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

  • Thread starter Thread starter 999sugarbabe
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Croc said:
As far as I'm aware food helps Merformin work which is why it should be raken with or straight after food. Taking it on an empty stomach is probably worthless which is why its doing nothing to reduce your levels in the morning.
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One should try to have a breakfast, and eat regularly. The 2hr rule is a new one on me, something to consider
 
I generally test before breakfast most days, and repeat if feeling unwell throughout the day
 
I'm on 850mg metformin twice a day and my T2 diabetes is well controlled - so well controlled that the Dr no longer wants to see me annually for a diabetes clinic (the practice has not replaced the diabetic nurse) although he suggested that I should still remember(!) to have the annual blood test. Whether I can get the actual numbers out of the practice without a doctors appointment remains to be seen. He was also sniffy about me taking my own BG readings... until I showed him my chart of BGs, weight, BP and pulse weekly readings.

I'm following my own form of 'maintenance testing' (Dr David Cavan, p 169 'Reverse Your Diabetes' endorsed by diabetes.co.uk). He recommends once a week fasting blood glucose testing - I add a 2 hour post breakfast test too. Because I use my own meter (they are cheap or free) and only 2 tests a week it is a relatively cheap way for me to keep track of how I am doing, what I can eat without undue consequences, and puts me in charge of my own health. It helps stop me falling back into a bad diet.

Besides which it's my health and my body.
 
I was at the Dr today asking questions on being put on to 200 metformin and asked if I got my hsbc1 down to 40 I could come off the tablets but he was not very keen on the idea at all and basically gave the impression I'd be on them for life. If just bought a testing machine and asked if I could get a prescription for strips etc and he suggested I shouldn't be testing at all as I would get 'frustrated ' with my levels going up and down he said my 6 month checks would be more accurate. When I countered that I wanted to physically see how what I was eating affected my levels he stated that I knew what I shouldn't be eating so it was unnecessary! ! Have decided to carry on testing myself and if I get my levels down will consider reducing my metformin myself. I hold my hands up and say that when I was supposed to be diet controlled only I didn't take it seriously enough and I did ask then for a testing kit so I could .'see' what affect my diet was having on my sugar levels but now that I'm trying hard to change I'm not being given much support.
 
Daverk said:
I generally test before breakfast most days, and repeat if feeling unwell throughout the day
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That will tell you what your BG is after not eating for several, possibly 12 hours. Readings taken after meals, 2 hours is usual, maybe 1 hr as well, will let you know what effect the food is having on your BG. Removing the spikes is the name of the game because that's what does the damage.
Also don't forget, high readings first thing can be down to liver dumping or what's called "dawn phenomena".
 
elginlass said:
. . . . basically gave the impression I'd be on them for life.
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It's possible, but there again nothing is impossible. Metformin is the standard first line prescribed drug for type IIs and helps overcome the resistance the body has to using insulin. If you can reverse that insulin resistance, bingo.

elginlass said:
. . . . . . . . . he suggested I shouldn't be testing at all as I would get 'frustrated ' with my levels going up and down he said my 6 month checks would be more accurate.
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You might get frustrated, but you don't want your BG going up and down, that's why using a meter is essential. You can tell, after eating something, what effect it has on your BG, sorry you know that, just reread. The HbA1c will only show you an average for the previous 8 - 12 weeks, so arguably even 6 month tests aren't enough. You could have extremely high BG for 3 months then well controlled BG for 3 months and the HbA1c is only checking the last 3 months, which were well controlled.

elginlass said:
Have decided to carry on testing myself and if I get my levels down will consider reducing my metformin myself.
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Be careful with that because Metformin effects builds up so that not only does it take a few weeks to become fully effective but when you stop taking it, it will look like everything is OK but after a few weeks you'll notice the higher BG.
 
Croc said:
Nice guidelines state that diet controlled or Metformin only don't need to test.

Are you taking Metformin in the morning and not having breakfast? Because thats not good.
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I have been taking Metformin now for the last 4years and have never been told not to test, however, neither have I ever been told by anyone at all that Metformin should be taken with or after food.
I only discovered this after being admitted to hospital 4 weeks ago with kidney stones,, so my next question is have I done any kind of damage by not eating 3 x a times with my tablet ?????
 
My doctor told me that as my Hb1aC levels which are checked twice per year, have always been in the acceptable range, I no longer needed to test and I am happy about this. She also said that if ever this situation changed, then I would need to start testing again.

I am a great believer in breakfast and a low GI cereal such as porridge is ideal and keeps you feeling full and maintains steady glucose levels. There are other low GI options too of course if you look around. I have found a delicious granola - Lizzie's which comes in a low sugar version.
 

You need to test 2 hours after food to see what effect it has on your blood sugar, your HBA1C is pretty meaningless in lots of respects because you could be having a lot of highs and a lot of lows but a respectable HBA1C. It is the spikes caused by food that damage the small blood vessels, eyes, organs etc.
 
To add to what Ali H said, I've always had the mental image that the HbA1c as a piece of data is rather like trying to ascertain if you've ever broken the speed limit by working out your annual fuel consumption and mileage. The figure is interesting in itself, but a low HbA1c doesn't necessarily indicate healthy complication-potential-free glucose readings during the period it covered if the readings fluctuated wildly. I've never quite grasped why the NHS puts so much store in this one number.

I've been diabetic for a long time and when first dagnosed, I was given a meter and log book and had to bring the book with me to appointments and the letters reminded you to do so. Then the thinking changed and strips were reduced on prescriptions and I knew people who were newly diagnosed who were told not to test. Now it seems to have changed back again to some degree, although my practice have never once balked at giving me strips, or occasionally, free meters. I think they've tried to encourage us to use meters with cheaper strips, which is perfectly fair.
 
Economists don't know anything about medicine per say. It's always working with your own doctor and diabetic nurse that's what is important
 
I have tried Porridge for breakfast but It does not fill me at all and I am left feeling really hungry.
 
delia57 said:
I have tried Porridge for breakfast but It does not fill me at all and I am left feeling really hungry.
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Porridge puts my BS up too high.

The reason the NHS initially used the Hb A1c test when it was first available is that many diabetice were good about their diet for a few days before their blood test but didn't follow their diet the rest of the time. The HbA1c caught thge cheaters but now we have home home testing meters they are still years out of date as with the "diabetic plate"; patience, give them another 5 - 10 years!!!!
 
Just to be clear; as a Type 2 you will have impaired ability to metabolise carbohydrates.

Some will be able to handle more carbohydrates than others (all carbohydrate turns to sugars things like 'GI' are only measures of the time it takes).

The primary elevator of blood sugars is the carbohydrate we consume.

You cannot know how well your pancreas is working by guessing and you cannot identify which foods spike you by looking at your HbA1c.

You need to be able to assess your own tolerance for carbohydrates and reduce them as necessary; that can only be done by checking your blood sugars before and after eating.

The primary reason for not giving Type 2's blood testing equipment is cost. It has nothing to do with assisting you in managing your diabetes. If you can get your GP to prescribe them great, if not you need to buy them for yourself at least until you get a handle on what you can and cannot eat.

In general the NHS thinks that fats and protein are 'bad' and carbohydrates are 'good'. They are wrong. Almost completely wrong when you are dealing with people like us who cannot metabolise sugars. This advice will change; see - http://drmalcolmkendrick.org/2015/05/20/sorry-seems-to-be-the-hardest-word/

You cannot afford to wait for the orthodoxy to change; you need to sort out what you eat right now. Diabetic medicine for Type 2's is pretty ineffective. Reducing your carbohydrate is not; it is brilliantly effective and can stop your diabetes in its tracks.

You don't need to eat breakfast if you are not hungry, you should avoid porridge unless you know that it does not spike you blood sugars (it spikes mine incredibly quickly and then drops them down quickly too).

As diabetics we are in a the bizarre situation where virtually all the advice we are given is wrong. You don't need carbohydrates, you don't need to avoid fats, you don't need to limit protein to protect your kidneys. Type 2 diabetes is not progressive (if handled properly). Metformin is fine but has trivial implications for your blood sugars.

We're out here on our own without maps; we need to think for ourselves.

Read this forum if you don't believe me.

Best

Dillinger
 
I have tried to get the equation right ↪. You need to have a balanced diet, a little bit of protein with the breakfast may help. The blood sugar levels may spike but usually stabilize after 2hrs.
 
I also went to my doctor because I was feeling unwell & my BG readings were high for me.She also gave me a lecture about not testing because I was on Metformin & it was unneccessary & my regular results from my Diabetic nurse were quite good.I try to explain the reson everything was going well was because I tested 2/3 a day but she didn't want to know,all she did want to know was who had prescribed the testing strips in the first place( my regular GP as it happens).Not had any stripes for 3 months now so it will be interesting to see what happens at my next review
 
When I told the nurse I test, she told me that they don't advise that. Only type 1s need to test.
Then in the next breath
She told me to come back immediately if my BG ever rose above 12 mmol/l.

Absurd.

Edited to correct from T2 to T1
 
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Brunneria said:
When I told the nurse I test, she told me that they don't advise that. Only type 2s need to test.
Then in the next breath
She told me to come back immediately if my BG ever rose above 12 mmol/l.

Absurd.
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Hi B... did you see Dillinger's brilliant post back upstream a little? It is very interesting.... Maybe the rest of the world will catch up with us now...
 
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