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What determines medication?

G

guybrush

Member
I was diagnosed type 2 at the beginning of Dec 2024. My Hba1c was 75.

I was immediately put on metformin. 1 a day for a week. Then 2 a day for a week. Up to 4 a day. Also Glicozide 2 a day.

What determines what i was put on? I've seen people have completely different meds, or none at all?

The nurse said once I have my hba1c test again in Feb that i will potentially come of Glicozide. When I asked about metformin she said "oh no you'll be on that for life" I was a bit taken back by that. She said maybe not 4 a day but certainly some. It's a good drug to be on, it has many functions that are good for your health. Cardiovascular etc...

That might be true but IF my hba1c is down under 42 surely it's worth coming of the metformin to see how my insulin can cope on its own?

Thoughts?
 
guybrush said:
That might be true but IF my hba1c is down under 42 surely it's worth coming of the metformin to see how my insulin can cope on its own?
Click to expand...
Metformin is one of those drugs that some suspect as being of benefit for a variety of things. I've no idea how strong the evidence is for most of them but it doesn't seem like it's a particularly risky drug. If you're in England, being prescribed at least some medication entitles you to a medical exemption certificate, so there's that if nothing else.
 
guybrush said:
I was diagnosed type 2 at the beginning of Dec 2024. My Hba1c was 75.

I was immediately put on metformin. 1 a day for a week. Then 2 a day for a week. Up to 4 a day. Also Glicozide 2 a day.

What determines what i was put on? I've seen people have completely different meds, or none at all?

The nurse said once I have my hba1c test again in Feb that i will potentially come of Glicozide. When I asked about metformin she said "oh no you'll be on that for life" I was a bit taken back by that. She said maybe not 4 a day but certainly some. It's a good drug to be on, it has many functions that are good for your health. Cardiovascular etc...

That might be true but IF my hba1c is down under 42 surely it's worth coming of the metformin to see how my insulin can cope on its own?

Thoughts?
Click to expand...

There are guidelines, which pretty much consist of 1 medicine (Usually Metformin) plus lifestyle changes.
If this fails to reach targets, add another tablet.
Then a third tablet.
It's all based around trying to get hba1c to an agreed target via medication and lifestyle.

Despite a hba1c of 83, I was only put on a low dose of Metformin and told to lose weight and cut carbs. It was halved 3 months later as I was down to 36, then eventually stopped completely.

The other benefits of Metformin aren't conclusive. My surgery doesn't want people to be on medication if they don't need it, so they were quite quick to stop it and see what happened.
 
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harbottle said:
There are guidelines, which pretty consist of 1 medicine (Usually Metformin) plus lifestyle changes.
If this fails to reach targets, add another tablet.
Then a third tablet.
It's all based around trying to get hba1c to an agreed target via medication and lifestyle.

Despite a hba1c of 83, I was only put on a low dose of Metformin and told to lose weight and cut carbs. It was halved 3 months later as I was down to 36, then eventually stopped completely.

The other benefits of Metformin aren't conclusive. My surgery doesn't want people to be on medication if they don't need it, so they were quite quick to stop it and see what happened.
Click to expand...

This is what I don't understand. Why was I given 2 different types of tablet? If there are guidelines then we have been given different ones!
 
@guybrush I was prescribed Metformin when first diagnosed back at the end of September with a similar ramp up in amounts, however I told the nurse that I felt I could achieve the changes needed via diet and exercise alone and initially they were happy to go with that approach. However, I had some major weight loss (about 1 stone over two months) and they got concerned especially when a random BG test at the end of November gave a result of 8.4 over two hours after I had eaten. As a consequence I have agreed to take 1 a day although preferably they would like me to take at least 2.

My understanding is that if your HbA1c is high (mine was 86) then they want to bring it down as fast as possible and Metformin has some kind of impact on your metabolism by improving how you body uses insulin thus reducing free BG in your blood. Glicazide increases the amount of insulin produced by the pancreas which in theory should work in conjunction with the Metformin to improve BG absorption and reducing the amount of free BG in your blood.

If you can get your HbA1c down low enough then the doctore should stop prescribing the drugs to see if you can maintain a healthy level for three months at which point they may mark you as in remission..
 
People's individual circumstances and medical history will probably determine what will be a suitable medication regime. The various medications work in different ways and some people may be intolerant to some of them which is why you will see that people will be taking different ones or combinations and different doses.
In most cases diet is a crucial factor and GP's will often assess how committed to engaging with changes people are prepared to make. It will also depend on how high their HbA1C is when diagnosed.
Other medical conditions will also play a part and how your body responds to the medication but at the end of the day it is really what works for you.
There are people who by making significant dietary changes either don't need medication or can reduce of come off it once their HbA1C is normal.
 
Although I was a smidge higher than you @guybrush at 76, I was only put onto Metformin, going from 2 to 4 per day. At my next hba1c I was down to 54 and kept on the higher dose, until I dropped below 42 and then told I could reduce metformin to 1 a day, to benefit from the heart protection it apparently brings. I'm happy with this, and to remain on the diabetic register to enable my annual checks to continue.
If your hba1c has come down significantly in February and you're happy to maintain a low carb lifestyle, you can always argue against the metformin at a later date. Fingers crossed for a good result for you!
 
I was put on metformin when diagnosed, it always upset my tummy, even after switching to the slow release one. Then I went down from 4x tabs a day to three. The tummy upset was much less, but still had it a bit. Then I started the T2D pathway to remission diet (basically the Newcastle diet), and was advised to stop taking metformin on the first day of the diet.
I have not taken any ever since then, so I am diabetes med free at the moment.
Just finished the first 12 week diet part, now on food re-introduction part. Weight loss and waistline reduction are all good and BG levels are stable in healthy range.
So it most certainly is possible to stop taking metformin, (depending on your own personal medical circumstances of course).
 
To be honest there is a lot of guesswork or GPs prescribing their favourites. Metformin is almost always started which probably makes sense. It doesn't do a lot but has few downsides apart the bowel issues which some have and the SR version can help. I was surprised to see NICE are still listing Pioglitazone which a few years back was found to cause cancer, I believe, in a small minority? In many ways it's hit or miss in general for meds as there are few good tests to determine the cause of your diabetes and hence the optimal meds.
 
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