A couple of questions...

[Andy1963 2]

Hi,

I've been on Metformin (2000mg) and Sitagliptin (100mg) now for just over a year.
I've just had my annual HbA1c test which came back at 88 MMOL/MOL. This is down from 120 when I was first diagnosed.

Is this amount of medication abnormally high, or is the Metformin just not working as well as it should?
If I exercise enough, and stick to a low carb diet, I can get my readings down to between 5 and 8mmol/L, but when I lapse (the odd curry) it will spike at around 17mmol/L.

One of the blessings (or maybe not), is that whether I am at 5 or 17, I feel exactly the same. I have no adverse effects whatsoever.

Am I normal in my abnormality?

 

[Bluetit1802]

That does seem a lot of medication to me, but I am no expert as I don't have any medication. I am diet only. You are on the maximum dose of Metformin.

Metformin is a mild drug and only helps to a limited extent, mostly with a morning fasting level. It won't help stop post meal spikes. The sitagliptin should help with that.

It is not abnormal to feel the same at 5 or 17. I have never felt any different when I have hit a double number, although I have never been as high as 17.

 

[Guzzler]

I would advise that you look carefully at your darbs plus ask about alternative drugs to treat those high readings and high HbA1c.

You may feel ok with no discernible symptons but constant high numbers will be causing damage as well as making your insulin resistance worse.

Could you give us a typical day's menu as we could help you tweak your diet to improve those numbers.

By the way, do you have other conditions such as anaemia that might skew your A1c results?

 

[Rachox]

Hi Andy, I think you’ve answered your own question. “If I exercise enough, and stick to a low carb diet, I can get my readings down to between 5 and 8mmol/L” .With that and your medication you should see your next HbA1c even lower, if you are taking blood glucose measurements before and after eating to get a range of readings.
You may well feel the same at high or low readings, however the high ones may be causing your organs, blood vessels or eyes damage, so please don’t be complacent.

 

[EllieM]

Are those reading before meals? An hba1C of 88 corresponds to an average glucose level of 13.6.... Having said that, it's possible for hba1c readings to be inaccurate. (Hopefully someone will correct me if I'm wrong about the conversion).

There are normally two ways to reduce medication: weight loss (if you're overweight) and diet (low carb). Diet is the most important and weight gain is one of the symptoms of untreated T2. If those levels are right then I'd expect your medication to go up at your next review, so it may be worth reviewing your diet. If you list a typical (non curry) day's diet, we may be able to pick up on something you've missed.

One other possibility, if the hba1c is accurate and you've really given low carb a go, is that you've been misdiagnosed T2 when you're actually a variant of diabetes where insulin production is lowered (ie T1). Have you had tests for this?

 

[Andy1963 2]

Thanks for the replies.

I don't usually eat breakfast. Not sure if that's good or bad.

Lunch usually comprises a mixture of ham, cheese (cheddar) and fish.

My teatime meal varies, but I try to keep my carbs below 50g for this, although it can be hard at times and I do occasionally weaken. For example I had a pizza with a tin of baked beans a couple of days ago (120g) which added a couple of points on my glucose level.

I haven't been tested for a diabetes variant and I don't have any other conditions. When I was first diagnosed with T2, I had lost 3 stone in weight without trying, which is why I went to the doctor in the first place. I have lost nearly 5 stone in total and am now approximately the average weight for my height. I've never felt better in my life!

 

[Bluetit1802]

Thanks for the replies.

I don't usually eat breakfast. Not sure if that's good or bad.

Lunch usually comprises a mixture of ham, cheese (cheddar) and fish.

My teatime meal varies, but I try to keep my carbs below 50g for this, although it can be hard at times and I do occasionally weaken. For example I had a pizza with a tin of baked beans a couple of days ago (120g) which added a couple of points on my glucose level.

I haven't been tested for a diabetes variant and I don't have any other conditions. When I was first diagnosed with T2, I had lost 3 stone in weight without trying, which is why I went to the doctor in the first place. I have lost nearly 5 stone in total and am now approximately the average weight for my height. I've never felt better in my life!

It is good to miss breakfast. It extends the overnight fast and gives your pancreas the rest it needs. It is called intermittent fasting. Same goes if you miss any other meal.

Eating pizza and baked beans will not be doing your body any favours. I expect you know this, so not a very wise choice. Be strong!!! You will have undone all the good you did earlier in the day.

As you were losing a lot of weight prior to diagnosis without trying, and as your HbA1c isn't coming down to acceptable levels despite your medication, I would be tempted to ask for the c-peptide test and the GAD anti bodies test. These are markers for Type 1 diabetes, and also will show if your pancreas is producing sufficient insulin. In most T2 cases there is an over abundance of insulin, which causes insulin resistance.