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To medicate or not to medicate, that is the question

N

niblue

Well-Known Member
Messages
210
Type of diabetes
Type 2
Treatment type
Tablets (oral)
I had a visit for blood testing etc. with the diabetic nurse at my local medical practice last week, with a follow-up call to discuss the results yesterday. Key points were:
  • HB1AC: Not great at 68, but down a fair bit from 80 the last time
  • Blood pressure: A week of my own measurements (the nurse didn't check blood pressure herself) averaged 138/81 but down from an average of 143/82 the last time
  • BMI: 28.5 so still too high, however down from 30.3 the last time
  • All my other checks including cholesterol etc. are OKish (e.g. total cholesterol of 4.4)
I’ve got my next scheduled blood test in early July but had a bit of a difference of opinion with my GP (who’s the diabetic specialist at the local surgery) on what to do now. Given I’ve been making reasonable progress my preference is to leave my medications the same for now (I’m currently taking 1 x 500mg metformin plus a statin daily) and continue with lifestyle changes. The GP however, (who from previous experience does tend to like to prescribe) wants to:
  • Increase my metformin to 2 x 500mg per day
  • Put me on blood pressure medication (which I’ve never been on before)
On the lifestyle side of things I’m on a reduced carb (and lower calorie) diet and also continuing to shift some weight (I’ve lost another kg in weight since I was in for tests last week, so BMI is now 28.1) as I know that’ll be beneficial for both my blood sugar and blood pressure. In the week since the blood test my own blood sugar readings have averaged 7.9, and my blood pressure 129/79 which would appear to indicate things are heading in the right direction.

Anyway we’ve agreed(!) to do it my way for now (although I expect he has me down a trouble maker) and then review again after the next blood test. I’m interested to know what other folks would have done though! Part of me isn’t that keen on going against a doctors advice, however in reality I’ve perhaps got better access to current data than he does, including on the direction of travel that my own tests are showing.

So what would you have done in those circumstances?

Regards
Steve
 
Short answer is it would depend, as I've never been in your circumstances. On (eventual) diagnosis I was offered metformin which I refused and was urged to take a statin, which I've also always refused. Metformin will lower BG a little and a statin will raise it. They might balance.

I wanted to lower my BG by a lot, and having read about people's experiences on this forum it seemed like a low carb/keto diet was the thing to do. It was essentially Atkins, which I'd done in the past and which had worked for me in terms of weight loss - no idea about blood glucose then. So that's what I did, and it worked (and continues to work).

If it hadn't - of course I'd have tried medication, whatever was available. I had some pretty bad diabetes-related symptoms and anything that got rid of them would have been welcome.
 
One of the slight oddities is that I've never had any symptoms of diabetes, instead when I was in for something else (an issue with my hip) the doctor decided to give me a full battery of tests as I hadn't ever had them (and in fact hadn't been to see a doctor in a decade or more).I was put on metformin and statins immediately at that point, and not really given any other advice other than to stop taking sugar in my coffee...

After doing my own research It's also my preference to progress with a low-carb diet, which is what I'm doing now. That's partly to reduce my blood sugar but also to lose some weight (which I think will also have a beneficial effect on my blood pressure as well).

Anyway, we will see what the score is when I get my next blood test done.
 
I am happy to take any of the pills offered to me. I struggle with my diet, always have, but I am aware that losing weight is very beneficial to BG control.
 
Often it works the other way about - you get a grip on your blood glucose, and the weight naturally comes off.
 
I'm happy to take diabetes meds (but not statins as they take my cholesterol too low) and I don't have high blood pressure so don't need meds for that.

My reasoning for taking diabetes meds is that the higher your blood sugar levels, the more potential damage may occur to my arteries, more risk of retinopathy in my eyes and more damage to the nerves in my feet.

I also restrict the amount of carbs I eat to stop my blood sugar spiking,
 
Hi
Since I developed T2 5 years ago I have followed a Low Carb diet, usually quite low when I bother to put my foods into the ‘FitnesPal’ app. Like you, I’ve recently had blood tests, myHbA1c is about 57 and GP STILL talking about me getting it lower!! I barely eat anything!
I keep getting told that I don’t need to monitor my daily blood glucose levels!! GP said only the HbA1c is relevant and average glucose reading
 
When I was first diagnosed a three years ago I got my HB1AC down from 106 to 53 in under 3 months - mainly by going low carb and losing a lot of weight, then down to 43 in another 3 months. So I know it can be done, I just need to do it again and then not get complacent this time. After a 3rd lowish test of 53 I then moved onto annual tests, with the next one being 80, and the one after that being the latest at 68. I'd pretty much stopped doing any testing or tracking my weight so this time, once I get back to where I need to be, the plan is to do at last weekly blood and weight checks.

This is how my own home blood sugar tests have been trending since my last HB1AC in mid March, so the appear to generally be heading in the right direction. I've also dropped nearly a stone in weight over that period as well.

blood_sugar_09052026.png
 
To clarify - I'm already on statins and metformin (although only 1 x 500mg a day), and have been on both for some time. My cholesterol is ok, my blood sugar was high (68) at my last HB1AC test but has likely dropped a fair bit from then (I'm expecting/hoping it'll be in the 50's when next tested). My blood pressure is definitely trending down, but still not quite where it needs to be (the average over the last couple of weeks being about 129/76. My BMI is now under 28, and also trending downwards.

My next HB1AC is in about 2 months and depending on how that goes I will definitely consider additional medication - especially for high blood pressure.

I do have some eye problems (just had a detached retina fixed in March) and while that wasn't diabetes related I am sensitive to factors which increase the risk to my eyes. I don't have any of the other potential side effects from diabetes at the moment though (my feet were checked a few weeks back and are fine, for example) and my kidney function etc. was all fine when checked recently.

I'm not against medication - far from it - however it'd be an easy crutch to hold onto, when in fact some of the contributing factors (primarily weight and diet) are 100% under my own control. So I'd really like to understand what I can do myself, without relying on medication.
 
Your figures are heading the right way so I think a wait-and-see approach is the best. The trouble is that many doctors are fixated on increasing meds even when there isn't strong enough justification for it. I'd say you made the right decision.

I'm on 40mg Gliclazide a day and 500mt metformin and my long term strategy is to come off meds if possible. My figures are also coming down but it takes a long time plus low carb diet plus a good amount of various forms of exercise.
 
I've just been down to the pharmacy to pick up my metformin and statin prescription and noticed there was a message from the doctor along with that:
- to arrange a blood test in June (already done, although for early July as that was closer to 3 months since the last test)
- a recommendation that if my h1bac was above 48 then he'd want to increase my metformin
- a recommendation that if my blood pressure was above 130/80 then he'd want to recommend I start blood pressure medication

An hb1ac of 48 is I think equivalent to 7.8 mmol/m, and since the last blood test in late April my own tests have averaged 7.2 (which is also the 3 day average from the Dexcom One+ that I'm currently trying out) so I think that might be possible -although personally I'd only been hoping for under 58 this time around, then under 48 after another 3 months.

My average blood pressure since that last blood test is about 128/77 (and for over the last week its been 126/74) so also feels like it might be possible to be under 130/80 at the next test as well. That's down a fair bit already, as my own readings had averaged 138/81 for the week running up to the last test (and the nurse took my readings and didn't carry out a blood pressure test herself, so they would be the only ones they'd have access to in over a year).

It is good to have targets anyway!
 
niblue said:
I've just been down to the pharmacy to pick up my metformin and statin prescription and noticed there was a message from the doctor along with that:
- to arrange a blood test in June (already done, although for early July as that was closer to 3 months since the last test)
- a recommendation that if my h1bac was above 48 then he'd want to increase my metformin
- a recommendation that if my blood pressure was above 130/80 then he'd want to recommend I start blood pressure medication

An hb1ac of 48 is I think equivalent to 7.8 mmol/m, and since the last blood test in late April my own tests have averaged 7.2 (which is also the 3 day average from the Dexcom One+ that I'm currently trying out) so I think that might be possible -although personally I'd only been hoping for under 58 this time around, then under 48 after another 3 months.

My average blood pressure since that last blood test is about 128/77 (and for over the last week its been 126/74) so also feels like it might be possible to be under 130/80 at the next test as well. That's down a fair bit already, as my own readings had averaged 138/81 for the week running up to the last test (and the nurse took my readings and didn't carry out a blood pressure test herself, so they would be the only ones they'd have access to in over a year).

It is good to have targets anyway!
Click to expand...
My doctor is happy if my bp is 140/80 max. I guess it's up to each person to decide. Mine is usually under 140/80
 
Anything over 130/80 is considered hypertension, of course it’s an individualised thing agreed with your HCP as they know your health history etc, But the higher your BP the more risk there is to your organs etc, your kidneys have to work harder etc

www.nhs.uk

Blood pressure test

Find out why a blood pressure test is important, how it's done and what your blood pressure reading might mean.
www.nhs.uk www.nhs.uk

I sit around 120/70 but can be a bit higher or lower also. It’s just a snap shot of that moment in time & lots of things can affect BP, hydration being a big thing, also white coat syndrome, the weather, caffeine, spices. My surgery lends out 24hr BP monitors & anyone can ask for one to use for a couple of days if they are at all worried about their BP

Looks like your BP numbers are pretty good @niblue :)
 
I have a home BP monitor and currently check it in the morning and in the afternoon each weekday, at the same time as I check my blood sugar. It's definitely trending downwards. This is a graph of the results from the last couple of months (from what I've recorded on the my diabetes my way site):

BP_18_05_2026.jpg

In the past I have tended to get a bit of white coat syndrome so tests at the surgery can be high, but it's quite a while since they tested my BP there.
 
I've got my own bp monitor. I can't help feeling that these limits for bp are a bit arbitrary and maybe influenced by the pharmaceuticals who want as many people as possible on bp meds? They've come out and said that calling it preventative medicine and for that reason I'm a bit suspicious especially as the limits for bp seem to get lower and lower over the years.

Ditto with cholesterol.
 
As with many things in the NHS, activity is driven by the Quality and Outcomes Framework which in turn is derived from the NICE guidelines which are supposed to represent best practice. There are many things about the diabetes indicators, for example, that might have been best practice when introduced over twenty years ago, but which I don't regard as being in my own best interests.

So (to take the example of high blood pressure) practices are incentivised to achieve certain levels in certain groups - for example -

HYP010. The percentage of patients with hypertension aged 79 years or under, without moderate or severe frailty, in whom the last blood pressure reading (measured in the preceding 12 months) is 140/90 mmHg or less (or equivalent home blood pressure reading).

For this, practices start being rewarded when 40% of the target group achieve the figure, and get maximum reward when 85% achieve it.

Full QOF for 26/27 is here:
 
KennyA said:
As with many things in the NHS, activity is driven by the Quality and Outcomes Framework which in turn is derived from the NICE guidelines which are supposed to represent best practice. There are many things about the diabetes indicators, for example, that might have been best practice when introduced over twenty years ago, but which I don't regard as being in my own best interests.

So (to take the example of high blood pressure) practices are incentivised to achieve certain levels in certain groups - for example -

HYP010. The percentage of patients with hypertension aged 79 years or under, without moderate or severe frailty, in whom the last blood pressure reading (measured in the preceding 12 months) is 140/90 mmHg or less (or equivalent home blood pressure reading).

For this, practices start being rewarded when 40% of the target group achieve the figure, and get maximum reward when 85% achieve it.

Full QOF for 26/27 is here:
Click to expand...
It's sort of comforting that they use 140/90 as a cut off for BP which is probably more realistic.

I wonder if the Cochrane Institute has any opinion on best practices re: diabetes?
 
I've had a look online as it does seem like prescribing at something like 130/80 wouldn't be the first recommendation for many doctors.

The British Heart Foundation calls 130/85 to 139/89 "high-normal or slightly raised" and it's only 140/90 and above the class as "high". This is from their website "High-normal or slightly raised blood pressure, sometimes called ‘pre-hypertension’, is when your blood pressure is high but it is not yet diagnosed as hypertension. It’s usually considered to be above 130/85 mmHg to 139/89 mmHg."

They also say "Your GP can help you create a plan to reduce your blood pressure. By making lifestyle changes, you can lower your blood pressure and keep it at a healthy level." but my GP has zero interest in discussing options which aren't drugs!

As my average readings from the week before my last checkup were 138/81 I suspect many/most doctors would be wanting to talk about lifestyle change options. What's also odd is that my blood pressure was much, much higher than that when I was first diagnosed with type-2 back in 2023 but the same doctor hadn't previously even mentioned it, never mind strongly recommending medication. When first tested at the clinic then I was 154/110 and then a few months later it was 154/91.
 
The British Heart Foundation's recommendation makes sense - certainly not the ridiculous 120/70 that I've seen touted by some around the medical world.

I can't help feeling that there are people out there that won't rest until we're all on BP meds irrespective of whether we need them or not, Their sales pitch is that it's a "preventative measure.".
 
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