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At what HbA1c level will medication be suggested?

Discussion in 'Ask A Question' started by tigerlily72, Oct 15, 2019.

  1. tigerlily72

    tigerlily72 Type 2 · Well-Known Member

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    I was diagnosed as type 2 in 2015 and have been unmedicated for my diabetes so far. I have several other health issues which I take both prescription meds and complimentary/supplements for.

    Anyway, I've just had my annual review and blood test and will be seeing the DSN on Tuesday (today). I phoned the surgery yesterday to get my results so I could mentally prepare. They are as follows:

    HbA1c = 50

    Sodium = 139

    Potassium = 3.8

    Creatinine = 80

    Thyroid = 3.27 (advised this was normal)

    Total Cholesterol = 4.4 (again, advised it was satisfactory)

    Am I likely to be advised to go onto meds and which ones? Bit concerned about metformin as I've read they can cause digestive upset/stomach pain!
     
  2. Mike D

    Mike D Type 2 · Expert

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    Metformin won't bring that figure down too much (and it should be the slow release version BTW) but your diet well might
     
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  3. Goonergal

    Goonergal Type 2 · Moderator
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    I would have thought that an HbA1c of 50 would be eminently reducible without meds as it’s not far into the diabetic range, although I see from your signature that your HbA1c has gradually crept up from a prediabetic number. By comparison my diagnosis A1C was 108 and has come down into non diabetic levels using diet only, so very doable.

    My question would be how do you want to manage your diabetes? Sounds like you’re wary of meds, so can we help with a dietary approach if that’s what you want?

    Good luck with the review.
     
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  4. Rachox

    Rachox Type 2 (in remission!) · Moderator
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    As @Goonergal says your HbA1c is still at the bottom of the diabetic range so a few adjustments with your diet could get you back below the diabetic range. However if you do decide to take metformin not everyone gets gastro symptoms, I take the standard release with no problems. Be aware that even though your cholesterol result is normal you may want to do your homework regarding statins as some GPs push Statins for all diabetics regardless of cholesterol results. Let us know how you get on.
     
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  5. Daibell

    Daibell LADA · Master

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    Hi. Have a look at the NICE Diabetes Guidelines website which gives a flow-chart for treatments at various HBA1C levels. Yes, Metformin SR (Slow Release) is much kinder on the bowels than the plain version. Metformin only has a very small effect on BS but is a safe drug. Try the LCHF diet first.
     
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  6. Bluetit1802

    Bluetit1802 Type 2 (in remission!) · Guru

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    At the end of the day, the decision to take any medicine is yours, and yours alone. It is not your doctor's decision. All he can do is offer it and advise. You are at liberty to refuse it. You could ask for another blood test in 3 months to see if you can improve it by tweaking your diet.

    Personally, my HbA1c on diagnosis was 53. Medication was never mentioned. I have been med free for almost 6 years and able to maintain non-diabetic blood sugars by diet only.
     
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  7. tigerlily72

    tigerlily72 Type 2 · Well-Known Member

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    Thanks to everyone who replied. Firstly, I don't require meds based on my HbA1c result. She said they'd only consider and suggest meds at a level of 52.

    I was advised to try and reduce my cholesterol levels, in particular the HDL (the "bad" cholesterol) and statins were mentioned if I'm unable to do this. She thinks I should be able to. I told her I'm wary of statins due to side effects I've heard about such as muscle aches and pains. I also have fibromyalgia so don't want any more muscle pain!

    I have to monitor my blood pressure and take a few readings as this has increased in the last couple of weeks so there's concern over that. I've been booked to see my own GP again in 3 weeks time. I was due a review with my GP in November anyway based on other health issues and meds I'm on.

    I was also advised to reduce and lose weight which is easier said than done, especially at this time of year. I guess I need to make some small changes and then build on them.
     
  8. Tipetoo

    Tipetoo Type 2 · Expert

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    I do not know if they will advise / prescribe Metformin or other medication.

    I was put on Metformin when my hba1c hit 58.4 mmol/mol, I did not have any gut problems when I was taking both versions of it.
     
  9. JenniferW

    JenniferW Type 2 · Well-Known Member

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    Like you, I was diagnosed T2 in 2015 and have not been on any medication. It was mentioned as a possibility at my last annual review because my HbA1c was up to 52. It's never been below 46 but this was only the second time it had gone up to 50 or more. It made me focus on a low carb diet for the 3 months till a re-test, which has come back at 41 - the lowest / best so far. I've had side effect problems with medication for another condition (hyperuricemia), so I really didn't want to add in any other medication if possible, and this has shown me I can do it - though it's not been easy! I've lost some- but not much - weight on a low carb diet where I've been averaging around 100g / day. But it's been enough for me to feel a difference, which also encourages me to stick with low carb. I can start to see how much the changes I've made in this first 3 months are already starting to feel 'normal'.
     
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  10. DianaMC

    DianaMC Prediabetes · Well-Known Member

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    I was diagnosed as prediabetic with an HBA1C of 43 - and advised that if diet didn’t change that, the next step would be metformin. I’m not good with medications so felt really scared. But I went on the NHS course they offered and continued to lose some weight - which I had already begun by researching and following a low carb (and healthier carbs) diet. My HBA1C has only dropped to 42 but it’s an improvement - and I’ve sustained weight loss of more than a stone across 15 months.

    I was also told my cholesterol balance could be better, but not threatened with statins! I’d read a book about the cholesterol “myth”/“con”, which points to the studies suggesting food as a causal factor to be flawed. The author says the real cause is stress. Stress can also cause higher blood sugar, so I’ve chosen to try mindfulness to help me relax more and be less tense and anxious. I could do with practising it more often, but prefer the idea of that to statins.

    Wishing you success with your goals, doing it the way that suits you best :)
     
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  11. milesrf

    milesrf Type 2 · Well-Known Member

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    One thing about cholesterol - too many carbohydrates in your diet will make your liver start turning those carbohydrates into a mixture of cholesterol and saturated fats.
     
  12. jaym

    jaym Type 2 · Active Member

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    Just a bit of background on my diabetes journey, I was diagnosed in 2016 hba1c was 51, by my next review I lost weight doing a low carb diet and got my hba1c down to 35, since then my hba1c has been creeping back up, I’m ashamed to say I have had a bad few years personally and let myself go, had my latest hba1c result today and it’s now 77, thankfully all my other results came back ok except my cholesterol (just started taking stains reluctantly), not been to see my go yet, but I want to turn this around myself through diet and lifestyle changes, I’m just worried with it been so high I will made to take medication.
     
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  13. JohnEGreen

    JohnEGreen Other · Expert

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    When I was formally diagnosed my HbA1c was 64 though I had been in the diabetic range for about two years by then I was prescribed Metformin immediately on the day I was officially diagnosed.
     
  14. HSSS

    HSSS Type 2 · Well-Known Member

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    No one can make you take any medication. They can just make their suggestions. The decision is yours.

    And if you have an understanding of what went wrong and a plan you know works they should at least be supportive of a short trial to see if you can bring it back down eg a 3 month retest.

    Statins will often raise glucose levels. Again your choice whether you want them or not. Make an informed choice. Have you seen https://www.diabetes.co.uk/forum/threads/cholesterol-and-statins.156985/
     
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