To take Metformin or not?

[suepledger]

Hi everybody
Recently had the result of my latest Hbc1a which says that I’ve gone from 7.0 to 7.2 (these are morning fasting readings) and my diabetic nurse wants to start me in metformin. What do you more experienced diabetics outthere think of this. I’ve managed to keep low figures with diet and exercise so am a bit miffed that I’m now being told I need to go on metformin. Anyway, I’m new to this and would welcome your comments please?

 

[MikeyBikey]

Hello and welcome.

I must admit I am slightly confused as the only fasting blood tests I have had done are blood sugar and cholesterol. HbA1c being a measure of average blood sugar over the preceding months and doesn't require fasting.

Be they either blood glucose or HbA1c they are slightly above the ideal values. Unless you have not addressed all the lifestyle changes seriously then I think you need to follow the DSN's recommendation. You can always come off them in the future if things improve (e.g. weight loss, exercise, temptation) although none of these may apply. Good luck.

 

[Gwynn]

Some say that there are benefits in taking Metformin. Some say the side effects can be a bit overwhelming, but there is a slow release version available to combat those side effects.

My view is that I will avoid taking any medicines that give side effects if I can.

It doesn't feel a huge increase in HbA1c to me and may well be within a testing error range so starting meds based on that change seems a bit strong and over reactive.

No one can tell you to take meds. They can advise you. You have the ultimate say and as you have to manage your diabetes based upon you and your knowledge (or lack of) of your body you must decide if meds are right for you. However, that depends on you knowing stuff and not just reacting emotionally.

Quite tough but it should get you asking questions and really searching out answers, which is what you are doing. Good on you !

 

[Docb]

Hi @suepledger and welcome to the forum.

I take it that the HbA1c results you quote are 7.0% and 7.2% which convert to around 53 mmol/mol and 55 mmol/mol, the units more usually used.

First off, they are to all intents and purposes the same.

Second is that they are both over the diagnosis level of 48 mmol/mol. Which means some action needs to be taken. They are only just over, so there is no need to panic about it.

Third that the result is not affected by fasting. If you were asked to fast before the test then that would be for some other reason than getting a good measure of your HbA1c.

Having got that out of the way, there are essentially four things you can think about in order to get back under diagnostic levels. In very simple terms these are:

1. Weight. If you are overweight (and not all T2's are) then there is a lot of evidence to say that getting your weight down to "normal" levels is a good bet to reduce your Hba1c.

2. Diet. Much of the glucose in your system (unless you are on a weird diet) comes from the carbohydrate you eat. For that reason reducing the carbohydrate in your diet is another good bet.

3. Exercise. This keeps the body systems working and helps all round health. Don't have to flog your self in the gym, anything you can do is a good thing but not a good bet to use exercise alone to get your HbA1c down.

4. Medication. There are medications that are proven to be effective in reducing HbA1c and in my mind should not be dismissed.

One of the things we say a lot on the forum is that there is no fixed, one size fits all, way of approaching blood glucose control. Each has to find a way to suit them but if you read around you will see those who succeed have tackled at least one of the things in my list. Some have hit one thing hard whereas others, including me, have rather more gently used all four. Depends on you, your lifestyle and circumstances.

 

[everydayupsanddowns]

Welcome back @suepledger

Great to see you again!

Sounds like you have been doing really well holding your diabetes at bay for a while, but perhaps things have begun to drift a little? Are you aware in any slight changes to your menu or activity levels over recent months? Have you been ill, or found things difficult over the lockdowns?

Were your fasting checks blood from the arm and sent to a lab? Or fingerpricks?

Might it help to keep a food diary for a week or two and note down all your meals, snacks, and drinks - along with a reasonable estimate of their total carbohydrate content?

Good luck, and keep asking questions 🙂

 

[suepledger]

Over lockdown there was a huge difference in my diet. Quite simply, I ate what I wanted, when I wanted! My husband who was Clinically Extremely Vulnerable and had to shield, we got stuff from the supermarket via home deliveries and the wonderful use of some very dear volunteers.
About two months before my Hbc1a test I had a UTI, never felt so ill and landed up at the hospital where I was prescribed Cipro. It took me a couple of weeks before I felt back to normal. I noticed (finger prick test in the morning) that my levels had gone up to 10! Alarmed I spoke to my Diabetic nurse who said it could be that as I was ill my pancreas had taken a hit and that as why my numbers were high. I waited another month and did an Hbc1a which showed that my levels had 8ncreased from 7 to 7.2.

I’ve been taking the Metformin and only had a problem when I took it in the morning after breakfast. I normally take it now after my evening meal.

I’ve lost weight from 78kg to 73kg and walk every day. I desperately want to come off metformin but have to wait another six months before I can have another test.

I’ve been pre-Diabetic for about 7 years so, as you can guess, I’m pretty gutted that I’m back on tablets.

I am nota great vegetable eater and find it really hard at times.

 

[suepledger]

Hi @suepledger and welcome to the forum.

I take it that the HbA1c results you quote are 7.0% and 7.2% which convert to around 53 mmol/mol and 55 mmol/mol, the units more usually used.

First off, they are to all intents and purposes the same.

Second is that they are both over the diagnosis level of 48 mmol/mol. Which means some action needs to be taken. They are only just over, so there is no need to panic about it.

Third that the result is not affected by fasting. If you were asked to fast before the test then that would be for some other reason than getting a good measure of your HbA1c.

Having got that out of the way, there are essentially four things you can think about in order to get back under diagnostic levels. In very simple terms these are:

1. Weight. If you are overweight (and not all T2's are) then there is a lot of evidence to say that getting your weight down to "normal" levels is a good bet to reduce your Hba1c.

2. Diet. Much of the glucose in your system (unless you are on a weird diet) comes from the carbohydrate you eat. For that reason reducing the carbohydrate in your diet is another good bet.

3. Exercise. This keeps the body systems working and helps all round health. Don't have to flog your self in the gym, anything you can do is a good thing but not a good bet to use exercise alone to get your HbA1c down.

4. Medication. There are medications that are proven to be effective in reducing HbA1c and in my mind should not be dismissed.

One of the things we say a lot on the forum is that there is no fixed, one size fits all, way of approaching blood glucose control. Each has to find a way to suit them but if you read around you will see those who succeed have tackled at least one of the things in my list. Some have hit one thing hard whereas others, including me, have rather more gently used all four. Depends on you, your lifestyle and circumstances.

Thank you for replying so fully. I was put on Glucophage 500 just once a day. This seriously upset my stomach so GP put me on a slow release Glucophage. Still the upset stomach.

My weight when I was put on medication for diabetes was 78.5kgs. I am now 71kgs. I’ve stopped taking any medication for diabetes when the stomach problems became serious enough that I could not leave the house and have been testing my morning readings and they’ve gone from 8.0 to an average of 5.0 to 6.5. This is the only way I understand it, sorry. I know that before starting on meds my A1c was 7.2 (50). My stomach has settled down completely. I guess what I’m saying in a roundabout sort of way is this: If I have reduced my morning fasting readings dramatically without medication with the help of a strict diet and exercise, then why should I take metformin to achieve what I have achieved without it? I’m going to speak to my Diabetic nurse tomorrow in the hope that she agrees with my decision that I’ve made to take myself off of it.

 

[Leadinglights]

With an HbA1C of 50mmol/mol then some GPs would give you the opportunity to try by diet and exercise to get it down. It sounds as if you are managing quite well to do that with the changes you have made. In any case dietary changes are still needed even if taking metformin as the metformin only helps the body to use the insulin it is producing more effectively but it can only do so much.
It is you decision whether to take the medication but I hope your nurse will support your view. Perhaps if you ask for another HbA1C test if it is 3 months since your last one to check the progress.

 

[suepledger]

With an HbA1C of 50mmol/mol then some GPs would give you the opportunity to try by diet and exercise to get it down. It sounds as if you are managing quite well to do that with the changes you have made. In any case dietary changes are still needed even if taking metformin as the metformin only helps the body to use the insulin it is producing more effectively but it can only do so much.
It is you decision whether to take the medication but I hope your nurse will support your view. Perhaps if you ask for another HbA1C test if it is 3 months since your last one to check the progress.

 

[suepledger]

Hi,
Spoke to my DN this morning and she is very pleased with what I’ve achieved. She has asked that I do another Hb1ac and I’ve booked that for tomorrow morning. So fingers crossed, I stay off the meds. She did say if I needed to go back on them, she would look at something different for me that wouldn’t play havoc with my tum. Thank you so much for your support and advice. It’s invaluable...thank you. I’ll keep you posted. Happy Christmas

 

[suepledger]

Just to let you know, I have been taken off Metformin and am officially now Pre-Diabetic! I’ve been extremely careful with what I’m eating and have managed to drop my weight from 12.4 to 11.0 stone. My DN is very pleased but for me it’s not the end of the story. My intentions are to get to a reversal of my diabetes. I need to lose another stone advocated by Professor Roy Taylor to achieve complete remission. I’m not following his 800 calories a day but rather dieting and walking. My morning fasting readings are now down from 10.0 to 6.3 evidence that what I’m doing is working....for me! I’m fully aware that diabetes is a progressive disease and feel positive that I can achieve total remission. I’m taking small steps to achieve the goal I want.

 

[Christy]

Fantastic!

 

[Norm1962]

I too am on Metaformin 850 x 3 times a day. My stomach gets very upset. I said to Dr but they didnt suggest an alternative ,I have small appetite now as I approach 60 soon. So I cannot eat little and often as advised

 

[gll]

I too am on Metaformin 850 x 3 times a day. My stomach gets very upset. I said to Dr but they didnt suggest an alternative ,I have small appetite now as I approach 60 soon. So I cannot eat little and often as advised

Make another appointment for this reason so it doesn't get lost in a conversation about other things. There is a slow release version you could try and other options of managing your levels. 🙂

 

[Leadinglights]

I too am on Metaformin 850 x 3 times a day. My stomach gets very upset. I said to Dr but they didnt suggest an alternative ,I have small appetite now as I approach 60 soon. So I cannot eat little and often as advised

There is no need to put up with the stomach issues as there alternatives, but it also depends on what your HbA1C is as to whether diet alone may be sufficient.
There are various theories about whether small frequent meals or more spaced out meals are better the idea being that frequent meals encourages over production and drip feeding insulin which is less good for blood glucose control than having well spaced out meals.