Diagnosed Yesterday

1. How long before the medication starts to work and I start to feel better
2. Is it true the medication can cause jaundice
3. Will the medication stop the dizziness

daisy1 said:

@Marcus1234

Hello Marcus and welcome to the Forum Here is the Basic Information we give to new members and I hope you will find it interesting and useful. Ask as many questions as you like and someone will 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 well over 235,000 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

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.

Over 145,000 people have taken part in the Low Carb Program - a 10 week structured education course that is helping people lose weight and reduce medication dependency by explaining the science behind carbs, insulin and GI.

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 blood glucose 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.
Take part in Diabetes.co.uk digital education programs and improve your understanding. Most of these are free.

• Low Carb Program - it's made front-page news of the New Scientist and The Times. Developed with 20,000 people with type 2 diabetes; 96% of people who take part recommend it... find out why
  
  
• Hypo Program - improve your understanding of hypos. There's a version for people with diabetes, parents/guardians of children with type 1, children with type 1 diabetes, teachers and HCPs.

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sally and james said:

@Marcus1234 To begin by trying to answer your question:
1. Metformin takes quite a while to build up in the body, a number of weeks, but it is a very mild drug that achieves very little in reducing blood sugars, though it is said to protect against some other things.
2. I have never heard of this, suggest you read the information leaflet that comes with the medication.
3. Dizziness is not normally one of the symptoms of T2 diabetes, but perhaps it is for you. Impossible to say if metformin will affect this.

Many of your symptoms are probably caused by raised blood sugars and the associated raised insulin levels. You can get these down very effectively and often in a short space of time by cutting right down on the sugars in your diet. "Sugar" includes all carbohydrates as far as diabetes is concerned, so that's bread, potatoes, anything made with flour as well as sweets, sugary drinks and puddings. Look up "low carb" for lots more on this.
Sally

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Alexandra100 said:

Here is part of an article on Metformin by the well-respected writer Jenny Ruhl. You will see that 500mg is a very low dose, which is as it should be, since starting with a higher dose makes it very much more likely that you will have digestive problems. You probably won't notice any benefit on 500mg. If your doctor doesn't increase the dose gradually (over weeks) I suggest you nudge him/her in that direction. IMO Metformin is helpful, but eating fewer carbs is much more effective.

"Metformin Lowers Risk of All Kinds of Fatal Outcomes
A study presented at the 2010 ADA Scientific Sessions analyzed records of " 19,699 patients over age 45 who had diabetes as well as documented cardiovascular disease or other atherothrombotic risk factors." It found: patients on metformin had a significant 33% reduction in the risk of death compared with those not on the drug (95% CI 0.59 to 0.75, P<0.001). After adjustment with the propensity score, there was still a significant 24% reduction in death (95% CI 0.65 to 0.89, P<0.001).The "propensity score" was a way of adjusting for other drugs given to control heart disease.

Diabetes in Control: ADA: Mortality Lower with Metformin
Metformin Started Early Far More Effective than Metformin Started Later
A study published of 1,799 Kaiser patients who were able to lower their A1c below 7.5% using Metformin found that when patients were started on Metformin immediately after diagnosis, they were able to stay at an A1c lower than 7% for longer than did patients whose doctors waited a year before starting them on the drug.

Secondary Failure of Metformin Monotherapy in Clinical Practice
Jonathan B. Brown. Diabetes Care Diabetes Care March 2010 vol. 33 no. 3 501-506 doi: 10.2337/dc09-1749

A more detailed discussion of this study can be found here:

Diabetes in Control: Early Treatment Doubles Chance of Success for People with Diabetes

This is important. Many people with diabetes resist taking a drug thinking that it is better to attempt to lower blood sugar with diet or exercise alone. Because the action Metformin is different from the effect of cutting carbs or exercising, this may be a mistake. It may be better to start metformin along with other approaches as soon as you receive a diagnosis of abnormal blood sugar (including a diagnosis of pre-diabetes) rather than waiting.
There's No Research Data about the Effect of Combining Metformin with Carb Restriction
Unfortunately, all studies of Metformin published to date have been performed with people who were encouraged to eat a high carbohydrate diet. So there is no definitive information about what happens when Metformin is combined with a low carbohydrate diet.
Anecdotal Evidence
Postings on newsgroups suggest that people who have a lot of weight to lose who stall out above their desired weight while on a long-term low carb diet often start losing again when they add Metformin to their diet regimen, if they continue to keep their carbohydrate intake low.
Women with PCOS have also found that the addition of Metformin to their regimen may improve both weight loss and fertility.

Metformin may prevent weigth gain independent of insulin resistance by blocking the liver's synthesis of triglycerides. It also appears to prevent the liver from storing glucose in the form of glycogen which leads to less ability to dump glucose inappropriately.

I have observed that when I am taking metformin while eating a very low carb diet and I raise my carbohydrate intake above the level that usually refills glycogen resulting in an instant water weight gain I do not see the water weight fluctuation I see when I am not taking it. I speculate that this indicates that metformin somehow interferes with the normal liver glycogen function.

What You Need To Know About Taking Metformin
Metformin takes about 3 days to kick in and 3 weeks to achieve its maximum effect. Because it can cause intense gastric problems, it's advisable to start out with a low dose and work up. Most people don't see an effect on blood sugars until they are taking between 1,000 and 1,500 mg a day. Larger people may need to take the full dose (2250 to 2500 mg depending on whether it is metformin ER or Metformin)

Timing when you take your metformin will often subtly change the impact it has on your blood sugar because even the ER form does not result in a completely smooth activity curve. Taking metformin ER it at night will often result in a stronger effect on fasting blood sugar but less action at dinner. Taking Metformin in the morning may give best coverage on lunch, decent coverage for dinner but result in the highest fasting blood sugars and the most stomach discomfort. You can experiement with the time you take metformin as long as you NEVER take more than the prescribed dose during a 24 hour period.
Side Effects
Gastric Distress
The most common side effects of Metformin are nausea, diarrhea, heartburn and gas. That's why it's been nicknamed "metfartin" by people who post on Web bulletin boards. These unpleasant digestive system symptoms often go away after a few weeks, but not always. Some people are unable to take Metformin because of the persistence of these symptoms.

The extended release form of metformin (metformin ER) often relieves gastric symptoms. Many of us find that taking metformin ER in the early afternoon after we have eaten several meals may eliminate heartburn or the stomach irritation that occurs when it is taken on a relatively empty stomach.

If your problem is gas or diarrhea, try eating less starch. These symptoms are caused by undigested starches reaching the gut where they are fermented by helpful bacteria."

You can find the full article here: http://www.phlaunt.com/diabetes/14045911.php

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Alexandra100 said:

Are you testing one and two hours after meals?

If /when you increase the dose to 500 x 2 you will be able to take it am and pm.

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Chris / Yorkshire said:

Hi. I’m new too and still learning. I’m sorry you are feeling so rotten. 5 weeks in and I get tired a lot but starting to feel better. There’s a lot going on:
The condition itself causes fatigue.
If you’ve changed your diet that can take some getting used to, especially if you are losing weight.
Then there is a lot to concentrate on with the testing and learning about the condition.
Then there is the stress, emotion and anxiety of the diagnosis.
Finally the medication is there to help but that takes time and in the meantime there may be side effects (in which case speak to your doc).
All considered no wonder you are tired.
I wish I had the answer for you - my approach was to crack on with low carb diet and push myself to exercise, even though some days a brisk 30 min walk was the best I could do.
I hope you start to balance out soon - this is hard isn’t it. We have lots of support though on this site - lean on it... I’m finding it so helpful on many levels.

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Alexandra100 said:

The idea is that in a truly healthy person bg rises to a peak about one hour after eating and has fallen back to normal levels by two hours. So you do need to test at both times, and you may need even to test again at 3 hours depending on what you see at 1 and 2. More helpful advice from Jenny Ruhl here: http://www.phlaunt.com/diabetes/14045524.php

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Chris / Yorkshire said:

Diagnosis is the first big step to managing the condition. You can’t manage what you’re not aware of.
Right now you might feel out of control but you’ve never been more in control.
You just need to gather the tools together, make yourself a plan, even if for just the next week: baby steps. Don’t over complicate it.
Breathe.
We are both going to get better Marcus - we can do this!

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