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

  • Thread starter Thread starter 999sugarbabe
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josie2843 said:
I have type 2 Diabetes on Metformin, I was told I don't need to test my blood sugar . If the reading was high there is nothing I could do about it.
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There is plenty you can do about a high blood sugar reading. If you start your own thread, we can go through it with you, and all the info will be in one easy to find place.
 
I have type 2 and am on Glicazide (took a bad reaction to Metformin some time ago). I recently had to take steroids for Occular Myasthnia Gravis. Blood sugars went wild, and soon came into control although higher than comfortable. Doctor and Practice Nurse told me no need to monitor. They say 3 monthly check up is sufficient. But how can one attempt control if no monitor tools...
Are they all stupid? I monitor daily and now having been off steroids for 5 weeks, blood sugars still between 8.5 and 11. They just keep telling me to stop monitoring, and if nothing changes they can give me insulin..... That's after been assured that sugars would return to pre-steroid levels....
 
 
I haven't read all 15 pages of this thread but I am staggered by some of the information given. I am was diagnosed asT2 diabetic over 25 years ago and I was taken off metformin some time ago because of its apparent effect upon kidneys although recent articles would seem to refute that. I take rapid acting insulin before each meal and long acting insulin once a day. Although there is always 'pressure' to reduce the amount of testing it is imperative that I test my blood sugar levels before eating and also late at night before bed to avoid a hypo during the night. I get the test strips needed on prescription.
However there is also another reason for regular testing and this is a requirement by the DVLA for persons using insulin to test levels before driving. If blood sugar readings are not taken within the DVLA guidelines before driving there is a strong possibility that an application for renewal of your driving licence will be refused arbitrarily. For many of us that would be a drastic life-changing event. I am not prepared to let cost led pressure on me to reduce testing to jeopardise my life style. Am I unreasonable in this? .

ptrmet
 
Not unreasonable at all. Access to adequate numbers of testing strips for people on insulin is a necessity. Those who try to reduce access have no understanding of the risks.
 

Lol. Righto CatLady.
 
I used to test daily and was prescribed tests etc until one doctor decided to stop them, just twelve months later my metformin was doubled, six months on, I started insulin (novo rapid and levemir) and have to tests three times a day. I could never have reported my T2 as I did had I not ordered strips online. I have never returned to the bad mannered g.p who took the strips and lancets away from me, I could never trust him.
 
I have been diagnosed with type 2 a couple of years ago and got told that I do not need to test my sugar levels. I have been to see my doctor today. I informed him that I am following a low GL diet and have bought myself a glucose monitor, so I can keep a check. He said that the new guidelines are that as Metformin does not lower your levels you don't need to test, it is only when you go on other medication or insulin. He was very good and advised best time to test is first thing in the morning. I am so determined to loose weight and get off my medication, so I believe you do need to monitor your levels especially if you start to feel unwell and don't know the cause.
 
 

He's incorrect, metformin does lower BG levels, by up to 1 mmol/mol. In rare cases it can cause the BG to go under 4, which is not very pleasant and can sometimes cause problems. Perhaps he was meaning it doesn't have a high risk of lowering them dangerously like some of the other meds and insulin.
 

Totally agree with the doc - the values are silly. What the real question is is why? If you can't find a reason, atrip to your GP is in order.
 
My Doctor told me not to test, i told him that was the only way for me to check my BG . I told him i was starting the Newcastle diet and he did not know what it was. I was on 1500mg of metformin each day and i stoped taking them last week and my BG has dropped to 5.5mmol and i have not told my doctor, and i feel more incontroll of my T2 . So isay take controll of your life and try the Newcastle Diet as you have nothing to loose . i will post my findings when i finish the diet i am it to my 2 week all going well.
 
Glad things are going well for you. It might still be a good idea to take metformin though, because it has other benefits, and it's best to discuss with your HCP first before you stop a medication.

To give you an example, my HbA1c is now 33 and has been for some time, but I still take 1000mg of metformin a day and I plan to keep doing it unless I develop bad side effects or I see research showing it's a bad idea for me.
 
CatLadyNZ said:
He's incorrect, metformin does lower BG levels, by up to 1 mmol/mol. In rare cases it can cause the BG to go under 4, which is not very pleasant and can sometimes cause problems.
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Metformin helps to lower blood glucose levels by reducing the amount of glucose produced and released by the liver, and by increasing insulin sensitivity. (Source: Diabetes.co.uk)
I've never seen anything that mentions by how much it can reduce BG levels, can you quote a reference please?
It is rare for someone taking Metformin to have BG going below 4, but you probably shouldn't blame Metformin, even by your calculations that suggest that Metformin lowers BG by up to 1 mmol/mol, without Metformin the BG would be below 5.
 
By way of a re-cap, I was responding to another poster saying their doctor had said:

"He said that the new guidelines are that as Metformin does not lower your levels you don't need to test, it is only when you go on other medication or insulin."

I wanted to correct that info, because metformin does lower BG levels, as it is intended to. It can cause false hypos, especially in the newly diagnosed (or newly low-carbing), and these can be uncomfortable. Iff the person overcompensates with carbs, their BG increases. I've been having a lot of false hypos lately, so my mind is focused on how horrible I feel when my BG is under 6, and a memory of it being 3.5 after a fast before surgery.

So I said:

"He's incorrect, metformin does lower BG levels, by up to 1 mmol/mol. In rare cases it can cause the BG to go under 4, which is not very pleasant and can sometimes cause problems."

My source for the first point is (emphasis added):

"Metformin

Though many people find that they can bring their blood sugar back into the normal range simply by limiting their carbohydrate intake, blood sugar control is not a short term project. When you have abnormal blood sugars you will have to spend the rest of your life keeping them under control, and not everyone is willing or even able to stick with a restrictive diet for the rest of their lives.

For this reason, most doctors assume that dietary changes will not solve their patient's blood sugar problems. So immediately after diagnosing diabetes they prescribe what are known as oral anti-diabetic drugs. Chief among these is metformin.

You may well be asking, if these drugs are effective, why bother with complex and restrictive dietary regimens?

Effective, But Not Effective Enough
Unfortunately, the catch lies in how you define "effective." Just as research has shown that the current criteria for diagnosing diabetes ignore the blood sugar levels at which damage occurs, other research shows that none of these drugs brings blood sugar levels down to anywhere near normal levels. So while an oral anti-diabetic drug might be "effective" by the FDA definition of the term, that effect might only be to lower a diabetic person's fasting blood sugar from a dangerously high 250 mg/dl (13.8 mmol/L) to an only slightly less dangerous 180 mg/dl (10 mmol/L) --a level which is still high enough to encourage the development of serious complications. Even when prescribed for people whose blood sugar is only impaired, as we will see, these drugs may only lower the OGTT 2-hour reading by 20 or 30 mg/dl (1.1 or 1.7 mmol/L)--which still leaves their blood sugars higher than a damaging 140 mg/dl (7.8 mmol/L) most of the day.
So metformin alone will not be likely to bring your blood sugars back into the normal range."
http://www.phlaunt.com/diabetes/14045911.php

I must have said up to 1 instead of 1.1-1.7 because I was working from memory instead of checking the source. I wasn't far off the ballpark figure.

Now, when it came to writing the second sentence, I made a mistake and forgot about the difference between hypos and false hypos (maybe I was having a false hypo at the time, lol). In any case, this is the part of the above source that I was thinking of:

"Can Metformin Cause Low Blood Sugar?
Metformin is not supposed to cause dangerous hypos. A very few people have found that it causes their blood sugar to drop low enough to make them uncomfortable. This may be because of the phenomenon called False Hypo. You can read about false hypos HERE."

Thanks for picking up the mistake in the second sentence.
 
Most interesting. I am T2 and managing on diet only. Am now age 79. Diagnosed by a family member about 14 years ago and given a standard high "good" carb low fat diet. On returning to South Africa purchased a meter and strips. Investigated on the internet and found that such a diet was dubious. Switched to low carb. Now still on low carb but also high fat. Take my levels in the morning between 7 and 8am. Evening meal no later then 7pm. Find that by 9 or 10am they have risen quite a bit. Today at 7am a level of 7.7. Not so good but not terrible. Will enter into my self made Excel program which gives me moving averages for 10, 20 and 70 days. The 70 day one is the most important and is currently 7.4. I'm happy with that as is my family member and my RSA GP. A meter is essential. Diabetes is the problem and not an hypo. I have never been overweight - BMI of 25. Your comments have caused me not to consider metformin.
Blood pressure check by GP a bit low. Only problem is vertigo. All other checks Ok. Keep on using a meter. Cost is minimal and with a low carb high fat diet you should be OK . My family member says I won't die of diabetes ! Just take it day at a time !
 
I'm confused, which comments caused you not to consider metformin, and why?
 
CatLadyNZ said:
I'm confused, which comments caused you not to consider metformin, and why?
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Comments about side effects concerned me. Also my local GP and the family doctor said beware of any reactions. Decided I would carry on with diet alone. A 70 day average of 7.4 not too bad but may get a HbA1c when my vertigo problem solved. HbA1C a bit expensive here and my GP may decide my daily readings to suffice.
 
My doctor also told me the NHS are trying to save money so they do not like doctors to prescribe testing strips.
When I told him I usually only check twice a WEEK is kindly prescribed me the strips
 
Glad it works for you, im in the mind that i take controll of my T2 and its working ok on low carbs. The newcastle diet is worth ago, so im on it now, no metformin and all is good so far.
 
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