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

[Trikelady]

Sorry for the length of this, it is all relevent...

I felt paticularly unwell the other day, and having gone without food for over 12 hours I tested my blood. My mmol/L was 12.0, which is high (for me).

I was preparing my lunch at the time and wondered if I should still eat my main meal with this high reading, or not? My thinking being - if my reading is already high then eating could raise it even more.

So, before cooking, I thought I'd ring "111" and ask their opinion (as it was a Bank Holiday and my options were limited).
I talked with a very nice lady on the phone. She checked with her superior and came back to me to say it was OK to still eat it. She said a doctor would call me back within the next couple of hours, but if I felt worse to ring 111 again.

Sometime later, after having cooked and eaten, I got a call from another lady saying the doctor was busy but would still call me back at some point. No problem I thought.

When the doctor eventually did call me he asked some routine questions but then launched into a lecture on blood testing!
He insisted I SHOULD NOT BE TESTING at all, as I was on Metformin. According to him, nobody on Metformin should be testing as it interferes with doing so (?!).
I tried to explain I have always tested once a day, originally on my G.P.s instruction (and whilst taking Metformin). I told him the doctor stopped issuing test strips about a year ago (£££), however I have been buying them to continue testing myself (normally only once a day).
I also pointed out to him if I didn't test my blood HOW was I supposed to know whether my diabetes was "under control" or not?
I had only tested twice on this occasion as I felt so unwell. Without testing I wouldn't have known my blood sugar level was the (probable) cause of me feeling ill.

The doctor grew increasingly stroppy saying I was making up my readings, as what I had told him wasn't possible!
WHY would I do such a thing? I even agreed with him that, the longer I went without food, I would have expected my reading to get lower, not higher.

For information my reading(s) that day were:

On waking (my normal testing time) my reading was 7.4
I don't eat breakfast, as a rule.
At 1215 (before eating) and after 12 hours + without food it was 12.0
(Lunch was eaten about 1300)
At 1410 it had reduced to 8.1
At 1515 it was 5.8
I ate again at teatime.
But at 2355 it was back up at 10.4 and I was feeling quite ill again. This time I didn't phone 111, as my previous dealings with their doctor had scared me off doing so!
I live alone, and I went to bed wondering if it would go higher in my sleep and (perhaps) never wake up.

Anyway, if you are still awake after reading all this...
Has ANYONE else been told NOT to take blood glucose readings whilst using Metformin? It's the first time since being diagnosed Type 2, in 2008, that I've ever heard of it.

How the hell is a sufferer supposed to take control of their diabetes WITHOUT knowing what their blood glucose is?

Puzzled.

That's a load of rubbish what Dr.told you I have been type 2 taking metformin and gliclazide 80 mg x2 daily metformin 2mg daily ,I test my bloods 3 timers daily as I tend to slide around 6.6 I start to feel shaky I try not to go above 10 before bed ,I have been diabetic since 24/12/2007 .My GP and diabetic nurse recommend me testing my bloods when ever I feel the need especially in stressful times .I have never been without testing strips or lancets .I don't know what your practice rules are but I would suggest you speak to a gp or diabetic nurse and show them your meter as they can access your memory on the machine lets know how you get on .

 

[Davyb]

Any Doctor who reads directly from a prepared script as this supposed NHS direct doctor did is not worthy of being a doctor and needs to re-train.

The NICE guidelines here are TOTALLY wrong, they are written by committee dominated by beancounters aka accountants and have little relevance when balanced against the cost of treatments such treatment of ulcers etc and amputation following diabetic complications.

This should be absolutely clear cut. metformin works by making your liver store glucose in a form that is harder to be converted back into glucose and will eventually be excreted via urine.

Self testing makes you more aware of your body, the informed patient is a better patient and makes you quickly seek to be put onto better treatments.

If you are a driver DVLA medical guidelines require you to self test before driving and periodically during driving, usually every 2 hours, anyone who does not risks an accident and may possibly be found to be not insured, and consequently eventually loose their driving licence. If anyone has problems getting adequate numbers of test strips, they should look at the DVLA guidance on GOV.UK, print it out and talk to their doctor with this in their hands.

Anyone with a fasting blood sugar of 12 mmol/L when treated with Metformin is clearly on the wrong treatment, they should be on blood glucose reducing tablets or possibly even insulin(s).

Many people on metformin long term will eventually become intolerant to the medication. I did. There are slow release formulations.

 

[Richard0804]

I am 59 yrs old and have been T2 for nearly 10 yrs. I test at breakfast usual reading around 6.5ish, I take 45units Insuman Basel and 10 units of NovaRapid. Next test Lunch, readings between 5-7ish I take 10 units of NovaRapid, Teatime readings around 7-9ish NovaRapid 15 units, Suppertime readings up to 12.7 depending what I've had to eat in the evening watching telly. I take 65 units Insuman Basel and 24 units of NovaRapid. Metformin 2x500mg 3 times a day. My hba1c is 54. My consultant is more than happy the way I control my diabetes. You must do what 'IS RIGHT FOR YOU' if you want to test 20 times a day that my friend is up to you and you alone. For your peace of mind test when ever you feel the need. I don't have that luxury I have to test a minimum of 4 times a day. Take Care my friend. Regards, Richard

 

[Sandybw]

Only recently diagnosed, I am still learning but would agree that long periods without eating is probably not good. Currently diet controlled, I asked about testing because it seems a sensible thing to do if I am to learn what is right for me. However, I was told my Health Authority would not allow it! I agree with previous comment that it is a cost-based decision rather than looking out for the needs of the patient. I would add that since being diagnosed, I have not been seen by my doctor but my diabetic nurse is lovely. Really appreciating the forums.

 

[tutti]

Hi , I am on Metformin and was diagnosed in last november. Suger levet was approx 5, 4.3. recently I think my BG went down and felt sweaty, hungry etc. I was told that is 'HYPO'. Now I am having tingling sensation on the tip of my tongue. Is that going towards hyPO? How do you know the symptoms of hypo? I have no meter and please someone let me know how to recognise hypo. Thank you in advance.

 

[bluerabbit]

Sorry for the length of this, it is all relevent...

I felt paticularly unwell the other day, and having gone without food for over 12 hours I tested my blood. My mmol/L was 12.0, which is high (for me).

I was preparing my lunch at the time and wondered if I should still eat my main meal with this high reading, or not? My thinking being - if my reading is already high then eating could raise it even more.

So, before cooking, I thought I'd ring "111" and ask their opinion (as it was a Bank Holiday and my options were limited).
I talked with a very nice lady on the phone. She checked with her superior and came back to me to say it was OK to still eat it. She said a doctor would call me back within the next couple of hours, but if I felt worse to ring 111 again.

Sometime later, after having cooked and eaten, I got a call from another lady saying the doctor was busy but would still call me back at some point. No problem I thought.

When the doctor eventually did call me he asked some routine questions but then launched into a lecture on blood testing!
He insisted I SHOULD NOT BE TESTING at all, as I was on Metformin. According to him, nobody on Metformin should be testing as it interferes with doing so (?!).
I tried to explain I have always tested once a day, originally on my G.P.s instruction (and whilst taking Metformin). I told him the doctor stopped issuing test strips about a year ago (£££), however I have been buying them to continue testing myself (normally only once a day).
I also pointed out to him if I didn't test my blood HOW was I supposed to know whether my diabetes was "under control" or not?
I had only tested twice on this occasion as I felt so unwell. Without testing I wouldn't have known my blood sugar level was the (probable) cause of me feeling ill.

The doctor grew increasingly stroppy saying I was making up my readings, as what I had told him wasn't possible!
WHY would I do such a thing? I even agreed with him that, the longer I went without food, I would have expected my reading to get lower, not higher.

For information my reading(s) that day were:

On waking (my normal testing time) my reading was 7.4
I don't eat breakfast, as a rule.
At 1215 (before eating) and after 12 hours + without food it was 12.0
(Lunch was eaten about 1300)
At 1410 it had reduced to 8.1
At 1515 it was 5.8
I ate again at teatime.
But at 2355 it was back up at 10.4 and I was feeling quite ill again. This time I didn't phone 111, as my previous dealings with their doctor had scared me off doing so!
I live alone, and I went to bed wondering if it would go higher in my sleep and (perhaps) never wake up.

Anyway, if you are still awake after reading all this...
Has ANYONE else been told NOT to take blood glucose readings whilst using Metformin? It's the first time since being diagnosed Type 2, in 2008, that I've ever heard of it.

How the hell is a sufferer supposed to take control of their diabetes WITHOUT knowing what their blood glucose is?

Puzzled.

Hi 999Sugarbabe,

I have recently been diagnosed with type two diabetes, it came about after receiving another rather shocking diagnoses for something else, but before this all my blood tests never read high or even pre diabetic, but I have to say it cam e as a real shock and has take a few months to get my head round and I ma still struggling, but I will get to the point, as I see your results are much like mine, so hopefully what i have learned may help you.
firstly, from what i have heard of the diabetic nurse, dr, internet and books, all information is contradictory and conflicting, this makes it really hard for us to know what the hell to do for the best, like you when I was told I was high and diabetic, ( i still think shock and uspest can cause high blood sugar readings, but the docs never seem to take this in to account...) but when they told me, like you, I thought logically, if I am high, I must not eat, and it will go down, but it got higher! I was terrified! When they told me, they just told me to loose weight, and take metformin.
I asked her if i lost weight, would it go, she said, no, it was for life, I did not fancy having to be on tablets forever, I know many people are, but I wanted to try and lower it myself via diet and exercise. Luckily , my husband i type one diabetic, so I have some knowledge of the subject, although slightly different form type two, but he had a spare blood testing kit, which is how i knew exactly how high my levels were, as the nurse would not give out any blood testing kits/strips, and said to just take the metformin.
After loosing all faith in the NHS from an earlier experience, and with the guidance of my husband who said you still need to eat, even if high, it what you eat that makes the difference.
I cut out all sugar, any sugar....these tone in most packaged food, so read the labels, I was and am veagn, so always thought my diet was pretty good, lots of fresh veggies and rice , pasta etc...but very low on protein, the diets the docs tell you are good, actually make your blood sugar higher, rice, pasta, potatoes, all the things we were let to believe were good, they are good, but less so if you are diabetic as they turn in to sugar once you eat them, so as lots of the diabetics now say, low carb high protein works best, but its all about testing your levels, before and after meals, to see what make you go high and for how long, and actually some foods will lower it, like protein. Also exercise, but i have found light exercise like walking is better if I am high, as anything rigorous, makes it go high too, its really hard to explain, and the dcs never believe me, but like you, I, am getting to the point, If I dont eat, I go high, if I exercise too much, I go high.
I dont know your history, but have you ever had, still have issues with food and not eating? as since I was diagnosed, I now eat more, more regularly, and more food in general, and have lost weight. I have cut out lots of carbs, by way of bread and pasta,and rice, potatoes, but still eat them about once a week and a small bit, but have upped my protein a lot, I eat lots of tofu, almond nuts fake meats, all high protein, so if you not veggie, then meat and dairy would do it.
But the protein helps balance the blood sugar, that was a revelation, and from bloody 'this morning' not from the drs!
they were saying that the juicing diets were not that great as many were high sugar from the fruit, and no protein, needed to regulate blood sugar! and a bell went off on my head!
From doing lots of tests, and keeping a food diary of everything I ate, it may have been a bit excessive to start with, but it really helped me understand my body and food, and its affect, I still tend to wake up with higher bloods, say, 6-8, but one I have breakfast, avacardo, tomato and seed or pate, soya and linseed toast, after 2-4 hours my blood sugar goes down to 5-6, if I am just working, but if I go for a walk, it goes lower and quicker, but if I go too long with out food, it will go up again, so after 2-4 hours I nibble on almonds, I used to leave 10 12 hours between meals, (and my husband says, again not scientifically proven, but seems to work for me) as I used to go with out food for so long, my body would compensate and when I had not eaten, it would release stored sugar from my liver to make up for it, the longer I go with out food, the higher it would go. But once i started eating little and often, which I hated to start with as its a pain in the ****! but my bloods regulated, and the weight started to fall off. my only problem was at night, my fasting bloods, as it would be 10-12 hours without eating, and I would wake up high, but on the nights I woke up at 3-5 am , and tested, I was at a good 5-6, but by morning, 7-8 am, it would be rising to 7-8.
I did try keeping a snack by the bed, a oat biscuit, or soya yogurt, ( I have found soya, but am sure any other no sugar ones would do the same, but if I am a little high, a yogurt helps lower it)
So now I try to eat late, again,which is again all the rules, but seems to work for me, so I have dinner about 8-10 pm, keep it lightish, you may also not feel so hungry after eating through the day anyway, and again, snack on almonds about midnight, this seems to keep me going through the night, as my body does not panic about not getting food and shoot out more sugar.
On the occasion that I cant control my food so well, on a meal out, I make sure I get walk in before and after, just to burn off any extra blood sugar.
Other things that make it high, is my period, and stress, illness, which can t be helped.
Again trying to get to my point, after getting reasonably good control via diet and exercise, I asked my Dr for test strips, as I had been buying them myself, he said i did not need to test! he also said if i lost more weight it would go away! more contradictory advice!
With out testing I would have no idea what my bloods were, or what make them go up and down, he also said to have just three small meals a day and no snacking, which I know actually makes me high, and gain weight! as I get the liver panic, no food, sugar dump!
So please if you can afford it, keep testing regularly , after foods, 2-3 hours, when you wake and before bed, and see what works for you.
xxx

 

[Rosieposie1990]

I cannot see in a million years (and I'm a biologist, albeit in a different area) how testing blood could ever affect metformin's activity, just can't! I get that it might not be relevant to test and thats different but still....

 

[GhostTalket]

When I was diagnosed with T2 in 2000, my levels was anything from 15 to 29.6 but I have never felt ill with them being that high. In fact I felt great, I've only had 2 times where my levels have gone below 3.2 and my index finger on my right hand starts to tremble. But now they are starting to go back up. I'm on metformin 1000mg twice a day, gliclazide 80mg in the morning and 120mg at night, insulin (Humulin I) 24 units at night and I test 3-5 times a day. My doctor has never said I should not test and issue my test strips when ever I need them.

Guess some doctors are better then others! LOL

 

[Newapothecary]

Metformin works in two ways... it encourages the pancreas to produce Insulin and it blocks the Insulin from being reabsorbed by the pancreas. It can only do this in the presence of food. If you only take your medication and not food, the lactose in the tablets will raise your blood sugar but the Insulin wont be released by the pancreas because it needs food to trigger the release. Hence .... no insulin but plenty of lactose.... result higher blood glucose.

I am with you on the BG testing though. Having a high HbA1c is like trying to lock the stable door after the horse has bolted but not knowing which door you need to bolt. Even 3 months of food diaries wouldn't tell you which meal(s) are the problem. We have two diabetics in our house. My son can eat bread (5 seeds stoneground) without affecting his blood glucose but can't eat roasted sweet potatoes. I can eat a plate full of roasted sweet potato but not one slice of bread. So just because a textbook says something is a fact doesn't mean your body wont have his/her say about it too.

 

[Scouser58]

Hi , I am on Metformin and was diagnosed in last november. Suger levet was approx 5, 4.3. recently I think my BG went down and felt sweaty, hungry etc. I was told that is 'HYPO'. Now I am having tingling sensation on the tip of my tongue. Is that going towards hyPO? How do you know the symptoms of hypo? I have no meter and please someone let me know how to recognise hypo. Thank you in advance.

Hello tutti, The signs of a hypo, well you can feel weak, shaky, bit sweaty, unstable on your feet, and cannot co-ordinate properly, each diabetic has different range of feeling and sensations, and the intensity depends on how low your blood sugar goes and also how fast it sinks below your own optimum bs levels.

This web site runs a hypo awareness course and it is free, go onto the main page of the site and find it there,,,, I would keep asking your doctor and diabetes nurse, for a meter and testing strips and lancets, as you have already had a hypo and are wondering about future ones. If you drive the DVLA will take away your licence if you have hypo's while you are driving, before, or after, and it would be very tough to get it back.
In your health centre there should be booklets about different aspects of the condition, and effects that happen, maybe you could get hold of these as something to read. Have got referred to the podiatry service for your feet, and they look after them every 12 weeks, and have you got your eye testing and retinopathy tests booked and have you been.
Discuss the tongue tingling feelings with either the doctor or nurse, so that they monitor it and keep a diary of them in places they occur. Also get referred to the hospital and the Diabetic Specialist Doctor there, who will keep a expert eye on you, and when they say something the doctor follows, each time I went the first thing he asked for was my meter readings, so if you tell them you don't have a meter, well you never know 1 on could come your way, they regard them as a part of the condition maintenance.

Everybody who posts onto this site has diabetes and many have so much experience of the condition, they can help and support you, and answer your questions, better than me, ttfn from Karen.

 

[Antfm11]

I always find it astonishing that Dr's and supposed diabetic nurses are so badly qualified to deal on the with one of the most common major medical conditions of the age.

My own diabetic nurse asked me how many times a day I test - I said 4 or 5 and she was angry... I was told this is not necessary and totally wrong. in short I ignore this bad advice.

Managing the condition proactively and regular testing would be the most sensible way.

Your Dr's advice as has many dangerous long term consequences and I would ignore his medical error - test as often as you feel is needed.

 

[Scouser58]

Hello Antfm11, the diabetic nurse got angry when you told her how ,any times you tested?
unbelievable,,,after all she asked the number of times you tested, so what is her problem?

I am writing this from another post, it is about a member who wrote to the Department of Health about the problems of being stopped from testing.

" Letter from, Daniel Cavill,,, Customer Service Centre, Department of Health.
He quotes NICE GUIDELINES, Self monitoring of blood glucose is helpful only as part of an overall package of support for self care, and it is vital that the results of self monitoring are fully understood.
ANY PRIMARY CARE TRUST (PCT) that is automatically discouraging the prescription of blood glucose testing slips is not acting in accordance with NICE'S advise"

This letter is very revealing in the tone of the reply to the original writer's letter, the use of testing strips is said to be helpful, but the doctors are not being helpful.
I have been fortunate in being supplied with testing strips and lancets and supply of new meters, since I was diagnosed many years ago, and I have and will always maintain that testing is important part of a diabetics overall treatment and control of their condition.
Keep fighting the cause and common sense will win the day and the sensible actions of testing, ttfn from Karen.

 

[tutti]

Hello tutti, The signs of a hypo, well you can feel weak, shaky, bit sweaty, unstable on your feet, and cannot co-ordinate properly, each diabetic has different range of feeling and sensations, and the intensity depends on how low your blood sugar goes and also how fast it sinks below your own optimum bs levels.

This web site runs a hypo awareness course and it is free, go onto the main page of the site and find it there,,,, I would keep asking your doctor and diabetes nurse, for a meter and testing strips and lancets, as you have already had a hypo and are wondering about future ones. If you drive the DVLA will take away your licence if you have hypo's while you are driving, before, or after, and it would be very tough to get it back.
In your health centre there should be booklets about different aspects of the condition, and effects that happen, maybe you could get hold of these as something to read. Have got referred to the podiatry service for your feet, and they look after them every 12 weeks, and have you got your eye testing and retinopathy tests booked and have you been.
Discuss the tongue tingling feelings with either the doctor or nurse, so that they monitor it and keep a diary of them in places they occur. Also get referred to the hospital and the Diabetic Specialist Doctor there, who will keep a expert eye on you, and when they say something the doctor follows, each time I went the first thing he asked for was my meter readings, so if you tell them you don't have a meter, well you never know 1 on could come your way, they regard them as a part of the condition maintenance.

Everybody who posts onto this site has diabetes and many have so much experience of the condition, they can help and support you, and answer your questions, better than me, ttfn from Karen.

Thank you Karen for all the information you have given. That is all what I wanted to know. I will ask for a meter next time when I go for the clinic. I have been to DRSS and they referred me to the eye clinic and they told me I have AMD and monitoring every 6 months.I really appreciate your advise-thank you again!

 

[Bernie 59]

Looks like I'm In for "telling off" at my first diabetes nurse appt since diagnosis then! lol As I have been testing every day as I'm trying to find out which foods are better for me. I plan to take three weeks of readings in! lol

I am on 500mg,my dosage increases to a 1000mg tomorrow.Do I take that all at once or 2 separate 500mg doses please?[/QUOTI am on 850mg. Metformin twice a day. I started on 850mg once daily, but when it was put up I was told to make it twice daily. Again check with your nurse or doctor as everyone is different. As far as food is concerned it is only trial and error. You'll get the hang of it eventually.

 

[membrew]

Hello Scoucer, Did you manage to obtain the information Bout being refused test strips and lancets? I have been refused today also and wish to do something about it and wondered if the information you requested would assist me to complain to the correct location. Hope you pick this up.

 

[happier than you]

I'd always trust the internet over what any doctor says. Sure there is a load of rubbish on the net stated as "fact", but it's not that hard to find the truth if you dig hard enough and ignore anything that sounds ridiculous. Doctors make it up as they go along and are under huge pressure to cut costs. The bottom line is always more important than patients health.

 

[JohnEGreen]

Forward to the nice guidelines addressed to the health professionals


Your responsibility
The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The application of the recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.

Local commissioners and/or providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties.

So it's totally up to the doctors whether they follow the guidelines or not if your GP wants to prescribe Meters and strips he/she is fully at liberty to do so.

 

[Scouser58]

Hello Scoucer, Did you manage to obtain the information Bout being refused test strips and lancets? I have been refused today also and wish to do something about it and wondered if the information you requested would assist me to complain to the correct location. Hope you pick this up.

Hello membrew,,,the letter information I got from an article about diabetes,,,and if you print off the post and show it to the doctor and nurse they could check out the writer,,,,the fact that this information is out there is something they must be shown and made to understand the need for the testing of BS,
Give them the honest impression that you are not going to give up requesting a meter,,it is part of the diabetes health plan,,,so that you can keep yourself well,,,tablets can only do so much... (Worst case action,,this site gives away meters and they also sell the lancets and testing strips),,, I will keep looking for where I got the information from,,,it was written to another diabetic who wrote the the department about the problems of getting the meters and consumables,,, sorry I cannot remember but it is truthful.
I hope this helps you and don't accept the line that because you are on metformin you don't need to test,,,you need to test,,,ttfn from Karen.

 

[DavidGrahamJones]

Metformin works in two ways... it encourages the pancreas to produce Insulin and it blocks the Insulin from being reabsorbed by the pancreas. It can only do this in the presence of food.

Where do you get that from? It disagrees with everything I've read about Metformin which in a nutshell stops the liver from releasing glucose and helps the body deal with the insulin that is produced.

 

[britishpub]

It disagrees with everything ever written about Metformin.

Can't wait to see this brand new research.