Consultant's surprising action/help?

[Yeoc]

Hi everyone,

I was diagnosed a couple of years ago with type 2 diabetes. My hbA1c was 77 at diagnosis. From there It was suggested I try dietary changes before looking to Metformin. I radically altered my diet and at my next test I was 53. A few months later 47 and then 43. I had been told all this was cery good and in fact the last test result was pre diabetic. I have slipped a little over the last 3 months with the diet having not been as well and had a little more in the way of carbohydrates (have been on a high fat low carbohydrate diet). Anyway I have just been sent a copy of the letter my consultant has sent to my gp. It says place the patient on metformin.

Is it just me or does this seem a little quick off the bat? I mean this is one, singular hbA1c result, a blip and is 50 that high anyway? I mean is that so high as to say move the patient (me) onto metformin? I instinctively feel a little resistant to this.

 

[urbanracer]

Hi @Yeoc

Technically, 50mmol/mol puts you firmly in the 'diabetic' category, so your consultant will have correctly prescribed medication. Are you are confident that you can achieve the required results by diet and exercise alone? Are you are monitoring your own blood sugar levels daily?

No one can force you take the medicine but not following your consultants advice carries it's own risks of course.

 

[Yeoc]

Firmly? It is one result, and if 48 is the point at which it is categorised as diabetic, how is that firmly?

As an average over the last year, I am below that categorisation anyway, if taking the mean, rather than the highest result. I'm completely perplexed.

What would metformin mean, rather than diet alone. What effects would it have on my hbA1c, blood sugar and general health? What is better about going lower without metformin, over and above use of that medication? Difficult questions I know.

Thx for the previous answer/thoughts by the way.

 

[Daibell]

Hi. I would be inclined to have the Metformin but do ask for the Slow Release (SR) version. Make that part of the deal with the GP! Metformin is a very safe drug. It only has small effect on blood sugar but does help with any insulin resistance thru excess weight and does reduce the liver's glucose output a bit.

 

[Jo123]

I would go on metformin, I am only prediabetic and have normalized my blood sugar by being very strict with my diet, however if it went up i would happily go on metformin as I believes it improves your insulin resistance, and stops your body overproducing glucose. Discuss with your GP if you don't want to go on medication.

 

[CollieBoy]

Firmly? It is one result, and if 48 is the point at which it is categorised as diabetic, how is that firmly?

As an average over the last year, I am below that categorisation anyway, if taking the mean, rather than the highest result. I'm completely perplexed.

What would metformin mean, rather than diet alone. What effects would it have on my hbA1c, blood sugar and general health? What is better about going lower without metformin, over and above use of that medication? Difficult questions I know.

Thx for the previous answer/thoughts by the way.

In itself the Metformin may not make that mutch difference to your BS (It won't alter your insulin production, just help with your insulin resistance!) but there are some non BS advantages to Metformin.
If it has just been a "blip" and your BS continues to fall, you could, ask to come off the Metformin later!

 

[Yeoc]

Thx for all the replies. Still super surprised, because I thought my control was very good with the diet. I have only heard of a couple of people ever achieving pre diabetic scores, so one blood test just tipping me over...well I thought that wouldn't have been regarded as significant unless it happened a few times. Even then most of the people I know generally have terrible diabetic control in comparison.

Are there really no adverse effects of Metformin itself? I mean, wouldn't diet alone be preferable if I was typically around 45/47nmol/mol HbA1c

 

[Yeoc]

I must be missing something...

 

[DeejayR]

Erm ... I was curious about this "consultant" so I consulted one of your previous posts ...

I was formerly a professionally qualified tennis coach in another life, but now have osteoporosis in my lower spine and also have a damaged knee, so being lectured on sport by a very ill looking un-sporty looking consultant is a bit much. I used to run 20plus miles every week as well as being on the tennis courts 6 days a week. I loved and was obsessive about exercise. It kinda feels like a person with no legs now being mocked for not owning a pair of trainers.

I've taken a personal dislike to this consultant and I certainly wouldn't respect his/her command to take metformin. My opinion is as good as his/hers in this single respect and in my view you're doing very well. You just need to get those carbs down and up the fat and you'll be back down to prediabetic.
BTW my GP supports my diet'n'exercise approach without drugs.

 

[Yeoc]

Wow, you're diligent/on the ball with the prior postings Deejay, I bet little gets past you. Of course I feel the same, and your response is the one I was possibly hoping for. It is easy to find agreement in what you have said, yet I don't want to be too quick to dismiss voices that differ from my own (aware of that danger). Trying to be open minded, but not so open minded that the brain in likely to fall out.

I certainly thank you and the others for taking the time out to thoughtfully respond, and in particular to yourself, for looking to my prior postings which is very considerate and thoughtful of you.

P.S

It should be said I probably do have an aversion to metformin and this might not be entirely rational, but instinctively I have come to seriously distrust the consultant concerned.

 

[DeejayR]

I just wanted to redress the balance a bit, plus having fallen over my own feet on a hard court some years ago I regret not being able to play tennis properly any more.
There is a thread elsewhere on the necessity for trusting our doctors.
The advice given in this thread will I hope help you make an informed choice, which is the aim of the forum I believe.

 

[sally and james]

I thought my control was very good with the diet. I have only heard of a couple of people ever achieving pre diabetic scores

@Yeoc While you are doing very well and HbA1c levels do go up and down a bit, you are borderline. Getting pre-diabetic results doesn't put you in the Guiness Book of Records, there are many examples of diabetics who start out at your level and then achieve non-diabetic results through a low carb diet. This is not said to discourage you, rather to put things into a wider context and then spur you on to greater achievements. I suspect this can be done without Metformin, but you can only find out by trying.
Sally

 

[NoCrbs4Me]

Thx for all the replies. Still super surprised, because I thought my control was very good with the diet. I have only heard of a couple of people ever achieving pre diabetic scores, so one blood test just tipping me over...well I thought that wouldn't have been regarded as significant unless it happened a few times. Even then most of the people I know generally have terrible diabetic control in comparison.

Are there really no adverse effects of Metformin itself? I mean, wouldn't diet alone be preferable if I was typically around 45/47nmol/mol HbA1c

In my opinion, 50 is too high. You say you thought you had very good control - do you test your blood glucose levels? If so, what kind of fasting and post-meal numbers were you getting? If you are not testing, you really can't know if your control is good or not. Metformin won't lower blood glucose levels all that much compared to a carbohydrate restricted diet.

 

[CarbsRok]

Perhaps your consultant was looking ahead and trying to avert any damage by the potential of an even higher A1c next time.
After all you are at liberty to stop the medication if you find it doesn't help or the side effects if any cause you problems.
Mind you I'm curious to know why you bother to see him if you don't like him and don't want his advice.

 

[Robbity]

I think I would be concerned if my HbA1c had zipped up from 43 to 50 in three months whether I was me or a consultant, since it could possibly be an indication of my body needing extra help. And I think in this situation I'd accept the metformin - it doesn't have to be permanent and I'd much rather my body had a helping hand than suffer potential damage from going back up to higher levels.

I've been down and kept to the low 40s for my last few tests (in spite of being ill and having a very bad ear infection) over the last 12 months but I'm still on SR metformin, and since it's actually a very safe drug I'm quite happy to continue until (or if) I can reduce and keep my HbA1cs down below 40 long term. But that 's just my feelings...

Robbity

 

[ButtterflyLady]

You got it down to 43, which is great, but that was still in the prediabetic range. Your consultant is taking a conservative/prudent approach, based on the available data, which shows that you haven't been able to keep your BG levels under control in the last 3 months. He is worried about the damage being done to your body and the chances that your next result will be even higher. His recommendation is a good thing - it shows that he cares and he is actively interested in your health. I would be worried if he didn;t recommend metformin at this point.

I got down to the 40s and then crept back up to 54. My GP told me at that level, microvascular damage was being done (which means I was heading down the path towards complications like neuropathy and retinopathy). So I started home BG testing again and eventually got it down to 37.

Needing metformin is not a sign of failure, it's a helpful med that has benefits that outweigh the risks.

 

[AndBreathe]

@Yeoc - Does the letter contain any of his reasoning, or is it just an instruction? Do you have any other health conditions that might have influenced his decision?

I am very keen to remain meds free, although it's not discussed, whilst my numbers are as they are (they are in my signature). Personally, before accepting a prescription I would want to understand why it had been prescribed.

 

[ronialive]

maybe have this conversation with the doctor who runs the diabetic clinics at your gp's. They may well be willing to wait 3 months and monitor.

 

[Yeoc]

Well an awful lot to think about.

For clarification. My test results did not jump from 43 to 50 in 3 months. I didn't have a hbA1c test for over 6 months. I was well and I think my control good upto the last 3 months. It was 6/7 months prior I had 43 and 6 months before that where I had 47. I suppose my initial explanation was a little ambiguous. When I said ill over the last 3 months I meant significantly. I have had multiple cancers and suffer long term problems as a result. My reason for seeing the consultant is not for diabetes, though he is a diabetes consultant. I see him for Growth Hormone medication as I suffer from adult Growth hormone deficiency as a result of chemotherapy. He has lowered my dose of GH and this coincides with increasing ill health and the upward blip with my hbA1c result. I suspect the lowering of the GH level is partly responsible for my increased hbA1c, rather than dietary changes alone.

I see another private consultant in London and he has told me altering GH can affect diabetes positively or negatively, depending upon the situation. All I know is, I was on a set medication and well/healthy enough and doing very well in terms of hbA1c. Then my medication was reduced and I have been exhausted and my hbA1c has increased.

I don't trust the NHS/diabetic consultant generally because I know the statistics when it comes to Adult Growth Hormone Deficiency. 84% of people in the UK go untreated by the NHS and morbidity is 13% higher than the populous as a result. Or put another way, 13 more people in every 100 with GH deficiency die in comparison to the regular population and most people are refused treatment and those that are treated are often kicked off treatment for various excuses. Most untreated or under-treated snuff it from cardio vascular disease. I feel the consultant and the NHS is always looking to withdraw treatment/find excuses not to treat...mainly because the treatment costs over four thousand pounds a year. That doesn't seem much money, but one look at the N.I.C.E guidelines reveals 3/4 pages are devotee to cost benefit analysis :-/


The risk of complications from GH deficiency if anything outweighs the risks of the diabetes, but the consultant would like nothing more than to pull the plug on that funding.

So trust is frankly, non existent.

When one variable is changed and mayhem occurs afterwards, it makes me think, go back and undo the singukar change and see what happens. So I am thinking of trying to argue the case for putting the dose of GH back up. That seems to make some logical/rational sense to me. Whether it makes a difference or not, whether this has been significant or contributory is something I can't really know right now.

Think. I might speak to my gp and talk about re-testing hba1c before making a decision.

I realise my results prior were nothing out of this world, just simply good/respectable. They were something I hoped to build on and do even better with. It is true though that outside of forums, with the people whom you typically meet...the results were generally far better than most people I heard about. That is something I put down to the high fat low carb diet.

Thx again for all the thoughts and time taken, appreciated.

P.S

One of the cancers was liver cancer - two thirds of my liver removed at 17 (having never had alcohol). 11 hour op to remove that. Second cancer unrelated primary too. Chemotherapy Cisplatinum causes kidney damage. So my liver and kidneys might not be so great. Lastly osteoporosis of the spine from the chemotherapy. So diet is doable exercise is not.

 

[ButtterflyLady]

Metformin is said to help the liver, so your need for it might be even greater than if your only condition was diabetes.

With everything that is going on for you, maybe it would be sensible to take the metformin, at least until your HbA1c goes down? Apart from possible gastric side effects from the short acting version, I can't see it being a huge risk.

 

[LucySW]

Metformin has been around a long time and is very well known and completely safe. It has very benign effects on limiting liver dumps. The only issue is that it gives some people disagreeable stomach pain. (It didnt me.) I would try it and see.