When to lower metformin

[Macca]

With an average of 5.2 mmol/L why would you be considered in need of pills? As far as I can see you have done very well indeed and have brought your blood glucose into normal range.

Thank you. This is what I have been aiming to do and was knocked for six when the nurse said that I had to take the pills, although her advice was based on an HbA1C (first one of 86, second of 54). I was hoping, and still am hoping, that with an early diagnosis I would have a good shot at putting it into remission. It was a very poor consultation and left me feeling very let down for a few days. That aside, I am still hopeful that I can make big improvements and that I can sustain a controlled blood sugar level via lifestyle changes. I am concerned about the comment that metaformin leads to poor outcomes.

 

[childofthesea43]

Thank you. This is what I have been aiming to do and was knocked for six when the nurse said that I had to take the pills, although her advice was based on an HbA1C (first one of 86, second of 54). I was hoping, and still am hoping, that with an early diagnosis I would have a good shot at putting it into remission. It was a very poor consultation and left me feeling very let down for a few days. That aside, I am still hopeful that I can make big improvements and that I can sustain a controlled blood sugar level via lifestyle changes. I am concerned about the comment that metaformin leads to poor outcomes.

HbA1c of 54 is pretty good considering the initial 86. If you are aged over 65 then 54 is not necessarily diabetic - for that age group the average for non-diabetics is about 48, with a threshold for diabetes being about 56. The key to all this is clearing fat from liver and pancreas. You may need to lose further weight to pull your number down a bit more. What is your current BMI? Aim to get waistline less than half your height, better still about 40% of your height. Metformin will do nothing to clear away any excess visceral fat, so if that fat remains long term in the pancreas (just half a gram is sufficient to compromise it) then the beta cells become irrecoverable and the road then turns into dependence upon injecting insulin, which is a challenging thing to deal with.

 

[Leadinglights]

I would have thought since you had done brilliantly in bringing your level down that giving you a big more time to continue with what you had been doing or even stepping up a bit on the diet front would have been better if you were willing to have done that.
I suppose they meet so many people who are unwilling to make the effort and expect medication to be a magic bullet.
You clearly have shown commitment and I would suggest if you get issues with the metformin then discuss again whether you really need them.

 

[Macca]

HbA1c of 54 is pretty good considering the initial 86. If you are aged over 65 then 54 is not necessarily diabetic - for that age group the average for non-diabetics is about 48, with a threshold for diabetes being about 56. The key to all this is clearing fat from liver and pancreas. You may need to lose further weight to pull your number down a bit more. What is your current BMI? Aim to get waistline less than half your height, better still about 40% of your height. Metformin will do nothing to clear away any excess visceral fat, so if that fat remains long term in the pancreas (just half a gram is sufficient to compromise it) then the beta cells become irrecoverable and the road then turns into dependence upon injecting insulin, which is a challenging thing to deal with.

Thanks. That’s useful to know. BMI currently 35.8, so a long way to go yet! Aged 46. Waistline is 42 inches (down from 48) so I have 6 inches or more to lose on that front. Changing the habits of a lifetime is going to be a long battle, especially since my job moved from a high activity one to a desk and car but this has been a great big kick up the arse. I only wish I had found the motivation sooner. My grandad was a type 2 on insulin, so I’ve seen that.
4.6 mmol last night then 7.2 this morning after posting the above with no food (bad nights sleep). Go figure!

 

[childofthesea43]

Thanks. That’s useful to know. BMI currently 35.8, so a long way to go yet! Aged 46. Waistline is 42 inches (down from 48) so I have 6 inches or more to lose on that front. Changing the habits of a lifetime is going to be a long battle, especially since my job moved from a high activity one to a desk and car but this has been a great big kick up the arse. I only wish I had found the motivation sooner. My grandad was a type 2 on insulin, so I’ve seen that.
4.6 mmol last night then 7.2 this morning after posting the above with no food (bad nights sleep). Go figure!

You’re doing great, and although BMI still very high you may not need to reduce it dramatically for the purpose of reducing blood glucose - it’s a very individual thing. But in general getting the waistline down will yield other benefits too. Have faith and keep doing what you have been. In your position I’d suspend using Metformin, but that’s a matter between you and your GP.

 

[Burylancs]

I would like it to be more widely acknowledged that these thresholds of <42 and <48 apply to people under 40, but for those in their sixties or older those thresholds need to be at least 6 mmol/mol higher. At age 75 my usual A1c of 41 is not near pre-diabetic but very comfortably below that. The research on this point seems incontestable and hcps need to wake up to it so as not to misdiagnose or overtreat those in their later years. So I’d hope to see an end in this forum to the same old numbers always being trotted out without considering the age factor.

Duration of diabetes is also a factor in setting targets for individual T2s.

 

[JITR]

At diagnosis on 12 December 22 my fbg was 17 and A1c 104. I decided to follow a real food version of the Newcastle Diet which can bring fbg down to a normal level in 7 days. On 22 December 22 I met my GP who knew nothing about Professor Roy Taylor's work. She could only follow the Nice guideline and take Metformin. The next day I had an ultrasound scan of my to confirm the diagnosis, also on 12 December 22, of hemochromatosis. The radiologist said I had a fatty liver and treat it by diet. I started my diet on 24 December 22 and measured my bfg at 5.8 on New Year's Eve. This was in line with the results of the Counterpoint study in c2008 so I contined without medication. My A1c was 39 at the end of March 23. I should point out that I had taken note of the study at the Hortens Hospital in Denmark in 199? that showed that smaller meals (as in the Newcastle Diet) are as effective as Metformin in controlling post prandial sugar levels, and more so than a 500 mg starting dose of Metformin. Libby needs to find out what the effect of reducing her Metformin dose on her fbg will be. It goes without saying that any such change, even by a single tablet, should only be made with the approval of her HCPs.

 

[childofthesea43]

At diagnosis on 12 December 22 my fbg was 17 and A1c 104. I decided to follow a real food version of the Newcastle Diet which can bring fbg down to a normal level in 7 days. On 22 December 22 I met my GP who knew nothing about Professor Roy Taylor's work. She could only follow the Nice guideline and take Metformin. The next day I had an ultrasound scan of my to confirm the diagnosis, also on 12 December 22, of hemochromatosis. The radiologist said I had a fatty liver and treat it by diet. I started my diet on 24 December 22 and measured my bfg at 5.8 on New Year's Eve. This was in line with the results of the Counterpoint study in c2008 so I contined without medication. My A1c was 39 at the end of March 23. I should point out that I had taken note of the study at the Hortens Hospital in Denmark in 199? that showed that smaller meals (as in the Newcastle Diet) are as effective as Metformin in controlling post prandial sugar levels, and more so than a 500 mg starting dose of Metformin. Libby needs to find out what the effect of reducing her Metformin dose on her fbg will be. It goes without saying that any such change, even by a single tablet, should only be made with the approval of her HCPs.

Although if those HCPs are like your GP in being ignorant of the science of remission then their opinions or “approval” on T2D might not be worth a fig.

 

[JITR]

Although if those HCPs are like your GP in being ignorant of the science of remission then their opinions or “approval” on T2D might not be worth a fig.

To be fair to my GP gave me an Accu-Chek when I asked how to check my glucose levels. Given upwards of 90% of pre-Ds and newly diagnosed T2Ds can potentially achieve remission, they should be encouraged to try diet and exercise first*. Conveys the right messages.

*The WHO protocol is diet and exercise to achieve an agreed target. Prescribe medication only if that fails.