dannybgoode
Well-Known Member
- Relationship to Diabetes
- Type 2
Well, it's not really very cunning. Certainly not the sort of fox like cunning the professor of cunning at Oxford University would come to but a plan nonetheless.
So went to see the DSNs today and had a really good chat with them. The team at the Northern General are so good - was in for over an hour going through next steps and I'm happy my concerns have been listened to but also they've had more chance to go through things in more detail from their side also.
They completely understand why I'm so reluctant to try Metformin and make it clear that if I don't want to, I don't have to. I can just stay on insulin if I want.
However, they also explained that, if I do tolerate Metformin and given my training coupled with dietary changes I've already made, that its actually a really good drug and that the only way I'll know whether I can cope with it is to give it a go.
They gave me the choice to a) think about it, b) outright refuse it or c) to give it a go and at least find out.
So, I've agreed I'll try it starting on 500mg for two weeks, upping to 1000mg for another 2 weeks and topping out at 1500mg if all goes well. They don't think I'll manage 2000mg regardless.
If it gives me gastro problems I just stop taking it and let them know and that will be that. The DSN I saw does have other patients with an ileostomy and some are fine on Metformin, others have tried and simply can't take it.
Interestingly there is a note from the consultant that, as I thought, SGLT2's are contraindicated due to hydration concerns with my ileostomy as is the SR Metformin due to absorption issues.
The DSNs think that it may be the case I'll not be able to stop all insulin in any event but may well be able to come down to a basal only if I do tolerate the Metformin.
Not sure what's happening with the DPP4 options. They aren't entirely clear what the consultant wants to do with that and they said they are not often used. Given my particular medical history they want to be sure what the plan there is.
The big positive for me is that they have agreed Libre, at least for a few months whilst I look at transitioning to oral meds and we'll review that one way or the other depending on how the Metformin goes. They think it is beneficial for me, particularly given my exercise load and desire to manage my diabetes the very best I can.
I will also be very closely monitored whilst I trial it and they're running the bloods for my baseline lactate so they can keep an eye on any sign of MALA. I'll have regular face to face appts too.
Overall this seems a very sensible plan and one that I'm happy with.
Oh, and on 6th Dec when I was diagnosed my Hba1c was 121 and as of 27th Dec it was 94 so a pleasing reduction in a short-ish time. They're testing my Hba1c again also and I have another appt scheduled for end of Feb for an early review of how I'm finding the Metformin.
So all in all very positive and I feel I can relax a little bit and see how everything goes over the coming weeks.
So went to see the DSNs today and had a really good chat with them. The team at the Northern General are so good - was in for over an hour going through next steps and I'm happy my concerns have been listened to but also they've had more chance to go through things in more detail from their side also.
They completely understand why I'm so reluctant to try Metformin and make it clear that if I don't want to, I don't have to. I can just stay on insulin if I want.
However, they also explained that, if I do tolerate Metformin and given my training coupled with dietary changes I've already made, that its actually a really good drug and that the only way I'll know whether I can cope with it is to give it a go.
They gave me the choice to a) think about it, b) outright refuse it or c) to give it a go and at least find out.
So, I've agreed I'll try it starting on 500mg for two weeks, upping to 1000mg for another 2 weeks and topping out at 1500mg if all goes well. They don't think I'll manage 2000mg regardless.
If it gives me gastro problems I just stop taking it and let them know and that will be that. The DSN I saw does have other patients with an ileostomy and some are fine on Metformin, others have tried and simply can't take it.
Interestingly there is a note from the consultant that, as I thought, SGLT2's are contraindicated due to hydration concerns with my ileostomy as is the SR Metformin due to absorption issues.
The DSNs think that it may be the case I'll not be able to stop all insulin in any event but may well be able to come down to a basal only if I do tolerate the Metformin.
Not sure what's happening with the DPP4 options. They aren't entirely clear what the consultant wants to do with that and they said they are not often used. Given my particular medical history they want to be sure what the plan there is.
The big positive for me is that they have agreed Libre, at least for a few months whilst I look at transitioning to oral meds and we'll review that one way or the other depending on how the Metformin goes. They think it is beneficial for me, particularly given my exercise load and desire to manage my diabetes the very best I can.
I will also be very closely monitored whilst I trial it and they're running the bloods for my baseline lactate so they can keep an eye on any sign of MALA. I'll have regular face to face appts too.
Overall this seems a very sensible plan and one that I'm happy with.
Oh, and on 6th Dec when I was diagnosed my Hba1c was 121 and as of 27th Dec it was 94 so a pleasing reduction in a short-ish time. They're testing my Hba1c again also and I have another appt scheduled for end of Feb for an early review of how I'm finding the Metformin.
So all in all very positive and I feel I can relax a little bit and see how everything goes over the coming weeks.
to danny and his DSN for working so well together.