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Diet v medication?

Syd

Syd

Well-Known Member
Messages
93
Location
Chester
Type of diabetes
Treatment type
Diet only
Hello all. I've been reading this forum for a few weeks now but this is my first post.

I was diagnosed T2 two days before Christmas Day with what I now know to be a Hba1C of 82.

Since then I have changed my diet and started to exercise a bit more. So far, 24 lbs of weight has been lost and according to the two glucose meters, my glucose levels have been brought under control, as has the high blood pressure which first alerted the doc that something was amiss.

I thought everything was going fine until I had my appointment with the nurse earlier this month, just over six weeks from diagnosis. She and I disagreed on treatment. My view was that as diet and exercise seemed to be working very well there was no need at the moment to commence pharmacological treatment. Her view was that as my Hba1C was over 58, I should be on medication, which I assume would be Metformin.

I made the informed decision not to accept the proffered prescription and carry on with the non-pharmacological treatment of T2 diabetes. Was this reasonable?




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Hippocrates — 'Let food be thy medicine and medicine be thy food'
He is mutch forgotten amongst HPCs
 
What sort of nurse was she? The practice nurse - the one who does the baby injections and the asthma clinic? In my experience they know very little. This is a discussion you should be having with your GP.

Your HbA1c is still quite high 58 is 7.5% in old money, I wouldn't want mine to be that high. What readings are you getting from your meter? You may need more help than just diet in your diabetes journey. Metformin isn't a terrible thing to have to take, and if you have stomach problems with it there is the SR version which is kinder.

The problem with Type 2 is that you don't know how long you had it before being diagnosed and how much damage you have done to your pancreas.
 
Yes, just keep doing what you are doing.

I was diagnosed in January 2013 based on a test taken on Christmas Eve. I was something like 86. My DN was hopeless and I had a couple of arguments with her because she wanted to 'fine tune my medication'. I told her on both occasions that I wasn't on any. She got very stroppy when I asked her why she didn't bother to read the notes. I was given another HBA1c at 9 weeks rather than the usual 12 and she was sneering when it turned out to be 48. Anyway, to cut a long story short, she has been exiled to the wrong part of town and the head GP has been forced to resign. My HBA1c is down to 36 after 12 months.

Her opinion is just that, an opinion. If you feel you can do it on diet and exercise, just say no. If you have got down from 82 to 58 since Christmas and have lost 24 lbs, you are doing well. From where I am standing, it looks like you just need more time. An HBA1c in Feb is too early anyway because it takes 12 weeks to re-cycle your haemoglobin and you still ahve many red blood cells with glycogen still bound to it from Christmas. They should wait at least 12 weeks and preferably 16 weeks from first diagnosis because it might take a bit of time for you to start. You've only had about 7 weeks.

It looks very much as if she is trying to bounce you onto medication
 
Hello Denise and Fergus thanks for your replies.

The nurse and the doc seem to work as a diabetes team. So I assumed that this was the standard procedure and that medication would be prescribed after seeing. I also assume that the intervention of the Christmas holidays lengthened the period between the diagnosis and the prescription. This was further lengthened when the surgery put back the nurse's original appointment from the middle of Jan to early Feb.

My HbA1C has not been tested as 58 but was tested as 82 in late December. The nurse said that as this was over 58 they would prescribe Metformin.

For the past month my fasting BG has been between 4.4 and 5.6 and post prandial is normally under 6. There has been one PP reading of 8.5 and one of 7.1 and 3 readings in the low 6's.

If my next HbA1C is too high then I would have no objection to Metformin, but it seemed perverse to leave me to my own devices for six weeks and then prescribe medicine on what would be out of date information.


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I don't know about the medication but I applaud you, you are doing a fantastic job with the dieting, keep it up, well done!
 
Thanks Yorksman for reply and encouragement.

I may have poorly phrased my original post in that I've only had the one blood test which gave a HbA1C reading of 82. The DN said that this was over 58 and she advised Metformin.

I take on board your comments about the timing of the next test. If the results show excessive HbA1C then I will agree to medication, but I would prefer to see how far a change of lifestyle will take me.


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I have nothing against metformin, I take it myself, but it seems to me you are making very good progress and that as long as your meter is telling you your levels are good just continue doing what your doing.

All the best

Pavlos


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With hindsight I might have done as you did but in fact I took the medication. It is now my opinion that it did nothing to help and gave me some side effects that I could have done without. Since I did not wish to alienate the nurse in case I needed her later I took the pills until she stopped them due to complications.

Since then I find that I have a much more significant effect on my Hba1c etc. with diet and exercise. When I say significant I mean that on pills my Hba1c was 68 and the pills did not affect it. Without pills ...........well read my signature.
 
HI. well done getting the weight down. The DN was following NICE guidelines and the advice to prescribe Metformin was sensible. However, it's your choice and if your weight continues to fall you may well have an HBa1C below 7%. Metformin is very safe and does help with insulin resistance and does slow glycogen output from the liver; every little helps as they say.
 
Well done with your results!

I found (and still find) Metformin very useful for smoothing out bg spike. I would recommend it especially in the initial months after diagnosis. Metformin also has some beneficial action against heart disease and is an appetite suppressant so will help you lose weight. It does not stimulate insulin production so it won't put your pancreas under any more pressure.

A purely selfish advantage of accepting Metformin is that you will then be eligible for free prescriptions on all medications you may need.
 
Syd said:
I've only had the one blood test which gave a HbA1C reading of 82. The DN said that this was over 58 and she advised Metformin
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So you had a test before Christmas, modified your diet, lost lots of weight and were then prescribed Metformin on the basis of the pre-Christmas test without any subsequent test to see if anything had improved? That doesn't sound like good practice to me. In your position I'd carry on with diet only until at least three months after your original test, then ask to have your HbA1C tested again. I think if you put it like that to the nurse or doctor they'll be happy to hold off on the Metformin while you see whether diet alone works.

Kate
 
I think that the way my surgery works is that the doctor diagnoses diabetes and then you see the diabetic nurse in a long appointment (nearly one hour) and after which prescriptions are issued. But because of Christmas and New Year the earliest the nurse could see me was 15 January but the surgery can called that and put it back to 4 February, so I had been left to my own devices for over six weeks. In that time I bought (1) a blood pressure monitor (2) an Aviva Nano BG meter (3) a set of Omron weighing scales and (4) when I discovered the cost of Aviva test strips, a SD Codefree meter, and began a duet weight loss programme.

I did say to the nurse that if my HBa1c was high next time it was taken I would go on the Metformin.


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Well done you have taken control of your DB and that is the main thing .Keep testing and then you will know how your body is dealing with the glucose and you can find good advice on here and some good recipes also
CAROL
 
I support your choice. On diagnosis, I had no intention of taking medication until it was proved I couldn't control my BG levels by eating the right foods in the right quantities and adding exercise. As things stand, I'm convinced I made the right decision and I hope you have too.
 
Hi,

I've taken the same choice as you. I was only diagnosed in January and saw my nurse almost immediately. I told her I wanted to try diet and exercise first then see what happens. She was quite happy with that, but my diagnosis level wasn't that drastic - HbA1c of 53. I've taken myself in hand, have lost half a stone in 3 weeks and added more exercise - 2 brisk walks daily instead of 1 amble, and 1 session of aqua-aerobics weekly. I am hoping against hope this works. One good thing that has already happened is my BP has dropped to the 120's/70's from the 140's/80's.

Good luck!
 
Thanks for the above advice and kind words of encouragement.

Just had my results of an HbA1c test from early April. Now 39 Mmol/mol or 5.7% down from 82 or 9.6% in December. So quite pleased. I have lost 50 lbs so far which is the main reason for the improved glucose levels (IMHO).
 
Quite pleased indeed!

That's brilliant Syd, well done and justifies sticking to your guns at the beginning.

I'm trying to do much the same, will have to wait until July for my next HbA1c though!
 
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