HBA1c shocking news

[asante_za]

I hae been taking weekly readings of my fasting BG since October 2008 when I was put on 2x2 500mg metformin. About a month ago I changed to glucophage XR 500 mg one tab with dinner (because of the nauseous side effect). My monthly average readings are as follows:

Month Average Value
Jan-09 5.45
Dec-08 4.88
Nov-08 5.31
Oct-08 8.02

I did all necessary blood and urine tests yesterday. This afternoon I got the news from the lab that all the results are excellent except my HBA1c which is 7.6. How is this possible? Theoretically my HBA1c should be 5.54.I am told the GP has therefore asked me to increase the glucophage dosage to 2 tabs a day. I recorded 4.6 before the lab test. Could someone help explain all this to me please.

 

[Stuboy]

you need to know that your finger stick reading is a reading at that single point in time, and will have no corrilation to your HbA1c taken minutes after.

The HbA1c is the average blood sugar over the course of red blood cells life... about 90days.

If you fasting levels are low, then that is good, but dont forget that is also just another single point in time.

You may be high during the day and over the course of most of the night and come down slowly during the night.

Do you test your blood sugars before and after meals? i know Type 2's generally dont, but if you want to find out why your HbA1c is higher than you expected, then this is the only way to find out.

Testing before and after meals is a really good way of finding out what foods affect you the most and how different foods affect you.

Hope that helps some.

 

[phoenix]

Written before Stu posted, think I say similar things

Hi, I,m sorry that your blood test result was disappointing.
The Hb A1c shows your BG average over the last 2-3months but weighted towards recent weeks.
Your fasting blood glucose was only done once a week so just gives a snapshot of your level at that moment and doesn't take into account your blood glucose levels on the other mornings, the rest of the day and most importantly after eating.
It may be that your glucose levels are spiking, possibly quite high after meals but then you are then able to produce enough insulin to bring your levels back down.
(for comparison my fasting levels are normally around 4.2 but my BG after meals may reach 7mmol and occasionally more two hours after meals, my latest Hb A1c was 5.2%)
There is always the (slight) possibility of lab error but if I were you I would do some tests before and 2 hours after eating and find out what is happening..

 

[sugarless sue]

This was my problem as well.Relatively low morning levels but Hba1c did not reflect this.I did some intensive before and after testing to find that some meals I was eating were 'spiking' me up to 12 after meals.A few refinements in my diet has smoothed those down so here's hoping that the next Hba1c will be lower.

 

[asante_za]

Thank you all so much for your comments. Here is a further information:

Before dinner: 3.8
1 hour after dinner: 6.8
2 hours after dinner: 7.1

Then took my dosage of glucopage (1 tab with vegtable soup before bed)

Fasting BG this morning: 4.7

Does it explain the 'spiking'?

Please advise if I should increase the dosage as recommended to 2 tabs.

 

[Dennis]

Hi Asante

I would say you are taking your glucophage tablet at the wrong time. The effect of the slow-release version you are taking will last for 12 hours. It doesn't make your body produce any extra insulin - it just make the insulin that you do produce work more efficiently. So if you take it before bed with a veg soup (not particularly high in carbs), then by the time you next have your dinner, the glucophage will have worn off. As dinner for most of us is the highest carb meal of the day this means that your insulin is not getting any help at the point it needs help the most.

If you were to take two tablets, one with your breakfast and the other with your evening meal, then the two tablets will cover you for the full 24 hours.

 

[Stuboy]

I can't talk about the other medication because i dont know anything about it.

But as far as your numbers are concerned... from a type 1 point of view, if 7.1 is the highest you go before you start dropping again, then you have no need to worry, as if that was the case your HbA1c would be lower than 7%... 5-6% maybe.

However your current HbA1c tells a different story. You should keep monitoring frequenty for a few weeks to see before you will see any patterns, after that, you can make a more educated decision on what you need to do with your meds.

You might find it useful to use a discovery sheet, where you can plot a graph with your results to physically see any patterns.

 

[Trinkwasser]

Agree with the others, there are basically three possible reasons

[1] your tests are missing spikes

[2] you are a "high glycator" things like the time your blood cells live or concurrent illness may bias the A1c, though I wouldn't have thought it would make that much difference, the effect is usually around 0.5 - 1% and is usually consistent for individuals

[3] your lab screwed up (can happen if the blood is poorly stored etc.) or have an exceptionally high "normal" range

Some more intensive testing

http://www.alt-support-diabetes.org/NewlyDiagnosed.htm

and at times you don't normally look might be useful

 

[SilverAndEbony]

I have just switched from standard metformin to glucophage SR. I initially had a problem with coping with high BG when I first went on to it. I went from 3 * 850mg a day to 1 * 500mg glucophage SR. I saw my diabetes nurse, especially as I also had a nasty virus at the time. I saw my GP about switching the formulation, and I suspect she isn't a diabetes expert. I usually see our Nurse Practitioner, who is my DN. She told me that it takes a while for the BGs to level off, and that 500mg of one doesn't equate with 500mg of the other. She said that you don't get as good control with SR compared to the standard version. On the basis that the standard formulation was giving me stomach pains and diarrhoea more and more often I though that most of the pills were occasionally going down the loo! I used to forget a tablet quite often too - either completely or over an hour I'd eaten. Which always spelt disaster for my digestive track!

 

[Dennis]

She said that you don't get as good control with SR compared to the standard version.

Hi SilverandEbony,
I just don't know how so-called health care professionals get away with giving patients mis-information like this. The reason they don't like patients taking Glucophage is that they cost nearly 3 times more than standard metformin. This is also probably the reason why they have replaced your 3 metformins with one Glucophage - because the cost works out the same, nothing to do with what level of medication you actually need! As far as strength and effectiveness goes, one metformin is pretty much the same strength as one Glucophage. In effectiveness Glucophage is far more effective because it releases its goodies over 12 hours instead of the 6 hours for metformin. As a result control is generally far better.

Effectively your health centre is cheating you of the medication you should have simply in order to keep costs down!

 

[MelanieL]

Just reading this thread and it's made me wonder if I'm taking my meds properly? Prescribed Glucophage SR 500 mg x 4 tablets, and originally took 2 tablets twice a day. The DSN told me that I'd got it wrong and that I should take all four tablets at night. Now, the comments here have got me wondering if I should revert back to taking them twice a day - any thoughts?

 

[Dennis]

Hi Melanie,
I think your DSN has been confused by the instructions that come with the tablets! In the section "How to take Glucophage SR" it says "normally you should take the tablets once a day with your evening meal". But it then goes on to say "your doctor may recommend that you take the tablets twice a day". The way my consultant explained it was that if you are only taking one or two tablets then with your evening meal is generally best. It does mean that only your evening meal will be covered but this is the meal when most of us eat our highest amount of carbs (and therefore produce the most insulin). If you are taking 4 a day (as I do as well) then it is best to take two with breakfast and two with your evening meal. That way it works for a full 24 hours. As your body produces insulin throughout the day and night (for example in response to your liver dumping glucose into your blood while you sleep), then having the glucophage assist the insulin throughout the 24 hours is always best.

 

[candy1567]

Hi

Regarding the taking of metformin, i to think i am taking it wrong, i was just told to take 2x twice daily. They didn't tell me when to take it just twice daily.

I also take Byetta am on the 5mg twice a day but soon to increase to 10 on next appt, i take that morning and tea time.

Now when should i take the metformin, i have been spacing it out as i thought i shouldn't over load my system and i take it at lunch time and before bed, is this right?

So can i take it at same time as Byetta or should i space it out, my sugars are a bit erratic at the moment as still adjusting my diet and getting used to eating low carbs

thanks in advance

Juliexx

 

[hanadr]

My Metformin says to take it with each main meal.
I usually don't midday, because I'm home alone andit isn't a main meal. thus I usually only take 2 most days. 3 if I havee a proper lunch. I'll know next week if It's working right.

 

[Trinkwasser]

[
I just don't know how so-called health care professionals get away with giving patients mis-information like this. The reason they don't like patients taking Glucophage is that they cost nearly 3 times more than standard metformin. This is also probably the reason why they have replaced your 3 metformins with one Glucophage - because the cost works out the same, nothing to do with what level of medication you actually need! As far as strength and effectiveness goes, one metformin is pretty much the same strength as one Glucophage. In effectiveness Glucophage is far more effective because it releases its goodies over 12 hours instead of the 6 hours for metformin. As a result control is generally far better.

You're probably right.

However a minority of people do seem to get an immediate "hit" from the met, despite the books saying this shouldn't happen, and find better results with the meals that the metformin is taken with. I don't know how common this is, but such individuals would probably do better on the non-SR pills. I also don't know if this effect occurs when people take SR twice or three times a day rather than once.

 

[SilverAndEbony]

I posted a great long reply to Dennis earlier this morning, but obviously didn't submit it before I left the forum!

Basically I said my healthcare team are wonderful! My post must have been missleading. I was initially put onto 1 SP a day by my GP - not a diabetes expert. I usually see my DN, but I was seeing my GP about something else so I asked if I could switch. My DN had suggested it because of all the digestive problems I've been having. My GP looked in the BNF and followed the advice given there. The 1 tab a day was a starting point, with me titrating up to what my final does would be. With the advice to see my DN if there were any problems or I had any worries. I did so I saw my DN. It was then she upped me from 2 a day to 4 a day. I had no problems getting an urgent appointment. I mentioned being worried about my BG levels, and was given an appointment that day. There weren't any appointments left, but they treat high BG problems as urgent!
It was at that appointment that my DN said that people taking glucophage SR don't always get as good control as when they were taking standard metformin. But, as I was having a lot of stomach pain, diahorrea as well as forgetting to take them at least a couple of times a week I thought it was worth a try. I have no problems trying the cheapest tablets. It's my money I'm spending after all. Especially if they DO work with no problems for a lot of people. The NHS are happily letting me have over £60 epilepsy tablets a month when I could be on a generic version costing a fraction of that. But they follow NICE guidelines relating to anti-convulsants and won't switch me from what I've been on for years.

I hate to say I'm very happy with the care I'm getting from my GP's surgery. My GP is great, my DN is wonderful, and the receptionist's are wonderful! I trust them to do their best for me. I don't have a big downer on the NHS and the people that work in it.
My company's Q4 and 2008 year results have just come out, so I'm more worried about my job at the moment!

 

[Dennis]

Hi SilverAndEbony,
I am very pleased that you are so happy with your medical team. My response was to your original post where you told us that you had been switched from 3x850mg of metformin to 1x500mg of Glucophage SR, so sorry if I upset you.

I do understand your last comment completely, having myself been made redundant last year, trying unsuccessfully to start a new business, and now back on the job market. The agencies I am contacting tell me that they are getting 300-400 applications for every new job they post - and these are temporary jobs!

 

[SilverAndEbony]

Hi Dennis,

The plan, when I switched from standard to SR metformin, was to start low and work my way up to the right dose for me. I think my DN would have put me on more than 1 a day! I'm hoping my BG levels will be OK for my next appointment. I don't think it will going by my own test results.
And not just because of the joys of Christmas
I really don't want to go back to 3 * 850mg a day. Maybe 2 SR tabs twice a day will do the trick.
Of course the obvious thing, as well as watching what I eat, would be to lose weight!

I've been made redundant from my last 3 jobs and I could really do without going through it all again!

 

[Jimbo1973]

I was also on "standard" metformin 3 x 500mgs daily, usual advice of take one with a meal etc etc,
went to see the Dr a couple of weeks ago and he changed me to Glucophage SR 4 x 500mgs, 1 to be taken in the AM and 3 at night - saw his partner the other day to discuss my Hba1C and Cholestorol results (not good, another story) and he has now said to take 2 in the AM and 2 at night.

I'veto go back in a month for more bloods and then two months after that for my usual blood tests- lets see if this works any better now

Jimbo

 

[MelanieL]

Dennis, thanks for your advice - no surprise that the DSN at my surgery got it wrong! I'm now splitting the dose - 2 with my evening meal and 2 with breakfast. I'll be interested to see the effect on my BG numbers.