Metformin. how soon does it show effect on hba1c?

Why are you eating raw veg?
Have you read any of the low carb threads on this forum?
www.dietdoctor.com/low-carb?
There is a huge amount of info on low carbing here please check it out
http://www.diabetes.co.uk/forum/category/low-carb-diet-forum.18/

Metformin enhances insulin sensitivity. It is not a BS lowering medication. Have a search for Blood Sugar Diet and 5:2 Diet. Plenty to get your teeth into, pun intended

have you looked into the rationale behind eating fats ? I am pretty sure my success at reducing blood sugars and dieting came from switching to a high fat and especially adding in significant SATURATED fats.

There is no shame in having type 2 diabetes, no matter what your occupation is. There is a lot to learn when first diagnosed and no quick fix solutions sadly. But the good news is that there is much that can be done to improve the outcome. Firstly we are all different and what works for some may not be as effective for all. The first thing is to find out what food you can tolerate and the only way to find this out is by monitoring you bgs before and two hours after eating. Try cutting out as many carbs as possible. Some people can tolerate porridge and wholemeal alternatives, but if you can't there are plenty of alternatives to try, perhaps changing from cereals and toast for breakfast to berries and yoghurt, or scrambled egg. Evening meals do not have to change drastically - just leave out the potatoes, pasta etc and have a few more vegetables and meat (above ground vegetables are best). It takes a little while to adjust to new eating habits, it's not a diet more a lifestyle change. Exercise in any form is essential to improving bgs - a brisk 20 min walk, a swim, going to the gym or anything you enjoy really helps. You will find all sorts of help and advice here - it may be a bit overwhelming at first, but bit by bit you will get to grips with it and find your way to making real progress.

Tagging @daisy1 for her advice to newcomers.

The low carb diet program is a great place to start:
https://www.diabetes.co.uk/lowcarb/

This guide is also very helpful:
http://www.diabetes.co.uk/forum/threads/a-new-low-carb-guide-for-beginners.68695/

Metformin only helps to a limited extent. It works on the liver. It doesn't work on the pancreas. It should reduce the amount of glucose your liver produces then dumps in your blood stream in times of starvation (in the mornings), times of stress, illness, pain, and exercise. What it won't do is reduce the amount by which your levels increase after eating. Only diet will do that unless you progress to insulin or one of the insulin stimulating drugs.

EDIT I should have added that it is an appetite suppressant mainly.

@clarejenkins Welcome! I am going to tag @daisy1 for you with some information that we send all newcomers. Without a deep analysis my best guess is that you have been ingrained with lowfat diet information for so long that you are eating very low fat without even thinking about it. Many forum members have found that eating a higher fat diet with reduced carbohydrates helps them to stabilize their blood glucose at lower levels than they were able to with a higher carb, low fat diet. Are you testing different foods with the libre to see what they are doing to your blood glucose?

clarejenkins said:

not testing regulaly after food but as there is a reminder on the libre i can do more of this. how high fat is high fat?

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I am currently at 40% (of total intake-I eat an average of 1500 calories per day currently-I am trying to slowly lose a few pounds still) which I consider pretty high. If you are down below 30% I would definitely consider adding some fats that you like. When the information from daisy1 arrives it will give you some more ideas.

So to test what a food is doing to your blood glucose watch your libre 2 hours after you eat. You said that you can not eat raw vegetables-are you having stomach problems? If you are having delayed stomach emptying then the blood glucose spike you get from food may happen later than two hours even.

@clarejenkins The reduction in carbohydrates is what brings your blood glucose numbers down. The addition of fat helps slow down digestion and even out the spikes you get from food and exercise. I try to keep my carbohydrates at 80 grams to 100 grams per day because I have found that that level of carbs gives me blood glucose in the target ranges for Type 2. Other forum members are lower or higher than me in daily carb consumption.

clarejenkins said:

ok i admit it. I am a doctor with diabetes 2 but know nothing about metformin. when i was first diagnosed hba1c 48 i was given metformin. after a month the hba1c showed no change and the dose was doubled. this made me vomit. i stopped it. a year later the hba1c hsd gone a lot higher. 60 i had been testing blood sugars and they had not changed. pretty much always 8.9 fasting, which it has been for years and noone had ever bothered before. anyhow i was given a reprieve to ok on my diet and exercise.I monitored my bs levels and got a slight reduction with cinnamon tablets. Also started using the freestyle libre which showed my hba1c was around 48 again but then it seemed to go up again so back on metformin SR twice a day. i am trying to stay low carb but have not achieved no carb. my stomach cannot tolerate salad and raw veg. .i just don't know what to eat. after a month by blood sugars don't seem much lower. will they drop gradually? my next hba1c is february. i would really like to do better with the diet to avoid dose increase. any suggestions?

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Well well well metformin doesnt help much the main part of control is actually a drastic diet change . Metformin helps mostly in the part of the disease that is due to the overactive liver spitting/producing far too much glucose out all day But especially in the mornings the dawn phenomenon and it helps insuline resistance a bit in those respects it helps like 10-25 % like reducing the HbA1c about maybe 10-25%
But most have such high levels that such a reduction is NOT at all enough . So there is no way avoiding changing ones diet in almost all aspects ... one needs to see carbs as a kind of personal poison especially the High spiking But actually also all the other carbs , some even has to also count their intake of proteins as They too are turned into glucose by ones liver if eating too High amounts of those too .. fat is the only food that doesn't at all affect the blood glucose ( only 5-10% is turnes into glucose when broken down , and only very slowly , and only if glucose is NOT already available and thereafter proteins from foods are NOT either ...

clarejenkins said:

not testing regulaly after food but as there is a reminder on the libre i can do more of this. how high fat is high fat?

Click to expand...

I'm doing 60% fat, 10-15% carbs 15-20% proteins and its great - I find it harder to limit the proteins than I do the carbs .

Nuts are a good choice of fats and Dairy fats and olive Oil and fish oil\ fatty fish Olives coconuts almond fluor and coconut fluor

Its actually ridiculously easy to eat 60% fats - which is why a low fat diet is so hard

for example

a favorite breakfast for me would be

A poached duck egg with a slice of bacon and a couple of button mushrooms and four cherry tomatoes fried in 10 g of butter
Then instead of bread , I have a bed of fresh spinach to which I have added say 5 grams of thinly diced red onion, 5g of olive oil and 5g of balsamic vinegar then sprinkled with 10 g of a seed mix of flax seed, hemp and chia
to drink I would start with a glass of water with apple cider vinegar , then a cup of tea with skimmed milk ( that should really be full fat milk but I don't like the taste in tea so I put up with the slightly higher carb count of the skimmed milk just not very often )

That meal would be 317 calories 8 g carbs, 21 g fat and 21 g of protein. because the fat is so much more calorific it also works out at 59% fat, 14% carbs and 27% protein ( I use cron-o-meter to record my foods)

On average over the last three months I have eaten1280 calories per day and lost 12 kilos, on average 28g of carbs per day, (target 25) 67g of proteins ( target 60 though should probably be a bit less) the balance fats - mainly various full fat cheeses, clotted cream, double cream . butter, lard, goose fat, fats on steak pork and lamb, pork rinds, avocados, olive oil and balsamic vinegar dressing, and nuts - primarily macadamia, almonds walnuts pecan , I also love and eat seafood - crab,prawns,lobster mussels , salmon, tuna white fish, I add butter to the fish , mayo/ cream to the shellfish, - plus copious quantities of above ground vegetables buttered and a tiny amount of fruit being mainly raspberries or blackberries with clotted cream and seeds .

Basically after thirty years of failing miserably to either be healthy or thin on a low fat diet, I am currently having the time of my life eating utterly delicious foods whilst amazing all my friends at how much weight I lost and my Hba1C has gone from 92 to circa 40 in 4 months whilst both my triglycerides and blood pressure has gone down.

@clarejenkins

Hello Clare and welcome to the forum As mentioned above, 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 there 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 220,000 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 free 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.

Freema said:

Well well well metformin doesnt help much the main part of control is actually a drastic diet change . Metformin helps mostly in the part of the disease that is due to the overactive liver spitting/producing far too much glucose out all day But especially in the mornings the dawn phenomenon and it helps insuline resistance a bit in those respects it helps like 10-25 % like reducing the HbA1c about maybe 10-25%
But most have such high levels that such a reduction is NOT at all enough . So there is no way avoiding changing ones diet in almost all aspects ... one needs to see carbs as a kind of personal poison especially the High spiking But actually also all the other carbs , some even has to also count their intake of proteins as They too are turned into glucose by ones liver if eating too High amounts of those too .. fat is the only food that doesn't at all affect the blood glucose ( only 5-10% is turnes into glucose when broken down , and only very slowly , and only if glucose is NOT already available and thereafter proteins from foods are NOT either ...

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@Freema may I ask where you get those percentage HbA1c drops of 10% - 25% from? From what I have read, albeit some time ago now, the percentage drop is considerably less than that, and unless on the maximum dose it is negligible. It also helps obese people better than others, presumably because the appetite suppressant works. Maybe the "experts" have changed their ideas since I last read up about it. I would be interested to know.

Bluetit1802 said:

@Freema may I ask where you get those percentage HbA1c drops of 10% - 25% from? From what I have read, albeit some time ago now, the percentage drop is considerably less than that, and unless on the maximum dose it is negligible. It also helps obese people better than others, presumably because the appetite suppressant works. Maybe the "experts" have changed their ideas since I last read up about it. I would be interested to know.

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somebody in here send me a link as I questioned the effect of metformin, if it was worth taking at all.. and I was convinced to continue from his argumantation and the numbers given in a link there, I´ll try to

find...http://www.diabetes.co.uk/forum/threads/how-much-does-metformin-actually-help.111894/

but yes it doen´t help everybody the same, and many do not get the maximum dose... and so on like it is with most druggs anyway.. we are not identical maschines and a lot of medicine doen´t work the same in different gene/ethnic variaties either...
also there cound be differences form one sex to the other and from young persons to older.

But I have trouble understanding these percentage numbers and ways to calculate if looked on the Daily average blood glucose a lowering of a HbA1b from 7.8 till 5.6 is Said to be a maybe 5% lowering But is it actually not a much higher percentage it has been lowered with if
7.8 = 100% How many percentage has it been lowered to become 5.6 instead about a third I would say ? A third is 30% I did ask and look for a graph that could show this but wasn't able to find any ilustrations of the effect put into a graph anywhere in the web..

here is an article on metformins effectiveness, it says :

Metformin lowers fasting blood glucose levels by an average of 25% (17 to 37%), postprandial blood glucose up to 44.5%, and the A1c by an average of 1.5% (0.8 to 3.1%). Metformin reduces raised plasma insulin levels in cases of metabolic syndrome by as much as 30% and reduces the need for injected insulin in Type 2s by 15 to 32%.http://www.diabetesnet.com/about-diabetes/diabetes-medications/metformin



guess that is where I got some of the numbers from