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Doctor said my Hba1c is too low!!!

Discussion in 'Ask A Question' started by sugarshy, Sep 21, 2019.

  1. sugarshy

    sugarshy Type 2 · Active Member

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    Over three years I have managed to reduce my Hba1c from 88 to 34. After my last visit to the doctor I was told that my Metformin dose was being reduced from 2 x 500mg a day to just one. The reason given and I quote "We don't like people with type 2 diabetes going to low with their Hba1c" is this really true? And why??
     
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  2. Tophat1900

    Tophat1900 Type 3c · Well-Known Member

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    Your HBA1C is simply brilliant!

    And not too low at all. Reducing medication is a good idea given how well you are doing.
     
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  3. Guzzler

    Guzzler Type 2 · Master

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    You are bucking (your doctor's) trend. An HbA1c of 34 is a winner, great job there well done.
     
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  4. Jim Lahey

    Jim Lahey I reversed my Type 2 · Well-Known Member

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    Well done! Ignore your doctor on this. He/she is talking complete claptrap. As is tradition.

    “We don’t like...” :rolleyes:
     
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  5. xfieldok

    xfieldok Type 2 · Well-Known Member

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    You are to be congratulated. A change in doctor might be in order.
     
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  6. LittleGreyCat

    LittleGreyCat Type 2 · Well-Known Member

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    A better approach might have been "You are doing so well that I think we could reduce your medication.".

    Metformin for general health and wellbeing is a contentious subject but I would be tempted to stay on at least one tablet a day however stellar your HbA1c results.

    Anyway, well done!:)
     
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  7. Dr Snoddy

    Dr Snoddy Type 2 · Well-Known Member

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    Congratulations of your great progress. Only one metformin a day will reduce the work your kidneys need to do to excrete any surplus drug. The comment your doctor made shows that s/he has low expectations of most Type 2 diabetics. These will, of course, be fulfilled by patients who stick to the standard NHS dietary advice!
     
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  8. ziggy_w

    ziggy_w Type 2 · Well-Known Member

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    Hi @sugarshy,

    This might be an artifact of the Accord trial.

    On this trial, they put people with diabetes on intensive treatment attempting very tight blood sugar control by upping medication (more insulin, more sulfonylureas -- probably leading to more swings and more hypos). The outcome was that people did worse on intensive treatment.

    Consequently, this was interpreted as diabetics doing worse on tight blood sugar control and communicated to HCPs.

    However, I believe normal blood sugars achieved on lchf/keto are very different from those achieved by intensifying medication. So, in my mind nothing to worry about.

    By the way, congrats on your HbA1c -- great result and well done.
     
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  9. mike@work

    mike@work Type 1 · Well-Known Member

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    Agree with all above here. Those results are very good. Did you get any kind of explanation, why your results NOT was something to cheer over?
     
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  10. Jim Lahey

    Jim Lahey I reversed my Type 2 · Well-Known Member

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    Indeed, although proponents of the overflow hypothesis posit that this is because heavy duty hypoglycaemics forcibly push glucose from the blood into the tissues where it does most of its damage. Not a factor with Metformin of course. But yes you’re right, this probably explains where the misplaced concern comes from.
     
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  11. Rachox

    Rachox Type 2 (in remission!) · Moderator
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    Well done on your number of 34!
    I have maintained my HbA1c mid 30s for the last two years whilst continuing on Metformin x 3 per day along with a low carb diet!
    My GP is happy for me to continue on it as am I. Have you considered that Metformin has other benefits, so you might like to reconsider once you are aware of them. Here’s an article about it:
    https://www.lifeextension.com/magazine/2001/9/report_metformin/Page-01
     
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  12. NicoleC1971

    NicoleC1971 Type 1 · Well-Known Member

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    As I understand it taking hypoglacemic agents such as insulin or sulphonureas is taking the glucose out of the blood and into the micro and macro vessels whereas low blood glucose achieved through diet and lifestyle means you have turned off the overflow tap of glucose and not merely widened the drain.
    It is possible that the OPs GP is thinking of type 1 diabetics where such a low HBA1c would indicate periods of hypos with those attendant dangers...I can't think of any other reason for it to be a problem when just taking metformin.
     
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  13. zand

    zand Type 2 · Expert

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    Wow! Well done...that is a great HbA1c result. Ignore the GP. It's probably a cost cutting exercise. :rolleyes:
     
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  14. Jim Lahey

    Jim Lahey I reversed my Type 2 · Well-Known Member

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    Yeah for sure. That is another possible explanation. Although if that is the case then OP definitely needs a new doctor :nurse:
     
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  15. sugarshy

    sugarshy Type 2 · Active Member

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    Thanks for all your replies, a lot to ponder on. I need to ask her (the doctor) for an explanation. A factor that might be relevant is that she changed my blood pressure pills from Ramipril to Losartan, perhaps they are more expensive? And the practice is going over budget?
     
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  16. sugarshy

    sugarshy Type 2 · Active Member

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    No, she seemed shocked at the 34 to the point that it seemed she was annoyed!
     
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  17. bulkbiker

    bulkbiker Type 2 · Master

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    Have you had your blood pressure checked with a 24 hour monitor rather than just at the surgery?
    You may be able to come off those meds too... my hypertension normalised after a few months of keto and fasting.
     
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  18. mike@work

    mike@work Type 1 · Well-Known Member

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    @sugarshy
    Strange. With only Metformin, you should namely not be able to have too much of hypos, which means a good all-time BSL (Blood Sugar Level).

    Edited to insert tag
     
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  19. Jim Lahey

    Jim Lahey I reversed my Type 2 · Well-Known Member

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    This times a hundred. My doctor tried her best to diagnose me with hypertension three years ago, but the 24h monitor revealed completely normal blood pressure. The funny thing is that to this day, the DN takes my blood pressure in the surgery and records high results on the system, despite acknowledging the existence of white coat syndrome, despite knowing that I exhibit it, and despite seeing the data from my own machine taken once per week every week.

    My annual reviews are like paint-by-numbers. Godda tick those boxes! The only blood tests I'm interested in, they don't even do (and don't understand). It all just feels like a potential sales opportunity for pharmaceuticals and an excuse for getting a ticking-off because "...you know you can eat SOME sugar!!" :banghead:

    Honestly it's getting increasingly pointless going. I may decline next year. Sorry for going off on a tangent, but amateur HCPs really wind me up.
     
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    #19 Jim Lahey, Sep 21, 2019 at 5:15 PM
    Last edited: Sep 21, 2019
  20. Resurgam

    Resurgam Type 2 (in remission!) · Expert

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    Oh - the how dare you be normal tantrum.
    Sometimes there are things beyond explanation or reason.
     
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