Is Metformin prescribed for impaired fasting glucose?

[mrsknitty]

Hi everyone,

I just said hello in the intro thread but have a couple of questions.

My first one is whether I might be prescribed Metformin? I had a OGTT last week and my fasting level was 6.5 and I don't yet have the results for the 1 hr and 2 hr but I know they are likely to be not too bad (i.e. probably also 6.5 or 7 - based on the one I had 6 months ago).

It is my fasting levels which are always too high - so I suppose my question is whether they would prescribe metformin for high fasting levels? I have read that it can work better the earlier it is prescribed, and that it can help with weight loss etc. If I am v strict with low carb diet then my fasting levels might be more like 5.5 but at the moment I am breastfeeding and have a 3 month odl baby (and a 4 yr old) and it is a challenging time in my life to start exercising more and being really strict about what I eat. So I suppose I am hoping that the metformin could prevent things getting any worse and buy me a little time to get on top of things?

My second question is whether complications can occur when levels are only pre diabetic? My eyes have been sore and blurry today and I know that that can be a sympton of diabetes and it makes me panic that it is due to that but I am not sure whether I am being overly dramatic.

I have an appt next week with my dr to discuss all of this but I am just feeling anxious about everything at the moment and just wondered whether anyone could help with my questions. Very many thanks xxx

 

[RussG]

Hi mrsknitty

It’s possible metformin might be prescribed – only your doctor can tell you. However it is usually only given when diet and exercise are not enough to keep your sugars down. Given you are classed as having pre-diabetes, which is a judgement based on you current BG levels and response, personally I don’t think it’s that likely you’ll get metformin without putting a case forward. You said your fasting levels are 'too high' - what do you consider that to be?

As for your second question, complications tend to arise after long periods of high sugars, which only happens in uncontrolled, 'full' diabetes. So I think it’s fairly unlikely your eye trouble is due to a complication such as retinopathy. Blurry vision is a reasonably common indicator of high blood sugars though but it could be other things as well. Did you do any testing whilst your eyes felt blurry? You’ll get an annual eye test to look out for any changes in the eye as standard now.

I would discuss this with your GP, but it sounds like you have caught your diabetes early enough to have a go with diet and exercise.

The last thing I would say is that some people will say very strict low carbing is fine for breastfeeding mothers but I would say that it is unproven and contentious. If you are in ketosis and burning fat, ketones will be produced in your breastmilk. We don't know if babies tolerate these well or not. The Atkins website recommends breastfeeding mothers don't follow the Atkins diet.

You have to think about your health and nutrition, and that of your baby. I know my wife needed quite a few extra calories whilst breastfeeding, so I would suggest thinking carefully about how you balance diabetes with breastfeeding. Perhaps some diabetic mums may have some perspective on this? It's clearly your choice on low carb diet but diabetes is a lifelong thing and sometimes other things need to take priority.

Good luck.

 

[mrsknitty]

Hi Russ, Thanks very much for your reply, I appreciate it!

My fasting levels vary between about 5.5-6.5 and it is the 6.5 that worries me - occasionally they can be 7. I think I read that it is once the levels are 6.5 or higher that the beta cells in the pancreas are destroyed so I panic once they are over 6.5. Last night before bed I tested and it was 5 and then this morning it was 6.5...!? (I am aware of the dawn phenonemon).

Yesterday when my eyes were blurry my levels were not high, around 5.5 or 6. The previous evening they were 6.6 when I went to bed ... so no, not high in general terms although I know on Sunday I did not eat well at all.

But thank you for the reassurance on that front, it really calmed me down to voice my concerns and have a reply as I don't really have anyone to talk to about this who knows about it and I can drive myself crazy worrying.

With regards to breastfeeding I am not low carbing that much, for a start I am vegetarian so I eat loads of vegetables - I mean low carb by cutting out pasta/bread/rice etc. I am definitely not in ketosis. But your point is really interesting and has made me wonder if maybe the breastfeeding is why I am struggling so much to stick to my low carb diet at the moment. When I was pregnant it was not a problem at all but since I had my baby I find it so much harder!

So maybe I do need to introduce small amounts of carb while I am breastfeeding, and hopefully that will stop me falling off the wagon so badly at times!

Lots of food for thought for me, and thank you again for the reply, I do really appreciate it! xx

 

[RussG]

Not a problem. None of us can give medical advice, but we can share our experiences and knowledge for you to contemplate against your own experiences.

I don't think you need to worry too much about beta cell destruction at a BG level of 6.5. This is taken from the diabetes.co.uk website:
Normal blood sugar ranges
The normal blood glucose level in humans is about 4 mM (4 mmol/L or 72 mg/dL)
The body, when operating normally, restores the blood sugar level to a range of about 4.4 to 6.1 mmol/L (82 to 110 mg/dL).
Shortly after eating the blood glucose level may rise temporarily up to 7.8 mmol/L (140 mg/dL) or a bit more in non-diabetics

So even non-diabetics' blood sugar can go higher than 6.5. That's not to say levels couldn't be lower, but 6.5 isn't panic stations for me. An average reading of 6.5mmol would equate to an HbA1c of 5.4%, which many people would be delighted with. However some people try to keep their BG levels to the same as non-diabetic people. That's not my route, but everyone is different.

I tend to find I suffer from higher fasting levels than during the day, but if I test at say, 0400 or 0500 my levels are good and it is the release of the hormones etc. that is pushing them up in the run up to waking.

I think levels of 5.5-6.0 are very unlikely to be causing eyesight problems either, so it may be something else causing that.

On the breastfeeding issue - I hope some diabetic mums will chip in here, but I think my view would be that breastfeeding is a time limited activity that places extra demands on your body. It may be appropriate to consider feeding more important than *very* strict control at the moment (but obviously all within reason etc.)

 

[mrsknitty]

Hi Russ and thanks again for the reply!

I went to bed with a level of 5.6 but even at 4am it was 6.5 Anyway I realised partly why it worries me so much, it is becasue when I was pregnant the diabetic team were concerned about my fasting level and as it wouldn't come down after a week of careful eating then I was put straight onto insulin.

So when I was pregnant (had my baby August just gone) having high fasting levels *was* seen as worrying and I suppose what you are saying is that for longer term management having high fasting levels is not so much seen as something to worry about?

I also ended up on what is apparently ALOT of insulin until my fasting levels came down, and so the consultant says that I have a very high level of insulin resistance and he would expect me to be fully diabetic in a couple of years> I think thats the other reason I am panicking right now as I feel like |I have a maybe two year window to lose weight and control my blood sugars and yet right now life is very demanding!

Anyway this has been really helpful so thank you again )