New to Metformin

[thebigyin]

Hi all,

Was wondering what the current scientific / medical advice is with regard to testing when on oral treatment.

I have been diagnosed with type 2 about 18 months ago, at the time I had fasting glucose after tolerance test of 7.2, and subsequent HbA1c's of 6.7 & 6.9 six months apart, so at that point was using diet control.

My latest HbA1c was 7.6, so the diabetic nurse at my surgery has prescribed me with an increasing dose of metformin resulting in four tablets per day over the next five weeks.

Both myself and my partner have been diagnosed with type 2, my partner's was following the birth of our first daughter 6 years ago, and the doctor advised her that as she is controlling by diet there is no need or benefit of testing, neither of us have tested for months.

My question is what testing regime (if any) should I employ given my change in status from diet only to metformin, and what use will the information be if I find a spike.

I do have a biomedical background and understand some of the terminology & science, but I have not been directly involved with the profession for well over 10 years, so would just like to know what current advice and thinking is?

Thanks for reading

Regards

Alister

 

[daisy1]

Hi Alister and welcome to the forum

Generally, for a Type 2, it is recommended to do a fasting test immediately on getting up, then test before, and 2 hours after meals. The before and after meals' tests will help you to work out what foods you can eat, in what quantities. These levels should be roughly the same. We have some members who are very knowledgeable about the scientific side of treating diabetes and I am sure someone will come along soon with some information for you.

Here is some advice that we give to new members and I hope you will find it useful. Ask as many questions as you like as we are all here to help you.

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.

 

[Grazer]

I think the issue is that their ISN'T a standard recommendation, other than most practices don't like the cost of prescribing strips to type 2's, especially those on diet only or metformin. Their argument is there is nothing you can do to instantly alter blood sugar levels so why bother testing? The reality is that we all react differently to different foods at different times of the day, cooked in diferent ways. We therefore need to test to make sure our diet maximises our ability to keep sugar levels down. If we do something that results in a bad level, don't do it again! For that reason, I don't test all the time, and test less frequently now than I did originally.
Originally, I tested all the time to see how I reacted. Now, I know what I can and can't eat. I test now :-
Occasionally to ensure things aren't changing
Regularly if I'm trying something new, to see how i cope with it. In this case, I test before eating, then 2 hrs after to see the difference in BG, then maybe before bed and next day fasting to check for any residual effect.

This means sometimes I don't check for weeks at a time, then I do lots in one hit.
Key thing is, I'm in control of my diabetes this way without excessive testing when I know what the result will be.
Others who are less in control of their diabetes at the moment will need to test more often. To a degree, within reason, we should feel free to test when we need to to avoid future complications and minimise future costs to the NHS

That's my view anyway!