At what HBa1c level did your GP recommend Metformin?

Hi @Littlemoon. Welcome to the Forum!

The current recommendation for the UK, I believe, as it is with my country - Aotearoa/NZ, is for docs to advocate diet and exercise and take metformin. (Leap in and say yes or no, UKites.)

You of course can insist you give diet and exercise a try first! And the medical professionals are definitely supposed to respect that. (In NZ it's called a partnership between the diabetes team and the person with diabetes - very nice!) (As rare as hens teeth, but it does happen. I've experienced it a couple of times!)

I was diagnosed with an HBA1c of 93, and I asked to go the diet and exercise route first, my reasoning being - I wanted to see what my body could do, and once you take a medication you no longer have that information. My doc thought it entirely reasonable, which it was.

She signed me up for a diabetes self management education course, and for monthly HBA1c's, and we tracked how I went, together. She did me a lovely graph of my lowering HBA!cs, and, she told me what my percentage of weight loss was (as that was pretty rapid, when I went off sugar and wheat products immediately). (I forget the percentage, as my brain does not retain numbers as a rule, especially back in those innocent days. Sigh.)

I do have to say that my HBA1c did not drop to the level that my country has a target in three months - and that is 53 and below. I told her it was going to take me personally longer than three months to completely transform my life, which is what I was having to do. (I was not much of a home cook, and I had to become one.) Many folk though, who write in this Forum do make such big reductions in that period of time, especially if they go straight to a very low carbohydrate diet with healthy fat, which I was later in doing. Many even get their type two into remission, which is not my story. But you will come across many of those the more you visit this Forum and the various threads that speak to you.

I was diagnoesd as T2 with HBA1cs of 60 and 61, was prescribed Mrtformin and told by DN to follow thr "Eatwell Plate" but also to avoidvery sugary stuff and anything specifically lebelled for diabetics . GP slightly later suggested I try the Atkins diet for weight loss. So I did actually get some good/correct advice.

I immediately cut out all obviously sweet things from my diet, but quickly discovered this should also apply to all high carbohydrate starchy stuff too. I was able to reduce my HbA1c to a just on pre-diabetc level of 47 by my 3 months follow up check. I've kept to generally low pre-diabetic levels ever since by eating a low carb/ketogenic type diet, but it took my GP about three years to trust me enough to ditch the metformin, though stopping taking it never made any apparent difference either way my glucose levels. But I didn' t generally have any unpleasant issues while taking it apart from some non-gastric issues for a short time on a different brand while my normal one wasn't available.

I don't remember being given any adivice on exercise, but prior to diagnosis I had "wonky" knees and could do little more than normal household activities and walking my dogs, and recently arthritis in my hips has put paid to most activities. But I have lost some necessery weight though, about 20kg in my first few months without being aware of it going until someone pointed out I looked thinner. Recently I've lost another 10kg again without my doing anything much to lose it. But both times I believe mainly due to diet.

I gew up eating , and for most of my life have eaten, a normal fat moderate carbohydrate type diet. It was really only the 5-6 yers before my diagnosis that I ended up - unwillingly - eating an extremely hgh carbohydrate diet. This turned ne into a sort of brain dead zombie, and I believe was also in part the cause of my diabetes - aother trigger IMO being long term use of statins My earlier esperience with a normal fat diet has been a great help in my being able to cut right down on those unnecessary carbs again, and keep me at a pre-diabetic status. I'm able to use both carbs and dietary/stored body fats as fuel for energy, and switching automatically to the stored stuff also was what has enabled me to lose weight easily. And as a bonus ketones
are for me a briliant source of brain fuel.

When I was first diagnose after a HbA1c test result of 52, I had no idea about diabetes and was given Metformin. I took just two of the tablets and knew I couldn't cope with them, they had such a frightening and violent effect on me, eg double vision, fuzzy head where I just couldn't follow a conversation, and diarrhea that was nothing like I'd experience before. My first call for help after that was this forum. I asked some very basic questions at that time, and each answer came back with positive feedback. I am healthily sceptical about 'big pharma' pushing drugs seemingly willynilly, so with the help and inspiration from this forum my diabetes is now diet controlled.

I've not had a test since mainly because I've been busy concentrating on my husband's terminal illness, though I have recently had to stay in hospital for 10 days due to suspected sepsis where my bloods were tested several times a day and all came back within range despite the high carb content of hospital food. Not one single doctor has mentioned Metformin, nor challenged my diet, since my initial diagnosis.

I was diagnosed with T2D about a month ago, with a Ha1c score of 80. I was put on Metformin - starting on 1 pill a day, and working up to 4 a day after a month. As long as I have them straight after food, I have no side effects.
I immediately started on low carb and had already begun exercising. My blood glucose has gone from 11.2 on the first day to an average last week of 6.3. My blood pressure and weight have also come down. My plan/hope is to get down to prediabetic or better by 6-9 months and once there, I will come off Metformin and see if I can maintain at that level.

Littlemoon said:

Hi all, I have just been diagnosed with diabetes today with an Hba1c of 49. I was told to take metformin immediately and when I asked if I could first try with diet the GP told to take metformin. I was curious as to when you all started with Metformin and if you all have any experiences/advice to share on this

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I'm surprised as 49 is only just over the T2 threshold and no test is 100% accurate. Was your test repeated? Mine was 56 (the test was repeated but I only have one of the results) and got an appointment with a dietician. I'm in Scotland.

Littlemoon said:

Yes it was 46 during my first test and the second test showed 49

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Can you sign up to get access to your medical stuff online? If you can' do so. Anyone in Scotland can (MyDiabetesMyWay - totally gross name IMHO) and I believe there is something similar in England.

It seems to vary widely from doctor to doctor. My initial hb1ac was 106 and I was (unsurprisingly) put on metformin straight away, however someone else I know (with a different practice & doctor) had an initial hb1ac of 80 and hasn't been prescribed any medication.

Littlemoon said:

Hi all, I have just been diagnosed with diabetes today with an Hba1c of 49. I was told to take metformin immediately and when I asked if I could first try with diet the GP told to take metformin. I was curious as to when you all started with Metformin and if you all have any experiences/advice to share on this


Thank you for all your replies in advance

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I was diagnosed with reading of 59. Medication wasn't mentioned as first choice treatment. Was told to change diet and exercise more .

96 but mine had almost doubled from previous 53, 6 months prior, so cannot blame GP. It was always suggested when I was in the 60’s last year but was offered chance to make lifestyle changes. Seems to depend on GP and DN you see. May also depend on other risk factors and how active you can be. 49 should be managed by lifestyle ideally.

I didn’t think GPs TOLD you what to take anymore, I thought they discussed the pros and cons and advised you what might be beneficial and let you make the decision. That’s what my GPs do with me. As I’ve said in other posts, every year my gp asks if he can tempt me to take a statin and he laughs when he asks me because he already knows my answer. They can’t force you to take anything!

KennyA said:

As I understand it there should be two tests over the threshold before a formal diagnosis is made solely on the basis of HbA1c, because of the potential error involved (three points either way at a reading of 50 is permissable). This is particularly relevant with the results you had.

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I think having symptoms or a fbg over 7 counts as confirmation too in association with a single hba1c

I was diagnosed with an HbA1c of 73, but have never taken meds for my T2.

What doctors suggest for individuals varies enormously, as you are likely realising.

Metformin is a gentle drug, in terms of diabetes management, but it can also help with weight loss, if you happen to carry any excess weight. Just a thought.

Personally I’d not go on meds in your situation, diet and exercise is fine at that level. I had a rogue reading after a bad 3 months of 75. My GP has been great, very supportive with no meds and I’m hitting diet and exercise hard (Keto and running) tp bring it down . Next check is in September. My view is that meds are a last resort if you can’t fix yourself.

MissMuffett said:

I didn’t think GPs TOLD you what to take anymore, I thought they discussed the pros and cons and advised you what might be beneficial and let you make the decision. That’s what my GPs do with me. As I’ve said in other posts, every year my gp asks if he can tempt me to take a statin and he laughs when he asks me because he already knows my answer. They can’t force you to take anything!

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Same with me

I was diagnosed at 54 and confirmed with an A1c of 52. Was already trying to lose weight, GP simply said to go away and sort by diet.