low bmi type 2 - doctor wants me to half my medication - I'm very worried about this

[jn81]

Hi everyone, I was diagnosed with an hba1c of 127 in February 2023.

I had lost some weight and was going to the bathroom more often, so went to docker and A&E and got diagnosed.
Two years before this my hba1c was 41 in a blood test - not even pre diabetes as determined in ireland, so something unusual happened to me that caused this extremely fast progression to a 127 hba1c. I wasn't living a life with a great diet and exercise, but I certainly wasn't terrible either.
Looking back ay symptoms that I didn't really recognise at the time, I was probably in the diabetes range for 6-9 months before diagnosis.

I was prescribed 1000mg of metafornin twice daily.
Straight away I worked hard on a strict healthy diet and exercise.
Being low BMI(~19 bmi) it is a challenge to maintain my weight on metafornin and with regular exercise - I am on a high calorie diet (mostly good fats, fibre , protein, ~200g carbs per day)..
In late May I got a hba1c of 43 on a strict diet and good exercise.
In early September I got a hba1c of 38.
I got close to these hba1c values mostly because of the medication dosage - my diabetes was obviously very strong.
At diagnosis my morning spike before medication was going up as high as 23mmol/L.
When I went on the metafornin I saw a huge improvement in blood sugars.
I monitor regularly.

I got the 38 hba1c in a period of ideal family life ( my fiancée covered many tasks for me while I exercised ) ,
I was working from home 5 days a week and could cook and exercise there, ( now only 2 days at home )
and was in perfect health all summer (no colds, flus, covid ).
I wont bore with the details but you cannot imagine how hard I worked on every aspect to get down from 43 to 38 hba1c.

I have a 2 year old daughter and all that matters to me is being around long enough and being healthy enough to look after her and my fiancée
and this is what motivated me for my extreme work in lowering my hba1c.

My reward for this extreme hard work is the hospital now want to half my medication now after seeing the 38 hba1c.
I ( and my fiancée ) are devastated with this as we know how extremely hard I worked to do this.
So it feels like I am now trapped in that I will always be stuck having to work to these extreme measures to get even a 45 hba1c now with half the medication.
It feel like this will not only affect my blood sugars, but my mental health, my partner, my concentration at work and my weight.
As I am low BMI and not far above the minimum healthy level. So on half the meds I won't be able to eat as much as I do now and will possibly lose more weight.

Also I have covid at the moment and as a result my sugars are much higher, but I don't even know how my sugars will be in the long term after covid.
Will they be the same as before covid? Should the hospital be making a change until my blood sugars settle after covid again etc...
Thankfully my covid symptoms are mild luckily enough.

I was just getting used of my routine and managing my diabetes and keeping blood sugars very healthy.
It was finally getting easier for me.

Now it seems I am stuck in a bad place and feel like being on half the meds will affect my mental health, my partner, my work, my child , my low BMI as I feel like I will have to always work to extremes.
It feels almost like it's almost a punishment for working so hard on getting excellent hba1c numbers and that my life would have been better off if I had ate ice cream and casually exercised and coming in with a higher hba1c. Then I could stay on same meds and live an easier life.

I measure my carbs in every meal, and for breakfast for example I almost always eat 40g oats, 60g walnuts, 2 large spoons greek yoghurt, soy/almond milk, a couple of strawberries. I know on current meds this will usually peak around 10mmol/L and drop to about 7mmol/L after 2 hours.
I feel like on half my meds I won't even be able to eat this breakfast as it will peaking higher , at maybe 12 or 13mmol/L.

Let me know if anybody has any advice or has had similar experiences?

Thanks

 

[KennyA]

Hi everyone, I was diagnosed with an hba1c of 127 in February 2023.

I had lost some weight and was going to the bathroom more often, so went to docker and A&E and got diagnosed.
Two years before this my hba1c was 41 in a blood test - not even pre diabetes as determined in ireland, so something unusual happened to me that caused this extremely fast progression to a 127 hba1c. I wasn't living a life with a great diet and exercise, but I certainly wasn't terrible either.
Looking back ay symptoms that I didn't really recognise at the time, I was probably in the diabetes range for 6-9 months before diagnosis.

I was prescribed 1000mg of metafornin twice daily.
Straight away I worked hard on a scrict healthy diet and exercise.
Being low bmi(~19 bmi) it is a challenge to maintain my weight on metafornin and with regular exercise - I am on a high calorie diet (mostly good fats, fibre , protein, ~200g carbs per day)..
In late May I got a hba1c of 43 on a strict diet and good exercise.
In early September I got a hba1c of 38.
I got close to these hba1c values mostly because of the medication dosage - my diabetes was obviously very strong.
At diagnosis my morning spike before medication was going up as high as 23mmol/L.
When I went on the metafornin I saw a huge improvement in blood sugars.
I monitor regularly.

I got the 38 hba1c in a period of ideal family life ( my fiancee covered many tasks for me while I exercised ) ,
I was working from home 5 days a week and could cook and exercise there, ( now only 2 days at home )
and was in perfect health all summer (no colds, flus, covid ).
I wont bore with the details but you cannot imagine how hard I worked on every aspect to get down from 43 to 38 hba1c.

I have a 2 year old daughter and all that matters to me is being around long enough and being healthy enough to look after her and my fiancee
and this is what motivated me for my extreme work in lowering my hba1c.

My reward for this extreme hard work is the hospital now want to half my medication now after seeing the 38 hba1c.
I ( and my fiancee ) are devastated with this as we know how extremely hard I worked to do this.
So it feels like I am now trapped in that I will always be stuck having to work to these extreme measures to get even a 45 hba1c now with half the medication.
It feel like this will not only affect my blood sugars, but my mental health, my partner, my concentration at work and my weight.
As I am low bmi and not far above the minimum healthy level. So on half the meds I won't be able to eat as much as I do now and will possibly lose more weight.

Also I have covid at the moment and as a result my sugars are much higher, but I don't even know how my sugars will be in the long term after covid.
Will they be the same as before covid? Should the hospital be making a change until my blood sugars settle after covid again etc...
Thankfully my covid symptoms are mild luckily enough.

I was just getting used of my routine and managing my diabetes and keeping blood sugars very healthy.
It was finally getting easier for me.

Now it seems I am stuck in a bad place and feel like being on half the meds will affect my mental health, my partner, my work, my child , my low bmi as I feel like I will have to always work to extremes.
It feels almost like it's almost a punishment for working so hard on getting excellent hba1c numbers and that my life would have been better off if I had ate ice cream and casually exercised and coming in with a higher hba1c. Then I could stay on same meds and live an easier life.

I measure my carbs in every meal, and for breakfast for example I almost always eat 40g oats, 60g walnuts, 2 large spoons greek yoghurt, soy/almond milk, a couple of strawberries. I know on current meds this will usually peak around 10mmol/L and drop to about 7mmol/L after 2 hours.
I feel like on half my meds I won't even be able to eat this breakfast as it will peaking higher , at maybe 12 or 13mmol/L.

Let me know if anybody has any advice or has had similar experiences?

Thanks

Hi and welcome to the forums.

You've done extrememly well in reducing your HbA1c so quickly. It's a bit unusual going from a normal value to such a high value, back to normal in such a short space of time. In addition, at 200g/day you're eating a fair amount of carbohydrate, which would be an issue for many of us, but you can clearly handle what you're eating. I usually have about 20g/day, which works for me.

Metformin (I have zero personal experience of metformin, so this is taken from the textbooks) doesn't itself lower your blood glucose. What it does is stop your liver topping up blood glucose from your body's stores, and therefore increases the action of your own insulin. This is well known but the medics are still unclear about how it works.

The question that your experience raises for me is that you managed the reduction from 127mmol/mol to 38 in six months, while eating that (reduced but still fairly high) amount of carb. I don't think I've seen anyone else claiming such a reduction due to metformin. Did anything else happen around the time your BG rose, that might have affected it?

My feeling is that if you want to stay on the level of metformin you're currently on, you need to be talking to your medical team. Your BG is normal - the thing you don't know is what would happen if the dose was reduced. I dodn't know if your team would be open to a deal where you (for example) reduced by half for three months, on the understanding that if there was a problem you could go back to the original level?

Anyuway, well done again.

 

[HSSS]

I think you aren’t giving credit to the right things here. Your extreme exercise is likely largely responsible for the drop rather than the Metformin. Metformin is a mild drug and typically only reduces hba1c by a small amount (maybe up to 10mmol)

Are they insisting your drop the Metformin or suggesting it? Have you asked to maintain it? You are still eating a lot of carbs for most type 2’s. You could half that instead and probably not need the drastic exercise regime to manage your levels and less or no medication. That might help maintain your weight if you are overtraining maybe. Proteins and fats won’t effect bgl much but will help you maintain weight.

I too think that’s an unusually big increase in a small time and then a big drop despite mild medication and still a fair amount of carbs. How many more carbs were you originally eating do you think? It might be explained it it were many many more. Or were you sick before diagnosis/when symptoms began (covid for example or longer term infections)? On any medications (steroids maybe)?

 

[jn81]

Thanks KennyA, yeah I doing my best to convince my diabetic medical team to maybe only reduce to 1500mg as a compromise.
I pay for a libre sensor myself and use it every 6 weeks and monitor regularly on with finger prices 5 times per day, so I know exactly how many diabetes behaves and I know how strong it is.
I do all the right things at the right times to get the low hba1c. It is not easy.

Hard to know what caused my diabetes initially. During and after covid lockdowns my diet got worse and I began eating things like lemon drizzle, banana cakes, ice cream - which i never really did much before. But i wasn't extreme with this either. I had a child 2.5 years ago and my partner got sick and was bad I'm hospital for a week after, and I'd to look after the baby for the 1st month and plenty of sleepless nights after. Maybe they had sone effect - but its hard to know - everybody has these types of things happen also. My child started creche around the time I think symptoms started , she got lots of bugs, some that I caught- maybe some affected my blood sugars.

Yeah it sounds like I will need to do some negotiation with my team. I have already sent them my worries about this and they contacted me back, but sounds like some meds change is inevitable.
To me it seems that I would have to reduce carbs to 100g but I don't think my consultant would agree with that. It was her who initially moved me from 100g to 200g in March.
And maybe take some known diabetic supplements but from what I've read I can't find one that seems to work well and has no long term usage health concerns.


I have a fair idea of what my blood sugars will be like when I half my medication because for my first two weeks on metafornin I was on this half dosage until my body got used of metafornin.
I was using a libre sensor during these 2 weeks, and my morning spike was large (up to maybe 13mmol/L) for a healthy breakfast.

Thanks for the reply @KennyA

 

[jn81]

I think you aren’t giving credit to the right things here. Your extreme exercise is likely largely responsible for the drop rather than the Metformin. Metformin is a mild drug and typically only reduces hba1c by a small amount (maybe up to 10mmol)

Are they insisting your drop the Metformin or suggesting it? Have you asked to maintain it? You are still eating a lot of carbs for most type 2’s. You could half that instead and probably not need the drastic exercise regime to manage your levels and less or no medication. That might help maintain your weight if you are overtraining maybe. Proteins and fats won’t effect bgl much but will help you maintain weight.

I too think that’s an unusually big increase in a small time and then a big drop despite mild medication and still a fair amount of carbs. How many more carbs were you originally eating do you think? It might be explained it it were many many more. Or were you sick before diagnosis/when symptoms began (covid for example or longer term infections)? On any medications (steroids maybe)?

Thanks for the reply @HSSS

I would have eat much more carbs before diagnosis, for example before I would play golf i would eat a large bowl of white pasta for energy. I did not know at the time this was damaging unfortunately.

I have graphs from libre, before starting the metafornin and managing by diet exercise alone and 3 weeks after starting metafornin. You can see the major changes. I've sent these graphs to my DDC team also.

I think it is inevitable that I drop carbs by half also. Although my consultant may not agree. From previous conversations she is adamant you need carbs and doesn't like keto, but it is like they are leaving me no other choice.

I had minor bugs that I picked up from my kid in creche in September 2022.
You never know if something in one of those triggered something with mg blood sugars.
This weeks is my first time with covid.
I'm not on any other medication or steroids.
Everyone agrees, it is an unusual case.

 

[jn81]

I am scheduling a meeting with a nutritionist also as it is so difficult to have a healthy high calorie (2800+), low sodium, low carb.
Also I found from once I go over ~45g of fibre per day metafornin doesn't work as well as too much fibre can cause it to bind with metafornin and reduce it's effectiveness, so I have to watch this.
Also too much protein isn't great for the kidneys.
The low BMI makes things tricky in diabetes, in that you have to lots of calories but do it in a healthy manner and not over eating any food type.
I know a lot about this type of diet now from my own research mostly, but getting to 2800+ is very difficult.

 

[jn81]

@KennyA @HSS you can see some example old libre graphs :

I was diagnosed early February 2023 and bought a libre sensor online.

FIRST TIME EVER MONITORING BLOOD SUGARS - NO MEDICATION, LIMITED DIET CHANGE BUT NO EXERCISE CHANGE
(This is what equates to a 127 HBA1C on a sample day)
2023-Feb-11

LEARNING HOW EXERCISE CAN AFFECT BLOOD SUGAR LEVELS
2023-Feb-12 (one day after above initial graph which stayed up at high teens and 20s all day)
Weights 30 minutes and jog on spot 10 minutes at approx 10am.
It is amazing when you compare this to the previous graph, the benefits of exercise that you can see.

TEN DAYS INTO TAKING MEDS & DIET & EXERCISE
-> INITIAL HALF DOSE OF METAFORNIN (500mg x 2 times daily) PLUS ONE DIAMICRON TABLET
The Diabetic Team started me on 500mg Metafornin plus one diamicron tablet . I only used the diamicron for 2 weeks, then stopped.

This is the type of morning spike I am worried about coming back.
At this point in time I was also on diamicron and I eating lower carb than now.
My fasting blood sugars without meds up to 10 days would have been about 16mmol/L (as measured by hospital & doctors).
So even with limited food in the morning I have a strong potential to spike.
Looking at how quickly the spike came down I most likely exercised , which is not possible every day in life to do this with work, family responsibilities etc...
But otherwise this graph looks good - but I was losing weight at this point in time as I wasn't eating enough calories.
And I cannot afford to do this now, as I am close to the low healthy limit of the BMI range (~19).




THREE WEEKS ON METAFORNIN - NOW ON MY FULL DOSE FOR 1 WEEK - 1000mg metafornin twice daily and no more diamicron

Now my morning spike was not as bad on the full dosage, and this is a general trend my graphs have been ever since apart from when I was sick.
I have been so happy with the last few months about my blood sugars and weight maintenance.
I was getting used to my diet and the food that I prepare.
I was getting used to my exercise regime.


JUST TO A MORE RECENT ONE FOR EXAMPLE - from July 29th which would have been in the 38 hba1c time period

In general most of my daily graphs are like the above one now.
I usually exercise at lunch which brings down by blood sugars a bit when my morning tablet is no longer that effective .
I eat no carbs after dinner at 7.30 which helps keep my night time blood sugars low in the night.
This as I mentioned was starting to get easier for me now finally and I was maintaining my weight and slightly gaining weight, which is what I need.
So this is why I am afraid of the medication being halved.
Strong morning spikes will come back and I will struggle to eat as much carbs and I will struggle to maintain weight.



And just out of interest for anybody reading - here is a recent graph while I had COVID
In this graph below my blood sugars are raised from covid infection quite a bit even though I am battling by exercising (lighty) a few times per day and eating low carb to keep them down.
My covid symptoms are mild so I can do brisk walks.
But you can image how much higher these would be if if I was eating my normal carbs, not exercising(if my symptoms were bad) and on half my medication.

 

[KennyA]

This is both unusual and interesting - your experience is unlike anything I've read about or known personally. I assume you've had the tests to rule out anything else as well.

Your graphs should make it easier to get some agreement from the medical team. I'm a strong believer in not fixing things that are working, and what you're doing seems to be working for you.

 

[jn81]

This is both unusual and interesting - your experience is unlike anything I've read about or known personally. I assume you've had the tests to rule out anything else as well.

Your graphs should make it easier to get some agreement from the medical team. I'm a strong believer in not fixing things that are working, and what you're doing seems to be working for you.

yeah my doctor at diagnosis time, tested me for whatever he thought may need testing.
I know thyroid was one, I was tested for type 1 also, had all the usual kidney, liver a few times etc...

 

[Deleted member 527103]

This is the type of morning spike I am worried about coming back.

Your oaty breakfast is highish carb and it is not uncommon for people without diabetes to spike to over 10 when eating higher carb meals.
Plus
- it is a very short spike so you body was able to recover quickly
- Libre is not that accurate. If you consider the standard accuracy parameters for a finger prick - this could be less than 10 mmol/l.
I would be reluctant to focus on a spike like this unless it was verified with a finger prick

Whilst it is great to be able to use technology like Libre, it is possible to over obsess with it, expect more accuracy than it was designed for and pay too much attention to "flat BG zealots". Everyone's BG varies all the time. You just need to Google something like "Libre graphs for people without diabetes" to see.

I am not a low carber (and don't consider 200g carbs a day for someone who does a lot of exercide to be "fairly high") but agree with @KennyA that your diabetes story is unusual and, whilst I am not a doctor or have any medical training beyond my own diabetes, your HBA1C of 127 looks like an anomaly. You may have been eating lots of unhealthy food but the majority of people eating that diet do not have diabetes. Many people can cope with very high carb intakes from a BG perspective. Was the odd HBA1C checked in any way or did you just rely on Libre (which can be highly inaccurate for some people) to justify the reading? Given your low BMI, it seems unusual to assume type 2 diabetes from one isolated blood test without any further investigation.

 

[jn81]

Hi @In Response thanks for your reply.
Yeah my hba1c of 127was retested as the doc thought it was strange.
It was 121 on second test.
It was 114 when tested in hospital shortly after.

I compare finger pricks to libre regularly and in my case ( allowing for time lag ) the libre slightly underestimates my finger prick values usually but they are usually always within 10% or less.

I am fine with a once off spike like that, but when it occurs every morning when you are not eating much carbs it adds up. Given my high hba1c history and my age of 42, the less daily spikes I get for the next 23 years until im 65 the better, when my daughter will be 25 and out of college if she chooses to go.
A daily spike over 23 years adds up to 8395 spikes, if you can avoid these I think it's worth doing so

 

[HSSS]

From previous conversations she is adamant you need carbs and doesn't like keto, but it is like they are leaving me no other choice.

She needs to educate herself then. First 100g a day is nowhere near keto, second the body doesn’t NEED carbs. It needs glucose which if there were zero carbs it would make from proteins and fats. I suspect that as a co sultans she sees a lot more type 1 than 2 and nutritional ketosis is very scary to such drs as it makes DKA easier to miss. Also many of the meds used in the more “difficult“ t2 will have a risk of hypos and this is another thing they are very wary of and so like the carbs to be maintained. Not all consultants think her way. Also a huge proportion of t2 in here do 100g or less without any ill effects, and plenty of benefits. But not everyone is willing to challenge or go against their drs so the choice is yours.

 

[HSSS]

I am scheduling a meeting with a nutritionist also as it is so difficult to have a healthy high calorie (2800+), low sodium, low carb.
Also I found from once I go over ~45g of fibre per day metafornin doesn't work as well as too much fibre can cause it to bind with metafornin and reduce it's effectiveness, so I have to watch this.
Also too much protein isn't great for the kidneys.
The low BMI makes things tricky in diabetes, in that you have to lots of calories but do it in a healthy manner and not over eating any food type.
I know a lot about this type of diet now from my own research mostly, but getting to 2800+ is very difficult.

Why low sodium?
healthy kidneys are fine with protein. It’s kidneys already struggling that might have issues.
why aim to go over 45g a day of fibre as that’s already double the recommendations

The nutritionist is likely to advise the NHS official line (eatwell lots of carbs, low fat) and according to their educational curriculum being set a long time ago and somewhat based on superseded science. Some are more enlightened.

 

[EllieM]

@jn81 I don't suppose you have access to your test results? I would be really curious to know what your cpeptide (a measure of insulin production) was doing all this time. There are other types of diabetes than T1 and T2 ....

The reason 48mmol/mol is regarded as the dividing line for diabetes is that diabetic complications (in particular eye issues) rarely happen for people with levels below that, so if you end up with a level of eg 42 instead of 38 I wouldn't personally stress too much. (But I am biased with over 5 decades of diabetic hba1cs, some very high).

Have they done any investigation as to why you are having weight loss issues? Is it just that your exercise regime requires so many calories?

I agree with the others that that is a very impressive drop in hba1c .

 

[HSSS]

My thoughts re your graphs.
Were there any dietary changes between day 1 and day 2? Obviously the exercise helped and whatever breakfast was wasn’t doing you any favours but lunch looked a lot better day 2
Day 10 of meds is a big improvement but there no way to tell what each change has done individually. Gliclizide (diamicron) does a lot more than metformin does too. Breakfast still not great.
You say fasting blood sugars without the meds would have been about 16mmol/L. I can’t see that on these charts (unless I’m mistaking breakfast and fasting). I’m confused about that statement and how you get those numbers.
3 weeks in and ALL the changes you made will be having effect. Again how can you identify which changes are doing what?

Re the 9am morning spike if it’s not breakfast have you read about dawn phenomenon yet? In type 2 it’s common to have an exaggerated response in the mornings when the liver dumps glucose into the blood to get us up and going. One of the main actions of Metformin (preventing some of this dumping) helps with this. So does times. It takes months for this effect to lessen even when the rest of the day is in a good range. For some of us it’s always a bit exaggerated. But as it’s internal glucose being drained from the liver that a) allows the liver to absorb more glucose later without it hitting the blood immediately and b) if you’re not adding too much glucose it allows the liver to remove excess stores it’s built up over time. Those extra stores are known as non alcoholic fatty liver disease. So both of these effects are a good thing.

 

[jn81]

She needs to educate herself then. First 100g a day is nowhere near keto, second the body doesn’t NEED carbs. It needs glucose which if there were zero carbs it would make from proteins and fats. I suspect that as a co sultans she sees a lot more type 1 than 2 and nutritional ketosis is very scary to such drs as it makes DKA easier to miss. Also many of the meds used in the more “difficult“ t2 will have a risk of hypos and this is another thing they are very wary of and so like the carbs to be maintained. Not all consultants think her way. Also a huge proportion of t2 in here do 100g or less without any ill effects, and plenty of benefits. But not everyone is willing to challenge or go against their drs so the choice is yours.

That's exactly it @HSSS . If I wasn't low BMI I would no problem living off 100g of carbs a day, but unfortunately I need as many calories as I can get

 

[HSSS]

That's exactly it @HSSS . If I wasn't low BMI I would no problem living off 100g of carbs a day, but unfortunately I need as many calories as I can get

So why not get the calories from fats and proteins ? That what people reaching their target weight do and the few that need to increase weight. Low carb doesn’t have to mean weight loss. It’s about balancing macros for your needs. There’s a saying carbs are a limit (to control bgl and hunger hormones and fat storage/burning), protein is a goal (to protect lean muscle and other metabolic functions) and fat is a lever (to balance weight and keep you feeling full)

 

[jn81]

So why not get the calories from fats and proteins ? That what people reaching their target weight do and the few that need to increase weight. Low carb doesn’t have to mean weight loss. It’s about balancing macros for your needs. There’s a saying carbs are a limit (to control bgl and hunger hormones and fat storage/burning), protein is a goal (to protect lean muscle and other metabolic functions) and fat is a lever (to balance weight and keep you feeling full)

@HSSS - I am eating lots of high good fats and proteins and doing weights. I got covid this week so that killed that and i'm back to 19 BMI.
high fibre naturally happens if you have a high calorie diet with not many carbs and the carbs you have are complex carbs.
eating the usuals like avocado, nuts, wholegrains . I was pairing an apple with cashews for a while. 85% dark chocolate , oats, legumes etc...

i've a high metabolism naturally and metafornin causes weight loss also.
at diagnosis I dropped to 65kg from 70kg as the high hba1c was causing major weight loss.
in the next 8 months I battled so hard to gain 1.5kg.
now covid had zipped that ...

 

[jn81]

My thoughts re your graphs.
Were there any dietary changes between day 1 and day 2? Obviously the exercise helped and whatever breakfast was wasn’t doing you any favours but lunch looked a lot better day 2
Day 10 of meds is a big improvement but there no way to tell what each change has done individually. Gliclizide (diamicron) does a lot more than metformin does too. Breakfast still not great.
You say fasting blood sugars without the meds would have been about 16mmol/L. I can’t see that on these charts (unless I’m mistaking breakfast and fasting). I’m confused about that statement and how you get those numbers.
3 weeks in and ALL the changes you made will be having effect. Again how can you identify which changes are doing what?

Re the 9am morning spike if it’s not breakfast have you read about dawn phenomenon yet? In type 2 it’s common to have an exaggerated response in the mornings when the liver dumps glucose into the blood to get us up and going. One of the main actions of Metformin (preventing some of this dumping) helps with this. So does times. It takes months for this effect to lessen even when the rest of the day is in a good range. For some of us it’s always a bit exaggerated. But as it’s internal glucose being drained from the liver that a) allows the liver to absorb more glucose later without it hitting the blood immediately and b) if you’re not adding too much glucose it allows the liver to remove excess stores it’s built up over time. Those extra stores are known as non alcoholic fatty liver disease. So both of these effects are a good thing.

@HSSS its hard to remember but no major dietary changes between day1 and 2. hard exercise caused the big drop in sugars then it stayed down.

ah the fasting blood sugars of 16mmol/L were from doctor's blood tests.

Regarding the changes I took some notes, and have saved lots of images / bloods etc... in email folders.

In the first 3 weeks on metafornin, I remember I was on a low carb (100ml) diet I researched myself based on what doesn't increase blood sugars. all the good usuals for diabetics. doing lots of exercise also. I remember with the results after moving from 1000mg of metafornin per day to 2000 mg . after 4/5 days everything became easier for me

I read about the dawn phenomenon alright but I don't think it is that. My major morning spikes seems to come usually after I get up in the morning at 8am or 9am or whenever I get up out of bed. I never get spikes earlier than 8 for example, unless I was getting out of the bed earlier perhaps.

 

[jn81]

@jn81 I don't suppose you have access to your test results? I would be really curious to know what your cpeptide (a measure of insulin production) was doing all this time. There are other types of diabetes than T1 and T2 ....

The reason 48mmol/mol is regarded as the dividing line for diabetes is that diabetic complications (in particular eye issues) rarely happen for people with levels below that, so if you end up with a level of eg 42 instead of 38 I wouldn't personally stress too much. (But I am biased with over 5 decades of diabetic hba1cs, some very high).

Have they done any investigation as to why you are having weight loss issues? Is it just that your exercise regime requires so many calories?

I agree with the others that that is a very impressive drop in hba1c .

Hi @EllieM thanks for your message.

I have always been skinny. But my good weight is about 70kg. I have a fast metabolism. Metafornin causes weight loss . Also all of the exercise I've been doing. I have to be careful to do it regularly, but not for too long - just enough to lower blood sugars.
Initially at diagnosis the very high sugars were causing my weight loss from 70kg -> 65kg, they basically make you malnutritioned even though your are taking in food - I can't remember the exact science but very extremely high bloods sugars prevent the food/nutrients being absorbed.
I need about 2800 calories which is hard to do healthily and avoid sugar spikes with my level of diabetes.