Newly diagnosed - metformin question

[SuzieL]

Hi
I have been prediabetic for a year or so and my HB1ac level has crept up to 49. Yesterday I was prescribed metformin to be taken as follows: 1 x 500mg a day for a week, then 2 a day working up to 4 x 500mg In 4 weeks. From everything I have read so far, 2000mg is the maximum dosage for metformin, which leads me to ask why I am heading straight for maximum dose? My GP and the diabetic nurse specialist are both on holiday now for 2 weeks so am asking advice on here. I didn’t start them yesterday as I have questions around the dosage amounts. Any advice welcome. Thank you

 

[rebrascora]

Hi and welcome

It does seem a bit excessive to start you on Metformin let alone set you on a course to increase it to maximum dose when you only have an HbA1c of 49. I would be getting in touch with your Health Care Professionals and negotiating a 3 month hiatus on medication to see what you can achieve through dietary changes and exercise. Perhaps they feel that you have had more than a year to make those changes and still not prevented the full blown onset....ie you crossed the HbA1c diabetic threshold of 48 and that you are perhaps not able or willing to make lifestyle changes and so need medication.

Unfortunately the NHS do not always give people appropriate dietary advice when it comes to diabetes. Did you make any lifestyle and dietary changes when you first got the warning pre diabetic reading. Were you offered a course?

 

[Anitram]

Hi
I have been predisbetic for a year or so and my HB1ac level has crept up to 49. Yesterday I was prescribed metformin to be taken as follows: 1 x 500mg a day for a week, then 2 a day working up to 4 x 500mg In 4 weeks. From everything I have read so far, 2000mg is the maximum dosage for metformin, which leads me to ask why I am heading straight for maximum dose? My GP and the diabetic nurse specialist are both on holiday now for 2 weeks so am asking advice on here. I didn’t start them yesterday as I have questions around the dosage amounts. Any advice welcome. Thank you

Hi. Welcome to the Forum.

Can I just say that I'm really surprised that you're on medication with an HbA1c of 49, as I would usually expect someone at that level to be advised to make some simple lifestyle changes around diet, exercise and sometimes weight loss. I expect though that your GP and DN must have had good reasons for putting you on Metformin.

Martin

 

[SuzieL]

Thank you for taking the time to reply, much appreciated. I was sent on a diabetic awareness course last year when level was at 47 and started the Blood Sugar Diet - I lasted about 10 days but found I was obsessing about what my next meal was going to be and the prep needed , all day.
Unfortunately I became quite ill in March and was hospitalised with Covid19 and Pneumonia. I didn’t eat for 8 days or so and only small amounts when I started to recover. Since then my blood sugars have gone up to 49, which isn’t surprising as I have been very inactive due to lungs being affected and fatigue. When the nurse called to talk about it, she said that as my weight had gone up then maybe it was a good idea to take a good crack at it with the meds but it was ultimately my choice. I asked if the meds could be temporary and she said absolutely and that if I lost weight etc it could send my diabetes into remission. Unfortunately they were both on holiday by the time I picked up the prescription yesterday and read the intended dosage. I have an appt on 18th Aug so may hold off taking the tablets until I can get more clarity. I have bought a blood sugar monitor and it varies - this morning it was 6.3 when I got up and tonight, 2 hours after dinner, my bloods were 9.6.

 

[everydayupsanddowns]

Welcome to the forum @SuzieL

Sorry to hear about your brush with Covid.

It could well be that you would benefit from a gradual start on met to support your dietary changes, which you could always then either increase or reduce depending on how your results go?

 

[everydayupsanddowns]

It does have a bit of a reputation for ‘gastric upheaval’ though, so do take it in the middle of a reasonable-sized meal, and consider increasing the dose gradually it you decide to gove it a go.

There is also a ‘slow release’ version which is kinder on the stomach for many people who struggle with regular met.

But of course, the other option would be to focus more on reducing carbs in your diet to begin with and to see if losing some weight helped your body metabolise the carbs you were eating.

If you give folks here an idea of an average day’s food, they may be able to offer you some helpful suggestions, swaps and tips from their own experience

 

[Anitram]

Thank you for taking the time to reply, much appreciated. I was sent on a diabetic awareness course last year when level was at 47 and started the Blood Sugar Diet - I lasted about 10 days but found I was obsessing about what my next meal was going to be and the prep needed , all day.
Unfortunately I became quite ill in March and was hospitalised with Covid19 and Pneumonia. I didn’t eat for 8 days or so and only small amounts when I started to recover. Since then my blood sugars have gone up to 49, which isn’t surprising as I have been very inactive due to lungs being affected and fatigue. When the nurse called to talk about it, she said that as my weight had gone up then maybe it was a good idea to take a good crack at it with the meds but it was ultimately my choice. I asked if the meds could be temporary and she said absolutely and that if I lost weight etc it could send my diabetes into remission. Unfortunately they were both on holiday by the time I picked up the prescription yesterday and read the intended dosage. I have an appt on 18th Aug so may hold off taking the tablets until I can get more clarity. I have bought a blood sugar monitor and it varies - this morning it was 6.3 when I got up and tonight, 2 hours after dinner, my bloods were 9.6.

Really sorry to hear about your Covid-19 and hope you're on the mend now.

For a T2 your fasting reading in the morning, taken as soon as you get up and before you eat of drink anything, should be between 4 and 7 so your 6.3 is in range, and two hours after eating it should be less than 8.5, so can I ask what you had for dinner?

Martin

 

[ianf0ster]

Hi, Because I used it to get my T2 Diabetes into remission (back down in the low pre-diabetic range so far) I would suggest you try Low Carb Higher (traditional) Fat as a Way Of Eating (not a Calorie restricted diet) at first.

Like others I'm very surprised that they put you straight on Metformin. Although Metformin can help a little, it doesn't compare with the improvements made by going Low Carb. Also the problem is that many T2D people started on the medication route never get around to tackling the cause (carbohydrate intolerance) and so get on a spiral of increasing medication and without that lifestyle change once they get onto Insulin then their weight will increase making the problem worse.

I'm not surprised that you couldn't last long on the Blood Sugar Diet. If your problem wasn't dealing with the starvation - just the food prep and obsessing about the next meal, then perhaps going down the Newcastle Diet (meal replacement shakes route would suit you better.

However I would still prefer the LCHF 'Way Of Eating' route because:
1. It focusses on the actual problem by cutting the carbs, not necessarily the calories.
2. It reduces the Blood Glucose immediately and results can be monitored using a BG meter on meal by meal basis.
3. For many/most, nothing else is required e.g. no need to get lots of exercise to burn off calories.
4. Weight loss is a side effect for most people, making getting a reasonable amount of gentle exercise much easier.
5. It is completely sustainable if you find the right foods (those you enjoy).

 

[rebrascora]

I too would look at just reducing your carb intake by swapping high carb foods for lower carb alternatives rather than following a set diet plan.
As suggested above, if you give us an idea of what you currently eat and drink on an average day, ie a typical breakfast lunch, dinner and any snacks and drinks, we can suggest where you can make changes to lower your blood glucose and therefore improve your diabetes management. Learning how to eat low carb takes time and a bit of trial and error. It is contrary to the way most of us have spent our lives eating, so it takes a bit of getting your head around but once you figure out what to buy and how to cook it and find things you enjoy just as much as the things you now need to avoid, it all gets a lot easier.
It also really helps to keep an honest food diary of everything you eat and drink so that you can see where extra carbs can be cut out. A low carb diet can be just as enjoyable as a carb heavy diet but it is just different and it takes time to find those new favourite foods/meals.
For instance, one of my daily luxuries is coffee with double cream.... I always said that I would rather not drink coffee as drink it without sugar. I didn't spoon sugar into my cup I just tipped it in pre diagnosis. Now I drink it without sugar or sweetener but I have cream in it and it tastes heavenly. Every morning I sit and really savour that cup of coffee in a way I never did with sugar. The cream is lower carb than milk and obviously much lower than sugar and the fat helps to keep me feeling full and provides slow release energy for the day ahead. This may not appeal to you but there will be other low carb alternatives which you will enjoy and will become a part of your daily routine and we can help you find them.

 

[NotWorriedAtAll]

Hello SuzieL,

I'm one of those (possibly irritating) people who have 100% enjoyed everything that followed from my Type 2 diagnosis so I will be burbling away about how much fun I've had changing my eating habits to the point where my blood sugars have been under what my medics have called 'excellent control' and I call "eating whatever I liked and it doing me good instead of doing me harm" for over a year now.

Sorry about your Covid experience, being ill can play havoc with blood sugar levels on top of the horrible experience it is in the first place. My own diagnosis came after Winter and Christmas 2018 which tipped me over the edge from prediabetes to actual diabetes. You can see a summary of my experience in my signature underneath this post.

Also in my signature under this post you'll see a link to my Facebook page that I started to keep track of my experiments in swapping out high carb food choices for very low carb high fat (aka keto) choices and then I developed into translating 'naughty' foods into keto versions that tasted the same or better and had the same mouthfeel as the originals.

One of the things that made me irritated were recipes that purported to be 'just as good' and 'delicious' but had soggy textures where I had learned to love crunchy textures - such as pastries and shortbread biscuits and crusty bread.

It took me over a year to work out how to replicate the taste and texture and smell of those particular components so they would genuinely be very low carb (not just like other 'low carb' recipes that are only low carb if you eat teeny tiny portions that were basically just tastes instead of meals) and fit in with my way of eating which makes me feel I've eaten a satisfying and deliciously naughty set of meals all day and actually they've had no effect on my blood sugars (and shouldn't logically have much of an effect on anyone's) and they've mostly been good for me as well.

So I'm going to say that with a little bit of a tweak on what ingredients you use and a change in some of the methods you use to cook you can enter what I felt was a bit of a Twilight Zone of eating without anxiety from now on and enjoying your food more than ever and it will only be of benefit to your overall health and wellbeing.

If you want to ask me any questions via my Facebook page feel free. I am so excited about what I found out it makes me super happy to share whatever information I can to help anyone feel a little less daunted by their diagnosis.