What will I need to reduce my HBA1C to, in order to keep off medication

[Jenny65]

Hi

My HBA1C level was 80, I am due my next test in 2 weeks time, my GP and DN have allowed me to try and manage by diet and exercise alone and I have lost over 2 stone and mysugr app shows my HBA1C should be about 44 (taken from my daily glucose tests) I am mainly keeping to under 7 with my readings but have had a few days were I am 11 (on one day 3 consecutive readings were in this range) but today for example I was 4.9 on waking, 7.2 after breakfast, 6.5 before lunch and 7.9 after lunch.

I am not sure what my DN or GP will require me to have lowered it to, to be able to continue without medication. I dont mind if I do need to have medication and realise this is a progressive illness and I am likely to require meds at some point in the future, but im trying to manage by myself for now. In particular I am concerned that my IBS which has basically cleared up since I have reduced carbs would return with vengance on Metformin. I used to have to go to the loo 12 times a day with my IBS but now I am just a once a day girl, and no pain or upset stomach, no constipation or diahorea. I dont want to go through that again and from the reported side effects this medication may result in this.

I am also losing weight easily now, its feeling like I am becoming younger and happier, more outgoing and apart from a lapse last week when I felt incredibly low and wanted to binge and stick 2 fingers up to this disease, I have been mainly positive, upbeat. Today I threw out and took to charity the clothes in much larger sizes (up to a size 22) and have bought some lovely trendy, stylish new clothes in size 14 (even one size 12). I go out and receive compliments about how well I look, apart from my manager who told me not to lose more weight as my face was looking gaunt! (it doesnt though, my knickname was cheeky as I had big cheeks, they now just look normal) I feel attractive and younger at the grand old age of 57, and have even joined a dating app this weekend) I dont want to lose all these benefits by having medication too soon.

Sorry for rambling on, but the thing I really want to know is what my doctor will be expecting for my next HBA1c result for me to carry on without medication.

 

[grovesy]

I personally find Mysgur app estimates of my HBA1C is always an under estimate of what the actual blood result is.
Metformin is only one of many medications for Type 2.

 

[Leadinglights]

I would have thought with all you have been doing that your HbA1C will have reduced considerably and if that is the case there would really be no reason for medication to be given at this stage and allowing you to continue as you are for another 6 months would be better. Don't forget it is always your choice to take the medication.

 

[Jenny65]

I personally find Mysgur app estimates of my HBA1C is always an under estimate of what the actual blood result is.
Metformin is only one of many medications for Type 2.

Yes I read that somewhere else too. I suppose it seems the med of choice for most, and I dont want one that would put weight back on as thats one thing thats working well at the moment. I will hope my result is 50 or less then, and hopefully wont be disappointed 🙂

I would have thought with all you have been doing that your HbA1C will have reduced considerably and if that is the case there would really be no reason for medication to be given at this stage and allowing you to continue as you are for another 6 months would be better. Don't forget it is always your choice to take the medication.

I hope you are right, I could probably have done more, but to give up smoking, diet and exercise is something I have achieved, I did have a couple of glasses of wine last night instead of dinner, which was a stupid thing to do but I just wanted to be social with my friends for the night and not increase my calories for the day - headache this morning to pay the price though.

And you are right about it being my choice, I keep forgetting that, even if they prescribe the medication and I collect it, I dont have someone with a gun to my head making me take it 🙂

 

[Deleted member 21371]

It entirely depends on you.
I went straight in on medication.
I decided longer term higher blood glucose would be more harmful than medication.
My view was there was absolutely nothing wrong with using all available options to reduce my BG.
(At a moderate rate)
After I had achieved that, I discussed the options against with my HCP team, and we decided it was no longer beneficial.

Other people have different methodologies.

I would say there is no point in agreeing to have medicine prescribed if you do not intend to take it though, it's a waste of NHS money, and totally misleads your HCPs with the care package they are giving.

 

[Jenny65]

It entirely depends on you.
I went straight in on medication.
I decided longer term higher blood glucose would be more harmful than medication.
My view was there was absolutely nothing wrong with using all available options to reduce my BG.
(At a moderate rate)
After I had achieved that, I discussed the options against with my HCP team, and we decided it was no longer beneficial.

Other people have different methodologies.

I would say there is no point in agreeing to have medicine prescribed if you do not intend to take it though, it's a waste of NHS money, and totally misleads your HCPs with the care package they are giving.

Yes, as soon as I typed that post I realised how wrong it was and as someone who works for NHS I agree with you entirely and of course wouldnt allow them to write out a prescription for medication I wasnt intending to take. I was just making a point that ultimately it was my decision but I can see how that read to others and apologise.

 

[Deleted member 21371]

Yes, as soon as I typed that post I realised how wrong it was and as someone who works for NHS I agree with you entirely and of course wouldnt allow them to write out a prescription for medication I wasnt intending to take. I was just making a point that ultimately it was my decision but I can see how that read to others and apologise.

I tend to tell my doctor everything, definitely warts and all.
It does mean he knows exactly what I'm doing, both good and bad, I find
we have better discussions that way.

 

[Jenny65]

I tend to tell my doctor everything, definitely warts and all.
It does mean he knows exactly what I'm doing, both good and bad, I find
we have better discussions that way.

Yes me too, in fact my doctor was very supportive of my plan to take control myself without meds, the DN was the same, so I am not sure why I think things will change following my blood test results. I am getting ahead of myself I guess. I was shocked by my initial result and am now expecting the unexpected when in reality if my level is still high it actually will show I need the help of medication. At least I will know I did all I could to see if I could manage without. I feel I ended up here because I was stupid about my food choices during lockdown, I basically changed from walking 7 miles a day (3.5 miles to work and back) eating sensibly so I could fit my work clothes etc) to eating takeaways (at least 4 times a week) and slumping on my sofa with my laptop, the only time I went outside was for a smoke. I lived in my PJs (unless on Zoom with work) and then I may just brush my hair and put on a top. I probably ate in excess of 4000 calories a day and smoked a packet of cigarettes every 3 days. I blame myself for developing diabetes and I suppose thats why I am looking to myself to get myself into remission. Not a punishment as such but a wake up call.

My doctor said I shouldnt blame myself for developing diabetes as plenty of other people gained weight and became couch potatoes in lockdown but not all got diabetes. It was in my genetic make up, I have always had thin legs and arms so all weight was on my middle (still is but in a smaller degree) I dont really blame myself in the same way I know that no one on here deserves to be sick, its just my own mental thought process that I am dealing with. In some ways I think back to my anorexic teen years and wonder if I had stayed more in control I would have been free from this, but I know 2 people who sadly lost their lives from the other extreme. The key in everything is moderation and some things just happen as bac luck through no fault, like my son having asthma, and my daughter having an auto immune condition, me gertting Pre-eclampsia etc, some things just happen and would happen anyway. Sorry rambling again, this place is good for getting me to open up and really helps.

 

[42istheanswer]

I don't know whether your GP would be happy with reduction at this point to pre- diabetic or want HbA1c to be under 42. If your doctor does want you to have medication, then you can ask about alternatives. There are other types that can be given as first line, the NICE guidance recommends that usually metformin is first due to it being much cheaper for the NHS but also says that others can be used if clinical judgment indicates metformin may not be appropriate. My practice nurse was willing to consider a couple of alternatives based on IBS history.

https://www.nice.org.uk/guidance/ng...rstline-and-further-treatment-pdf-10956472093 if you want to look at options (and look up side effects) to be prepared before your appointment

 

[AndBreathe]

@Jenny65 , it sounds like your A1c will be a goodly chunk lower than at diagnosis, although anything more accurate can only be an estimate.

I would like to think that with your positive changes in lifestyle - blood sugar, weight, smoking status and at least as importantly feeling so much better and more positive, that even if your A1c were not ideal that your medics would allow you to continue, to see where you can get to, with just a little more time.

Good luck with it all. You're doing really well.

 

[Jenny65]

@Jenny65 , it sounds like your A1c will be a goodly chunk lower than at diagnosis, although anything more accurate can only be an estimate.

I would like to think that with your positive changes in lifestyle - blood sugar, weight, smoking status and at least as importantly feeling so much better and more positive, that even if your A1c were not ideal that your medics would allow you to continue, to see where you can get to, with just a little more time.

Good luck with it all. You're doing really well.

Thank you for this positive response. This place really is a godsend isnt it, my family although they are supportive I think I have just become a bit of a bore and I can see their eyes glaze over when I start checking carbs when out for a meal etc (I am probably imagining it but wouldnt blame them). This place is a great outlet and no one will judge you for saying the same things over and over as reassurance is often whats needed and often more than once.

I don't know whether your GP would be happy with reduction at this point to pre- diabetic or want HbA1c to be under 42. If your doctor does want you to have medication, then you can ask about alternatives. There are other types that can be given as first line, the NICE guidance recommends that usually metformin is first due to it being much cheaper for the NHS but also says that others can be used if clinical judgment indicates metformin may not be appropriate. My practice nurse was willing to consider a couple of alternatives based on IBS history.

https://www.nice.org.uk/guidance/ng...rstline-and-further-treatment-pdf-10956472093 if you want to look at options (and look up side effects) to be prepared before your appointment

When you say you dont know whether my GP would be happy with pre-diabetic or under 42 is that the normal reduction they want or is it just a guide line. I have also heard that too much of a drop can cause issues with eye sight too, this is so confusing isnt it 🙂

 

[42istheanswer]

When you say you dont know whether my GP would be happy with pre-diabetic or under 42 is that the normal reduction they want or is it just a guide line. I have also heard that too much of a drop can cause issues with eye sight too, this is so confusing isnt it 🙂

I don't know what they normally want, I haven't had mine rechecked yet. Under 42 is normal, so would mean fully in remission. Under 48 would still suggest remission as below "diabetic" level, but at risk. So some GPs/ nurses may still want you to be able to reduce it further. But may not necessarily think starting medication immediately is needed as you'll have reduced it significantly already, so may think that more time on low carb will improve insulin resistance more.

There can also be an age aspect. I saw a study which suggested that our HbA1c may naturally increase slightly without necessarily meaning someone is diabetic as we get older. I think that may be why my dad says his initial reading at diagnosis was the same as mine but his GP didn't suggest medication - or it may be because he probably doesn't have as many years to live with diabetes. So if your GP is aware of that research, they may be happy with you achieving and maintaining an HbA1c of e.g. 46, but might not be with a 20 year old type 2 doing the same.

 

[everydayupsanddowns]

Hope you are pleased with the result of your next HbA1c @Jenny65

Do discuss your concerns about the possibility of Metfartin triggering your IBS amd how much improved your IBS symptoms have been recently when you speak to your GP or nurse - they may be able to offer alternatives, and should try to tailor your treatment to work for you as a whole person in an ideal world 🙂

 

[Jenny65]

Hope you are pleased with the result of your next HbA1c @Jenny65

Do discuss your concerns about Metfartin triggering your IBS amd how much improved your IBS symptoms have been recently when you speak to your GP or nurse - they may be able to offer alternatives, and should try to tailor your treatment to work for you as a whole person in an ideal world 🙂

Yes I will discuss it with them. I was diagnosed with IBS at the age of 17, when I returned from Paris. I went for a weekend with my 19 year old sister. I got mugged on the metro. Luckily my sister can speak fluent French so we were able to report it accurately to the police and I did get my money back, but as a result I had cripling stomach pains and at one point thought it was appendicitis. When I got back to the UK I went to my GP who said it was IBS and it then just became part of my life, I also had other terrible pains in my back on and off and again once in the care of my sister, my parents had gone away for the weekend and the 2 of us in our late teens were home alone (I think I was 16 and my sister 18) and we had a house party. The morning after the party I was in absolute agony (thought it was a heart attack)

My sister took me to the doctor, who just said it was my IBS, but I knew it was a different pain, and then on and off over the years this pain returned, the only cure was sitting against a boiling hot radiator. Eventually when my daughter was 8 months old and I was 30, I had another attack, so bad I had to go to my GP in my nightie, they gave me a shot of pethedine and said, "This is classic gall stones" I paid to go private for a scan as the waiting list was too long, and my gall bladder was three times the size it should have been and full of stones.

My parents both worked for the civil service and I was covered to received medical care at Beneden Hospital and had key hole surgery to have my gall bladder removed and then never looked back, no more pain....except and this is a bit revolting, I basically had my IBS, 12 visits a day to the loo from then onward and my motions were yellow in colour, I did tell the doctor but they brushed it off, I now wonder if having my gall bladder removed, damaged my pancreas or something else at the same time, but that means my "IBS" which I have been just putting up with for all these years (I was initially prescribed an anti spasm medication Buscopan I think but it made me very sick). I was anorexi as a teen too and wonder if my weird diets and surgery have led me to where I am today.

 

[Jenny65]

Sorry didnt mean to give my life story, just trying to explain what it means to finally be free of this pain and constant upset stomach, I really dont want it back even if just for another 3 months of managing without meds to let my bowel recover

 

[everydayupsanddowns]

Goodness! What a lot you’ve been through @Jenny65 - no wonder the lack of IBS comes as such a relief!

 

[Jenny65]

Goodness! What a lot you’ve been through @Jenny65 - no wonder the lack of IBS comes as such a relief!

every one of us has a story that led us here. I just wanted to share mine in case it helped anyone else, also wondered if anyone else had a history of gall stones and IBS at any point in case there is a connection, thank you for being kind and taking the time to respond, it means a lot