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Absolutely raging, please help me

Discussion in 'Ask A Question' started by spaglemon, Jan 25, 2013.

  1. spaglemon

    spaglemon · Active Member

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    just had my latest HBA1c result which came back as 5.5% in old money, i was diagnosed at 10% 14 months ago and put on 2x metformin daily with the help of this forum and other research i quickly started very low carbing (i'd say as close to zero carb as possible for the first 4 months) to drop fat and drop my blood sugar level as fast as i possibly could, i went from just over 20 stone and 34% bodyfat to just under 14 stone and 18% bodyfat and dropped my HBA1c from 10% to 5.8%

    i eased up a bit on the zero carb diet to try and find a point that i felt i could be comfortable with going forward and moved to a low carb diet ( less than 50g most days, perhaps upto 100g on the 2 days i weight train ) my last result approx 6 months ago was 5.9% and my gp was very keen to take me off meds, however i tried to explain how strict i was dietwise and that the metformin gave me a little bit of flexibility in my diet, i hasten to add i don't abuse meds to let me eat whatever i fancy but he wasn't impressed with the whole low carb thing but agreed to leave me on the 2 x metformin daily at that time however following todays result of 5.5% he really wants me off them as in his own words "i'm too low" ? *** ? i asked him why he would want me any higher than an average non diabetic ? he had no answer to that and just said 7% is the "safe" limit, i'd prefer to stay on the metformin for the reasons i've already outlined as well as the potential cardiovascular protection as well as the possible anti cancer properties.

    can he force me off the metformin ?

    i keep getting told that there is no possibility of me having a hypo and this is used as one of the reasons for me not to test myself yet my gp is now telling me that i'm too low and there is evidence to suggest that being too low is as harmful as being too high ? but surely i want to be as close to a non diabetic level as i can get and sustain comfortably ? i thought i had a good grasp on this but am now confused ?

    we ended the conversation with the agreement to drop down to 1 x metformin daily and i'm to have another HBA1c in 3 months time, i don't know how people on here feel about this but i'm seriously tempted to sabbotage this next test ?

    i hope someone understands where i'm coming from with this ? if i stick to the same diet and decrease my meds surely my HBA1c test results can only go up ? and although i'm sure they'll still be within they're healthy range but they won't be where i want them to be ?

    am i right to want to be as close to a non diabetic level as i can comfortably sustain bearing in mind this is a progressive condition which to the best of my knowledge will only get worse ?

    does anyone else feel that the NHS "safe" limit of 7% will be revised down the way in the future ?


    Thanks just for reading this and if anyone can identify with any of this and can take the time to reply i'd be extremely grateful

    Craig
     
  2. Sirzy

    Sirzy Other · Well-Known Member

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    Hi Craig,

    I'm afraid I can't help you with the Metformin question as I'm not yet on any medication, but I follow a very low carb diet and my HbA1c is usually around 5.1-5.3% My diabetic consultant is very pleased with this and says I'm lower than almost all of his other patients. although I'd still like to be lower, possibly in the high 4's (i.e. the non-diabetic range). I asked him out of curiosity what sort of HbA1c levels I'd have to be getting before he'd start considering meds and he said they'd have to be in the 6's, so your GP's suggestion of 7% as a 'safe' level sounds way too high to me. As I understand it, doctors prefer insulin taking diabetics to run a little higher than non-insulin diabetics to avoid hypos (I think, not totally sure, as I'm not taking insulin yet), but as you're not at this stage yet, I think your GP has got this wrong to be honest.

    It might be worth doing a bit of research about HbA1c values and how they can lead to complications if they're too high (the Blood Sugar 101 website is a good starting point for this as she specifically addresses this problem http://www.phlaunt.com/diabetes/35169265.php), then you can go back to your GP armed with some evidence that a low HbA1c is actually a good thing!!

    Sarah :D
     
  3. alaska

    alaska · Well-Known Member

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    I can totally understand your frustration.

    My understanding is that this 'safe' limit comes from research studies that were featured strongly within health news. If I had more time I'd locate the study and stories that resulted. Others on the forum will probably be aware of which study I'm referring to.

    If I remember right, the study focused on more elderly people with diabetes and the study showed that aggressive treatment of diabetes to lower HbA1c levels below 7% (including involving insulin to lower blood glucose levels) showed higher mortality rates for HbA1c values lower than 7%.

    If my memory serves correct, this does not address your situation so well as we're talking about use of metformin rather than insulin. As you may know, the actions of insulin injections and metformin are significantly different.

    Hope this gives you a start.

    Ed
     
  4. michael D

    michael D Type 2 · Active Member

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    hi
    i recently dropped from 2x2x500 metaform to 2x1x500 because of good results via low carbing
    my doc said she was lowering the metaform as its partly to do with the weight/body-mass
    so try to look at it has confirmation of the good work your doing
     
  5. spaglemon

    spaglemon · Active Member

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    just read through my original post and realise that i sound like i'm moaning about being 5.5% to anyone really struggling to reduce their blood sugar levels, i apologise, i don't mean i'm unhappy at 5.5% it's just that we're all on our own journey with our own goals

    thanks
     
  6. spaglemon

    spaglemon · Active Member

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    thank you all for the replies, some great info there which i'll look into

    could anyone hazzard a guess what my HBA1c would rise to without 1000mg daily of metformin but with my consistent diet staying the same ?

    cheers
     
  7. Dennis

    Dennis Type 2 · Well-Known Member

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    Hi Craig,

    Your weight reduction and HBA1C improvement are both really impressive - well done!

    I can answer/comment on a couple of the points you raise. Firstly your GP is correct in telling you that 7% is regarded as the "safe" limit. But what this means is that the NHS regards 7% as the absolute upper limit, not the figure that patients should be aiming for! Your GP seems not to have understood this point. Personally I have never understood why 7% can possibly be regarded as a safe figure. It is generally accepted that people who run blood sugar levels constantly above 7.5mmol/l are at risk of diabetes-related complications, and a 7% HBA1C equates to an average of 8.6mmol/l, which is well in the danger zone. A blood sugar average of 7mmol/l (i.e. HBA1C of 6%) would be a much more sensible target. Your latest HBA1C of 5.5% equates to an average of 6.2mmol/l, which as you already know is very healthy.

    The other point is about the metformin. Metformin in itself doesn't directly lower blood sugar. What it does do is to help overcome insulin resistance, the prime cause of which is a high level of body fat. As your body fat has reduced considerably, it is posible that the metformin is now doing little to help your diabetes, so I can understand why your GP would want you off it. However, that's a big assumption to make whithout running further tests to see how much insulin resistance you now have. I appreciate your concerns about the other non-diabetes reported benefits of metformin, but I am not sure how well researched these benefits are. I have seen articles on this in the press from time to time, but when you look at the sources of the stories they often come from the manufacturers rather than any independent research body . . . vested interests?!?

    Hope some of this helps,
    Dennis
     
  8. paul-1976

    paul-1976 Type 2 · Well-Known Member

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    Great post Dennis! I too have been told that my hbA1c is too low at 6% by a 'Unenlightened' HCP..not that I would take any notice of them! but your post hits the nail on the head.
     
  9. spaglemon

    spaglemon · Active Member

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    Thanks Dennis, great info there, by any chance to you have any links to evidence of this i could use ?

    " It is generally accepted that people who run blood sugar levels constantly above 7.5mmol/l are at risk of diabetes-related complications"


    Craig
     
  10. hanadr

    hanadr · Expert

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    It's a common misconception that 7% is the safe lower limit. It comes out of a flawed sudy, where people on massive doses of medications, were found to be at risk if the HbA1c was low. The ACCORD study. No-one has ever studied Low HbA1cs brought about safely by diet[or diet with a little Metformin] Metformin rarely causes hypos, so I's suggest you ask your doctor what the dangers are.
    If you have test strips, look out the leaflet. It's the only place I know where non-diabetic HbA1c and BGs are rouinely quoted. Then ask the doctor if Non-diabetics are in danger. Show him the leaflet. In my experience medical personnel don't know what a normal Bg is. they all quote the DUK figures. Even here that's what's quoted ie 4 - 7 before meals anup to 8 2 hours after. I can say that in years of letting people play with bg meters, I've only ever found one n0n-diabetic with a reading of over 7 even immediately after lunch. Most are around 5.
    I personally don't believe that t2 is inevitably progressive. I'm sure it is if treated the usual NHS way with high bg targets. All that circulating glucose is bound to be doing damage along with all those medicines. Every now and again a T2 medication is withdrawn because it's seen to be killing people.If your blood glucose is at Non diabetic levels without loads of medications, you should be pretty safe. In fact my Gp told me Iwas safe doing things naturally. { After 10 years, I'm using 2 x 500mg Metformin per day.
    Hana
    PS look up Richard K Bernstein. an insulin dependent diabeic since he was 12 and now in his 70s:he consistently keeps his A1c at below 5. { I wish I could get down that low even once!]
     
  11. Dennis

    Dennis Type 2 · Well-Known Member

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    Hi Craig,

    I'm trying to find the link to the article where I read about blood sugar risk levels for diabetes complications but at the moment I can't find it. It was a few years ago and I'm pretty sure it was something produced by the American Diabetes Association (ADA). Meanwhile, here's a few links you might find interesting that actually suggest we should all be aiming at A1Cs of below 7% (including one from NHS Direct!

    http://www.nhs.uk/Conditions/Diabetic-r ... ntion.aspx
    http://www.sciencedaily.com/releases/20 ... 162937.htm
    http://diabetes.niddk.nih.gov/dm/pubs/c ... IC_508.pdf

    I'll let you know when (if) I find what I am looking for.

    Regards,
    Dennis
     
  12. viviennem

    viviennem Type 2 · Well-Known Member

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    I agree with hanadr - I see no reason why blood glucose levels in the non-diabetic range should be bad for a Type 2. That's what I aim for. My HbA1c is consistently in the lower 5s range and my GP is fine with it.

    I am on 3 x 500mg Metformin daily, and want to stay on them because they suit me, and because of the protective effect they have against strokes/CVD. I won't take statins. My GP has never suggested stopping them or even reducing the dose, though he won't put the dosage up! (yes, I did ask!).

    It was dificult for diabetics in the past to control their BGs as well as we can now, and all the figures "they" quote are based on previous evidence - even if it's quite recently previous. With improving medications and understanding, I see no reason why some of us at least can't achieve tight control, and I think our GPs should be pleased with us when we do.

    Finally - the higher the HbA1c the more likelyhood of complications later on. Isn't it best for us - and the NHS costs - to keep within non-diabetic levels as long as we possibly can. It's cheaper to give you metformin than for you to have an amputation!

    Viv 8)
     
  13. phoenix

    phoenix Type 1 · Expert

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    This article shows why doctors may express concern about lower levels. i
    http://www.pulsetoday.co.uk/national-pr ... QLFK7_olcU

    The most recent of the studies mentioned is a UK one, in this they looked at people who increased medications (ie changed from met alone to met + another drug or changed to insulin) . It doesn't really apply to people on metformin alone.

    The Accord trial also included increasing medication to achieve lower levels (do a search here for Accord trial, )
    The VADT trial found no differences in outcomes between patients with average HBA1c of 8.4% and those intensively treated to 6.9% The subjects were 'poorly controlled' before the tiral.
    The Advance trial did find that there were lower levels of kidney disease at an average of 6.4% compared with an average of 7.3% but found no difference in cardiovascular outcomes.
    This Mescape article puts the ACCORD research into perspective here.
    http://www.medscape.com/viewarticle/735118
     
  14. Dennis

    Dennis Type 2 · Well-Known Member

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    Hi Craig,

    Apologies for the delay in following up. I finally found the article I was referring to regarding danger levels for blood sugars, but it wasn't an ADA article after all (and I got the figure wrong - it should have been 7.8mmol/l not 7.5). Here's the link
    http://www.phlaunt.com/diabetes/14045678.php

    Dennis
     
  15. kevinf1967

    kevinf1967 Type 2 · Well-Known Member

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    simply non tablet controlled diabetes means no free prescription...
     
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