Metformin raised hbca1 to 90

Elsasuave said:

Hi I just want to ask if anyone has had a higher hbca1 after newly starting metformin.
It was 64 when Dr put me on 1000mg metformin and 3 months later blood test results show my hbca1 higher-90. I’m worried as to why? Now have been put on higher dose -2000mg. Can anyone help?

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Hi Elsasuave, and welcome Might the rise have to do with your diet? Can you tell us a bit about what you eat in a typical day, please. I've never heard of anyone whose BG levels were raised by metformin, nor experienced it myself.

Metformin should not raise your blood sugars.
Presuming that you are type 2 then it may well be down to what you are eating, however note that illness,stress and some other meds (for other things) can also raise it as well.
If you could let us know what you've eaten in the last day I'm sure some forums members may be able to give you advice

Maybe you can tell us what type you have?
What your diet is like.
Are you testing bg levels?
Do you take other medications and do you take other diabetic medications?
And welcome to the forum.

I actually wonder whether a person gets sent off with metformin (with no explanation how it works so they assume it just 'lowers your sugars all on its own)', get given a copy of the eatwell plate (and end up eating MORE of the stuff that raises levels than they ever did before) and are then left wondering why their hb1ac has risen. I do wish they would try and give people a more scientific explanation as to what happens to a body when a person eats and how insulin responses, carbs, medication and everything else works together. I cringe when I think back to what advice I was given when they said I had pre diabetes, I had always followed a medium carb diet pre diagnosis (barely any obvious rubbish). Then I started to include wholemeal bread and baked beans thinking I was doing alright, that dish alone must have contained 200 carbs!

KK123 said:

I actually wonder whether a person gets sent off with metformin (with no explanation how it works so they assume it just 'lowers your sugars all on its own)', get given a copy of the eatwell plate (and end up eating MORE of the stuff that raises levels than they ever did before) and are then left wondering why their hb1ac has risen. I do wish they would try and give people a more scientific explanation as to what happens to a body when a person eats.

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If I were a betting man, this would be my proposed explanation. All else being equal, Metformin on its own can’t possibly raise HbA1c.

Elsasuave said:

Hi I just want to ask if anyone has had a higher hbca1 after newly starting metformin.
It was 64 when Dr put me on 1000mg metformin and 3 months later blood test results show my hbca1 higher-90. I’m worried as to why? Now have been put on higher dose -2000mg. Can anyone help?

Click to expand...

Hi @Elsasuave ,

Since metformin is more a T2-default kind of medication, I'm for the moment going on the assumption that you are a confirmed T2? Did you change your diet at all? Because if you did and it was exactly the opposite of what a T2 should do, then those numbers would have more to do with diet than they would the metformin.

That said, it is a significant raise, and if you didn't change your diet at all, I'd ask for a C-peptide and GAD test to check if the diagnosis is correct. There's a load of different types of diabetes, not just 1 and 2, and they need to be tested for if the T2 diagnosis is dubious; they are all treated differently, so you really do need to know.

For now though, have a read through the below and see whether you changed your diet in a way that would negatively impact your T2. And maybe share your usual daily fare with us, maybe we can tweak it?


There’s a few things you should know.

1. Practically all carbs turn to glucose once ingested, so not just straight sugars, but starches too. Food doesn’t have to taste sweet to make your blood sugars skyrocket.

2. A meter helps you know what foods agree with you, and which don’t. Test before and 2 hours after the first bite. If you go up more than 2.0 mmol/l, the meal was carbier than you could handle. (It’s easy to remember, as you’re a T2: all 2’s, all over the place!)

3. In case you didn’t know already, this isn’t your fault. It’s genetics, medication, decades of bad dietary advice, and basically all manner of things, but nothing you can actually blame yourself for.

4. Diabetes T2 is a progressive condition, unless you (also) change your diet. So you have options. Diet-only, diet with medication, or medication only. But that last option will most likely mean more medication over the years. (And there is more than just metformin, so if it doesn’t agree with you, there’s lots of others to try). So even if going really low carb isn’t for you, you might consider moderately low carb an option, with meds to assist.

5. Are you overweight? 90% of T2’s are. Yeah, that means 10% are slim and always were. If you did gain weight, it was the precursor of this metabolic condition. We make loads of insulin, but become insensitive to it. So carbs we eat turn to glucose, and normally, insulin helps us burn that glucose for fuel. When it doesn’t, that glucose is stored in fat cells instead. When those fat stores are full, the glucose remains in our bloodstream, overflowing, into our eyes, tears, urine, saliva… And then we’re T2’s. So weight gain is a symptom, not a cause. This also means that “regular” dietary advice doesn’t work for us. The problem lies in our inability to process carbs. And most diets focus on lowering fats and upping carb intake. Which is the direct opposite of what a T2, or prediabetic, for that matter, needs.

6. There are 3 macro-nutrients. Fats, protein and carbohydrates. Those macro’s mean we get the micro-nutrients we need: that would be vitamins and minerals. So… If you ditch the carbs, you should up another macro-nutrient to compensate, to make sure you don’t get malnourished or vitamin deficient. Carbs make our blood sugars rise. Protein too, but nowhere near as bad as carbs do, so they’re alright in moderation. Fats however… Fats are as good as a glucose-flatline. Better yet, they’ll mitigate the effects of any carbs we do ingest, slowing down their uptake and thus the sugar-spike. Contrary to what we’ve been told for decades; fats are our friends.

7. Worried about cholesterol? On a low carb diet, your cholesterol may rise a little as you start to lose weight. That’s a good thing though. (Believe it or not). What was already there, stored in your body, is starting to head for the exit, and for that it’ll go into your bloodstream first. So when you have lost weight and it stabilises, so will your cholesterol. And it’ll probably be lower than what it was before you started out.

8. You’ll lose weight on a low carb diet. Weight loss will help with your insulin-resistance, and not only that… Going low carb might help with other issues as well, like non-alcoholic fatty liver disease and depression.

9. Always ask for your test results. You don’t know where you’re going, if you don’t know where you’ve been.

10. Last, but certainly not least: If you are on medication that has hypoglycemia listed as a side-effect, like Gliclazide for instance, do NOT attempt a LCHF diet without a meter nor your doctors’ knowledge/assistance. You can drop blood glucose levels too far, too fast, if your dosage isn’t adjusted accordingly. This could mean a lower dose in stages or even stopping medication completely. Never do this without discussing it with your doctor first!


So what raises blood sugars? Aside from the obvious (sugar), starches raise blood glucose too. So bread, and anything made with grain/oats flour, rice, potatoes, pasta, corn, cereals (including all the “healthy choices”, like Weetabix and muesli), most beans and most fruits. So you’ll want to limit your intake, or scratch them altogether.

Which food items remain on the shopping list? Well, meat, fish, poultry, above ground veggies/leafy greens, eggs, cheese, heavy cream, full fat Greek yoghurt, full fat milk, extra dark chocolate (85% Lindt’s is great!), avocado, (whole) tomatoes, berries, olives, nuts, that sort of thing… Meal ideas? Have a couple:

Scrambled eggs with bacon, cheese, mushrooms, tomato, maybe some high meat content sausages?
Eggs with ham, bacon and cheese
Omelet with spinach and/or smoked salmon
Omelet with cream, cinnamon, with some berries and coconut shavings
Full fat Greek yoghurt with nuts and berries
Leafy green salad with a can of tuna (oil, not brine!), mayonnaise, capers, olives and avocado
Leafy green salad with (warmed goat's) cheese and bacon, maybe a nice vinaigrette?
Meat, fish or poultry with veggies. I usually go for cauliflower rice or broccoli rice, with cheese and bacon to bulk it up. Never the same meal twice in a row because of various herbs/spices.

Snacks? Pork scratchings, cheese, olives, extra dark chocolate, nuts.

Of course, there’s loads more on the web, for people more adventurous than I. (Which is pretty much everyone). Just google whatever you want to make and add “keto” to it, and you’ll get a low carb version. There’s a lot of recipes on the diabetes.co.uk website, as well as on www.dietdoctor.com where you’ll also find visual (carb content) guides and videos. And I can wholeheartedly endorse Dr. Jason Fung’s book The Diabetes Code. It’ll help you understand what’s going on in your body and how to tackle it, whilst not being a dry read. Not only that, but you’ll know what to ask your doctor, and you’ll understand the answers, which is, I believe, quite convenient.

I agree with the others. Metformin is a mild drug that only helps Type 2 diabetes to a very limited extent, and is intended to be used alongside a suitable diet. It isn't a miracle cure allowing you to continue eating anything you like. I'm afraid that in Type 2 diet is the key, not Metformin.

If you tell us what sort of foods you eat in a typical day we may be able to help you tweak some of your choices. Meanwhile, I'm tagging @daisy1 for her useful information for newcomers.

In my view its all down to diet.

I have been on Metformin for years and any changes in my HbA1c have been down to what I have eaten over a period of time rather than the drug. That has been the constant in my life whilst my diet has varied according to mood and err...common sense being applied. And yes, HbA1c can be adversely affected by illness and stress so there could be other factors at play.

Elsasuave said:

Thank you all so much for taking the time to write. I am T2, and if I’m honest I did relax a bit with my diet believing that the metformin would do the work. I’ve read all the info you sent and I’ve decided to be really careful. Really surprised to hear there are different types of Diabetes, thought there were just the 2. Don’t know wether I should see GP and ask for the tests that you recommend Jokalsbeek or wait for my next blood test in 3 months. Thank you all again

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If you thought metformin would be a fix-all, odds are it was "just" diet that caused the rise. So I'd just look to improving that and seeing what the testresults will be in 3 more months. If it's still on the rise in spite of it all, then request the tests, but I doubt that'll be the case then. Metformin doesn't do anything about what you ingest, it just tells your liver to knock it off with the glucose dumps in the morning. (Dawn Phenomenon; it dumps glucose into our bloodstream to help us get started. With metformin there's about 75% less glucose dumped into our system, but that doesn't do squat for what you eat, alas...). As for diabetes, there's T1, T2, LADA, MODY, T3C, etc etc... Though some GP's don't even know that, that's Endo territory. You don't have to know and implement everything overnight. You'll get there.

Elsasuave said:

Thank you all so much for taking the time to write. I am T2, and if I’m honest I did relax a bit with my diet believing that the metformin would do the work. I’ve read all the info you sent and I’ve decided to be really careful. Really surprised to hear there are different types of Diabetes, thought there were just the 2. Don’t know wether I should see GP and ask for the tests that you recommend Jokalsbeek or wait for my next blood test in 3 months. Thank you all again

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Do you have your own blood glucose meter? If not, you need to seriously consider buying one. This will help you enormously with your food choices. Most of us T2s on here don't know how we could ever have managed without one. You can test before you eat and 2 hours later to see how your body reacted to that meal. This gives you chance to reduce or avoid particular foods in future. The result is instant. You can also use it to keep track of how you are doing generally, so your next HbA1c won't come as such a shock.

@Elsasuave
Hello and welcome to the Forum Here is the Basic Information we give to new members and I hope you will find it interesting and helpful.

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.

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