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Just Diagnosed As Prediabetic Today And Put On Metformin

T

Toffeepenny

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Hello, I'm a newbie, just a bit shell shocked from the news from my Doctor this morning.

I had a Plasma fasting glucose Test on 25th May - Result: 6.3mmol/L {Ref:3.5-6.0] Above high reference limit. Impaired fasting glycaemia, if not know diabetic.

I didn't know this result until today as I'd had many other tests done too. I got a letter after that test also asking me to go for a Fasting Oral Glucose Tollerance Test, I just presumed they'd forgotten to add that one, but it seems it was triggered by the above result. So it was a while before I got the time to do it, but today I got the results.

GTT fasting glucose on 2nd July: 6.6mmol/L
GTT glucose 120 minutes later: 8.1mmol/L
GTT Interpretation: Fasting glucose <7.0 and 2hr glucose >7.7 but <11.0mmol/L. Consistent with Impaired Glucose Tolerance which is associated with increased risk of progression to DM and significantly increased cardiovascular risk. Suggest full CVD assessment, lifestyle advice and repeat OGTT in a year.

So the doctor told me she wants me to see the surgery's nurse who specialises in Diabetes, I'm seeing her next week. The Doctor also said this needed to be a wake up call and I need to address my diet and exercise and she has put me on 500mg of metaformin (take one twice a day). She said, I'll be on these for at least a year, even if I lose weight and that I will be re-tested in A YEARS time with a different test, HBA1c, which she said would show my levels over six weeks.

So after having had a read around this site, my questions to anyone who knows are:

Lots of you already seem to know your HBA1c levels, why am I not being given this until A YEARS time?
I can't seem to find any pre-diabetics talking about Metformin, so WHY have I been given this?
And, if this huge scare is the kick up the butt I needed to get my weight sorted and I manage to do that, say over the next 3-6 months, then WHY do I need to still be on this Metformin and why can't I be tested along the way as my weight improves? How will I know if I'm getting better? Is it reasonable to have to wait another year with this worry and medication to know?

On a side note, I also have hypothyroidism, I've heard this can be connected with Type 2 Diabetes? And the Doctor also sent me away with Folic Acid and Vit D as they both came back low too. I'm age 52, 5ft 2", 14st 10lb.

Thanks in advance for any advice
 
Hi,

Welcome to the forum.

I'm hoping that someone else will pick up on your thread as there are some issues I'm not familiar with. One thing I do know though is that if you self test your blood glucose levels before and after meals you will find out for yourself what you should and shouldn't be eating. Not all doctors / nurses are keen on this as it may cost , but from my experience I've found it really, really helps. There is info on the forums about which kit is better but look for one with cheaper strips. - It costs less than a cup of coffee a day for me to know pretty much exactly where I am sugar wise. Sadly its difficult to trust anyone, including the health care professionals, but why trust when you can verify for yourself. Good luck, its just a small discipline you have to get used to and there is so much info on this site if you take time to browse through
 
There will be lots of people here who can advise you. Metformin can be an appetite suppressant so may help a bit with weight loss. On the HbA1c as fully T2 I had tests every three months to begin with. Not sure why you would wait a year. Best to be fully on top of it now.
 
You have a lot of "why" questions I have no answer to, because the info and regime you've been given make little sense to me too. No HbA1c for a year, but on metformin for at least that time? That's... Odd. Maybe even lazy doctoring. Anyway... You're right, you're flying blind if you have to just guess for a year. That's stressful, and uselessly so. (Stress raises bloodsugar, so not the best method to help you, this!) Loads of people here self-fund a meter, and I recommend you get one. Actually having diabetes is no walk in the park, so if you can avoid getting there, do! If you test like mad (before a meal and 2 hours after first bite) and enter the numbers into the MySugr app, it'll be able to give you an estimate of your current HbA1c, or you can buy an admittedly expensive home test. If you change your lifestyle to a low carb one, (it's not exactly a diet, as people tend to quit those after a while, and this is for the long haul), I don't see why you wouldn't be able to avoid T2 altogether. And though I am no doctor and cannot give medical advice, you can be off the metformin in no time, if you low carb, test often initially, and see non-diabetic numbers consistently. I was a full blown diabetic for years before I was finally diagnosed, and could drop all meds after 3 months of a low carb, high fat diet, including the statins for cholesterol. (Bacon every day, and my cholesterol's fine!). You can take control of this. Good luck!
 
Sorry, forgot to touch on these things; if you lose weight, keep an eye on your thyroidlevels; your meds might need adjusting as your body weight changes. If your dosage is off, it can affect bloodsugars too. It did for me. And a lot of diabetics are vitamin d deficient, (extra B won't hurt either,) but try to just get a little sun here and there. 15 minutes a day of sun on your bare arms can make a difference in fatigue, osteomalacia and muscle weakness.
 
Toffeepenny said:
WHY do I need to still be on this Metformin
Click to expand...
These days NICE recommends GPs prescribe Metformin even for pre-diabetics, because, as they told you at diagnosis, even being pre-diabetic raises one's heart attack risk considerably, and Metformin reduces that risk. In addition it has other benefits and few disadvantages. The vital thing is to reduce one's blood glucose asap. (Someone said that having glucose in the blood is like having ground glass circulating round to one's eyes, kidneys, feet etc etc.) If Metformin can help reduce this even by a little (a lower carb diet can help more) why not go for it? I am not even pre-diabetic, but I worked very hard to persuade my GP to give me it and to raise it gradually to the maximum dose (2g daily). I do think it has helped, in addition to my efforts at low carb and exercise. Here is an article on the subject by a respected journalist who used to frequent this Forum: http://www.mendosa.com/blog/?p=1261
 
I too have a defunct thyroid and take 175micrograms of Thyroxine daily - (when I remember - my memory is rather iffy these days) and that can increase blood glucose levels - but I found that even with full blown diabetes, which I had when diagnosed, my levels returned to normal very fast when I cut back on the carbs in my diet - to the same level which allowed me to control my weight when doing Atkins, but I have cut back even further now to try to lose more body fat - though it will mean yet another set of clothes.
 
JoKalsbeek is right, your dr does sound rather lazy! I would be asking her why you haven't had an HbA1c blood test as it is considered the gold standard for diagnosis of both pre diabetes and Type 2 itself.

As for Metformin Nice actually recommends life style changes first, it is most unusual to be put straight onto medication unless there is some other factor? You are only just into the pre diabetes range and I really would question the Metformin. Diet is key specifically low carbing so beware of the diabetic nurse when she recommends the 'Eatwell Plate' as there is far too much carbohydrate in it. Beware also of weight loss programmes that recommend low fat products. Fat has no carbs in it and low fat products invariably have added sugar to make them palatable.

Many people here buy the SD Codefree glucose meter and test before and 2 hours after a meal. It is one of the cheapest and available online. That way you can tell which foods spike your levels. A friend of mine is also a diabetic nurse [but not mine] and she says there is no need to test but as JoKalsbeek says you are flying blind if you do not test.




 
gardengnome42 said:
You are only just into the pre diabetes range and I really would question the Metformin.
Click to expand...
Jenny Ruhl cites research suggesting that Metformin works best when taken early after diagnosis:

"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."

The whole article on Metformin research can be read here: http://www.phlaunt.com/diabetes/14045911.php
 
gardengnome42 said:
You are only just into the pre diabetes range
Click to expand...
Doctors in the UK will not acknowledge this, but many many research studies (I am citing Jenny Ruhl again) have shown that:

"Post-Meal Blood Sugars and High Normal A1cs Predict Heart Attack

If you need any more motivation to pursue normal blood sugars consider this:Heart attack risk more than doubles at blood sugar levels considered to be "prediabetic." Indeed, a good case could be made that higher than normal blood sugar levels which only reach the prediabetic range most doctors ignore are the biggest risk factor for heart attacks--one that explains why so many people who have heart attacks seem not to have any of the commonly cited risk factors like high cholesterol."

from: http://www.phlaunt.com/diabetes/15945839.php
 
Sorry, I'm late to this thread, so you may have had an appointment already but I would ask for an A1c to be done as a benchmark. I was led to believe (for many years) that I was pre-diabetic based on OGTT tests. I recently got access to my medical records and the OGTT tests have always put me in this range but the A1c results contradict this massively! (between 30-35mmol/l over 10 years). I'm not saying this is what is happening but I think you need that A1c to be able to formulate a plan. Getting hold a meter and testing what you're eating pre-meal and 2hr post-meal is a great start, it's amazing what small tweaks can make
 

Callieuk

I was interested in what you were saying above.

So you had a very healthy A!C level, but your OGTT was over the limit into pre-diabetic numbers each time???

I am wondering what having a good A1C, (35) and a post prandial number that is fine, less than 7.8 at 2 hrs) but some times a higher fasting number might mean? (4.9 often but sometimes as high as 6.2?)
 


I cannot do decent fasting numbers at all - my morning monitored BG figure has never been below 7.8 but is more often than not between 8.5 and 9.2, and my A1c last month was 41. The OGTT are always done fasting overnight and so the evidence points to early morning spikes for me but the nurse wasn't interested and I haven't spoken to a doc at all. At one point a few years back I had 3 OGTT in the space of 6 months and 2 A1cs! My BGs are always better afternoon/evening.

I have read that that early morning spike can often be the last thing that gets sorted, if at all!

I guess it depends when you are fasting? If you are doing a dietary fast then my morning spikes likely aren't an indicator of use.

Cal
 
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