and explicitly said it should have been done within back in June, Oh well). She also put me on empagliflozin 10mg twice a day. They will re-do the A1C sometime in November and cut back meds if they're happy with the results.
My current issue is that I have a breakfast meal replacement shake that doesn't seem to be enough with my new meds as I was at a hypo within 3 hours so I was wondering if anyone had any suggestions for breakfast options - I'm currently considering overnight oats or overnight chia seed pudding. Any recommendations would be helpful. My lunch and dinner is recipes from the 800 calorie cook book by Dr. Michael Moseley

Do you actually have a monitor so you can check that you are actually hypo (less that 4mmol/l) or it could be that you are not but feeing like you are, as your body has to adjust to a lower glucose level which could come about by an increase in medication and a fairly substantial change in diet.
You could try Full fat Greek yoghurt and berries, seeds or nuts for breakfast or eggs in any form with bacon, mushrooms, tomatoes.
It is better to reduce your carbs gradually it is less likely to cause issues with your eyes and nerves.

 

[NewdiabeticRo]

Hi, yes I do have one that I have had since my diagnosis, but was monitoring a lot to check how I reacted to different foods and told off by the gp and diabetes nurse to "stop obsessing". There has been no change in diet. I have continued as is, actually eating more now

Do you actually have a monitor so you can check that you are actually hypo (less that 4mmol/l) or it could be that you are not but feeing like you are, as your body has to adjust to a lower glucose level which could come about by an increase in medication and a fairly substantial change in diet.
You could try Full fat Greek yoghurt and berries, seeds or nuts for breakfast or eggs in any form with bacon, mushrooms, tomatoes.
It is better to reduce your carbs gradually it is less likely to cause issues with your eyes and nerves.

 

[Leadinglights]

Hi, yes I do have one that I have had since my diagnosis, but was monitoring a lot to check how I reacted to different foods and told off by the gp and diabetes nurse to "stop obsessing". There has been no change in diet. I have continued as is, actually eating more now

I think it is good reason to use your monitor if you get the 'hypo' symptoms just to check. What you were doing, checking meals seems key to managing your blood glucose sad that many GPs don't appreciate that.
If you have not changed your diet and you were having the meals you mention, I am surprised your GP wasn't happy with your progress and felt the need to add more meds.
Make sure you are drinking plenty as the empagliflozin removes excess glucose via urine so it would be easy to become dehydrated, the recommended liquid intake is 3 litres a day, of course the consequence of that is more loo visits.

 

[Drummer]

Hi, so since I was last here I have seen my GP this week who's confirmed my eyes are all okay, and increased my Metformin to 1000mg twice a day (and explicitly said it should have been done within back in June, Oh well). She also put me on empagliflozin 10mg twice a day. They will re-do the A1C sometime in November and cut back meds if they're happy with the results.
My current issue is that I have a breakfast meal replacement shake that doesn't seem to be enough with my new meds as I was at a hypo within 3 hours so I was wondering if anyone had any suggestions for breakfast options - I'm currently considering overnight oats or overnight chia seed pudding. Any recommendations would be helpful. My lunch and dinner is recipes from the 800 calorie cook book by Dr. Michael Moseley

I suggest telling the GP about the hypos and requesting that the medication is reconsidered in light of them - what I am thinking can't be posted here.

 

[NewdiabeticRo]

I suggest telling the GP about the hypos and requesting that the medication is reconsidered in light of them - what I am thinking can't be posted here.

I did speak with them. They've said no reduction in meds as they have to get the blood sugars in my next A1C under control as that would make them very happy since I'm very young. She's mentioned trying to stop the meal replacement and eat more whole foods for breakfast because the hypos happen mid morning and given me information about different sites she uses to understand nutrition and mindful eating. She's also said that my medication shouldn't cause hypos but it is probably a result of a quick spike which then reduces into a hypo and all in all that I should eat more whole foods for breakfast

 

[Eddy Edson]

I did speak with them. They've said no reduction in meds as they have to get the blood sugars in my next A1C under control as that would make them very happy since I'm very young. She's mentioned trying to stop the meal replacement and eat more whole foods for breakfast because the hypos happen mid morning and given me information about different sites she uses to understand nutrition and mindful eating. She's also said that my medication shouldn't cause hypos but it is probably a result of a quick spike which then reduces into a hypo and all in all that I should eat more whole foods for breakfast

Sounds good. She should be better placed to advise you than anybody here.

 

[Drummer]

I did speak with them. They've said no reduction in meds as they have to get the blood sugars in my next A1C under control as that would make them very happy since I'm very young. She's mentioned trying to stop the meal replacement and eat more whole foods for breakfast because the hypos happen mid morning and given me information about different sites she uses to understand nutrition and mindful eating. She's also said that my medication shouldn't cause hypos but it is probably a result of a quick spike which then reduces into a hypo and all in all that I should eat more whole foods for breakfast

I just checked for information about Empagliflozin and it stated that it can cause hypos and that when taking it you should carry treatment for hypos at all times.
I think you should be testing your levels to be safe, and do you usually have people around you that you could educate on how to assist if necessary?
Maybe you should show your GP the information leaflet supplied with the medication if you are being told that it should not cause hypos.

 

[Deleted member 21371]

I did speak with them. They've said no reduction in meds as they have to get the blood sugars in my next A1C under control as that would make them very happy since I'm very young. She's mentioned trying to stop the meal replacement and eat more whole foods for breakfast because the hypos happen mid morning and given me information about different sites she uses to understand nutrition and mindful eating. She's also said that my medication shouldn't cause hypos but it is probably a result of a quick spike which then reduces into a hypo and all in all that I should eat more whole foods for breakfast

What numbers have you been seeing?