Off Statin or not?

[Mr Hairyman]

Hi all.
Was diagnosed with T2D in May 23 with a HbA1c of 80. Dropped Carbs and sugars. Took up exercise, lost 45lbs
Have had 3 subsequent tests, with scores of 36, 34 and 34 again just last week. Have gone from 2000mg of Metformin down to 500g. I asked the nurse if I could come off it following my second 'good' score and she suggested dropping down to 500g and doing one more test. Now that has happened, I'm expecting a call from her this week and the green light to come off it altogether.

I was also put on Statins when I received my diagnosis last May. My understanding is that this is standard in anyone with a greater than 10% risk of heart attack or stroke, even though my cholesterol scores were ok. My cholesterol scores are still ok. I'm still overweight and could still stand to lose another 50lbs or so - I'm working on it.

So my questions:
- should I be looking to come off Statins? Do they help reduce heart attack/stroke concerns if my cholesterol and Hba1c is actually fine? I dont think I'm suffering any side effects.
- I want to come off Metformin, I dont see any logic in staying on it. Surely the next step is come off it and see how that goes? My nurse is pretty conservative.
- Am I right in thinking you aren't regarded as being in remission until you have had 6 months med free and stay below a HbA1c of 40?

Appreciate peoples thoughts on this.

 

[coby]

Hi all.
Was diagnosed with T2D in May 23 with a HbA1c of 80. Dropped Carbs and sugars. Took up exercise, lost 45lbs
Have had 3 subsequent tests, with scores of 36, 34 and 34 again just last week. Have gone from 2000mg of Metformin down to 500g. I asked the nurse if I could come off it following my second 'good' score and she suggested dropping down to 500g and doing one more test. Now that has happened, I'm expecting a call from her this week and the green light to come off it altogether.

I was also put on Statins when I received my diagnosis last May. My understanding is that this is standard in anyone with a greater than 10% risk of heart attack or stroke, even though my cholesterol scores were ok. My cholesterol scores are still ok. I'm still overweight and could still stand to lose another 50lbs or so - I'm working on it.

So my questions:
- should I be looking to come off Statins? Do they help reduce heart attack/stroke concerns if my cholesterol and Hba1c is actually fine? I dont think I'm suffering any side effects.
- I want to come off Metformin, I dont see any logic in staying on it. Surely the next step is come off it and see how that goes? My nurse is pretty conservative.
- Am I right in thinking you aren't regarded as being in remission until you have had 6 months med free and stay below a HbA1c of 40?

Appreciate peoples thoughts on this.

 

[coby]

Wow, fabulous results there @Mr Hairyman so congratulations!
I cannot advice you on the statins as I always refused them and used Plant Sterols instead.
My figures have been 38 and 40 over the past three years and I recently took myself off my one tablet of Metformin per day, but only in the last couple of weeks and waiting to see how that pans out. I wish you well with remainder of your weight loss

 

[KennyA]

Hi all.
Was diagnosed with T2D in May 23 with a HbA1c of 80. Dropped Carbs and sugars. Took up exercise, lost 45lbs
Have had 3 subsequent tests, with scores of 36, 34 and 34 again just last week. Have gone from 2000mg of Metformin down to 500g. I asked the nurse if I could come off it following my second 'good' score and she suggested dropping down to 500g and doing one more test. Now that has happened, I'm expecting a call from her this week and the green light to come off it altogether.

I was also put on Statins when I received my diagnosis last May. My understanding is that this is standard in anyone with a greater than 10% risk of heart attack or stroke, even though my cholesterol scores were ok. My cholesterol scores are still ok. I'm still overweight and could still stand to lose another 50lbs or so - I'm working on it.

So my questions:
- should I be looking to come off Statins? Do they help reduce heart attack/stroke concerns if my cholesterol and Hba1c is actually fine? I dont think I'm suffering any side effects.
- I want to come off Metformin, I dont see any logic in staying on it. Surely the next step is come off it and see how that goes? My nurse is pretty conservative.
- Am I right in thinking you aren't regarded as being in remission until you have had 6 months med free and stay below a HbA1c of 40?

Appreciate peoples thoughts on this.

First off - well done.

"Remission" is "Officially Defined" these days. There has been agreement

https://diabetesjournals.org/care/a...ence-and-Characteristics-of-Remission-of-Type

that it's now defined as two sub-48 HbA1c scores at least three months apart without use of glucose lowering medication.

As you know, we are not allowed to give dosage or medication advice on the forum. I have never used statins or metformin - I know statins will reduce cholesterol - my question is whether cholesterol actually needs to be reduced. Have a read of this, for example, which shaped my thinking:

Re-evaluation of the traditional diet-heart hypothesis: analysis of recovered data from Minnesota Coronary Experiment (1968-73)

Objective To examine the traditional diet-heart hypothesis through recovery and analysis of previously unpublished data from the Minnesota Coronary Experiment (MCE) and to put findings in the context of existing diet-heart randomized controlled trials through a systematic review and...

www.bmj.com

You're doing fine, and you'll get there.

 

[Mr Hairyman]

Thanks for that @KennyA - good to have an official diagnosis for remission. That's the next target to aim for.
Statins don't have any side effects with me, so I'm not bothered for that, but it can have a bearing on things like life and travel insurance. Plus I think it's one of those things that influences future medical decisions.
I dont think I'm on Statims for Cholesterol as such - there's a belief that if you are T2D and your heart attack or stroke risk is above 10%, it's a good idea. I'm guessing there's a reason for this, but I dont understand it fully.

 

[KennyA]

Thanks for that @KennyA - good to have an official diagnosis for remission. That's the next target to aim for.
Statins don't have any side effects with me, so I'm not bothered for that, but it can have a bearing on things like life and travel insurance. Plus I think it's one of those things that influences future medical decisions.
I dont think I'm on Statims for Cholesterol as such - there's a belief that if you are T2D and your heart attack or stroke risk is above 10%, it's a good idea. I'm guessing there's a reason for this, but I dont understand it fully.

One of the catch-22 aspects of this (if you use the online Qrisk calculator) is that once someone has been diagnosed with T2 it appears not to be possible to get risk below 10%.

This is how it is for me - even if I fiddle all the other stats, I am still coming out around 13-14%. In fact my risk goes UP is I input a lower BP value, which I find hard to understand. There is no way to input a HbA1c score to Qrisk. It seems that once diagnose, it doesn't matter in the slightest for these calculations (as opposed to real life) whether my HbA1c is 34 or 134.

But if I take diabetes out.....I still score 12%. Just on my age. I am working on a solution for that.

 

[Mr Hairyman]

One of the catch-22 aspects of this (if you use the online Qrisk calculator) is that once someone has been diagnosed with T2 it appears not to be possible to get risk below 10%.

This is how it is for me - even if I fiddle all the other stats, I am still coming out around 13-14%. In fact my risk goes UP is I input a lower BP value, which I find hard to understand. There is no way to input a HbA1c score to Qrisk. It seems that once diagnose, it doesn't matter in the slightest for these calculations (as opposed to real life) whether my HbA1c is 34 or 134.

But if I take diabetes out.....I still score 12%. Just on my age. I am working on a solution for that.

Yeah, QRisk is a whole other thread I think. I wasn't aware of it before my T2D journey, and it was used to scare me into action (which in fairness, worked). I do wonder how serious or accurate it is? Things like BMI and the NHS's current official approach to T2D are old hat now. I wonder about QRisk too.
I guess anyone in their 50s with a bit of extra timber is going to be over 10%. The older we all get, the higher that % gets, no matter what we do.

 

[KennyA]

Yeah, QRisk is a whole other thread I think. I wasn't aware of it before my T2D journey, and it was used to scare me into action (which in fairness, worked). I do wonder how serious or accurate it is? Things like BMI and the NHS's current official approach to T2D are old hat now. I wonder about QRisk too.
I guess anyone in their 50s with a bit of extra timber is going to be over 10%. The older we all get, the higher that % gets, no matter what we do.

I think my point is that we are invited to make decisions based on a test that appears to be objective and rational but in practice is far from it. It all depends on the assumptions that go in to it, and we are not shown those.

 

[MrsA2]

@Mr Hairyman
I'm finding this a fascinating read

https://www.amazon.co.uk/Clot-Thickens-enduring-mystery-disease/dp/1907797769

Rexamines lots about Qrisk, statins, links to diabetes and more

 

[Lupf]

Let me add my congratulations on lowering your HbA1c. well done @Mr Hairyman.

QRisk calculators (there are several versions) are very crude. I played with them and realised the following.
They basically add roughly 10% to your risk of heart disease, when you tick the T2D box,
independent of how (well or not) you control it. In other words, according to QRisk,
it doesn't matter if your Hb1AC is in around 40 or around 100, your risk for heart disease is the same.
This can't be correct, hence I've decided that this the QRISK tool is below threshold for me,
and I am willing to argue this point, if it ever comes up.

There is a rather long thread on "Cholesterol and Statins",
with lots of information, opinions and many useful links to published studies or there discussion in the media.
You can find my view on it in a post to this thread, see

Cholesterol and Statins

If memory serves me right someone quoted on another statin thread that the surgery ( not the individual doctor) gets £1245 a year if they get enough of their patients who the nhs think should be taking a statin to take one, given surgeries now regularly have thousands of patients ...... do we...

www.diabetes.co.uk

For transparency, please note that the thread "Cholesterol and Statins" was started by a member who is now banned (bulkbiker),
but I still consider it a useful repository for information.

 

[HairySmurf]

For me at least ticking the T2 box is not putting me over the 10% mark. Based on my last bloods from a few weeks ago:
Age: 46
Male
Non-smoker
Type2
On blood pressure treatment ticked
Cholesterol/HDL ratio: 2.25
Systolic BP 130
Height 170cm
Weight 85.7

I get a risk of 7.1%
If I drop by BP to 120 I get 6.3%
I was told by doc it something like 56 or 59% based on bloods and BP in October, before going on BP meds and before weight loss
I'm guessing the 10% for T2 thing might be age or BMI weighted or similar?

QRISK3

qrisk.org