what does the HbA1c need to be before medication is prescribed?

[Carina1962]

I am Type 2 and get my first HbA1c results on 5 Jan. I was wondering what reading it has to be before the DN and GP decide to put one on medication?

 

[Steff]

hi carina i think seen as this is your first hbA then i aint to sure if they can gage whether u need to go on pills or not, how long ago did you have test done and how long have you been diabetic? with me my first hbA was 9.4 and he left me diet controlled for first 3 weeks., then decided to put me on when he weighed me and seen no results

 

[AlisonM]

My first was 11.7 and I was put on pills straight away.

 

[Einstein]

It very much depends on what your results were at diagnosis and how you are managing your diabetes.

There are some GPs who were prescribing Metformin and other tablets to type 2 patients on diagnosis, before letting diet and exercise regimes be tried with the individual patient.

You also need to consider in advance how you are feeling within yourself with your current management. If asked on the spur of the moment you will tend not to look all the way back through the past six or twelve months.

As with all things to do with diabetes, try not to worry about it. The more you worry, the worse things appear. Eat and drink in moderation over the next couple of weeks and good luck!

 

[Carina1962]

I was diagnosed in October this year and my fasting level was 7.8. I have lost quite a bit of weight and i try and do some excercise every day but in this cold weather my walking has gone out the window but i do have an excercise machine in my bedroom which i try and do 10 mins a day on. I thought i was doing really well with my BS levels to start with but just recently my after meal readings have not been as great as in the beginning so i am sort of expecting to go on medication but i'll have to wait and see. Although i would prefer to carry on with diet and excercise if medication will help lower my levels that i won't mind taking it but not sure if i am told to take it should i ask to be given more time in trying to get them down myself with diet and excercise? i'm just worried that if they are high then the longer this happens the worse it will be for me. When i get a high level i do start to worry. Tonight my level was 10.1 after my main meal but i was in a bit of a rush tonight and i stopped off at the chippy/chinese and had a small portion of mushy peas and some spare ribs and thought it would be OK.

 

[Steff]

sounds like your going the right way the exercise your doing is really good, the best thing to do is when you go in for your results just make it clear you want to be given more time on the diet/exercise , i mean thats for your gp and you to discuss but if your losing weight and generally going ok then id say so to him.

 

[twinnie]

the doctor didnt even wait untill my appointment he phoned me up and he had left tablets {glizade} at the 24 hour chemsit for me my hb1c was 13.6 i think it depends on the docs and the dsn 🙂 good luck

 

[wallycorker]

When I was diagnosed my HbA1c was still quite low and in the 5s. It stayed that way for quite a long time - around three or four years. However, it did slowly start to climb. My GP prescribed metformin when it reached 9.4%.

With the hindsight of knowing what I know now, I wouldn't have let that happen myself. I'd have made dietary changes earlier - i.e. mainly cutting back dramatically on the starchy carbohydrates that I eat - i.e. cereals, bread, potatoes, pasta and rice. That leads to a very big and quick improvement of blood glucose levels in most Type 2s.

These days, my HbA1c results are back in the 5s for the last four tests and 5.3% for the last two. I'm going again for another test tomorrow and expect that to be the same and possibly lower still.

Best wishes - John

 

[sofaraway]

I think that that NICE guidelines for treating type 2 say that if that A1c is above 6.5% then metformin should be prescribed and if after that it still above then gliclazide is to be prescribed, theres a flow chart that the doctors should be using. But it also depends on the individual patient.

 

[LisaLQ]

Mine was 6.7, and I'm staying diet controlled, so the cut off must be higher than that.

 

[Einstein]

Mine was 6.7, and I'm staying diet controlled, so the cut off must be higher than that.

The problem with NICE is that not everyone reads it and when they do, often there is a PCT is looking over their shoulder at the cost of prescriptions etc.

I feel 6.5% is a low figure really to be prescribing medication. Ok, if after 12 months of diet the figure can't be reduced any, but it's still pretty bordeline in my opinion.

 

[cazscot]

My hba1c on diagnosis was 7.2 and I was put on Meformin straight away. But I had been attending weightwatchers and had upped my excercise for a couple of months before that so nurse took the decision just to put me on medication. But everyone is different.

 

[Vanessa]

Cazcot's story indicates how every one of us should be treated as an individual case. In my view, the decision about treatment should be taken by you on the advice of your GP and in the context of your full medical history.

 

[Peter C]

I am Type 2 and get my first HbA1c results on 5 Jan. I was wondering what reading it has to be before the DN and GP decide to put one on medication?

Hi Carina,
NICE guidelines state that if the HbA1c remains at or above 6.5 after a trial of diet and exercise then metformin should start.
But earlier this year Diabetes UK launched a big campaign stating that many T2s were prescribed medication "too soon". The general thought now is that the medics should hold off from early prescription of meds because the T2s have to understand the absolute NECESSITY for diet and lifestyle changes.
On the other hand, the UKPDS ( the massive research effort in the 1990s) showed that complications start at 6.2 so they can't let T2s pussy-foot too long on D&E if they are not getting under 6.5.
As far as medications are concerned, you shouldn't really try to fight against them ; T2 diabetes is a pervasive, malign force that effects every cell and function of the body adversely - you need to come out at it with all guns blazing.
Here's the news story from last March...
http://news.bbc.co.uk/1/hi/health/7930007.stm

 

[Corrine]

It does depend on the person - I was 7.2 on diagnosis over a year ago and my last one was 6.1. However, after congratulating me on my efforts and saying it was 'perfect' the Doc still wanted to prescribe me metformin - which I turned down! Why would I want to do that after being told how well I was managing.....pah.

 

[C*5_Dodger]

All Docs Are Different!

It does depend on the person - I was 7.2 on diagnosis over a year ago and my last one was 6.1. However, after congratulating me on my efforts and saying it was 'perfect' the Doc still wanted to prescribe me metformin - which I turned down! Why would I want to do that after being told how well I was managing.....pah.

Dear Corrine,

I'm with you on this one - my Doc wanted to put me on Metformin at my last review and my HbA1c was 5.7. Needless to say, I'm still meds-free after 16 years!

Warmest Regards Dodger