New to the forum. Query about Type 2 Meds

[Coanda_24]

Thank you for the response. I think having something before bed is important to try.

I had an appointment, today, with my practice nurse and the specialist diabetes nurse.

According to the results from Libre 2 my sugars are generally in range, so they’ve suggested coming off Metformin altogether for a trial period to see if that helps my stomach.

Even though I’m type 2, they’ve agreed to add Libre 2 to my prescription just to keep any eye on things whilst the investigations go on.

One issue I have is that the Hospital GI specialists won’t investigate my issues (ie endoscopy) because my sugars have been high and this poses a surgical risk.

The specialist nurse is going to check with the Consultant Endo to see if I need to be under their care.

It seems that my limited diet and weight loss has at least had a positive impact on my diabetic control (life in the old pancreas yet). I am a bit anxious about not being on any diabetic meds for the first time in years, but my practice nurse is going to check in wirh me weekly, and log into look at my Libre. For now they accept that my sugars will have to run a little higher, but if things go too far out of range I can look at taking the Gliclazide on its own.

According to Libre 2 my HBA1C is 38: It was 103 on 2nd Jan. They’ve taken my bloods again to check HABA1C even though it’s only been 6 weeks to evidence for GI that diabetes control is being addressed. They’ve also going to test for Celiac disease.

Instinctively I feel my GI issues have been going on for so long that this is something permanent, but I guess I just need to be patient now.

Does anyone have experience of how long it takes for Metformin to clear the system?

 

[Lucyr]

If you’re only on metformin now then there’s no need to be concerned with bgs in the 3s, totally normal. Your bg graph looks perfect.

 

[harbottle]

It takes around 4 days to clear, but I guess as the concentration will be falling as it halves every 17 hours or so and as this falls the effect with diminish.

 

[Coanda_24]

Just wanted to update my thread.

The results of my interim HBA1c came back and I’m at 77: 6 weeks ago it was 103. Also I’m unlikely to have Coeliac disease: my result came back as 2.46

The reason that I had the interim HBA1C was because Gastroenterology have a policy of not carrying out any GI investigations for anyone with a HBA1C over 69. My GP wanted to make the case for trying to convince them to see me sooner rather than later.

I know it’s dangerous to bring sugars down quickly but with all the anxiety of the last few weeks this feels a little bit positive.

I’m currently into day three of not taking Metformin on a trial basis to see if this helps my stomach. Sugars run a little higher but generally okay. Libre 2 helps me understand my daily patterns so thats good in terms of understanding what foods I can consume to keep things stable. I suspect the challenge will be over the weekend when the last of the Metformin has left my system.

 

[Neens]

There are numerous other oral meds that can be tried in combination with Metformin before you reach insulin.

Type 2 diabetes | Treatment summaries | BNF content published by NICE

This treatment summary topic describes Type 2 diabetes

bnf.nice.org.uk

Thanks for this information - insulin is where I am being pushed and have only had 2 alternatives mentioned by my team and can't use 1 of them due to another chronic condition I have. So it's useful to have this knowledge.

 

[Coanda_24]

Thanks for this information - insulin is where I am being pushed and have only had 2 alternatives mentioned by my team and can't use 1 of them due to another chronic condition I have. So it's useful to have this knowledge.

I hope they help you find a treatment that works for you. What I’ve come to understand is that there’s no one fits all approach, I am really fortunate in that my GP and nurse are listening to me and willing to look at all options.

 

[Coanda_24]

An interesting observation this morning. My sugars were stable over night (mid 5s to low 6). However on waking up my sugars have been climbing for the last 4 hours (Libre has been saying 7.3, finger prick says 8.7). I’ve not consumed any calories since 17:00 yesterday. Not sure if this is a strange side effect of metformin withdrawal.

 

[Leadinglights]

An interesting observation this morning. My sugars were stable over night (mid 5s to low 6). However on waking up my sugars have been climbing for the last 4 hours (Libre has been saying 7.3, finger prick says 8.7). I’ve not consumed any calories since 17:00 yesterday. Not sure if this is a strange side effect of metformin withdrawal.

This is likely the 'famous' Foot on the floor phenomenon where the liver releases glucose to give you energy in the absence of food so pushes up blood glucose until you eat. It could be if that didn't happen noticeably before it was the metformin doing it's job (one of it's functions)

 

[Coanda_24]

This is likely the 'famous' Foot on the floor phenomenon where the liver releases glucose to give you energy in the absence of food so pushes up blood glucose until you eat. It could be if that didn't happen noticeably before it was the metformin doing it's job (one of it's functions)

Thank you for that insight: it makes a lot of sense. The reason for not eating this morning was just because I had a bad night with stomach ache. I will make an effort to eat something just so my system has something to work on.

 

[Leadinglights]

Thank you for that insight: it makes a lot of sense. The reason for not eating this morning was just because I had a bad night with stomach ache. I will make an effort to eat something just so my system has something to work on.

For some people the increase happens as soon as they get out of bed, so they test when in bed. It could of course be a response to the pain of the stomach ache.

 

[grovesy]

An interesting observation this morning. My sugars were stable over night (mid 5s to low 6). However on waking up my sugars have been climbing for the last 4 hours (Libre has been saying 7.3, finger prick says 8.7). I’ve not consumed any calories since 17:00 yesterday. Not sure if this is a strange side effect of metformin withdrawal.

It's more likely to be the Dawn Phenomenon, mine starts often before I even wake.

 

[Neens]

I hope they help you find a treatment that works for you. What I’ve come to understand is that there’s no one fits all approach, I am really fortunate in that my GP and nurse are listening to me and willing to look at all options.

Thank you - I am pushing to try alternatives first as I know I have not managed my T2D well foodwise for a couple of years and am on max. metaformin - but feel I can reduce numbers with proper meal plans. I did manage to get 119 down to 44 so I know I can do something to improve the Hb.

 

[Leadinglights]

Thank you - I am pushing to try alternatives first as I know I have not managed my T2D well foodwise for a couple of years and am on max. metaformin - but feel I can reduce numbers with proper meal plans. I did manage to get 119 down to 44 so I know I can do something to improve the Hb.

As you are a new returner to the forum you may not have noticed this link that I have posted which people have found useful. There are some do's and don'ts with some meal plans to suit various tastes and budgets. It is a low carb approach but no a NO carb one. https://lowcarbfreshwell.com/

 

[Drummer]

An interesting observation this morning. My sugars were stable over night (mid 5s to low 6). However on waking up my sugars have been climbing for the last 4 hours (Libre has been saying 7.3, finger prick says 8.7). I’ve not consumed any calories since 17:00 yesterday. Not sure if this is a strange side effect of metformin withdrawal.

That is why I eat at 12 hourly intervals (approximately) as if I eat a small amount of carbs early in the day my glucose levels stop rising. The division is about 1/4 of my carbs in the morning and the rest in the evening. It keeps me in normal numbers.

 

[everydayupsanddowns]

Thanks for keeping us updated @Coanda_24

Hope your HbA1c continues to gently reduce so that the Gastro team are able to investigate.

 

[Neens]

As you are a new returner to the forum you may not have noticed this link that I have posted which people have found useful. There are some do's and don'ts with some meal plans to suit various tastes and budgets. It is a low carb approach but no a NO carb one. https://lowcarbfreshwell.com/

Thanks @Leadinglights, funnily enough it was one of the first links I clicked on when I returned last night. Thanks for posting it again - useful for a lot of people. @Coanda_24 apologies for going slant on your post, but guessing the advice/links will help you and others too.

 

[Neens]

That is why I eat at 12 hourly intervals (approximately) as if I eat a small amount of carbs early in the day my glucose levels stop rising. The division is about 1/4 of my carbs in the morning and the rest in the evening. It keeps me in normal numbers.

That's interesting @Drummer as I tend to have less carbs morning and lunch and a few more in the evening --- or when working I swap evening meal for lunch. I am going to get one of the wearable readers to see how it all registers with BG etc. But it may be worth swapping carb division and having more first thing.

 

[Proud to be erratic]

Picking up a thought triggered partly by your recent post "Libre 2 query" @Coanda_24, along with remarks within this thread ...

When you have periods (a day even) of negligible food because you don't want anything to eat, then that can cause your liver to dump even more glucose regardless. I think a layman's explanation would be your brain constantly demands glucose specifically; it doesn't matter to your brain whether that glucose has come from carbs you've eaten or proteins and fats you've eaten that will be metabolised into glucose in the absence of carbs. Or just glucose released by your liver store, or ultimately glucose from muscles and existing body tissue. Our brains will grab glucose from wherever it can and at the expense of other bits of us, in extremis. Thus you can still get glucose releases without eating anything.

So I wondered if those BG surges you've told us about earlier, even when you haven't actually eaten, were being caused by internal glucose releases. A further factor is that the brain is the one bit of us that does not need insulin to help transfer glucose from blood to cells. We tend to not know when the brain is working hard and drawing glucose out of our blood; if we are exercising or physically active a circumstance has taken place that we know about and can use to explain something to ourselves. We are generally blissfully unaware when our brains are working hard!

There are so many things that can affect our BG that it can be really tricky to see the wood from the trees. It is why I was so impressed with your Practice Nurse deciding to give you a Libre 2 (and now for the time being continuing that help). Your symptoms and circumstances are confusing - and one BG factor may be overwhelming another; recent posts sound unduly complicated, possibly because 2 factors are mixed together and its not so evident about what is causing what. So extra visibility from Libre makes so much sense. In theory you might get a reasonable view from frequent finger prick tests - but so much easier from a CGM graph. I reiterate my non-medical thoughts that, because you are most unlikely to go hypo, I don't believe it is important to get readings continuously from one fortnight to the next. The big thing for me would be to identify possible explanations if at all possible, try to explore those methodically and thus eliminate each possible explanation (or not as appropriate). Within that methodology try and monitor just one thing at a time; so try not to introduce more than one variant at a time. If you change a parameter, such as type of meal or a certain level of activity, let that run for a couple of days and see what that tells you - if anything. And so on. I do understand this is not simple. In real life "stuff" intervenes.

Anyway, I am not any sort of expert on this and my thoughts could be totally off track. Good luck.

 

[Coanda_24]

As you are a new returner to the forum you may not have noticed this link that I have posted which people have found useful. There are some do's and don'ts with some meal plans to suit various tastes and budgets. It is a low carb approach but no a NO carb one. https://lowcarbfreshwell.com/

Thanks for sharing this. It’s really helpful in breaking down the eating plans.

 

[Coanda_24]

Thanks for keeping us updated @Coanda_24

Hope your HbA1c continues to gently reduce so that the Gastro team are able to investigate.

Thank you for saying. I just wanted to say how thankful I am for all of the support from this forum and all the contributors.