What happens if metformin etc doesn't work?

[RobsterinSheff]

Hi

Today is 5 days since started metformin and max of 200g a day whole food based carbs diet and exercise (mixture of stationary bike and weights).

Been using the iBGstar to monitor BG and clinistix to monitor UG.

Up early as have to go to Manchester today. I have not eaten since 19:00 yesterday.

BG is 18.6mmol and UG showing as light reading i.e. there is some glucose in there.

My question is: what happens if diet, exercise and metformin don't get your BG under control??

I know these are are very early days for me (and BMI for example is still 32.8)- but some here seem to have seen a measurable reduction in BG in the FIRST week whereas I have not.

Any advice/ observations really welcome.

Rob

 

[RobsterinSheff]

IPad typo= no smiley in there (obviously as my BMIis nothing to smile about)

Time to start using 'preview' !

 

[borofergie]

Today is 5 days since started metformin and max of 200g a day whole food based carbs diet and exercise (mixture of stationary bike and weights).

Rob

What do you mean by "whole food based carbs diet"? Do you mean a low carb diet or a high carb diet? If it is the latter then frankly it isn't going to work...

How many grams of carb are you eating a day?

 

[RobsterinSheff]

Target is less than 200g a day only from whole food (rye bread no wheat; no white flour based products; only rice brown basmati; no potatoes etc etc). So reduce the % of carbs to 40-45% of calorific intake.

Reading through multitude of posts on here it is clear that successful BG management has been attained by people at both ends of the "lo carb" (<80g carb per day) debate.

My question is really about - post BG medication- should I expect to see quick, slow or no impact (latter has been the case in my example thus far 5 days into 1000 metformin per day).

 

[Anonymous]

Reading through multitude of posts on here it is clear that successful BG management has been attained by people at both ends of the "lo carb" (<80g carb per day) debate.

I've not seen evidence that carbs of 200g a day (whole food type or not) is going to give you successful management. Frankly, if your posting a fasting reading of 18.6 and you're trying to hold it on Metformin alone, especially with your BMI at 32, then I think you're kidding yourself or have been badly advised.

There are new joiners in the Low Carb section who have got their fasting readings in to single figures in just weeks.

 

[borofergie]

Target is less than 200g a day only from whole food (rye bread no wheat; no white flour based products; only rice brown basmati; no potatoes etc etc). So reduce the % of carbs to 40-45% of calorific intake.

Reading through multitude of posts on here it is clear that successful BG management has been attained by people at both ends of the "lo carb" (<80g carb per day) debate.

My question is really about - post BG medication- should I expect to see quick, slow or no impact (latter has been the case in my example thus far 5 days into 1000 metformin per day).

Most people seem to think that metformin is worth about a single point reduction in BG score, which is minimal, but not to be sneezed at.

200g (or 40%) sounds like a lot dude. There are different ways of moderating your carb intake but, as far as I can recall, all the successful T2s manage there carb intake to some extent, whether by GI, portion control, or carb counting. Off the top of my head I think Sid Bonkers probably does best on a relatively high proportion of carbs, but he is a strict portion controller, which means that he probably eats far less than 200g (although he can speak for himself).

20 to 150g seems like a more reasonable target, both from the literature, and from experience here. I sit at the bottom end of that (more from choice than necessity), and Grazer sits at the top end (but he has the constitution of a sheep). Don't be confused by some of the insulin users who can get away with more carbs by virtue of their medication (but even these usually restrict their carbs to some extent).

I'm not saying this can't work, but it seems to be outside of the general experience here. You seem to have given it some thought though and I'm very interested to see your progress.

Good luck!

 

[RobsterinSheff]

If it doesn't work at that level then the next stage is maximum 150g = medium carb intake.

 

[RobsterinSheff]

80g-200g of carb is defined as medium carb as far as my (UK) research finds.

Also swapping carbs for fats (the classic atkins approach) is regarded as a problem in terms of lipids and cardio health again from my research.

As my original question was about observing progress (or not) and speed of that progress (or not)- having been placed on metformin and required to eat a balanced diet and to exercise- it would seem that the consensus of responses is predominantly to drastically cut carbs.

Interesting and something to ponder!

 

[borofergie]

If it doesn't work at that level then the next stage is maximum 150g = medium carb intake.

Yes. Testing your BG and reducing your carbs in response to your results is an entirely reasonable way to proceed.

 

[dawnmc]

Unfortunately Rob, low carb is the only way. I'd love to eat bread, rice etc, but its not safe. And there is no evidence to prove that fat is bad, if you look at paleo diets for millions of years man didn't eat grain. Diabetes is a modern illness, probably caused by modern food,

 

[borofergie]

80g-200g of carb is defined as medium carb as far as my (UK) research finds.

Based on an outdated dogma that most well controlled diabetics disagree with,

Also swapping carbs for fats (the classic atkins approach) is regarded as a problem in terms of lipids and cardio health again from my research.

Again that's the dogmatic opinion of the establishment, which isn't reflected by the latest scientific research (or indeed by any scientific research). Eating a higher fat diet won't increase your mortality. In fact the reverse is true, it seems that a principal cause of CV problems is related to poor insulin response to carbohydrates.

I'm off to work now, but I'll post you some links later.

As my original question was about observing progress (or not) and speed of that progress (or not)- having been placed on metformin and required to eat a balanced diet and to exercise- it would seem that the consensus of responses is predominantly to drastically cut carbs.

Interesting and something to ponder!

It doesn't have to be drastic. The iterative approach you described above is a great way to proceed, although don't be disheartened if it takes a while. I'd be tempted to short cut the process by dipping to 150 or even 100g, realising that you can iterate upwards as well as downwards once you have some control.

Exercise is great, but less important than diet.

 

[RobsterinSheff]

Cheers- would really appreciate links being posted (short cuts my own search).

I have to admit that I am cautious about the "fried bacon and eggs with a glass of full fat milk" notion of very low carb diets = as my cholesterol level is 7.0 and my GP says if it goes up again I need an increase in my statins! Already on 40mg and really don't want any more...

A direct question on a slightly different issue: in your experience/ opinion which is more effective for BG management: aerobic exercise or weight resistance?

 

[dawnmc]

Google Dr Donald Miller on you tube. Oh and you can eat the bacon and eggs but leave out the milk - its full of sugar lol

 

[andrewk]

BG is 18.6mmol and UG showing as light reading i.e. there is some glucose in there.

My question is: what happens if diet, exercise and metformin don't get your BG under control??

I know these are are very early days for me (and BMI for example is still 32.8)- but some here seem to have seen a measurable reduction in BG in the FIRST week whereas I have not.

Great question. You seem to be starting from exactly where I was in 2005. About the same BMI. My BGs were in the range 12 - 25 mmol/l. In my case, my BG levels were controlled mainly by increasing levels of medication. Metformin is just the start. Later, you might have glimepiride, sitagliptin and possibly more glimepiride. You'll rattle as you walk!! Over time, if you don't get to grips with the notion that you MUST go on a low carbohydrate diet, then your BGs will rise and it might not be too many years before your GP is muttering darkly about insulin injections.

Fortunately, you have found these forums many years before I did. If I could go back to 2005, I would firstly read all of the documents linked to by the first post in this thread http://www.diabetes.co.uk/diabetes-forum/viewtopic.php?f=27&t=23135&hilit=defatizing After you have read about the Newcastle Study, I suspect you might not need or want any answer to the "What if" question that you asked.

Best of luck
Andrew

 

[borofergie]

Reading list:

On low-carb for diabetes and the range of carbohydrates necessary for good control:
1. http://rdfeinman.wordpress.com/2012/03/ ... 15-theses/
2. http://www.nutritionandmetabolism.com/content/5/1/9

There are lots and lots of these, but low-carb for diabetes is more or less the established position in the diabetic community, and you shouldn't take much convincing.

On high-fat diet and cardiovascular health:
1. http://www.nytimes.com/2002/07/07/magaz ... all&src=pm
2. http://www.youtube.com/watch?v=vRe9z32NZHY
3. http://www.sott.net/articles/show/24251 ... rt-Disease
4. http://rdfeinman.wordpress.com/2012/02/ ... our-blood/

The first is an easy to read primer. If you have the time, I'd recommend that you also read "Why We Get Fat" by Gary Taubes (lots of people try to dig small holes in his stuff, but the overall message seems to stand up to major scrutiny - although the debate is moving on slightly).

Lots of recent, well respected meta-studies have failed to demonstrate a link between fat intake and mortality, the most prominent being the Cochrane Review who concluded that eating a reduced-fat diet might reduce the risk of a heart attack, but it probably won't influence your mortality:
http://summaries.cochrane.org/CD002137/ ... rt-disease

I'd also note that there has been very little work done on people increasing their fat intake on a very-low-carb diet (high-fat high-carb is almost certainly a bad idea). Where work has been done it generally finds that blood-lipid profiles significantly improve on a low-carb/high-fat diet compared with a low-fat diet:
http://dl.dropbox.com/u/37202414/Volek_ ... s_2008.pdf

Most of the sensible advice I listen to involves replacing artificial trans-fats with "healthy" natural fats such as animal fats or coconut fat. I steer away from grain based vegetable oils too.

 

[borofergie]

Great question. You seem to be starting from exactly where I was in 2005. About the same BMI. My BGs were in the range 12 - 25 mmol/l. In my case, my BG levels were controlled mainly by increasing levels of medication. Metformin is just the start. Later, you might have glimepiride, sitagliptin and possibly more glimepiride. You'll rattle as you walk!! Over time, if you don't get to grips with the notion that you MUST go on a low carbohydrate diet, then your BGs will rise and it might not be too many years before your GP is muttering darkly about insulin injections.

Fortunately, you have found these forums many years before I did. If I could go back to 2005, I would firstly read all of the documents linked to by the first post in this thread http://www.diabetes.co.uk/diabetes-forum/viewtopic.php?f=27&t=23135&hilit=defatizing After you have read about the Newcastle Study, I suspect you might not need or want any answer to the "What if" question that you asked.

Yeah, what Andrew is describing is the standard NHS approach to managing diabetes, a high-carb diet with increasing medication. Undeniably it works for some people, but the downsides of insulin and insulin provoking drugs are many, and if you can control your diabetes without them, then you'll be healthier and happier.

Here is a rebuttal of this approach (by Feinman again):
http://www.diabeteshealth.com/read/2008 ... at-to-eat/

 

[tree-peony]

Hi Rob,

It sounds like you and I are in about the same place, except I am now 6 weeks in. I was diagnosed by my Ophthalmic surgeon when having a pre-op assessment for a cataract. My BG was 23 that afternoon I had to get my level down to "mid-teens" or they would do the op, and I really needed it doing ASAP (work commitments).

My GP took ages to give me Metformin and when he finally did I had a very nasty gastric reaction to it (not uncommon!), so I had no alternative BUT to go very low carb if I wanted that op! It happened exactly a week ago

Personally I know that for me, exercise is the key. I do 50 min on the crosstrainer a day. I've not been able to do this for the last week and have watched my levels creeping up and up. I am now on the slow release Metformin, and so far so good, but I know it's not the whole answer.

My plan is this- get up to 4 x Metformin SR a day, keep exercising, keep doing low carb (for me this is about 50g a day - I can't manage much lower than that, and tbh I'm not sure I want to) and see where I am in another month/6 weeks.

My GP keeps telling not to worry that my levels are only coming down very slowly, that this is actually for the best - he's probably correct!

 

[Grazer]

Even an old sheep like me would struggle on 200 grams of carbs a day! I'm considered extravagant on 150 of low GI carbs, and my BMI is only 22 so low insulin resistance. I wouldn't worry about cholesterol with higher fats. When I reduced my carbs but upped my fats (dairy mainly) my cholesterol went from 5.5to 3.8. Souch for fats raising cholesterol! Without being rude, with your weight and BG levels, you need to be on far less carbs than me if you want to avoid stronger meds.
Maybe you need to crash into really low carb to get weight and BG under control, then you can sneak them up if you can later. Eat then test-higher than 7.8, don't eat that again! Or use whatever two hour post prandial BG target you like, but stick to it and aim to get below 7.8 quickly.
Good luck!

 

[didie]

A direct question on a slightly different issue: in your experience/ opinion which is more effective for BG management: aerobic exercise or weight resistance?

I'd go with aerobic exercise which brings my levels nice down.

 

[RobsterinSheff]

postby andrewk

Great question. You seem to be starting from exactly where I was in 2005. About the same BMI. My BGs were in the range 12 - 25 mmol/l. In my case, my BG levels were controlled mainly by increasing levels of medication. Metformin is just the start. Later, you might have glimepiride, sitagliptin and possibly more glimepiride. You'll rattle as you walk!! Over time, if you don't get to grips with the notion that you MUST go on a low carbohydrate diet, then your BGs will rise and it might not be too many years before your GP is muttering darkly about insulin injections.

Hi

did you go on all of these medications and then- post low carb- are currently not on ANY of them?