Bg Down, Metformin Up?

[ding79]

Just had my first DN meeting, 6 weeks after diagnosis. I went through my BG readings with her using my meter and we agreed that these were massively lower than my diagnosis level (hba1c of 126 compared to average fasting mmol/l of 7 and post meal mmol/l of 5.6) - raising questions over accuracy of initial reading.
But i was then told to up my metformin from 1,000 to 2,000 to protect against future heart issues.
Does thus sound right? I keep reading about people reducing metformin as BG readings reduce.
Thanks

 

[sally and james]

Personally I am very much against taking medicines to "protect" against some vague, future possibility. I see it as over medication and would want to know what my real likelihood of the disease actually was in real terms and what evidence there is to say that my likelihood of the disease would be reduced by a seriously worthwhile amount. I would then set these figures against the possible side effects of the drug.

Remember that when nurse says, "this will halve your chance of getting X", if your chance of getting X is one in a hundred, taking a pill every day (with side effects) to reduce that to one in two hundred, may not be worthwhile. You need to look at the figures and make up your own mind.

Having said all that, most people around here tend to reduce drugs as their blood sugars improve, but it could be that your DN is aware of other issues.
Sally

 

[Rachox]

I’m currently on 1500 of Metformin and going to discuss reducing it in view of my consistently good HbA1c results. However I'm happy to stay on a small dose as I tolerate it well and it does have added benefits.
I think maybe a jump from 1000 to 2000 is a big jump, I wonder why she didn’t suggest 1500 first? Also the decision hasn’t been based on an HbA1c. I believe an HbA1c is more reliable as your finger prick tests average may be missing higher or lower readings.
Here’s an article that may be of interest to you about Metformin:
http://www.lifeextension.com/magazine/2001/9/report_metformin/Page-01

 

[ding79]

I’m currently on 1500 of Metformin and going to discuss reducing it in view of my consistently good HbA1c results. However I'm happy to stay on a small dose as I tolerate it well and it does have added benefits.
I think maybe a jump from 1000 to 2000 is a big jump, I wonder why she didn’t suggest 1500 first? Also the decision hasn’t been based on an HbA1c. I believe an HbA1c is more reliable as your finger prick tests average may be missing higher or lower readings.
Here’s an article that may be of interest to you about Metformin:
http://www.lifeextension.com/magazine/2001/9/report_metformin/Page-01

Thanks Rachox. You are right, its 1500 for a week then 2000. I just wasnt expecting an increase given good numbers from meter. Will know more with results of new hba1c (surprised not to have had bloods tested before consultation).
Thanks for the article, it makes interesting reading

 

[ding79]

Personally I am very much against taking medicines to "protect" against some vague, future possibility. I see it as over medication and would want to know what my real likelihood of the disease actually was in real terms and what evidence there is to say that my likelihood of the disease would be reduced by a seriously worthwhile amount. I would then set these figures against the possible side effects of the drug.

Remember that when nurse says, "this will halve your chance of getting X", if your chance of getting X is one in a hundred, taking a pill every day (with side effects) to reduce that to one in two hundred, may not be worthwhile. You need to look at the figures and make up your own mind.

Having said all that, most people around here tend to reduce drugs as their blood sugars improve, but it could be that your DN is aware of other issues.
Sally

Thanks Sally
That's pretty much where im coming from. And, no, DN isnt aware of any other factors as none of the expected symptoms are present and no other health issues. BP 'ideal' and cholesterol ok.
I suppose i can always ignore the advice and see how things go.

 

[rhubarb73]

The disparity in your FBG and initial Hba1c may mean that you just managing the condition very well. When diagnosed I was Hba1c of 66 and FBG of 9.7 - all very consistent. However, as soon as I started eating a healthier diet the FBG began to tumble and has settled in the 5.5-6.5 range pretty consistently. By the time the Hba1c was tested again (after 5 weeks) it had gone down to 44, which reflected the improvement in my daily readings.
So here is an idea for you - maybe tell your healthcare team that you'd be happy to consider a dosage increase but maybe get them to first do a retest of your Hba1c to get a more accurate basis from which to set the dose. They might say yes.
I managed to persuade my doctor to book me in for another test after 12 weeks (so it'll be my third) by saying that I wanted to come off statins and see what effect it had on my cholesterol levels now my diet had improved.
If you don't ask you don't get.

 

[britishpub]

- raising questions over accuracy of initial reading.

I think that is quite common amongst HCP's as their standard training informs them that T2D only ever get's worse and dramatic improvements are unlikely.

As for the Metformin, I was prescribed 500mg a day as a "precaution" recently (not that I take any notice) so it is not completely unusual for that to happen.

 

[sally and james]

I suppose i can always ignore the advice and see how things go.

Of course you can. You are not obliged to accept any drug or treatment. It is also up to you whether you, A. tell the nurse, thanks but no thanks, or B. accept the paper prescription but not act on it, or C. collect the drugs and don't take them. People have their own reasons for each of these, but I feel that A is probably best.
Sally

 

[Prem51]

Will know more with results of new hba1c (surprised not to have had bloods tested before consultation).

Does that mean you have had a more recent HbA1c test and are waiting for the result?
If so, it might not be much different from the test 6 weeks ago as it takes around 10-12 weeks for red blood cells to be replaced.
If you have had a recent test, or are going to have one at 3 months I would wait for result before making any decision on changing metfornin dosage.

 

[Phoenix55]

It sounds too close to the mantra that everyone over 50 should be taking a statin. It is up to you and I have not read all the papers on metformin but remember HCPs are there to advise you, not dictate what you must do/take. Having started on metformin I would suggest waiting until the results are in from my next HbA1c test before making a decision based on how well you are managing on the current dosage.

 

[ding79]

Does that mean you have had a more recent HbA1c test and are waiting for the result?
If so, it might not be much different from the test 6 weeks ago as it takes around 10-12 weeks for red blood cells to be replaced.
If you have had a recent test, or are going to have one at 3 months I would wait for result before making any decision on changing metfornin dosage.

Hi Prem, yes. I had a blood test today, results on wednesday, at my suggestion given disparity in current v original results. But DN increased metformin prescription today in advance of those results and with knowledge that current BGs dont reflect original results.

 

[Prem51]

Well unless there was a serious error with your original test it's unlikely that Wednesday's test result will be much different.
But wait and see how it goes. I'm not on metfornin or any meds, but I don't understand why the dn would suggest increasing dosage if your self testing is indicating a much lower HbA1c than the original test showed.
Personally I wouldn't mind being prescribed Metfornin, as it is reputedly a fairly benign medication though can have unpleasant side effects initially, but I wouldn't want to take more than is necessary.
Anyway I hope your recent test result is good, let us know the result.

 

[Resurgam]

I find it strange that in my 'lecture notes on endocrinology' William Jeffcoate - fifth edition from 1993 published by Blackwell Scientific publications it advises that an attempt be made to withdraw the Metformin tablets after 2 to 3 weeks.
The book is intended for medical students.
There is also a warning that Metformin might cause lactic acidosis in people with renal failure, though it is unproven.
I wonder when the notion that it should be not only continued indefinitely but at ever increasing doses arose.

 

[ding79]

Well unless there was a serious error with your original test it's unlikely that Wednesday's test result will be much different.
But wait and see how it goes. I'm not on metfornin or any meds, but I don't understand why the dn would suggest increasing dosage if your self testing is indicating a much lower HbA1c than the original test showed.
Personally I wouldn't mind being prescribed Metfornin, as it is reputedly a fairly benign medication though can have unpleasant side effects initially, but I wouldn't want to take more than is necessary.
Anyway I hope your recent test result is good, let us know the result.

 

[ding79]

Hi Prem51.
Got the result now. New reading is 71. Booked in for another test in 3 months.

 

[Prem51]

@ding79, well that's certainly better than 126, so maybe there was a mistake with last test. But it's still higher than your bg readings would indicate.
So have you and dn decided to increase metfornin, or are you staying with current level?

 

[ding79]

@ding79, well that's certainly better than 126, so maybe there was a mistake with last test. But it's still higher than your bg readings would indicate.
So have you and dn decided to increase metfornin, or are you staying with current level?

Hi Prem51. As the reading is based on 12 weeks and this change is over 6, im sticking with the current dosage. I did have a 2 days in bed virus 10 weeks ago (unusual for me to hug the duvet for yhat sort of thing) so i think that may have skewed things a bit. So no change until next 'proper' reading, if then.