HBA1C of 55 but doc says no metformin?

[MrsDoodle72]

Hey all. So after a month of dieting, my HbA1C has gone from 55 to 49! But the doctor now wants to put me on Metformin. I'd rather wait another month or two, as I have lost 6kg, a little more than 5% of body weight, and am feeling much better. I will take the stuff if he insists. Any views ?

I have 6 weeks left on the 800 cal diet and then i go onto a low carb maintenance programme. (lots of fish, unsweetened dairy, broccoli, eggs and lean protein with veg and the odd small low GI bit of carb every so often)

Mrs D

 

[Oldvatr]

Hey all. So after a month of dieting, my HbA1C has gone from 55 to 49! But the doctor now wants to put me on Metformin. I'd rather wait another month as I have lost 6kg, a little more than 5% of body weight, and am feeling much better. I will take the stuff if he insists. Any views ?

I have 6 weeks left on the 800 cal diet and then i go onto a low carb maintenance programme. (lots of fish, unsweetened dairy, broccoli, eggs and lean protein with veg and the odd small low GI bit of carb every so often)

Mrs D

Metformin has very little effect on blood sugar levels. Its main purpose is as protection against CVD events which diabetics carry at a greater risk. it also helps to improve any insulin resistance you may have. The GP will advise medication, but it is up to you to decide if you take it. Make sure your GP has tested your kidney function since Metformin is not advised if kidney function is weak.

Your maintenance programme seems fine and well researched.

 

[MrsDoodle72]

I was diagnosed with T2 about 6 months ago (48 mmo/l). My GP only put me on one tablet of Metformin per day. But to be honest I don’t even notice what difference it may be making.
I didn’t get diagnosed with as a pre diabetic but generally, I feel, Dr don’t emphasise it’s significant a enough. If I had my way, pre diabetics should be treated the same as diabetics and get all the support and information which diabetics get.
That aside, through a strict low carb / keto diet I gave been able to get my BG levels down to 35mmo/l and my GP is already talking about dropping my Metformin by next year.
I have started to exercise more as it is a good way of using up your glucose stores. It’s just a question of finding an activity that works for you. I went for HIIT training on an old cross trainer we had sitting in the garden for the last 10 years!!
But you can do HIIT training without equipment. The reason I chose HIIT was because it can be done in 15 minutes, so for me it took very little of my day.

I think you are right to question retesting your HBA1C so soon as it is a 3 month average. The only login that would explain it to me is that your GP is simple confirming the first results, or trying to gauge a trend, is it going up or down??

so to answer you - after amonth of dieting my HbA1C is now 49 from my original 55. after a month. But they are still going to stick me on metformin and ignore my weight loss and the stats........i'm very frustrted with the GP who seems not to support my fight for remission.

 

[MrsA2]

so to answer you - after amonth of dieting my HbA1C is now 49 from my original 55. after a month. But they are still going to stick me on metformin and ignore my weight loss and the stats........i'm very frustrted with the GP who seems not to support my fight for remission.

They may prescribe but you don't have to take it. Entirely up to you

 

[Bluetit1802]

so to answer you - after amonth of dieting my HbA1C is now 49 from my original 55. after a month. But they are still going to stick me on metformin and ignore my weight loss and the stats........i'm very frustrted with the GP who seems not to support my fight for remission.

All GP's can do is suggest or recommend. They cannot insist or force. You are allowed to say no thankyou.

 

[HSSS]

After just 1 month of changes your hba1c will still constitute a significant amount from your pre change lifestyle. Ie the full benefits cannot be seen yet and if you maintain the changes you have made it will get better still. Your dr should know this and I’m shocked he wants to act now rather than see the improvements you’ve already made.

I’d strongly argue for a 2 month delay and a retest at that point to see the full effect of the changes you have made. Even at that point all the dr can do is recommend medication. It is your choice whether to take it or not.

In fact I’d refuse it outright for now and say if he retests in another 2 months and you haven’t made the improvements that seem likely will happen then you’ll reconsider. I doubt you’ll meet the criteria then and to be honest you barely do now. Most drs would advise lifestyle changes only at 49mmol.

it seems confusing he didn’t want to use it before but he does now ……..

 

[MrsDoodle72]

After just 1 month of changes your hba1c will still constitute a significant amount from your pre change lifestyle. Ie the full benefits cannot be seen yet and if you maintain the changes you have made it will get better still. Your dr should know this and I’m shocked he wants to act now rather than see the improvements you’ve already made.

I’d strongly argue for a 2 month delay and a retest at that point to see the full effect of the changes you have made. Even at that point all the dr can do is recommend medication. It is your choice whether to take it or not.

In fact I’d refuse it outright for now and say if he retests in another 2 months and you haven’t made the improvements that seem likely will happen then you’ll reconsider. I doubt you’ll meet the criteria then and to be honest you barely do now. Most drs would advise lifestyle changes only at 49mmol.

it seems confusing he didn’t want to use it before but he does now ……..

My cousin is a GP and he said almost exactly what you said. he is shocked by my GP's odd attitude to patient care (he's angry about my text message 'diagnosis' and the drug prescription was passed to me in an offhand way with no advice and no message about side effects!) and also that my GP is not praising me for losing nearly a stone in a month and correcting my HbA1c by 6 points. Downward trend should be encouraged and supported said my cousin. At least he's rooting for me. I am sticking to Professor Roy Taylor's instructions apart from occasionally having a 190 cal salmon steak and 32 cal of brocoli for supper instead of a shake. (bored of shakes after two in one day).

At least the tachycardia is under control with Bisprolol but no cardiology appt until mid feb 'our nhs'.

 

[KidDougi]

so to answer you - after amonth of dieting my HbA1C is now 49 from my original 55. after a month. But they are still going to stick me on metformin and ignore my weight loss and the stats........i'm very frustrted with the GP who seems not to support my fight for remission.

That’s very good for a month. You will get to remission, irrespective of what you Dr says, keep up the good work.

 

[MrsDoodle72]

That’s very good for a month. You will get to remission, irrespective of what you Dr says, keep up the good work.

Hiya. I do hope so. I am feeling a bit down after the doctor told me this evening that 'there was no such thing as remission just control'. But I disagree with him. Professor Taylor says you can reverse it and hold that if you keep the weight off and eat low carb. I will tentatively try the scary metformin but if it gives me the digestive upset then it stops.

By March I aim to be HbA1c on or below 43. I need to shift another stone and get to below 80kg. I can do this! Exante shakes and Broccoli to the rescue.

 

[Oldvatr]

Hiya. I do hope so. I am feeling a bit down after the doctor told me this evening that 'there was no such thing as remission just control'. But I disagree with him. Professor Taylor says you can reverse it and hold that if you keep the weight off and eat low carb. I will tentatively try the scary metformin but if it gives me the digestive upset then it stops.

By March I aim to be HbA1c on or below 43. I need to shift another stone and get to below 80kg. I can do this! Exante shakes and Broccoli to the rescue.

The GP may actually tell you to raise your HbA1c above 43. The current training for GP's seems to follow the insulin users guide, and they are taught that glucose readings below 7 mmol/l are to be avoided because of the possibility of hypo damage. When I was in hospital recently I was taken off all my meds, and had to get my FBG to 12 mmol/l which was 'good'. They only got concerned if my bgl registered above 20 on the scale. My GP greeted my 43 with advice to get my averages to around 7, not the 5.4 I had been aiming for. When I was in hospital I did hit 5.6 one day, and they decided that was a hypo, and force fed me digestive biscuits.

 

[Outlier]

Goodness me: it's a real headbanger at times. Thank goodness for the knowledge and support here.

 

[KidDougi]

The GP may actually tell you to raise your HbA1c above 43. The current training for GP's seems to follow the insulin users guide, and they are taught that glucose readings below 7 mmol/l are to be avoided because of the possibility of hypo damage. When I was in hospital recently I was taken off all my meds, and had to get my FBG to 12 mmol/l which was 'good'. They only got concerned if my bgl registered above 20 on the scale. My GP greeted my 43 with advice to get my averages to around 7, not the 5.4 I had been aiming for. When I was in hospital I did hit 5.6 one day, and they decided that was a hypo, and force fed me digestive biscuits.

That makes no sense to me. With those numbers they are saying that we should all be sitting in the middle of pre-diabetic range ?? Have they changed all the bands?

 

[Alexandra100]

That makes no sense to me. With those numbers they are saying that we should all be sitting in the middle of pre-diabetic range ?? Have they changed all the bands?

There is no one definition of pre-diabetes. For the American Diabetes Assn. pre-diabetes starts at the equivalent of an A1c of 38.8mmol/L but for the WHO and therefore the NHS we are not pre-diabetic until we reach 42. For Dr Bernstein harmful blood glucose levels start at a far lower level. Unfortunately for me I believe Dr B, but so far have not been able to get my bg lower than 38 /39.

 

[pre-predb]

There is no one definition of pre-diabetes. For the American Diabetes Assn. pre-diabetes starts at the equivalent of an A1c of 38.8mmol/L but for the WHO and therefore the NHS we are not pre-diabetic until we reach 42. For Dr Bernstein harmful blood glucose levels start at a far lower level. Unfortunately for me I believe Dr B, but so far have not been able to get my bg lower than 38 /39.

Eeek! I've never knowingly been below 39. I eat low carb, am a normal BMI and exercise daily. I am 65 (I think the risk goes up with age somewhat) and also have (treated) hypothyroidism, which I believe can be a contributory factor. What else can I do though?

 

[Alexandra100]

Eeek! I've never knowingly been below 39. I eat low carb, am a normal BMI and exercise daily. I am 65 (I think the risk goes up with age somewhat) and also have (treated) hypothyroidism, which I believe can be a contributory factor. What else can I do though?

I wish I knew! I take comfort from my age (79). Maybe I won't have to dodge amputation, blindness etc etc for too many years!!! (This sounds too pessimistic. I love life and am doing my utmost to avoid Covid.) Dr Bernstein's patients have the extra resource of small doses of insulin added to their ultra low carb diets. Sometimes I envy them, but then I only have to worry about hypers, never hypos!

 

[Grannypat]

Hey all. So after a month of dieting, my HbA1C has gone from 55 to 49! But the doctor now wants to put me on Metformin. I'd rather wait another month or two, as I have lost 6kg, a little more than 5% of body weight, and am feeling much better. I will take the stuff if he insists. Any views ?

I have 6 weeks left on the 800 cal diet and then i go onto a low carb maintenance programme. (lots of fish, unsweetened dairy, broccoli, eggs and lean protein with veg and the odd small low GI bit of carb every so often)

Mrs D

 

[Oldvatr]

That makes no sense to me. With those numbers they are saying that we should all be sitting in the middle of pre-diabetic range ?? Have they changed all the bands?

You have to realise that most GP's and DSN are 'senior' members of the profession, and the training they recieved on nutrition was 10 or more years ago. They were taught Eatwell as the way to go, and they have been told by the nutritionists that Low Carb is a Fad Diet, and is dangerous. They are taught by NICE that diabetes is an incurable disease, and leads unfailingly to insulin dependancy. They do not have the knowledge of modern diets such as LCHF or ND, and so treat their patients as they have been taught. To do otherwise opens them up to the risk of a malpractice suit in court. (as has occurred on several known occasions).

Also to be considered is the demographic of their patients. T1D and similar are already on insulin. Their T2D are generally elderly and suffering other health issues. Many of these people are not tech savvy and do not access this site.

The information we gain here is invaluable, but is not in use by the general public. Most HCP's will advise you to not access this site because it is not following official policy lines and gives misleading and dangerous information. Eatwell is designed to support insulin users who adjust their meds to match their carbs. The converse also holds, in that insulin users must eat carbs to sustain sensible bgl levels that match their medication. We here are Rebels, especially when we start adjusting our medication to match our carbs.

 

[Bluetit1802]

Thank goodness I have an enlightened GP practice.

 

[KidDougi]

So if the experts can’t agree between themselves, I’m not surprised that some doctors prescribed meds and others don’t, for a given blood glucose level!!
I suppose it’s down to us as individuals to do our research and find a balance that works for us, and hopefully find a doctor who can agree with us, and only interjecting to give us options and guidance as opposed to dictating what we should do.
Imagine, a doctor who can treat us as adults!!

 

[MrsDoodle72]

The GP may actually tell you to raise your HbA1c above 43. The current training for GP's seems to follow the insulin users guide, and they are taught that glucose readings below 7 mmol/l are to be avoided because of the possibility of hypo damage. When I was in hospital recently I was taken off all my meds, and had to get my FBG to 12 mmol/l which was 'good'. They only got concerned if my bgl registered above 20 on the scale. My GP greeted my 43 with advice to get my averages to around 7, not the 5.4 I had been aiming for. When I was in hospital I did hit 5.6 one day, and they decided that was a hypo, and force fed me digestive biscuits.

I chose HbA1c of 43 as a target to get me under the '48' they say is diabetes. I just don't want to be on meds if I can do remission by losing enough weight to get under my personal fat threshold for diabetes. If a 6.1kg loss gets me to 49, a 15 kg loss must get me below 'diabetic' on their chart.... I don't think I can hypo as a borderline type 2 unless I don't eat? (new to this)

weight now 94.6...kg. still on downward trajectory