Advice please

[Larkspur]

Hi everyone
I have a dilema and would apreciate some comments.
I was about two stone overweight on diagnosis a year ago and my first HbA1c was 10.5 in February . I was put onto three Metformin a day and started to diet to lose weght by cutting out all cakes and sweets and reducing portion size. This worked a treat and over the next six months I lost weight steadily and now have a BMI of 23. My following HbA1c also fell to 7.9 then 6.3 and in November 5.9.
So far so great! So what's the problem?

My doctor feels that we "may have addressed this too strongly" and that my HbA1c is now "too low"
and has taken me off the metformin. I agreed to this provided he let me test (which he was strongly against in the first place) and he has agreed (but suggests only once every three days). So for the last three weeks I have not been taking the metformin and have tested three times a day to get some idea what is going on. These suggest that my BS are increasing.
So - should I press to go back onto the metformin (at a reduced dose perhaps), try to manage via reducing carbs (which I would find very difficult) or accept a higher BS of say 6.3 which the doc seems to feel is best?

 

[hanadr]

Metformin is a safe and useful medicine and your doctor is talking rubbish. Ask him what his own HbA1c is. Your 5.9% is brilliant ! If you are not using anything to cause frequent hypos, you are in no danger with a lower A1c. 5.9% is still a diabetic level. Non diabetics are in the 4s and lower 5s and there's NO REASON, why you shouldn't be there with them. Askfor his explanation and evaluate it for yourself.
Hana

 

[wallycorker]

Hi Larkspur,

Yes - you've come a long way and achieved a lot in terms of HbA1c readings and weight loss. Well done! My advice would be not to accept a higher HbA1c if you can achieve a lower one.

I'm a Type 2 of some nine years - eight years getting slowly worse by following "do not test" and "eat plenty of starchy carbohydrate" advice my HbA1c rose gradually until it reached 9.4% and my GP prescribed metformin. I have improved my situation by starting to test (buying my own strips) and reducing drastically the amount of starchy carbohydrate that I eat. My last two HbA1c readings have been 5.3% . Despite that, my GP hasn't suggested reducing my metformin medication which is still at 2000mg per day. I'd quite like to see what levels I could maintain without taking the metformin but I've not been pushing that approach, not so far anyway. I had a further test last week which I think might come back as lower than 5.3% - I might use that to discuss the matter with my GP.

If I was in your shoes, I'd try to see what you can achieve without the metformin and explore the dietary changes further. In my opinion, diet is our most powerful tool. In particular, I'd recommend that you try cutting back dramatically on cereals, bread and potatoes - also, I'd be careful with the pasta and rice. As far as the latter are concerned, I'd try the brown rice, spelt or pulse pasta versions if you haven't already done so.

As far as testing is concerned, if I was limited one test every three days then I'd test fasting 'on rising' readings because I find that they seem to tell me most about my overall control.

Whatever you do it is important that you keep pushing to improve your situation and don't let things slip backwards. Stick with it - as you know, it's important to your long-term well being.

Best wishes - John

 

[hanadr]

Larkspur
I too buy my own strips. They supplier of meters is the best buy.
Hana

 

[Larkspur]

Thanks for the quick replies - they are very helpful.

I would like to follow the diet route but I am very doubtful about my own ability to keep on track. I have no problem with ignoring sweets etc but bread and rice are so integral to my familys eating habits that I cannot see how I can get on without them
I will have to start buying my own extra strips and see which carbs I can manage - I really like my cereals in the morning.

Hana - my doctor claimed that there are more "unexplained" deaths in diabetics with levels below 6! I shall have to ask where he got this statistic from!

 

[fergus]

Larkspur, you are headed in the right direction. My advice would be to change your doctor.

fergus

 

[cugila]

My doctor feels that we "may have addressed this too strongly" and that my HbA1c is now "too low" and has taken me off the metformin. I agreed to this provided he let me test (which he was strongly against in the first place) and he has agreed (but suggests only once every three days). So for the last three weeks I have not been taking the metformin and have tested three times a day to get some idea what is going on. These suggest that my BS are increasing.
So - should I press to go back onto the metformin (at a reduced dose perhaps), try to manage via reducing carbs (which I would find very difficult) or accept a higher BS of say 6.3 which the doc seems to feel is best?

Hi Larkspur.
There's a few things here......

Firstly, you say you have been taken off Metformin. You haven't been taking it for around 3 weeks. Yet you say your Bg levels are rising ?? That to me would indicate that the Metformin was previously doing it's job and you are probably missing the help it was giving you. So, going back onto it, as you say at maybe a reduced dose MAY be something you need to consider.

Secondly, you say you would have difficulty in reducing carbs, therefore I suppose that route for you may well be one you wouldn't consider.....if you can just reduce them say by half, that in itself may show great benefits to your Bg levels. Which leads us back to Metformin. A choice you would have to make....one or the other, or maybe even a mixture of the two ?

Thirdly, testing. The infrequency of your testing....three times daily is not really good enough to make any decisions. You need to test on waking, before ALL meals, then at 2 hrs after each meal. A further test before bedtime would also be advantageous. Take the reading to your next GP appointment and show the GP what you consider to be the trend, upwards...? Then ask if you should be on Meds or not ?

Fourthly, your HbA1c level is very good and I too wouild like to know why the GP stated that it is too low. Have you asked him/her why ? Is it that he/she is following some guidelines ? Do you have some other medical condition/s which would mean that your Bg/HbA1c level needs to be different from other patients, what some would accept as the 'norm.'

Quite often another condition can mean that low levels like yours are not advisable. There are instances where low levels are not the best thing. A little higher could well be better for you. This is something you should discuss with the GP before telling him/her he doesn't know what he is talking about, rubbish, or, changing GP's. He may well just have your best interests at heart and a valid reason behind the advice.