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8 months on Metformin and no change in HbA1c

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ll1000

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I was put on metformin at the beginning of June 2012 after a 3rd consecutive HbA1c of 48 to 49. It started at 1 x 500mg dose, increasing to 2 x 500mg after two weeks. I had another HbA1c test after 8 weeks (end July 2012) result was 47. I have just had another test (almost 8 months from starting Metformin. The result was 47 again. These results are no different from those I was achieving for the 8 years prior to starting Metformin when I was trying to control by diet only.
Although my diabetes nurse sais I am doing well, i am very disappointed that my results are not really any better than before I started metformin.

Has anyone had similar experience?
 
Hi. Yes, Metformin does not make a great difference to your HBa1C level; perhaps it has the greatest effect if you are T2 and grossly overweight as it improves insulin sensitivity. If you have a reasonable BMI and have a low-carb diet then a further tablet such as Gliclazide and/or Sitagliptin may be added if your HBa1C continues to creep upwards as mine did.
 
ll1000 said:
Has anyone had similar experience?
Click to expand...

Oh yes. During the first two years I began to suspect that Metformin wasn't much help so I asked permission to stop taking it for three months. It made no difference at all.

I got it in the neck from the GP who seemed to think Metformin is very important as does my nurse. Neither of them have explained in what way it is important but both offer some long term but non specific benefits. I currently take the Metformin because I like a peaceful life and don't like to see my Doctor cry.

I think their main purpose could be to see if you are a rebel or not. If you don't take your Metformin then you are not co-operating.
 
Metformin gives protection against stroke and CVD - very important for a non-statin user like me! I don't know how much difference it makes to BG levels, but it has helped me reduce my appetite.

When you say you are diet controlled, is that the NHS-recommended diet or are you low-carbing? The NHS diet has far too many carbs for me, and would send my BG levels too high. I eat very low carb (with the odd lapse! :oops: ) and my BGs are usually in the non-diabetic range.

Can you let us know the sort of foods you eat, and we may be able to help you tweak your diet a little bit :D

Viv 8)
 
Hi All, thanks for all the responses. I was diet controlled until 8 months ago when I was put on Metformin. The diet recommended by NHS dietician they sent me to several years ago had about three times as much carb as I usually eat and I told her so. On a typical weekday carbs are about 100g, a bit more at weekends - probably about 130g. I try to keep to a balanced diet but reduce on bread, potatoes, rice, pasta etc. Fortunately I have never had a sweet tooth, so sweets, cakes and biscuits are very rare events. I don't eat a lot of meat and never beef.
I was sold metformin on its advantages, the biggest advantage seen to date is that I get all my other prescriptions free now. I'm on statins and medications for high blood pressure. I have also lost some weight since I started metformin, but that could also have something to do with having diverticulitis and other bowel problems in the last 6 months.
 
I currently take the Metformin because I like a peaceful life and don't like to see my Doctor cry.

I think their main purpose could be to see if you are a rebel or not. If you don't take your Metformin then you are not co-operating.
Click to expand...
So, you just want to bash the NHS without even looking up Metformin on webmd? Or Wikipedia?
Metformin improves hyperglycemia primarily by suppressing glucose production by the liver (hepatic gluconeogenesis).[65] The "average" person with type 2 diabetes has three times the normal rate of gluconeogenesis; metformin treatment reduces this by over one third.[...]
In addition to suppressing hepatic glucose production, metformin increases insulin sensitivity, enhances peripheral glucose uptake (by phosphorylating GLUT-4 enhancer factor), increases fatty acid oxidation,[89] and decreases absorption of glucose from the gastrointestinal tract. Increased peripheral utilization of glucose may be due to improved insulin binding to insulin receptors
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For the mathematically challenged, 2/3 of 3x baseline = 2x baseline > baseline
If you want a more tangible real effect:
In this group, over 10 years of treatment, metformin reduced diabetes complications and overall mortality by about 30% when compared with insulin and sulfonylureas (glibenclamide and chlorpropamide) and by about 40% when compared with the group only given dietary advice
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More the mathematically challenged, following your advice of not taking Metformin will result in additional preventable complications and death.
So please stop smearing proven effective treatments if you don't know what you are talking about.
 
Hi AMBrennan. I don't think II1000 was smearing Metformin; just saying that it hadn't helped noticeably. I think some of us do have a right to bash the NHS when they dish out seriously bad diet advice, issue prescriptions without listening or discussion, assume we are an overweight, food guzzling T2 without looking up from their prescription pad to see that we aren't etc. Yes, Metformin is very useful and good drug but it's effects on blood sugar can be overrated.
 
Hi,
No I wasn't smearing Metformin. The line quoted by AMBrennan, was from Squire Fulwood's response, not my origional post. It's just that I'm so disappointed to see no change, despite sticking with Metformin religiously for 8 months. Since I got my latest result to be told there's no change, despite also losing a stone and a half in the last 8 months, I have been so depressed. So many other posters in the "newly diagnosed" to "6 months or so after diagnosis" category have fantastically good HbA1c reductions and I just can't understand what I'm doing wrong. My Diabetes Nurse says I'm doing well, but I don't think she really means it. Probably just relieved it's not getting any worse.
 
You could try dropping your carbs a bit to see what happens. I've been eating just about "NHS recommended" since Christmas and my BGs have been up to the 6s instead of the 4s and low 5s that I prefer. I've just done 2 days back on Viv's Modified Atkins Diet (a Sticky Thread in the Low-carb section of the forum) and I was back down to 4.8 this morning.

I'm not suggesting you go right down to 25g per day (unless you want to!), but dropping down to about 70g daily may make a difference.

Are you having problems with the Metformin? It can have horrible side-effects such as diarrhoea and wind at first. Many people settled down with it quite quickly, but some people never do. If you already have diverticulitis etc, it might not be doing you any good. And obviously you must have to be careful about the foods you eat. You could mention this to your GP and see if they'll give you the slow release (SR) version, which is supposed to be easier on the system.

Viv 8)
 
The max dose of Metformin, 1000mg twice daily, can help to reduce bg levels by between 1 and 2 mmol/L if you are taking half the max dose the expected drop will naturally be less than 1 to 2 mmol/L.

I still work in the old system of HbA1c numbers so converted your numbers which work out at:
49 = 6.6%
47 = 6.4%

Your HbA1c's of between 6.6% and 6.4% are pretty good in the scheme of things so firstly congratulations :clap:

I'd say you are doing pretty well for someone who has been diabetic for 9/10 years and only recently started on minimal medication. And its probably unreasonable to expect a larger reduction without further medication. Possibly an increase to the max dose of Met may help and Viv makes a good point re the slow release (SR) version being kinder on the digestive system in view of your other problems.

ll1000 said:
I have also lost some weight since I started Metformin, but that could also have something to do with having diverticulitis and other bowel problems in the last 6 months.
Click to expand...

You dont say whether or not you are over weight but if you are then further weight loss will almost certainly help reduce your insulin resistance which in turn will have the knock on effect of lowering your bg levels, interesting that you mention your other bowel problems starting shortly after starting Metformin?! Definitely try the SR version, it could be a great help.
Alternatively perhaps discuss other medications with your nurse/doctor as it could be that an alternative medication could help both with your bowel problems and your bg levels.

All the best and good luck....

Taken from the DUCK HbA1c page: http://www.diabetes.co.uk/what-is-hba1c.html

How does HBA1c return an accurate average measurement?

Due to the fact that red blood cells survive for 8-12 weeks before renewal, by measuring HbA1c, an average blood glucose reading can be returned.

  • For non-diabetics, the usual reading is 4-5.9%.
  • For people with diabetes, an HbA1c level of 6.5% is considered good control, although some people may prefer their numbers to be closer to that of non-diabetics.
  • People at greater risk of hypoglycemia may be given a target HbA1c of 7.5%

This prevents too many low blood sugars from occurring.
 
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