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Metformin - for life or just for Xmas?

G

goulster

Newbie
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3
Hi,

Firstly - I've been a lurker on the forums since first diagnosed type 2 in July and wanted to express thanks for all the excellent advice in the forums. I guess having some time off has given me the chance to finally write down some of my worries/concerns, so here we go :

Like lots of you the initial diagnosis was a shock at 42 and has led me to try and change my ways.
I was put straight on Metformin (3x500mg per day) along with Simvastin (statin) and Ramparil (BP) - and given my weight 119kg (18.7 stone) and the shock of it all I didn't protest.

Fast forward 6 months and I've lost 30kg(4.7st) through a fairly restrictive 1200cal low(ish) carb (target sub 100g daily) diet. Also, by nature I'm a geek, so I've measured *everything* I've eaten in that period. The local PTC won't give test strips to me, but I've funded my own and am testing first thing in the morning before food and in the evening (typically 2-4 hours after eating evening meal). These readings settled down to a weekly average of 5.2-5.6 in the mornings and 5.2-6.0 of an evening after about 3 months and have kept at those levels.

In that whole period I've been lucky enough to have had three appointments with local diabetic nurse but I'm feeling a little lost. Post the diagnosois I've felt I'm not getting any form of personal care but having been put into a generic bucket and prescribed based on that.

In my last appointment I confessed to going down the low carb route and I was admonished for not taking the standard advice NHS is giving. When I explained I'd done this in an informed way and done some serious reading and mentioned diabetes.co.uk (a resource give to me by them in intiial information pack) I got a fairly patronising smile along with "if thats what the internet says it must be true".

I'm not a confrontational person so I tried to keep things light and asked her to look at my BG readings. She was pleased with them but said she would work from the tests they had taken the week before (I assume this would have been my HbA1c test) and that they had shown great progress too. So I asked if that means we should review the Metformin dosage given that things looked stable and I'd lost a lot of weight. The response was a very firm "No", because "the drugs are working fine".

So to get to the point, I'm after some advice :

a) Once on Metformin am I now on it for life? Is this a pointless discussion with them? i.e. it doesn't matter how much weight I lose or how stable the readings look. My general attitude is that I would rather take less drugs unless they are necessary - should I just cut back and keep measuring to see if it affects my readings (and how quickly would that actually show up?).

b) Are the readings I'm getting good, should I be targetting lower? I've not been given my HbA1c result so I've only my weekly averages to go by.

c) Is the way I'm measuring of an evening worthwhile - i.e. when I go to bed rather than strictly 2 hours after eating (i.e. 2-4 hours post meal?)

Thanks in advance, I've a young family and I want to be around as long as I can be to keep them in the style they have become accustomed too ;)

Goulster.
 
Hi Goulster

You've done really well. Metformin only reduces levels by 1 - 2 mmol, so getting your levels down has been achieved with your low carb diet.

You weren't actually sent here by your HCP, you were advised to go to www.diabetes.org.uk (the charity) who advise eating starchy carbs.

On low carbing, my thoughts are that your pancreas can't cope with carbs (grains and potatoes), so why give it something it can't cope with. It is also bunkum that your brain needs glucose from grains, when it can get all it needs from veg and some fruit.

If I were in your shoes, I would keep on the level of metformin that you are on to maintain those low levels that you have. As long as you don't have stomach issues with it, it is a safe drug with heart protective qualities. If you stopped taking it then you would have to eat even less carbs. You could negotiate taking less metformin (still enabling you to have free prescriptions and still getting the heart benefits).

I'd be more for getting off the statins and the rampril, with your low carbing and weight loss, it is a possibility that you don't need them any more.

With testing, test as much as you feel comfortable with (and can afford). I like to know what my BS is doing so I can plan what I am eating.
 
Hi goulster
after my intial diagnosis from my GP It was to put me on 3 x 500 mg metaformin tablets with the weekly build up from 1 to 3 tablets .I had a further blood test during the period of my second tablet so i made the decision to wait for those results and see if there had been any change . The appointment was with my diabetic nurse and as a result of the blood test figures she decided to reduce my dosage to 2 tablets . She did give me the usual NHS line about diet but i also talked to her about the information on diet & excercise that i had read on this website .To her credit she was open minded about this and was happy for me to continue with this different view on food . 6 months later after my next blood test and discussion she has reduced my medication to 1 tablet . i am now aiming to hopefully control my diabetes by diet & exercise after my next blood test (hopefully) . Through various postings on this website it would appear that some NHS staff stick rigidly to the line and some don't so it does reduce it to a lottery . I do not take any other form of medication , Eat to my meter ,yes i know i have to buy the strips,lancets,etc but i consider that to be and investment in my quality of life .I use my meter to test out different foods and the effect on my blood sugars levels having intial recorded readings for breakfast lunch & evening meal over a period of time so that i could get base line figures on what would be my revised normal diet. times for these test are all in the standard posting that will be attached to this thread by Daisy 1 shortly . Good luck , i am sure you can reduce medication in the future .
 
Hi goulster and welcome to the forum :)

Here is the information mentioned by orangevandriver which was written for new members. Ask all the questions you like and someone will 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 30,000 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

Another option is to replace ‘white carbohydrates’ (such as white bread, white rice, white flour etc) with whole grain varieties. The idea behind having whole grain varieties is that the carbohydrates get broken down slower than the white varieties –and these are said to have a lower glycaemic index.
http://www.diabetes.co.uk/food/diabetes ... rains.html

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

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.
 
Hi. I agree with the comments from Denise and others. The NHS carbs advice is not evidence-based so if your nurse challenges you again ask her for the carbs evidence; she won't be able to provide any. Tell her you understood the NHS and NICE work on evidence-based medicine not myth :-) Your figures are good. I would stay on the Metformin. It will keep your nurse happy and reduce your glucose and appetite just a little. There are very few bad side effects with Metformin. I normally test 2 hours after a meal to find out what foods affect me. I rely on a 6-monthly HBa1C to tell me my average trend. BTW I personally would only take Simvastatin at the level needed to keep your cholesterol below 4-5; same for Ramipril to keep BP below something like 130/75 but do discuss these things with your nurse before any changes.
 
To summarise :

a) I'll go ask about my HBa1C result.
b) Sounds like consensus is that I shouldn't be in any rush to drop off the Metformin, I'll see how things pan out. I should be looking more at the BP/statin side (BP has been 115-125/80-85) last few weeks).
c) I should probably be testing around 2 hours after eating rather than later as I have been.
d) Stick with carbs regime (and try to ignore tin of quality street in corner of room).

I appreciate all the positive comments - thank you all.
 
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