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NHS Direct doctor says... NO testing when taking Metformin

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As a newbie myself, I have probably done the standard thing of Internet thing and one site - NitritionFacts.org claims eggs and diabetes are a bad combination.? Discuss ...
 
I would never be able to control my diabetes without using regular testing. My GP is really good with this. I am on Insulin and metaformin. It is also a requirement of my restricted driving licence that I test before driving and every 2 hours during long journeys.
 

Metformin's main purpose is to suppress excess glucose production by the liver since the messed-up insulin is giving it the wrong messages. Taking metformin without food is simply a waste. Without food, the liver isn't going to produce any glucose and the metformin you've taken never gets to do its job.

Since I'm posting, I'll add that while understanding the reasoning behind the NICE advice, that testing isn't needed by people on metformin. If their needs were more acute, they'd be insulin dependent and there wouldn't be an issue. Test strips are expensive and budgetary concerns can't be thrown aside. So, while testing isn't necessary, it would be a fool who'd not see the wisdom of testing. I think any response from a doctor other than 'Well, the guidelines advise against it, but if you can see your way to buying them yourself...' should be responded to with sharp words.

By the way, on the couple of occasions when I've run short because of over-testing, I've bought boxes of Contour Next 50 test-strips off eBay from a seller in Galway (Ireland) at €15 a pop and no postage. At the current exchange rate , that's just over a tenner.
 
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Hi There
I take two 500 gr tabs after breakfast and two 500gr tablets after Tea I do some times feel unwell but once I have something to eat that is sweet I am fine again I also when out and about carry a tube of glucose tabs with me just in case , however I have never tested or told to test my sugars perhaps I should in light of what has been said here.
 
Hi everyone. This is the first post I've written even though I've been watching the forum for a couple of years. I'm t2 and was diagnosed nearly 7 years ago. I had previously had gestational diabetes when I was 37. I will be 50 at the end of the year. There is a strong family history of t2 diabetes and if I think back over my life I realise I have probably had some diabetic tendencies since my later teens. My diabetic diagnosis started with control through diet alone for two years. Then one 500 mg metformin tab followed by two 500mg tabs six months later. I got a meter issued by my DN at the same time. It broke about 2 years ago and I was issued a new one in January this year. My metformin was increased to 1000 mg twice a day. In June I was put onto glucophage instead because it is kinder on my intestines and also gliclazide (80mg) once a day at breakfast. I generally keep a record of all my food intake, exercise, illnesses, and any age related factors in a journal. I keep a note of all my Blood sugar readings, hba1c, cholesterol and blood pressure plus my weight readings when taken at the same time as hba1c. I could not possibly consider low carbing as I find a protein based diet tastes rancid very quickly. Hba1c days are great because after my blood is taken I give myself a diet holiday for the rest of the day. At diagnosis my hba1c was 7.9. The lowest it has ever been in the last 7 years is 6.2. Last reading in June was 8.0 and it is heading down from a high of 8.5 in January. My weight goes up and down in line with my blood sugars but overall I am nearly 2 stone lighter than at diagnosis and that's pretty much where it stays within a half stone range either way. I avoid slow release carbs like oats because the metformin is too fast acting to effect the rise in blood sugar oats give me. (Tho glucophage is a delayed release so perhaps I can revisit that idea) Actually I constructed a chart of GI verses GL and eat according to it. Therefore melon is very edible and potatoes are problematic. I am currently reviewing my food intake due to the gliclazide that gives me hypos at approx 11-30 am. My general attitude to the diabetes is that I can eat whatever I want to so long as I plan when I eat whatever it is I want to eat! I don't eat between meals as a rule. I don't eat after 6pm. I'm not much of a drinker alcohol wise. I don't have caffeine except what's in chocolate. I eat very little salt. Idon't smoke. I refuse statins that keep being offered even though my cholesterol is 5.4 with all my individual levels being better than required and my blood pressure is 116 over 70. No one in my family has had a heart attack not even those with diabetes. The only diabetic complications I experience is with my gums and teeth. Had a second tooth extracted today. 30 years of gum pain hopefully ended!! Sorry I have rather got carried away here. I'm guessing another reason the medical profession do not want us testing our own sugar levels is so that we develop a better sense of sugar levels through how we feel. Testing takes the intuition away and dulls our senses. We need to be tuned into how our bodies feel when we have high sugar readings or low sugar readings. I think it absolutely necessary to test our bloods to confirm our own instincts and to inform our eating habits and exercise but it is also important to note where the diabetes is affecting us as individuals. When my sugar is running high my gums bleed, my fingernails become brittle and my fingers are sore. When in a hyper I fall asleep. When my sugar is running low I get verbally aggressive and short tempered. When in a hypo I am shakey and I feel suddenly very sick. I react to how I'm feeling rather than take a sugar reading to see why I'm feeling that way. Only if the weigh scales show a changing trend do I go back to regular blood testing (unless I'm getting used to new medicines). I'm a lazy diabetic but not too careless. If I'm gonna live with this condition for the rest if my life then I will do it my way. I love this forum because I feel it puts me in control. My body, my life.
 
Hi Fizzylaa I sometimes have similar if not the same feelings and reactions as you and am on 1000gr tabs twice aday glad im not alone but never ever been told to test my bloods only have it done once per year at the Diabetes Clinic weird or what are the Doctors saving money ??
 
Hi Michael WCH. My hba1c is usually tested twice yearly. Sometimes the doctor gets confused with the new measurements and mistakes 59 for 5.9 but who am I to tell him his job? This forum keeps me informed. I've never been told to test my blood sugars, but I have been allowed to do so with the provision of a meter, strips and lancets courtesy of the NHS. Now I'm on gliclazide even my GP is happy with the arrangement because I could get hypos. And I have on several mornings since being put on this medication three weeks ago. I have to have hba1c taken again in mid September to see how the new meds are working. I can tell you now they are doing the job quite well. Weight dropping and less intestinal upset. I feel less sleepy. My gums are not bleeding. Today's tooth extraction site is really fine. No pain. No painkillers! I am feeling well. Diabetes sure is a complex illness. 7bn people worldwide - I bet if we all had diabetes there would be 7bn different ways of reacting to it and dealing with it. We are such complex organisms with such widely diverse lives and diets with other possibly unknown complications and DNA variations how are we ever expected to totally control the disease? Need to find all the triggers and need to find all the cures. Not in my lifetime I expect. I'm not cross I have it. I have three beautiful daughters. One of them is bound to get it too as it seems to run in my family. We discuss this. They understand how frustrating the media is with how it perpetuates all the worst myths about diabetic causes. We are all tarred with the same brush it seems. I expect in some far off future world they'll look back at our time in history and realise they over emphasised the wrong aspects of diabetes and how they got their understanding all skewed.
 
My diabetes (t2) when discovered was way out of control. Some of my early tests showed levels over 21, yet I never experienced what I thought was an apparent feeling of illness, and it was only contstant lethargy and high rates of urinating that my doctor finally agreed (yes I had to get him to agree) to test for diabetes.

When I went on an education course for Diabetes, everyone in the room was shocked when we were sharing our diagnosis experiences.

Ever since being diagnosed over 3 years ago, my blood sugar levels have never been well maintained. After around a year, I was getting my levels down to 7-10 which was quite good for me even with a change of diet. I was told by my nurse I didn't need to test anymore and was then asked only to go in 6 months later for my hb1ac test. When those results came back, I was told I needed to make adjustments. I decided to buy some strips and found that my levels were back up to 12-17 for no apparent reason.

Just before Christmas last year, some lifestyle changes with work and eating habits, tied in with now having to use Zicron and inject every day with liraglutide, my levels are back down to 7-8. However, due to the extra medication my GP prescribes my test strips as I have been told now I must test regularly (twice a day). Since going on this medication I have had 2 episodes of sickness, dizziness and feeling feint and testing at those times has seen my sugar levels decrease below 3, one as low as 1.9 which is very dangerous and I was at work at the time.

My point in relation to this thread is that if I was allowed to get prescription test strips (on low income) I would have spotted the dangerous high's I was getting and gone to see my nurse or GP. As it was, it was left unmonitored for months. Given the fact you were paying for your strips I cannot understand where this GP was coming from. GP's are only concerned with the ever increasing cost of type 2 diabetes and it is the only reason I know of why they won't prescribe them.

When I was on Metformin only, my GP prescribed test strips anyway until it was under control. I do however find it strange that a reading of 12 would make you feel ill as your blood sugar levels would reach that shortly after a meal anyway, and 12 isn't really dangerous unless left at that level (and not below) for long periods of time.
 

Hi All ... - I'm sorry, I rarely say anything on this forum, in fact I don't really know how to do more than read the postings, but this thread has really made me see red... This sort of totally irresponsible advice "not to test if you are on Metformin" is absolute complete and utter rubbish. It doesn't matter if you are on Metformin or not - EITHER WAY IT IS ESSENTIAL TO TEST YOUR BS LEVELS...if you want to be able to control your life properly..!! Cheers.. Robin
 
Fizzylaa said:
I could not possibly consider low carbing as I find a protein based diet tastes rancid very quickly.
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Low carb doesn't have to mean eating a protein based diet. I cut out bread/potato/rice/pasta and increased the amount of vegetable in my diet, still eating less than 100gms carb per day. I eat a bit more cheese (300gm per week) than when I followed the low fat idea (when I ate virtually none), 4 eggs rather than 2 per week, I eat yoghurt regularly rather than hardly ever and tend to have more berries and nuts (to go in the yoghurt).
It's a personal thing at the end of the day, we are all so different that what suits one doesn't suit another. Being able to avoid progressing onto insulin, chucking out the Gliclazide (I gained 10 kgs when I started taking it), Januvia and Atorvastatin is incentive enough to keep me eating to my meter.
 
I never used to eat breakfast not even as a child.....after being diagnosed with Diabetes I started eating breakfast and the Nurse said must be serials she still insists on this.....so I eat shredded wheat for brecky as for testing on Metformin I think it a must If you want to learn to control the darn thing....
 
Hi graj0. Low carbing. Overall in a day I probably eat reletively low carb amounts. But I do not seek to remove them from my diet. If I have little carb at a metformin meal then I get the trots. I learned that regular quick release metformin is out of my system inside two hours. Eating slow release carbs did no favours for my long term blood sugars. So, counter intuitively, I opted for direct sugars at those meals when taking metformin, with little fat and no drink. At lunchtime when I had no metformin I would eat practically zero carb. Though in reality I'm only human and occasionally I lapsed from this plan. The prospect of perpetually avoiding many carbs that I like fills me with sadness. I love pasta, bread and fruit. So I eat it all but with considerable planning. I sometimes eat too much at one sitting but I don't chastise myself with any guilt. I have to bring up three children which requires sitting down together to eat the same meals. What they need to eat as active teenagers is not the most ideal for me I know but eating separate menus would drive me crazy and possibly send mixed messages subliminally to them about how women have to eat to stay slim. The lack of exercise is my undoing with regard the diabetes, not so much the diet I eat. Getting a dog at the end of the year!
 
Fizzylaa said:
If I have little carb at a metformin meal then I get the trots.
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Another good reason for me cutting out the obvious carbs. I'm still quite angry that when I was getting really severe diarrhea so bad that I didn't want to leave the house, my GP at the time was telling me not to cut my carb intake under any circumstances. Because he didn't accept that Metformin was the problem I underwent all sorts of tests like Barium enemas to see if I had something nasty. Blooming waste of NHS money, I knew it was the Metformin causing the problem, the problem started when I started taking Metformin, only they said it would just take a couple of weeks to settle down.
Now I realise that the lower my carb intake, the less of a problem Metformin is.
With you 100% on cooking different meals, fortunately I just cut out the pasta/rice/spud/bread bit without too much trouble and have some extra veg. There again, I only have one other person to cook for.
 
simonseaford said:
As a newbie myself, I have probably done the standard thing of Internet thing and one site - NitritionFacts.org claims eggs and diabetes are a bad combination.? Discuss ...
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Can you give me references that say eggs are bad for diabetics. Eggs are the perfect food. If its about cholesterol - our bodies produce cholesterol all on its own some, we don't get it from food.
 
dawnmc said:
Can you give me references that say eggs are bad for diabetics.
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http://nutritionfacts.org/video/eggs-and-diabetes/ The video on this page talks about research that is supposed to show that people who eat more eggs have a higher risk of dying. It goes beyond cholesterol which as you say doesn't affect our total cholesterol, the more we eat, the less the body makes, the less we eat, the more the body makes (Surrey University Study was interesting). It goes on about Salmonella and other toxic stuff that you might find in eggs. I'd have to do further reading to check the claims made by nutritionfacts.

To be honest, I'll take my chances with as many as 4 eggs a week.

I'm also very suspicious of anything that's got "facts", "the real truth", "myths" or similar words in the title.
 
My GP's view is that I don't need to test on a regualar basis unless I want to out of curiousity ("You'll probaby worry yourself unneccesarily") but to do so, if I wish, if I feel unwell. At my last review he asked if I needed test strips (he supplied them on prescription but I expect that may stop any time now!).

Though obviously if I feel unwell/have any concerns to pop in.

And I always have a good breakfast, taking my morning metformin straight afterwards, and my evening metformin is after my evening meal. Apprantley it works better that way and/or there is less risk of feeling nauseous
 
Having spent over an hour reading this thread I am shocked and appalled by the lack of understanding and knowledge of the condition and medications and by the attitude of many people. With the easy access to information we have nowadays there is absolutely no reason for everyone, not just diabetics to have a good understanding of the subject. If a doctor dianosed me with a condition I would read everything I could find on the subject and not just believe 'anything' but do some research into it and I certainly would not take any medication that I did not fully understand how it worked, why and when.
Diabetics on insulin do need to test because they can do something about the result. If you test your blood and the levels are high what are you going to do about it? You cannot adjust your medication to correct it, this is the main point of testing when on insulin. The best thing to do when first being diagnosed with type 2 diabetes is change your lifestyle, change your diet and exercise regime, get fit, lose weight and you may be able to drastically change your medical condition. I understand there are times when lifestyle is not the case but this is not the majority. Testing in the beginning stages may be useful to understand how different carbs effect your blood glucose but once understood it is unnecessary.
If you wish to buy your own strips to test your blood then that's up to you and honestly I would probably do the same for initial stages of diagnosis or when feeling unwell but why do people think it is their right to get these paid for by the NHS? How much money do you think is in the pot? Have you not seen the budget with all cuts? If you think how much it costs you for a year's worth of strips then times that by how many diabetics in the country that's an enormous amount of money. Retinopathy and other conditions caused by diabetes are normally as a result of long term uncontrolled high blood glucose levels not occasional highs, HbA1c shows your average levels so is a good indicator for this thus very important and potentially more useful than a once a day or twice a day test.
I could go on more but I am sure I am going to get a whole heap of abuse from many of those who have posted. From someone who has lived closely amongst type 1 and type 2 diabetes and who has nursed them I plead all people, not just diabetics to take diabetes seriously and do some research.
 
Hi Portia113, when I asked my practice nurse about testing I was told that because you shouldn't have hypers or hypos on Metformin that I didn't need to test, she said that I had plenty of time before I need to test. However, I recently bought a BG monitor and I was horrified at how high my BG was before and after food. I don't test every day but I know my diabetes is not under control by any means and trying to get test Stripe's etc from the GP is a waste of energy they just ignore my request. It's been nearly a year since my last HBA1c and as long since I was seen in the diabetic clinic. I'm sure they're hoping I'll just disappear if they ignore me long enough. Good luck
 
My experience as a type one for 25 years has been that the only group who actually really know what they are doing in the NHS (regarding diabetes in general) is the DAFNE (Dose Adjustment For Normal Eating) group. Not all counties have one and I had to shift to the neighbouring county to get included on a DAFNE course. It is a full time 5 day course run by specialist nurses and is excellent for type one diabetics - not available for type two at present, however.

My research into diet and diabetes leads me to the belief that type two (where there is still insulin production) in most cases can be sorted by a low carb diet and getting ones entire physiology into a properly alalkaline state. There is evidence that this also works for some type ones as well. Some very good books are now around, which explain how to kick type two into touch permanently in a matter of weeks

However, you as the Patient have to take the lead in managing your condition and not give away your personalpower to others
 
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If you take Metformin and your pancreas can't cope with the diet you are eating then you will certainly worry yourself by testing as you will see what absolute chaos the suggested diet given by your health care team is doing to you.

If you drive along a mountain pass at speed do you think it would be a good idea to close your eyes? If you keep them open you will just worry about those steep curves and precipitous drops; if you close them; you'll be fine. Until you drive over the cliff; but at least you won't be worrying. This is essentially the equivalent advice to 'don't test; you'll worry'.

Not testing and not changing one's diet (i.e. reducing carbohydrates) as a diabetic (of any type) is just 'group think' from our health care providers; it has no basis in sense or science.

If you don't test and you are getting good HbA1c as a Type 2 then that's fine; it just means that your pancreas is not badly impaired, but as soon as it starts to worsen then you need to test and test often.

Best

Dillinger
 
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