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Meds increase

S

SuzieW

Newbie
Messages
2
Location
Cheshire
Type of diabetes
Type 2
Treatment type
Tablets (oral)
I've been on Metformin 1000 mg for 18 months - following my annual check (results received today) my HbA1c has increased from 59 (Nov 17) to 66 today. They want to add another med into the mix, which is Alogliptin 25 mg. I'm currently reading up to see if there are any issues - but in the meantime wondered if anyone is on this mix.

In the same review just now - they are pushing me hard to take statins. I am considering high at 8.6 total - 2.07 HDL - 6.5 non HDL. I really don't want to take statins but, crikey, did she push hard facts at me. I am in a spin as to what to do.

For info - I'm 5 foot, 62 yo female, 139lbs, fit and active.
 
Hello and welcome,

Can you first of all tell us what your current diet is? A typical days food? It may well be you can reduce your HbA1c just with Metformin and a different way of eating. Diet really is the key to all this.

As for cholesterol and statins, have a read of a magnificent thread by @bulkbiker . He has gathered together a load of research and videos, and other members have added to it. You will need a long sit down to read it all, but it will be worth it.
https://www.diabetes.co.uk/forum/threads/cholesterol-and-statins.156985/

Also tagging @daisy1 for her very informative post given to all newcomers.
 
If glucose levels going up on metformin, there are several options. Drug wise, adding a gliptin avoids adverse vascular events like heart attacks compared to adding in a sulphonylurea (Colin Currie wrote papers on this and there are quite a few on the internet now). Aloglipton was studied in a big trial whose name escapes me, and seems safe - the gliptin group seem very safe compared to other meds (not to say totally safe).
The cholesterol question is fiddly, but coming from a medical background, I would avocate the statin; if you try the statin and it upsets you, you could switch to ezetimibe. With your age (similar to mine) and diabetes and high cholesterol, your risk of heart attack is quite high (you could google QRISK 2 calculator and look up the figures yourself), so I would go for it. My 10 year risk is about 8% because I run a lowish blood pressure of 110 systolic. That is a good HDL-C value, but unfortnately dibetic HDL-C is not as protective of blood vessels s non-diabetic HDL-C
best wishes
 
Thanks for the welcome.

My diet is pretty moderate, I guess. Breakfast is mostly eggs, sometimes with toast. Occasionally I've have muesli, but mostly egg-based. Lunch today was half a baked spud with cheese and butter. Supper/tea/dinner is usually meat/veg based.

I had previously tried being low carb, to the point of very low carb - I could cope with it but prefer to have some carbs in the mix. I never eat cakes and biscuits, pretty much never have. I can, however, fall face-first into a large bag of crisps without coming up for air. I do drink alcohol and it would be more than the Gov want me to.

Reading that back - there is probably a fair bit of room for improvement. But honesty is key when asking for help and advice as I am here.
 
SuzieW said:
I've been on Metformin 1000 mg for 18 months - following my annual check (results received today) my HbA1c has increased from 59 (Nov 17) to 66 today. They want to add another med into the mix, which is Alogliptin 25 mg. I'm currently reading up to see if there are any issues - but in the meantime wondered if anyone is on this mix.

In the same review just now - they are pushing me hard to take statins. I am considering high at 8.6 total - 2.07 HDL - 6.5 non HDL. I really don't want to take statins but, crikey, did she push hard facts at me. I am in a spin as to what to do.

For info - I'm 5 foot, 62 yo female, 139lbs, fit and active.
Click to expand...

Hi Suzie, and welcome. I'll tag @daisy1 for the welcome pack, there's loads of into in there. I'm going to ask you a couple of questions, none of which you have to answer of course, but they might help. I'm not a doctor but I've been a diet-controlled T2 for 2 years now. Once diagnosed my cholesterol was much like yours, and my HbA1C was much higher, so I was put on metformin, which didn't agree with me so was switched to gliclazide, and statins. Once I changed my diet though I could ditch both the glic and the statins: Low Carb, High Fat eating had such an impact I now have a healthy person's levels, both in cholesterol and HbA1c. That's with about 3 eggs a day, and bacon once or twice. Insane, I know, but it works.

Statins often do more harm than good, (From joint and muscle pain to what looks to be altzheimer's, but isn't, as it vanishes when the statins are stopped) and your doctor's "facts" may be out-dated. Was just discussing them with a friend yesterday so i have a link someplace... https://www.tandfonline.com/doi/full/10.1080/17512433.2018.1519391?scroll=top&needAccess=true& Hope that helps. Not saying you shouldn't go on statins, but if you decide to, and it IS your choice, you go in prepared.

As I said, I, like many here, follow a Low carb, High Fat method of eating. For me, LCHF didn't quite go far enough as I have a non-alcohlic fatty liver I wanted to solve too, so I took it a step farther and started on a ketogenic diet, meaning my body does't run on carbs anymore for energy, but on fat. (I eat 20 grams or less carbs a day). That's what I wanted to do though, but with a HbA1C like yours, I doubt you'd have to go that far.

Have you changed the way you eat, or are you completely relying on metformin to regulate bloodsugars? You see, the thing with medication is, it doesn't halt the progression of T2. In the end there's more pills required, dosages upped time and again, possibly eventually leading to insulin injections, and they don't prevent complications. A change in diet does all that though, and you can actually achieve remission, maybe even be able to ditch the meds entirely while maintaining good levels. Not saying you should, again, it's all your choice, but you should know you have options. For me, meals look like this: 3 eggs with bacon, cheese and mushrooms, sometime a couple of cherry tomatoes tossed in. Green salad with a can of tuna, mayo, capers, olives and avocado. Meat or fish with broccoli- or cauliflower rice with more bacon and cheese, and whatever herbs I feel like tossing in that evening. No bread, pasta, rice, cereal, potatoes, beans, fruit (save for berries, avocado and the odd tomato), and my HbA1c is 34... And as I mentioned, my numbers were quite a bit higher than yours when diagnosed. I think you could quite possibly move mountains if you cut the carbs. And it would impact your cholesterol too, if you want it down.

In any case, again, welcome. Have a read around here, ask questions if you have them, and decide what works for you. One last question: do you have a meter? When you check before a meal and 2 hours after first bite, and your mmol/l went up by 2.0 or more, then that meal was too carby for you to process back out again. (That's the thing with carbs... They practically all turn to glucose, and with our insulin not doing what it's supposed to, it just floats around doing damage.). Could help you get a little better control without adding even more meds into the mix.

Good luck!
Jo
 
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Ah - bread and potatoes are not your friends, neither is muesli.
I would never even think of eating them, I want normal numbers.
There are lots of foods which are lower in carbs and less like eating cardboard.
 
@SuzieW

Do you test your own blood sugars? If not, I strongly urge you to buy a meter and start. By testing before you eat and 2 hours after first bite you will very quickly learn which of your food choices need either tweaking portion-wise or eliminating completely. Recording these levels alongside a detailed food diary will show you what to do - it is an excellent guide and without one you are working blind.

You would have a shock most likely after eating any breakfast cereal, potatoes, bread, rice, pasta, fruit and various other foods you might never have thought of. It is carbs that raise blood sugar levels, so the fewer we eat, the better our levels will be.
 
@SuzieW

Hello Suzie and welcome to the Forum :) Here is the Basic Information we give to new members and I hope you will find it useful. Ask as many questions as you need to and someone will be able to help.

BASIC INFORMATION FOR NEW MEMBERS

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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