Thanks again,
@Alexandra100, you've given me an idea. My HbA1C is up and down like a yo-yo and I have great difficulty trying to figure out why that is happening - which is one of the reasons why I would love to be able to afford the Libre, even if only intermittently. Am due to see my GP next week, so I think I'll take the opportunity to raise the question of metformin. I have read from comments on here that it has several beneficial properties once you get over the initial tummy-troubles. The other option, of course, is to let my BS 'drift' upto the magic 48, and take it from there!
I am currently very enthusiastic about Metformin, but with the caveat that if it is a choice between low carb diet and Metformin, the low carb diet would win. But why should it be either or? The respected writers on diabetes, Dr Bernstein and Jenny Ruhl, both speak highly of Metformin. I have been very discouraged by the fact that even eating <20g carbs daily I could not get my bg anywhere near the level I am aiming for. I am convinced that even with A1cs of 37 to 41 I have developed several important diabetic complications. Ideally I would like to get my A1c down to 31, which is the level considered truly normal. Dr Bernstein insists that if one can maintain normal bgs over a long period one can reverse many diabetic complications, even severe ones. I have been very discouraged because even eating <20g carbs daily I would see my bg rise every day in the afternoon and evening.
With difficulty, I convinced my GP to prescribe Metformin. I began on just 500mg daily and have increased slowly. I very recently asked my GP to prescribe me Glucophage XR 2000mg daily. Dr Bernstein claims that Glucophage, the original form of Metformin, is much more effective than the generic forms. Since starting Glucophage at this higher dose I have seen a big change. I have less bowel loosening and better bgs. Before I was seeing 5s, going up to a few 6s most days, with the occasional 4. Now I see lots of 4s with an occasional 5. I haven't seen a 6 since I began Glucophage. This in turn is motivating me to be very careful about my LC diet. I don't mind the restrictions too much, but to make all that effort without reward was soul destroying.
I suggest printing out the NICE guidance below to give to your GP, as it is fairly recent and many health professionals have not heard of it yet:
"1.19 Metformin
See
why the committee made the 2017 recommendation on metformin.
1.19.1 Use clinical judgement on whether (and when) to offer metformin[
6] to support lifestyle change for people whose HbA1c or fasting plasma glucose blood test results have deteriorated if:
- this has happened despite their participation in intensive lifestyle-change programmes or
- they are unable to participate in an intensive lifestyle-change programme,
particularly if they have a BMI greater than 35. [2017]
1.19.2 Discuss with the person the potential benefits and limitations of taking metformin, taking into account their risk and the amount of effort needed to change their lifestyle to reduce that risk. Explain that long-term lifestyle change can be more effective than drugs in preventing or delaying type 2 diabetes. Encourage them to adopt a healthy diet and be as active as possible. Where appropriate, stress the added health and social benefits of physical activity (for example, point out that it helps reduce the risk of heart disease, improves mental health and can be a good way of making friends). Advise them that they might need to take metformin for the rest of their lives and inform them about possible side effects.
[2012]
1.19.3 Continue to offer advice on diet and physical activity along with support to achieve their lifestyle and weight-loss goals.
[2012]
1.19.4 Check the person's renal function before starting treatment, and then twice yearly (more often if they are older or if deterioration is suspected).
[2012]
1.19.5 Start with a low dose (for example, 500 mg once daily) and then increase gradually as tolerated, to 1500–2000 mg daily. If the person is intolerant of standard metformin consider using modified-release metformin.
[2012]
1.19.6 Prescribe metformin for 6–12 months initially. Monitor the person's fasting plasma glucose or HbA1c levels at 3-month intervals and stop the drug if no effect is seen.
[2012]"
https://www.nice.org.uk/guidance/PH38/chapter/Recommendations#metformin
You might also like to note carefully the beneficial side effects attributed to Metformin. I think in the end it was the beneficial effects on the heart that swung it for me with my GP, as she thinks that as regards diabetes I am making a fuss about nothing, but she knows I do have AF, sleep apnoeia, and a strong family history of heart disease and stroke.
https://www.diabetesdaily.com/blog/5-surprising-potential-benefits-of-metformin-324858/
Good luck!
I jest of course, but hope that on the day I can match your ability in the arena, as it were.
