Recent Content by Dr_Ian_Dickson

Sure. Lowering carbs, lowering calories, losing fat mass/weight and taking more exercise - walking etc will probably work better.

Metformin lowers HbA1c. It helps reverse insulin resistance meaning glucose can enter the tissues more easily and as you say it reduces hepatic glucose output. It lowers insulin levels and does not cause hypos. In early T2D or prediabetes you want to aim for low insulin and good BG control.

I agree totally. When I started med school my pharmacology prof said “all medicines are potentially poisons and should be looked upon that way”. Everything is a balance of pros and cons. On balance metformin is likely to offer many more benefits than dangers unless you have progressive CKD and...

You need a series of 3 or better 4 or better 5 EGFR results to establish a definite trend in what is happening. Simple things like being a bit dehydrated when you have a test can affect the individual test.

I’m not totally clear what your readings are. There should only be 1 result per date. The reference ranges can vary for different populations. The readings above are all well within normal. You have to remember lab tests are only accurate to +/- around 5-10% so 2 tests on consecutive days can...

I should have also said other medication particularly ACE Inhibitors can be related to this problem but they are also protective of the kidneys - quite hard to explain in a short post but again best to speak to your hcp

Generally speaking EGFR is a better measure of kidney function and would be preferred over creatinine levels. Remember also that conditions other than T2D can cause kidney function to deteriorate. You should be monitored for microalbuminuria which is an early warning sign of diabetic kidney...

Metformin does need to be used with caution in CKD. CKD has 5 stages and you need to know what stage you are at. Your GP can tell you this from a routine blood test that measure EGFR - how well your kidneys are filtering your blood. Also you need to know if this EGFR is stable or deteriorating...

From my knowledge and clinical experience this is another difficult question to answer categorically. I would make a few comments. Metformin used in prediabetes has been shown to prevent/delay the onset of full blown T2D. In the biggest UK study UKPDS it came out well on top of other treatments...

I’ve been retired for 2 years but generally HbA1c wasn’t really advocated then. However a level of 48mmol/mol was the diagnostic level as the other threads have suggested - so you probably had IGT or prediabetes. 48 equates in the old UK % figures to an HbA1c of 6.5%. Diagnostic criteria did...

This is an important question that is not really able to be answered. I’ll try to explain a little more. The current diagnostic levels on fasting, 2hr post eating glucose (similar to randomly being tested) were based on longer term risks for developing small blood vessel disease in the eyes and...

I am pretty sure if you have hypo awareness and are not getting hypos that your low HbA1c is good and not a worry. The earlier post is correct that in the ACCORD study there was an intensively treated group whereby lower HbA1c was tried to be obtained by putting Insulin doses up which led to...

This thread began with a person on a low carb diet who had been testing regularly and was stable and sticking to a stable low carb diet and asking was their a purpose to continually routinely testing. I believe in this case no there is no reason to routinely test. I then get barraged by others...

Many of the points made are very fair. I think many of you are venting strong feelings at me personally which is not really what the forum should be for. If you follow a carb counting diet and are restricting carbs to under 40gms daily I doubt you will get many serious BG spikes - but maybe I’m...

Here’s a copy of today’s blog - maybe look at the earlier ones if they are of interest. My earlier blogs have argued that we not only want to strive for good blood glucose control but low insulin levels. Insulin while essential for controlling blood sugar has many adverse functions. (1...