confused Type 2 - medication?

alexjames3 said:

Hi all, i was told i as type 2 6 weeks ago, my dr has told me to wait until the end of September before she decides which medication she puts me on, she tells me she doesn't like metformin, is this the usual road to follow with medication

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It can be a good approach for a newly diagnosed person to try getting their blood sugars down with diet and exercise for 3 months before seeing if meds are necessary. Metformin is the standard first line option, and it is very safe compared to the other meds. If I were you I would ask her why she doesn't like metformin, as it would be a shame to miss out on what could be a good treatment.

Do you happen to know what your HbA1c blood test result was? And are you willing to reduce your carbs and portion sizes, and do some exercise, if that will get your blood sugars down? If so, you might not need meds, but ultimately this will be a decision you should make based on discussion with your doctor.

I will tag @daisy1 as she has some info for people new to the site that she can post. Welcome

alexjames3 said:

hba1c has been between 48 and 52 (if i remember rightly) ive been on a a strict healthy diet for two years, which she said did not need changing, exercise is virtually impossible due to other problems, she basically refuses to give metformin based on a personal opinion

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As 48 is the threshold for the diagnosis of T2, then that range of results is at the low end of the spectrum. But it still needs addressing, and it should be possible for most people to eventually return their numbers to below 42, which is the non-diabetic range. (Prediabetes is 42-47).

With a level like 48-52, if you can reduce it through diet, then you may not need meds. Your diet has probably been healthy in accordance with the standard dietary advice that most doctors, nurses and dieticians give, which is the "eatwell plate", which includes a more carbs than what many of us believe are appropriate for T2s. It doesn't surprise me that she said it doesn't need changing. But if you read around the forum and Daisy1's post in particular, you will see information about low carbing and the positive effect that it can have on blood sugars.

Exercise is not as important as diet, in reducing blood sugars. If you aren't able to do it that's ok.

It's her refusal to give metformin that is quite unusual. The NICE official guidelines advise doctors to use metformin as a first choice of meds, unless there is a specific reason not to, like if the person has certain other conditions. I guess you have some options here. If it looks like you would benefit from metformin, you could change doctors and you would most likely be able to try it. If you don't need metformin, then you might consider whether you want to keep seeing her, if she is opposed to a standard treatment and won't give a good reason why. Such a stance would weaken my ability to trust a doctor. But if it sits well with you, that's ok too. It's entirely your call.

And I think it may be too early to tell if you need meds, because you should have an opportunity to try low carbing first, if you want to.

A lot of members here think most doctors/nurses put T2 patients on medication to soon so yours seems to have a different approach to it and wants to see how you go on without it for a while and maybe you will not need it at all. Some control it with diet and exercise alone but you did say exercise is difficult for you
You say you have a healthy diet and you have been doing it for two years so you were doing it long before your T2 diagnosis. A lot here do the low carb high fat diet but those who want to do it and have other health issues need to check with their doctor first that it will be suitable for them

@alexjames3

Hello Alex and welcome to the forum Here is the information we give to new members and I hope you will find it useful. Ask more questions and someone will be able to help.


BASIC INFORMATION FOR NEWLY DIAGNOSED DIABETICS

Diabetes is the general term to describe people who have blood that is sweeter than normal. A number of different types of diabetes exist.

A diagnosis of diabetes tends to be a big shock for most of us. It’s far from the end of the world though and on this forum you’ll find over 150,000 people who are demonstrating this.

On the forum we have found that with the number of new people being diagnosed with diabetes each day, sometimes the NHS is not being able to give all the advice it would perhaps like to deliver - particularly with regards to people with type 2 diabetes.

The role of carbohydrate

Carbohydrates are a factor in diabetes because they ultimately break down into sugar (glucose) within our blood. We then need enough insulin to either convert the blood sugar into energy for our body, or to store the blood sugar as body fat.

If the amount of carbohydrate we take in is more than our body’s own (or injected) insulin can cope with, then our blood sugar will rise.

The bad news

Research indicates that raised blood sugar levels over a period of years can lead to organ damage, commonly referred to as diabetic complications.

The good news

People on the forum here have shown that there is plenty of opportunity to keep blood sugar levels from going too high. It’s a daily task but it’s within our reach and it’s well worth the effort.

Controlling your carbs

The info below is primarily aimed at people with type 2 diabetes, however, it may also be of benefit for other types of diabetes as well.
There are two approaches to controlling your carbs:

• Reduce your carbohydrate intake
• Choose ‘better’ carbohydrates

Reduce your carbohydrates

A large number of people on this forum have chosen to reduce the amount of carbohydrates they eat as they have found this to be an effective way of improving (lowering) their blood sugar levels.

The carbohydrates which tend to have the most pronounced effect on blood sugar levels tend to be starchy carbohydrates such as rice, pasta, bread, potatoes and similar root vegetables, flour based products (pastry, cakes, biscuits, battered food etc) and certain fruits.

Choosing better carbohydrates

Another option is to replace ‘white carbohydrates’ (such as white bread, white rice, white flour etc) with whole grain varieties. The idea behind having whole grain varieties is that the carbohydrates get broken down slower than the white varieties –and these are said to have a lower glycaemic index.
http://www.diabetes.co.uk/food/diabetes-and-whole-grains.html

The low glycaemic index diet is often favoured by healthcare professionals but some people with diabetes find that low GI does not help their blood sugar enough and may wish to cut out these foods altogether.

Read more on carbohydrates and diabetes

Eating what works for you

Different people respond differently to different types of food. What works for one person may not work so well for another. The best way to see which foods are working for you is to test your blood sugar with a glucose meter.

To be able to see what effect a particular type of food or meal has on your blood sugar is to do a test before the meal and then test after the meal. A test 2 hours after the meal gives a good idea of how your body has reacted to the meal.

The blood sugar ranges recommended by NICE are as follows:

Blood glucose ranges for type 2 diabetes

• Before meals: 4 to 7 mmol/l
• 2 hours after meals: under 8.5 mmol/l

Blood glucose ranges for type 1 diabetes (adults)

• Before meals: 4 to 7 mmol/l
• 2 hours after meals: under 9 mmol/l

Blood glucose ranges for type 1 diabetes (children)

• Before meals: 4 to 8 mmol/l
• 2 hours after meals: under 10 mmol/l

However, those that are able to, may wish to keep blood sugar levels below the NICE after meal targets.

Access to blood glucose test strips

The NICE guidelines suggest that people newly diagnosed with type 2 diabetes should be offered:

• structured education to every person and/or their carer at and around the time of diagnosis, with annual reinforcement and review
• self-monitoring of plasma glucose to a person newly diagnosed with type 2 diabetes only as an integral part of his or her self-management education

Therefore both structured education and self-monitoring of blood glucose should be offered to people with type 2 diabetes. Read more on getting access to bloodglucose testing supplies.

You may also be interested to read questions to ask at a diabetic clinic

Note: This post has been edited from Sue/Ken's post to include up to date information.

Hi and welcome. Your GP is ignoring NICE guidlelines and perhaps you need to quote them to her! Go to the NICE website to download them. Metformin is a very safe and extremely commonly prescribed drug. The only real problem that occurs is when the standard version causes bowel upset. The Slow Release (SR) virtually always avoids this and I wonder if your GP is even aware it exists; I have been on it for 10 years. In case your GP isn't knowledgeable on diabetes (!) then be aware that Metformin is the first drug of choice for a T2 when there is some excess weight present. If you are a slim T2 (in effect a LADA) then Gliclazide is the first choice drug. GPs often wait 3 months using a diet (not the NHS one) to check the HBa1C and then decide if any medication is needed. All of this is in the NICE guidelines which are actually very sensible.

alexjames3 said:

Hi all, i was told i as type 2 6 weeks ago, my dr has told me to wait until the end of September before she decides which medication she puts me on, she tells me she doesn't like metformin, is this the usual road to follow with medication

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These are the NICE guidelines for medication.

http://www.surreyandsussex.nhs.uk/w...CG-Type-2-Diabetes-Prescribing-Guidelines.pdf

As you will see, diet and lifestyle options are the first suggestion and if this is not working after three months then medication is the next step.

Is her reluctance to prescribe Metformin for you because you have any G.I. tract conditions, i.e. Diverticulitis, Crohns, Ulcerative Colitis, IBS? You really need to ask her what her reservations concerning this drug are.

alexjames3 said:

she states that she personally doesn't like to prescribe them

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How were you diagnosed? Did you go to see your GP with any symptoms? Was the HbA1c test the only one, or had they done other tests, followed by the HbA1c?

In your shoes, I'd want to try to get things under control by tweaking my diet a bit.

What sort of things do you like to eat? Most people find amending their diet a bit can make a real difference.

alexjames3 said:

i went because of constant tiredness and lack of energy, feeling extremely ill, i had 7 blood tests over 3 weeks, haba1c was 48-52 and she told me i had type two, that was the last she mentioned of it

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I don't think 7 blood tests over 3 weeks is necessary to diagnose diabetes, and diabetes should have been one of the first thing she thought of with your symptoms. So one, or maybe two tests were all that were needed.

Has she been a GP for long? Was she trained in the UK?

alexjames3 said:

8 years and a UK Dr, ive seen her about depression in the last few weeks and shes basically told me get a grip, i am in the middle of changing Drs

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I'm so pleased to hear you are changing doctors.

Sorry to hear you have depression. I have that too. Hope you are able to get some help from your new doctor.

Maybe if you give us a sample menu of what you eat in a day, we can give you some tweaks to bring down your BG?