Newly diagnosed T2 - meds or not?!

[Magneto2009]

Hi. I'm slightly surprised the Dr didn't start with Metformin and then add some Glic if needed. If you have excess weight that would be the normal approach plus the low-carb diet. The 40mg dose of Glic is very low and almost certainly wouldn't cause a hypo. If someone has a hypo with Glic then the dose needs reducing as it implies the beta cells are working quite well and don't need much stimulating with the Glic. A T2 with excess weight is unlikely to benefit from Glic as the problem will be insulin resistance and Metformin can be more useful. You could try a low-carb diet at first without any meds. As for statins, see what your lipids ratios are and if needed have the minimum statins dose needed to get them right.

Thanks, it’s good to have some reassurance about possible hypos if I do take the meds. I am also confused at being prescribed glyc over metformin for exactly the reasons you specify. As my BG levels are dropping that would suggest there’s not a problem with production of insulin, just overall resistance to it?!

 

[Magneto2009]

Any idea what your cholesterol level was?
Ideally full lipid panel results.. most GP's just look at the total which is pretty meaningless in isolation.
If you are getting readings in the 9's after a short period without meds then I wouldn't worry about fat in the diet whatsoever providing it's from animal sources and not processed seed oils. Your cholesterol will do all sorts of things while in weight loss and blood sugar reduction mode wait until your weight stabilises and you get decent blood glucose levels before worrying about cholesterol.

I don’t know the results yet, have just been notified that the dr wants to discuss the results, so I’m assuming he’s not happy! I’ll try to ask for the full results though. My GP is generally great, but I suspect there will be a push to medicate for cholesterol at this stage too, so I’ll read up more about that too. It’s all a learning curve! I definitely need to lose weight, it just seems to me that the change in diet needs to be given a chance to work prior to medication, but it may take some convincing on the doc’s part. I know it’s my choice, but it’s difficult to communicate these things to the GP without sounding like someone who thinks they know it all because I’ve read the internet for a few days!

 

[Hotpepper20000]

I don’t know the results yet, have just been notified that the dr wants to discuss the results, so I’m assuming he’s not happy! I’ll try to ask for the full results though. My GP is generally great, but I suspect there will be a push to medicate for cholesterol at this stage too, so I’ll read up more about that too. It’s all a learning curve! I definitely need to lose weight, it just seems to me that the change in diet needs to be given a chance to work prior to medication, but it may take some convincing on the doc’s part. I know it’s my choice, but it’s difficult to communicate these things to the GP without sounding like someone who thinks they know it all because I’ve read the internet for a few days!

They can prescribe anything but it doesn’t mean you need to take it.
Also as long as your losing weight then your cholesterol will be changing drastically. Also unless your blood test where fasting then they are in accurate as well.

 

[Magneto2009]

They can prescribe anything but it doesn’t mean you need to take it.
Also as long as your losing weight then your cholesterol will be changing drastically. Also unless your blood test where fasting then they are in accurate as well.

Yes, true! It was a fasting test, so I’ll wait to hear the results and will go from there

 

[Hotpepper20000]

Yes, true! It was a fasting test, so I’ll wait to hear the results and will go from there

Also after you have done some reading on the forum you’ll be better informed about what cholesterol does and that lower isn’t always better

 

[bulkbiker]

but it’s difficult to communicate these things to the GP without sounding like someone who thinks they know it all because I’ve read the internet for a few days!

To be honest if you have done that you're probably better informed than them..

I have a fairly low opinion of most GP's as you can tell.

 

[Resurgam]

When my doctor can explain why people live longer with higher levels of cholesterol I will be willing to discus medicating to lower mine, but I suspect it will not be anytime soon.

 

[VioletFoxtrot]

I think you should listen to your doctor.

 

[Mike d]

I think @Resurgam is also capable of making her own decisions

 

[Resurgam]

I think you should listen to your doctor.

I do listen - and then I think about it.
Having a B.Sc and a lifetime in situations where logic was an asset, I cannot find anyone able to match my knowledge and intellect amongst those wishing to influence my present behaviour.
I asked the GP who wanted me to reduce my cholesterol why they were advising me to reduce fats and drink Benecol when cholesterol is manufactured in the liver, and is an essential part of the immune system.
I did not get an answer, just that I would be retested in 6 months.
My very unfortunate response to statins IS in my notes, so why even try to push me into below average numbers when to all purposes I am no longer diabetic?

 

[Daibell]

I think you should listen to your doctor.

Hi. The increasing problem with GPs is that they cover far too wide a range of conditions and meds and can't possibly keep up no matter how competent they are. The result is a lottery on how good the advice is that they give. Add to that the advice that comes down from PHE for diet, statins etc which is not based on good science and the GPs can be left floundering. Having 70 years behind me also with a B.Sc, and a career in engineering similar to @Resurgam I have learned to listen to but not necessarily accept what a GP or DN tells me without putting it into context with other sources of knowledge.

 

[Mike d]

As the old adage goes, Learn first, speak second

 

[VioletFoxtrot]

Hi. The increasing problem with GPs is that they cover far too wide a range of conditions and meds and can't possibly keep up no matter how competent they are. The result is a lottery on how good the advice is that they give. Add to that the advice that comes down from PHE for diet, statins etc which is not based on good science and the GPs can be left floundering. Having 70 years behind me also with a B.Sc, and a career in engineering similar to @Resurgam I have learned to listen to but not necessarily accept what a GP or DN tells me without putting it into context with other sources of knowledge.

That's very true, and so a second opinion can be useful, or seeing a doctor and/or dietician who specialises in diabetes.

I was actually addressing Magneto's original post, not Resurgam's comment above mine. Sorry for the confusion but I can't believe everyone's piling on because I suggested a new diabetic take the advice of the medical professionals who have their medical history, test results, etc, as a basis for their decisions. No one here, no matter how qualified they think they are, has that.

BTW Magneto...I take 30mg of Glic daily, I'm on a low(ish) carb diet - 70-100g a day - but not keto low, and I've never had a hypo. I don't dip below the low 4s. But everyone is different, and it's important to test your BG regularly, especially in the beginning, but I think you should listen to your doctor, or find another if you;re not happy with the care you're getting.

 

[HSSS]

Ultimately it’s your body, your decision and I for one think you are wise to fully understand the implications of all choices available. Otherwise it is hardly “informed consent”. More than once I’ve resorted to that phrase when drs have been reluctant to explain recommendations or their advice against certain actions.

as you can tell many others have reduced their readings from similar to yours or even higher in a matter of months without any medication or just metformin. Before taking a powerful medication it seems eminently wise to seek reassurance that it is indeed necessary. A 3 month trial supported by regular testing to ensure improvement is being made seems more than reasonable.

Some drs even do a 6 week repeat Hb1ac in these situations to check how things are going and see if they would still advise the same at that point. Often the fall is enough to change their minds even if the journey is ongoing.

It’s also more than possible they have never seen a patient achieves the potential results before, hence their reticence (probably because most patients aren’t equipped with the knowledge you now are or allow themselves to be pursued to go the medication route).

 

[ziggy_w]

I think you should listen to your doctor.

Hi @VioletFoxtrot,

Not sure how to put this -- and definitely don't want you to take this personally, but just trying to explain where many of us come from.

When I was diagnosed, I really didn't get much helpful advice from my GP -- in fact he said verbatim, with blood sugar levels as high as yours (HbA1c 100) a change in diet won't work and there won't be a way around insulin for you. At the next three months' appointment, my blood sugars were back in the normal range (HbA1c 34) due to switching to low-carb and a little help due to metformin. Upon receiving my blood test results, his only comment was that he had never seen an improvement in blood sugar levels like this ever before. So, if I had listened to him, I would have been down the path to insulin and ever worsening health.

I understand that for GPs it's difficult and probably risky to stray from the official mantra. However, the standard of care rarely results in remission of T2 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4237974/. Remission is apparently around 1 to 2 percent. (Some even argue that the standard of care often increases insulin resistance and therefore makes the problem worse.) In contrast with low-carb or ketogenic diets, remission rates are much higher around 50 to 60 percent (see David Unwin or Virta health, for example, both also published in scientific journals).

So, personally I have hugely benefitted from taking my health into our my own hands.

 

[Magneto2009]

That's very true, and so a second opinion can be useful, or seeing a doctor and/or dietician who specialises in diabetes.

I was actually addressing Magneto's original post, not Resurgam's comment above mine. Sorry for the confusion but I can't believe everyone's piling on because I suggested a new diabetic take the advice of the medical professionals who have their medical history, test results, etc, as a basis for their decisions. No one here, no matter how qualified they think they are, has that.

BTW Magneto...I take 30mg of Glic daily, I'm on a low(ish) carb diet - 70-100g a day - but not keto low, and I've never had a hypo. I don't dip below the low 4s. But everyone is different, and it's important to test your BG regularly, especially in the beginning, but I think you should listen to your doctor, or find another if you;re not happy with the care you're getting.

Thanks, it’s useful to hear the experience of someone who takes Glyclazide. I think it’s more a case of me wanting more of a discussion with my doctor, and that hasn’t been forthcoming, rather than seeking a second opinion. I’ll try to do that, but given I’m testing regularly throughout the day I think I’m going to resist the medication at least until I speak to him again next week.

 

[Magneto2009]

It’s also more than possible they have never seen a patient achieves the potential results before, hence their reticence (probably because most patients aren’t equipped with the knowledge you now are or allow themselves to be pursued to go the medication route).

That’s a really good point, I think. If there is a formulaic approach to dealing with newly diagnosed T2s based on levels then a GP may not have encountered someone able to commit to a diet change immediately to address the problem, and bring levels down that way. I can also understand it from their perspective in terms of risk to a patient - they may feel medication is the quickest and most efficient way to reduce BG and then they can worry about the diet afterwards. That just feels backwards to me at the moment though.

 

[Magneto2009]

Hi @VioletFoxtrot,

Not sure how to put this -- and definitely don't want you to take this personally, but just trying to explain where many of us come from.

When I was diagnosed, I really didn't get much helpful advice from my GP -- in fact he said verbatim, with blood sugar levels as high as yours (HbA1c 100) a change in diet won't work and there won't be a way around insulin for you. At the next three months' appointment, my blood sugars were back in the normal range (HbA1c 34) due to switching to low-carb and a little help due to metformin. Upon receiving my blood test results, his only comment was that he had never seen an improvement in blood sugar levels like this ever before. So, if I had listened to him, I would have been down the path to insulin and ever worsening health.

I understand that for GPs it's difficult and probably risky to stray from the official mantra. However, the standard of care rarely results in remission of T2 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4237974/. Remission is apparently around 1 to 2 percent. (Some even argue that the standard of care often increases insulin resistance and therefore makes the problem worse.) In contrast with low-carb or ketogenic diets, remission rates are much higher around 50 to 60 percent (see David Unwin or Virta health, for example, both also published in scientific journals).

So, personally I have hugely benefitted from taking my health into our my own hands.

Thanks, I’ll look up those papers I totally agree with your approach, and I really hope I can see similar results!

 

[Andydragon]

That’s a really good point, I think. If there is a formulaic approach to dealing with newly diagnosed T2s based on levels then a GP may not have encountered someone able to commit to a diet change immediately to address the problem, and bring levels down that way. I can also understand it from their perspective in terms of risk to a patient - they may feel medication is the quickest and most efficient way to reduce BG and then they can worry about the diet afterwards. That just feels backwards to me at the moment though.

I believe that whilst there are those who do diet and take control there are many who do not. I didn’t for many years for example

so, for those who won’t take that path medication to get blood levels down isn’t a bad thing, quite the contrary. Long term high bloods are awful. I have seen the impact and if you haven’t... well let’s just say it is not a good thing

Some are deluded, don’t want to change and blame everyone but themselves. others are not as educated. Others want to do different but don’t as they don’t want to admit their favourite foods are off the menu or extremely limited. I’ve said before, my father and mother were so adamant that he was being good and open the door, avalanche of chocolate. I also know they would never have given up carbs

When you see those types of patients day after day then I kind of get it.

Doctors are spread thin and are general practitioners obviously, those that specialise in diabetes are few I bet

you can and should manage your own health and if you can get the doctor onside to try something different or prove them wrong if needed

my doctors have been great at listening and reducing my drugs as I change my behaviour and my levels. We can and should educate upwards but I doubt personally that we are the majority unfortunately

 

[HSSS]

I believe that whilst there are those who do diet and take control there are many who do not. I didn’t for many years for example

so, for those who won’t take that path medication to get blood levels down isn’t a bad thing, quite the contrary. Long term high bloods are awful. I have seen the impact and if you haven’t... well let’s just say it is not a good thing

Some are deluded, don’t want to change and blame everyone but themselves. others are not as educated. Others want to do different but don’t as they don’t want to admit their favourite foods are off the menu or extremely limited. I’ve said before, my father and mother were so adamant that he was being good and open the door, avalanche of chocolate. I also know they would never have given up carbs

When you see those types of patients day after day then I kind of get it.

Doctors are spread thin and are general practitioners obviously, those that specialise in diabetes are few I bet

you can and should manage your own health and if you can get the doctor onside to try something different or prove them wrong if needed

my doctors have been great at listening and reducing my drugs as I change my behaviour and my levels. We can and should educate upwards but I doubt personally that we are the majority unfortunately

Agree entirely there are many patients that don’t (want to) change lifestyle and diet and getting bgl down is the priority of a lot of drs, hence medication.

The problem is when drs make automatic assumptions about which type of patient you are as an individual, often based on no evidence. Even worse when you have demonstrated a willingness to participate your health and have actively sought information and what is now a recognised approach* to treatment and the dr tries to dissuade you from even trying this. Lifestyle is always supposed to be the first consideration in treatment unless good reason in that case not to.


*not all drs have stayed up to date enough to realise this or the enormous success that surgeries promoting this option have had. There are low carb professional training programs on the nhs websites for medical staff. Some areas even prescribe the low carb program developed by the same people as this website here.