Who actually does know best

[wozey]

So today I’ve been in to see my GP about some test results and the conversation turned to my diabetes, it went something like this

“well I see the nurse has put you on Metformin, why didn’t you want to try diet modification first?”

She said I should be on them so that’s what I’ve done, his response was

“I just feel that diet should be the first line when you’ve only just gone into diabetic territory but then the diabetic nurse knows best so you should carry on with that”

I’m reading into that he thinks I’m being needlessly medicated but isn’t prepared to step on anyone’s toes so as I don’t have a diabetic appointment till mid May I’m considering stopping the medication immediately. Is there any risk abruptly stopping taking this or do I need to step it down over a few weeks or should I wait and get the diabetic nurse who’s given me nothing but useless advice to this point to explain why she feels forcing 4 massive pills down my throat every day and dealing with the unpleasant side effects is necessary if diet alone could work on it’s own

 

[Antje77]

There's something to say for both approaches, so I guess they're both right. HCP's have personal preferences too, and both approaches fall within the guidelines I think.

Who actually does know best is your glucose meter.
It's completely unbiased and will tell you what works and what doesn't.

As for stopping medication, this is not something we can comment on. Medication and doses are between a patient and their HCP (in your case two HCP's who are giving mixed messages to make things even more confusing).

Many people don't feel making long term lifestyle changes is possible for them, or they haven't been informed of the possibilities.
So your average T2 does need the medication.
Now things may very different for a highly motivated T2, like many of our members are.

Good luck!

 

[catinahat]

Metformin is a relatively mild drug, it helps a little if you are lucky enough not to suffer from it's unfortunate side effects. It is said that there are other benefits to taking met, apart from it's help with T2, you will have to do your own research on that.
In your shoes, if you can tolerate them, I think I would take any help I could, at least until the next HbA1c, see what improvement there has been and then decide if I wanted to continue with it.
For me the side effects were intolerable and it was definitely not worth suffering just for whatever slight help metformin was giving.
You don't need to wean yourself off metformin if you decide to stop taking them, the side effects disappeared almost instantly

 

[HSSS]

he thinks I’m being needlessly medicated

the diabetic nurse who’s given me nothing but useless advice to this point

forcing 4 massive pills down my throat every day and dealing with the unpleasant side effects is necessary if diet alone could work on it’s own

You seem to have formed your own opinion already.

In your shoes I’d not be taking the tablets and having the side effects (and didn’t). The dr endorses your preference for diet only too. I’m not a medical person and not telling you what to do with medications but I’ve never heard of issues stopping Metformin instantly and would do so myself. Loads of us have achieved non diabetic levels on medication alone - when we get the right advice in the first place.

When is your next hb1ac schedule? It should be 3 months from diagnosis. NICE say 3 monthly tests til stable and they can’t say your stable til you have at minimum 2 in a similar range, ideally more.

 

[wozey]

When is your next hb1ac schedule? It should be 3 months from diagnosis. NICE say 3 monthly tests til stable and they can’t say your stable til you have at minimum 2 in a similar range, ideally more.

Next one is in May, it was supposed to be April but been pushed back. I felt right from diagnosis the easy option for them was tablets, no mention of diet control however it clearly says on the NHS website that medication is usually prescribed when diet alone is not effective. I could tell from the doctors body language he wasn’t best pleased

 

[Oldvatr]

Next one is in May, it was suprosed to be April but been pushed back. I felt right from diagnosis the easy option for themrwas tablets, no mention of diet control however it clearly says on the NHS website that medication is usually prescribed when diet alone is not effective. I could tell fromr the doctors body language he wasn’t best pleased

It is usual for newly DX'ed diabetics to be given Metformin regardless. It is not for glucose control so much as for general maintenance of the cardiovascular system (heart etc). The question of whether or not to provide further tablets will be made later, thus giving a window for one to attempt lifestyle changes to bring the next HbA1c down again.

 

[Lainie71]

Next one is in May, it was supposed to be April but been pushed back. I felt right from diagnosis the easy option for them was tablets, no mention of diet control however it clearly says on the NHS website that medication is usually prescribed when diet alone is not effective. I could tell from the doctors body language he wasn’t best pleased

I went through the same with my gp and could see her frustration along with the dn, however I have not been offered statins or meds since. DN told me she had never had anyone in her years of nursing controlled their bg with diet alone, I proved her wrong!

 

[Hopeful34]

t is usual for newly DX'ed diabetics to be given Metformin regardless. It is not for glucose control so much as for general maintenance of the cardiovascular system (heart etc).

Why are type 1's not (usually)given Metformin on diagnosis (never been offered them myself, although I know some type 1's have asked for them) @Oldvatr?

 

[Deleted member 475901]

I told my GP at diagnosis I wanted to try low first and he agreed to 'let' me. The nurse who saw me a month later said Oh the dr forgot to prescribe your metformin and statins.
She'd never heard of the impact of low carb or the possibility of remission.

 

[Antje77]

Why are type 1's not (usually)given Metformin on diagnosis (never been offered them myself, although I know some type 1's have asked for them) @Oldvatr?

Because metformin is prescribed for insulin resistance in the first place, which is not part of having T1 (although T1s can of course have IR).

The only thing a plain T1 has wrong with them is that they don't produce insulin, so adding that insulin should make them no different than people without diabetes (in a perfect world with perfect dosing that is).

So they aren't usually prescribed metformin for the same reason that everybody without diabetes isn't prescribed metformin.

 

[Oldvatr]

Why are type 1's not (usually)given Metformin on diagnosis (never been offered them myself, although I know some type 1's have asked for them) @Oldvatr?

I have seen Type 1's on Metformin. I think if the doc thinks there may be concurrent Insulin Resistance then it may be prescribed. Not many T1d are Insulin resistant, but it is not rare either.

The effects of metformin in type 1 diabetes mellitus

This retrospective study investigated the effect of adding metformin to pharmacologic insulin dosing in type 1 diabetics on insulin therapy 1 year after treatment compared with patients on insulin therapy alone.Twenty-nine adults with type 1 diabetes ...

www.ncbi.nlm.nih.gov

Overview | Type 1 diabetes in adults: diagnosis and management | Guidance | NICE

www.nice.org.uk

Para 1.7.18 of NG17 is relevant. introduced officially in 2015

 

[wozey]

Spoke to a friend earlier and she thinks I’m just trying to ditch the medication because then the diabetes isn’t as important or a big deal anymore. That’s not the case I just think that I can do it myself without the pills like so many on here have done and continue to do, I always achieve the things I set my mind to so it’s not a risk to me and I’m already very low carb but I’ve agreed to wait until my next appointment and now I’m better informed it should be a more useful appointment

 

[Hopeful34]

I realise about metformin for insulin resistance thanks, it was really @Oldvatr saying it being for general maintenance of the cardiovascular system.

 

[Resurgam]

Spoke to a friend earlier and she thinks I’m just trying to ditch the medication because then the diabetes isn’t as important or a big deal anymore. That’s not the case I just think that I can do it myself without the pills like so many on here have done and continue to do, I always achieve the things I set my mind to so it’s not a risk to me and I’m already very low carb but I’ve agreed to wait until my next appointment and now I’m better informed it should be a more useful appointment

For a plain ordinary type 2 the only thing that is really very dangerous is to ignore it.
I don't need medication because I live every day as though I have to control my blood glucose (even on days when break my own rules) but because I am always aware of the carbs and my reaction to them, it works out long term. My usual strategy is to stay under 40gm of carbs a day.
I was put on Metformin and Atorvastatin from diagnosis and they hit me hard, I only managed 5 weeks and then I threw them out. It took a long time to get over the effects - or at least be able to tell myself that I had even if I will never regain everything I lost.

 

[Robbity]

I was prescribed metformin for several years after my T2 diagnosis, until my GP decided I could manage on my low carb diet alone. I just stopped taking it and had no issues with doing this, but apart from one brand that disagreed with me I'd never had any of the unpleasant gastric issues that can be associated with "metfartin".

 

[JoKalsbeek]

So today I’ve been in to see my GP about some test results and the conversation turned to my diabetes, it went something like this

“well I see the nurse has put you on Metformin, why didn’t you want to try diet modification first?”

She said I should be on them so that’s what I’ve done, his response was

“I just feel that diet should be the first line when you’ve only just gone into diabetic territory but then the diabetic nurse knows best so you should carry on with that”

I’m reading into that he thinks I’m being needlessly medicated but isn’t prepared to step on anyone’s toes so as I don’t have a diabetic appointment till mid May I’m considering stopping the medication immediately. Is there any risk abruptly stopping taking this or do I need to step it down over a few weeks or should I wait and get the diabetic nurse who’s given me nothing but useless advice to this point to explain why she feels forcing 4 massive pills down my throat every day and dealing with the unpleasant side effects is necessary if diet alone could work on it’s own

"Who actually does know best", is an excellent question. Your meter. That's the answer. It won't try to sell you on something, it'll just tell you whether something is working for you or no. If you read the leaflet of the metformin, it actually does say to try diet first for three months, then if that doesn't work, to try medication. So to attempt it under your own steam first. Make of that what you will.

As for not having the confidence to think you can do this on diet alone.... Time'll have to tell. And your meter'll help with that. Right now I'm a mess, had numerous infections that required antibiotics, ate strangely... My blood sugars are higher now than they have been in years, but after 7 years of low carbing and some zero carbing in the mix, my insulin sensitivity is much improved. It'll get back down right quick, if it does go up, and right now I haven't seen anything higher than an 8,5, which for me, is high. People can stick with low carb just about forever, and some (or all, really) will fall of the wagon sooner or later. Circumstances happen. I got infections just when my mom was dying, so... Stress, bad food, infections. Those'll mess any person up, not just diabetics. And I am STILL making it work in so far I can right now. My levels have not even come close to the numbers I was seeing when I was first diagnosed, when I was hitting the twenties. Bottom line: If you want to do this your way, and considering this is YOUR body, you have to live in it, you decide how you handle things. You can experiment, and see how it works out with your meter. Diabetes doesn't have to be perfectly fixed overnight, you have a moment to decide what you want to try, and how you want to try it. And if something does throw a wrench in, somewhere down the line, there's no reason why you wouldn't be able to pick it up again. While reaping the benefits of prior months/years of low carbing, if that's the route you decide on. Metformin, it's not something that'll make you hypo if you decide to have that beside a low carb diet. You can take a little less, see what your meter tells you, or take none, or just stick with what you're on now. You're your own guinea pig here. Not seeing anyone until May? Then you have until then to see whether diet alone, or any amount of metformin of your choosing, will make the difference you want it to make, before seeing the nurse again. It'll help plead whatever case you want to make.

It's your diabetes. You decide. Trust your meter.
Hugs,
Jo