3 month results today and improved, but need help on explaining results

[Stuart7152]

Great results today from the 05/12/16 and HbA1c 39mmol/L - Should I be asking to lower my medication to 1 x 500mg Metformin per day from existing 1 x 500mg x 2 per day.

I originally pushed the doctor to prescribed the drug as he wanted to wait 12 months to see what any life style changes and exercise would do to my levels. I made some good progress without the drug, but was very unhappy with been at a higher than normal HbA1c for any time and I thought the drug is completely saf, would help with weight loss and lower the risks of other diseases as a positive side effect?

I've check all the result print outs result and only the below seem out of NHS recommended ranges, but they didn't take a Urine test with this batch of blood tests, (Liver/Chol/HBA1c), so I believe can't check the ACR to validate CKD markers.

Can anybody explain what they mean or if I should be worried. I'm seeing the specialist diabetes doctor later today. The urine test is an old one 05/04/16 and the blood test 05/12/16.

Should I insist on a urine test to fully check out the CKD markers or I'm I worrying about nothing.

Confirming the specific normal range for the urine tests will help validating further ones!!!

1. Serum urea level(5/12/16) = +9.1 mmol/L
I assumed normal range = 2.1-8.0, so above this?, what does this mean

2. GFR 85 (MDRD mL/min/1.73m*2) (5/12/16)
60-89 G2 - check kidney disease marker ACR
As ACR less than 3.0 then no CKD

3. Urine album/creatinine ratio mm/mmolL (5/4/16)= 0.3
I assumed ACR less 3.0=normal; 3-30=moderately increased; +30 severely increased

4. Urine creatinine level mmol/L (5/4/16) = 20.7
I assumed normal range = 27.7 - 111, so out of range? what does this mean?

5. Urine albumin level mg/L (5/4/16) = 6.4
I assumed less than 30mg/24hrs (urine) & 3.4 - 5.4 (blood)

6. Urine albumin / creatinine ratio mg/mmol (5/4/16) = 0.3
I assumed less than 3.0 normal; less than 2.5 for T2D

Merry Christmas and a Happy New Year to you all

 

[walnut_face]

I had my medication cut from 1 x 1000mg SR to 1 x 500mg in the summer. Since then my HbA1c has stalled, was 44 now 43. That tells me that improvements are going to either come from diet, or upping the dose again. I plan to try a 56 day <1000Cal diet from mid January to see if that helps, if it doesn't I will ask to up the metformin

 

[Stuart7152]

I had my medication cut from 1 x 1000mg SR to 1 x 500mg in the summer. Since then my HbA1c has stalled, was 44 now 43. That tells me that improvements are going to either come from diet, or upping the dose again. I plan to try a 56 day <1000Cal diet from mid January to see if that helps, if it doesn't I will ask to up the metformin

@walnut_face it's only my first result under 42, so will at least hold out for the next 3 months follow up as I'm wanting doctors approval/support to change diet from moderate carbs to the more typical LCHF diet as the BG meter is showing much better results with this approach. Shame I only got the meter last week and not 8 months ago!!!

If I can keep it under 42 for a couple of tests I may try and halve the dose and evaluate its outcome, but first need a result post trying the LCHF approach

 

[britishpub]

Well done on the improvements. I think you are right to be cautious over making a change in medication too swiftly. Evaluate the effectiveness of diet changes for a few months and go from there.

 

[walnut_face]

To get your BG down to 42 without a meter is no mean feat, I take my hat off to you! Thats like driving ½mile with your eyes shut and not crashing

 

[Stuart7152]

Just come back from the doctors this evening and I'm some what depressed.

I thought the doctor would be happy with my results which he was in part, but in the same breath wants me to increase my weight as he says I've lost too much. He wanted to immediately stop the metformin as apparently he believes this is the cause of my weight loss and not hard work as nobody possibly can lose this amount of weight!

We agreed to retain dose at 1x500mgx2 per day for the next 3 months and then for the next prescription reduce to 1x500mg per day if HBA1c reduces any further and possible stopping them completely . Is he just trying to save NHS money as he thinks I'm completely normal know and the T2D was all down to my fat levels been too high and nothing wrong with my liver / pancreas or insulin resistance.

I tried to show him my BG levels/spikes with eating moderate carbs and immediately he stopped me saying you shouldn't test and didn't need too.

Does metformin by itself reduce your weight?

I explained that I was starting to increase my total calories to maintain weight, but had targeted 14% body fat as my challenge and would more likely add muscle and retain current position going forward.

He couldn't comment on LCHF other than the normal NHS plate rubbish,but did admit he's not qualified in nutrition and referred me to a specialist education group for any question I might have.

Think the whole appointment felt like it was against the clock to get me in and out as soon as possible and I only see him once every 3 months.

What everybody's experience of doctors once you get below HBA1c of 42 as for me it's your fixed why are you here!

Merry Christmas

 

[Hiitsme]

Hi @Stuart7152
I had a similar experience in that I was told I had lost too much weight and needed to increase it. My BMI at that time was 19.6 well within the NHS guidelines so was very surprised. I think he thought I was malnourished as my trigs were very low 0.49 and something else as well. I got sent to dietitian who thought my diet was very good, even though I restrict carbs my body can't cope with. She seemed very happy most of my carbs came from vegetables. I don't do very low carb, probably now almost up to 100g a day though it had been down to about 50g a day to get control.
I have put on the weight (BMI now almost 21) but I'm scared that I might lose control so still carefully monitoring. My HbA1c did go up from 33 to 34 so still within normal limits. My trigs are still low 0.48 but I think that is because I do a lot of walking, probably 8 to 10 miles most days.
Can't help you with meds as I don't take any. I reacted violently to Metformin so got taken off that and I chose to try without meds for as long as possible.
I think you've done really well and would encourage you to keep going.

 

[douglas99]

I don't low carb either, my Hba1c is down to 39 as well now, and has been fairly constant for a few years.
I'm on 500mg metformin, and resisting being taken off it.
My trigs were 0.72 last test, no comment was made.

I don't like my BMI at the bottom of the scale, simply because I look ill.

I don't think anyone can really comment on your individual test results, some filtration rates are based on estimated body mass, so you need to speak to your HCP about them.

 

[Jogreen21]

@Stuart7152 all the numbers sure confuse me alright!!

 

[walnut_face]

@Stuart7152 Sorry you had such a negative appt at the Drs. Sadly it seems to be the experience of the majority. If he had taken note of your lifestyle changes, the fact that you still 'spike', so are clearly still plagued with Insulin problems, it would swim against the tide of 'NICE' advice and their comfort zone. The Doc would have to 'rock the boat'.......They dont get any more for doing that, so I guess they stick to the quiet life

 

[douglas99]

@Stuart7152 Sorry you had such a negative appt at the Drs. Sadly it seems to be the experience of the majority. If he had taken note of your lifestyle changes, the fact that you still 'spike', so are clearly still plagued with Insulin problems, it would swim against the tide of 'NICE' advice and their comfort zone. The Doc would have to 'rock the boat'.......They dont get any more for doing that, so I guess they stick to the quiet life

I think you seem to have mis-read the post.
The doctor originally didn't prescribe meds, he suggested a diet only approach.
Then amended that when discussed with the op.
It seems to have been a very positive experience, with a very understanding HCP.

 

[douglas99]

Great results today from the 05/12/16 and HbA1c 39mmol/L - Should I be asking to lower my medication to 1 x 500mg Metformin per day from existing 1 x 500mg x 2 per day.

I originally pushed the doctor to prescribed the drug as he wanted to wait 12 months to see what any life style changes and exercise would do to my levels. I made some good progress without the drug, but was very unhappy with been at a higher than normal HbA1c for any time and I thought the drug is completely saf, would help with weight loss and lower the risks of other diseases as a positive side effect?

I've check all the result print outs result and only the below seem out of NHS recommended ranges, but they didn't take a Urine test with this batch of blood tests, (Liver/Chol/HBA1c), so I believe can't check the ACR to validate CKD markers.

Can anybody explain what they mean or if I should be worried. I'm seeing the specialist diabetes doctor later today. The urine test is an old one 05/04/16 and the blood test 05/12/16.

Should I insist on a urine test to fully check out the CKD markers or I'm I worrying about nothing.

Confirming the specific normal range for the urine tests will help validating further ones!!!

1. Serum urea level(5/12/16) = +9.1 mmol/L
I assumed normal range = 2.1-8.0, so above this?, what does this mean

2. GFR 85 (MDRD mL/min/1.73m*2) (5/12/16)
60-89 G2 - check kidney disease marker ACR
As ACR less than 3.0 then no CKD

3. Urine album/creatinine ratio mm/mmolL (5/4/16)= 0.3
I assumed ACR less 3.0=normal; 3-30=moderately increased; +30 severely increased

4. Urine creatinine level mmol/L (5/4/16) = 20.7
I assumed normal range = 27.7 - 111, so out of range? what does this mean?

5. Urine albumin level mg/L (5/4/16) = 6.4
I assumed less than 30mg/24hrs (urine) & 3.4 - 5.4 (blood)

6. Urine albumin / creatinine ratio mg/mmol (5/4/16) = 0.3
I assumed less than 3.0 normal; less than 2.5 for T2D

Merry Christmas and a Happy New Year to you all

I've just had my Urine creatinine back, it's low at 11.2, but agrees with my blood tests, and is likely due to my diet, as it's been low protein, so my kidneys are having to do little work at the moment.
Microalbumin is less than 5, so that's tracking as well.

(To be fair, that have been constant at that for quite a few years, apart from one blip, when I got tested a couple of days after my summer holiday, then they increased into the mid range)

 

[yiannis_]

If I were ever in your position (I doubt I'll ever be too light) I think I would be trying to build lean mass in the gym which in the medium term may help reduce spikes.
Personally I don't want to be on any drug that I don't absolutely need for it's primary reason. I prescribe as a big part of my day job and tend to take all the claims of additional benefits of these drugs with a large pinch of salt.

 

[Kittylitter]

Just come back from the doctors this evening and I'm some what depressed.

I thought the doctor would be happy with my results which he was in part, but in the same breath wants me to increase my weight as he says I've lost too much. He wanted to immediately stop the metformin as apparently he believes this is the cause of my weight loss and not hard work as nobody possibly can lose this amount of weight!

We agreed to retain dose at 1x500mgx2 per day for the next 3 months and then for the next prescription reduce to 1x500mg per day if HBA1c reduces any further and possible stopping them completely . Is he just trying to save NHS money as he thinks I'm completely normal know and the T2D was all down to my fat levels been too high and nothing wrong with my liver / pancreas or insulin resistance.

I tried to show him my BG levels/spikes with eating moderate carbs and immediately he stopped me saying you shouldn't test and didn't need too.

Does metformin by itself reduce your weight?

I explained that I was starting to increase my total calories to maintain weight, but had targeted 14% body fat as my challenge and would more likely add muscle and retain current position going forward.

He couldn't comment on LCHF other than the normal NHS plate rubbish,but did admit he's not qualified in nutrition and referred me to a specialist education group for any question I might have.

Think the whole appointment felt like it was against the clock to get me in and out as soon as possible and I only see him once every 3 months.

What everybody's experience of doctors once you get below HBA1c of 42 as for me it's your fixed why are you here!

Merry Christmas

In answer to the bit about your HBA1c being under 42 - yes my doctors keep telling me my levels are fine, even though I am worried I am one point away from being pre-diabetic, and my fasting morning levels are 7.4, doctor still says there is nothing wrong and he will re-test my HBA1c next year and he says there is no way it will go up in that time.

 

[Bluetit1802]

My experience with my doctor with levels under 42?
Zilch. I have never once seen a doctor, not even on diagnosis. Always a nurse. The magic number as far as she is concerned (and presumably surgery protocol) is 47. Because I was under 48 for over 18 months post diagnosis - without medication, she suggested I came off the diabetic register and would be added to an At Risk register. As that would mean only annual blood tests I declined. That was 12 months ago, and at a very recent appointment with the nurse she again suggested me coming off the register. I declined again. I like my 6 monthly blood checks, although I only see the nurse annually.

Does Metformin by itself reduce your weight?
Metformin is known to be an appetite suppressant, so in that respect it does help with weight loss.

 

[Resurgam]

Yes, Metformin is known to cause weightloss, though it did not supress my appetite - when I take it I experience hunger which I do not do as a rule. I also get stomach cramps, nausea, and jet propelled diarrhea, which gives me great enthusiasm for diet control.

 

[Pinkorchid]

Yes Metformin did reduce my weight but that was because it almost totally took away my appetite I have never been overweight but because I was not eating enough I did loose weight that I did not need to. My doctor told me to reduce the dosage from the 1000mg twice a day I was taking until my appetite came back. I had to go down to 500mg once a day before I got my appetite back I am eating really well again now but have not put back the weight I lost yet