Stopping medication

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Dornfield

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I have adopted a low carb diet (I don’t obsess over counting, but just much less than I used to consume), and I (58M) have shed a bit of weight (87kg down to 83kg) but again, at four weeks in, this is ‘ sensible’ weight loss rather than dramatic. Only a moderate increase in excercise from a largely sedentary existence beforehand. My CGM is normally in the 6.5-7.2 range throughout the day, with reasonably well contained post prandial glucose ‘spikes’ (humps) eating veggies first and apple cider vinegar. So, BG is still a bit high (as measured by the CGM anyway).
My question is, given I am also still medicated with Metformin (2x500ug twice a day) and Atorvastatin (20mg in the evening), what are the ‘break points’/ triggers that would allow me to consider halting drug therapy? I presume my Blood Glucose concentration is still being impacted by the Metformin. Does it need to have dropped to <5.6mmol/L before you’d even contemplate stopping Metformin, or is this something that you should only ever do with the blessing of your GP?
 
It's when your HbA1c blood test has consistently proved to have dropped to much lower levels than the 48+ level you were last proved to be - not simply just because your CGM estimates it to be there! No way is that likely to happen after a couple of weeks.
 
You’d need your a1c to be consistently in the non diabetic range, under 42, before considering stopping it. As a1cs are usually annually then I’d consider it in a couple of years time.
 
I am not seeing if you posted what your HbA1C was when diagnosed but it will only be when your HbA1C goes down to below 48mmol/mol for 2 consecutive tests and even then people are often 'required' though your decision, to stay on the medication until their HbA1C is below 42mmol/mol.
The CGM or finger prick tests are not a particularly good at predicting HbA1C, for some people they do seem close but not everybody.
 
They stopped my medication. So I would be advised by your GP or DN whoever gives your prescription. i would not stop medication of my own back.
Also at the moment, your readings are that with Metformin so coming of it may set it to rise.
As they say remission is less than 42 mmol and that over a couple of HbA1c tests but they have stopped my medication and my readings have improved.
So it is not all about diet and medication.
 
You should never reduce or stop taking diabetes medication without the agreement of your GP or DN. I was on Metformin after diagnosis but only stopped taking it when my DN said she didn't think I needed it any more, and that was after several weeks of suffering with the side effects. I could have hugged her.
 
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Historical HbA1c results
Sept 2018 6.1% (43 mmol/mol)
Oct 2018 6.1% (43 mmol/mol) (too soon: I wonder if this was 2019?)
June 2022 8.9% (74 mmol/mol)
Sept 2023. 6.8% (51 mmol/mol)
Feb 2024 6.2% (44 mmol/mol)

Thanks for the insights. This are my HbA1c test results. Metformin since that high 74 (post-pandemic) reading. So the reduction in 2023/24 is largely due to medication, although I had a modest weight loss. My diet did not change dramatically. It’s only more recently that I have gone very low carbohydrate, so hope the next test will be lower still.
But normal HbA1c is also impacted by age, and I’m much closer to 60 than I am to 50. Is any ‘allowance, made for age? Or is the level of HbA1c that is deleterious to health unconcerned with what age you happen to be? I would imagine that is the case, and so it must be harder to achieve drug free remission as you get older, and the benefits of remaining on a BG lowering medication outweigh any other considerations.

Thanks for your useful comments.
 
Dornfield said:
Historical HbA1c results
Sept 2018 6.1% (43 mmol/mol)
Oct 2018 6.1% (43 mmol/mol) (too soon: I wonder if this was 2019?)
June 2022 8.9% (74 mmol/mol)
Sept 2023. 6.8% (51 mmol/mol)
Feb 2024 6.2% (44 mmol/mol)

Thanks for the insights. This are my HbA1c test results. Metformin since that high 74 (post-pandemic) reading. So the reduction in 2023/24 is largely due to medication, although I had a modest weight loss. My diet did not change dramatically. It’s only more recently that I have gone very low carbohydrate, so hope the next test will be lower still.
But normal HbA1c is also impacted by age, and I’m much closer to 60 than I am to 50. Is any ‘allowance, made for age? Or is the level of HbA1c that is deleterious to health unconcerned with what age you happen to be? I would imagine that is the case, and so it must be harder to achieve drug free remission as you get older, and the benefits of remaining on a BG lowering medication outweigh any other considerations.

Thanks for your useful comments.
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NICE brought out some new guidelines based on some research that suggested that the more elderly who may have multiple health issues and be frail were being overmedicated to keep their HbA1C low and that an individual plan should be put in place.
I would not say at the age you are you would classify as 'elderly' and age should not influence what you should be aiming at unless of course you are anaemic for example as that may affect the accuracy of the HBA1C test.
Low carb is likely to have greater effect than metformin so you change to that regime hopefully will be reflected in you next result.
 
At diagnosis I was really unwell taking Metformin and Atorvastatin, so after 5 weeks of hellish side effects I stopped taking them and relied on diet alone.
I seem to be going on well enough over 7 years later, so, from my own experience, stopping the tablets was a sensible thing to do. It took some time to recover, but I did, and I find that telling myself that there is always the option of tablets is a sure way to stiffen my resolve to avoid high carb foods.
 
Have you and your GP discussed using your CGM to monitor the effect of halving Metformin for a trial period? Would need a bit of planning.
 
Leadinglights said:
NICE brought out some new guidelines based on some research that suggested that the more elderly who may have multiple health issues and be frail were being overmedicated to keep their HbA1C low and that an individual plan should be put in place.
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According to NICE guidelines everyone should have an individualised treatment plan, though having read so many members' experiences I don't think that happens all the time.
Leadinglights said:
I would not say at the age you are you would classify as 'elderly'
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Out of interest, at what age would you class someone as elderly?
 
Martin.A said:
According to NICE guidelines everyone should have an individualised treatment plan, though having read so many members' experiences I don't think that happens all the time.

Out of interest, at what age would you class someone as elderly?
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I think 'elderly' is both in the mind as well as the body. So that is a very good question. I regularly ring church bells with people in their late eighties and although physically they struggle with the spiral staircases they are as on the ball as the rest of us with their ringing.
So I don't really know.
 
on this site it says “

Older people​

As people age, their target HbA1c may be increased by their diabetes healthcare team. This is because the risks of keeping your Hba1c to a target of 48mmol/mol may outweigh the benefits.For example, there may be greater risk of a harm from a fall due to a low blood sugar than the risk of long term health problems linked to higher blood sugar levels. If you are unsure if your target have changed or why your targets have changed you should ask your diabetes team about it at your next appointment.

However, I think that is more to do whether one is frail rather than getting older.
As Leadinglights says your body might fail first rather than your mind. A young person can get older due to ill health.
 
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Leadinglights said:
I think 'elderly' is both in the mind as well as the body. So that is a very good question. I regularly ring church bells with people in their late eighties and although physically they struggle with the spiral staircases they are as on the ball as the rest of us with their ringing.
So I don't really know.
Click to expand...
Good answer. Diplomatic even. As I read somewhere, the trick is to get older without getting old.
 
Partly it is relative. A five-year-old may think their teacher is old, when they are actually in their late twenties or thirties! When you are in your 40s you may think those in their 60s are old, but when you are 60 that becomes late 70s or 80s.........

It is also very much to do with attitude, mental and physical well-being. Sometimes I do feel like an old woman, but not always.
 
I haven't discussed my CGM (Dexcom One) with my GP as yet. It is more an aid to see what effect certain foods/ behaviours have on spikes, and to that end it has been very revealing. With a view to reducing alcohol consumption in general, I used to enjoy a particular brand of non-alcoholic Belgian beer, but after two very small bottles, had an enormous CGM spike. Alcohol-free yes, but demonstrably not maltodextrin-free! Guess I need to stick to the malt whisky.
I'll probably wait for my next scheduled round of tests and discuss then.
 
My medication was halved as soon as hba1c was in the thirties. Three months later it was still in the thirties. Earlier this year it was stopped completely. Three months later it was still in the thirties. Conclusion was that it wasn’t doing anything,
 
Some recent research (not to hand as I write) has found Metformin acts on mitochondria to reduce the amount of food digested and thereby glucose. When HbAic is back down in the mid 30s (near normal?) secretion of insulin by beta cells and regulation of glucose and lipids is restored. On this basis Metformin has nothing to do as the body can handle normal levels of glucose anyway. Such as those resulting from the varied diet Harbottle described in a recent post. The research also indicated Metformin inhibits regeneration of beta cells after exercise. That's not good. Better stopped than continued?

Note: I refused Metformin as no one seemed to know how it worked. Instead I relied on Professor Taylor's dietary research (Counterpoint study in c.2008) to get my blood glucose down to below 6 mmol/l in 7 days.
 
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Dornfield said:
Historical HbA1c results
Sept 2018 6.1% (43 mmol/mol)
Oct 2018 6.1% (43 mmol/mol) (too soon: I wonder if this was 2019?)
June 2022 8.9% (74 mmol/mol)
Sept 2023. 6.8% (51 mmol/mol)
Feb 2024 6.2% (44 mmol/mol)

Thanks for the insights. This are my HbA1c test results. Metformin since that high 74 (post-pandemic) reading. So the reduction in 2023/24 is largely due to medication, although I had a modest weight loss. My diet did not change dramatically. It’s only more recently that I have gone very low carbohydrate, so hope the next test will be lower still.
But normal HbA1c is also impacted by age, and I’m much closer to 60 than I am to 50. Is any ‘allowance, made for age? Or is the level of HbA1c that is deleterious to health unconcerned with what age you happen to be? I would imagine that is the case, and so it must be harder to achieve drug free remission as you get older, and the benefits of remaining on a BG lowering medication outweigh any other considerations.

Thanks for your useful comments.
Click to expand...

It's possible that your second HbA1c was done at the time you have listed, less common with pre-diabetes (42-47 mmols) but HbA1c is often repeated within 3 months to check for diagnosis at lower diabetic levels (48-50s)
 
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