Prescribed Metformin but wondering I can do this on diet alone

[HSSS]

What

I think I've mentioned this earlier, but the Libre reveals that light exercise (pedalling my e-bike, using the motor to go uphill) spikes me quite badly, whereas working up a sweat and a 140-160 bpm heart rate, and making my legs ache on my exercise bike, does not. I think exercise releases sugar, but the exercise has to be quite intense for me to actually burn it off.

What happens several hours after the exercise induced spike? I’ve read a fair few people reporting that initial spike but then lower levels for a noticeable period afterwards giving an overall improvement both in the 24 hr picture and in overall insulin sensitivity

 

[Nicole T]

What

What happens several hours after the exercise induced spike? I’ve read a fair few people reporting that initial spike but then lower levels for a noticeable period afterwards giving an overall improvement both in the 24 hr picture and in overall insulin sensitivity

I can't say I've noticed it lower afterwards. But then my levels are generally all over the place in the range of around 4 to 8mmol/L.

New lesson today: never trust a sausage unless you can read the nutritional label. I asked the Holiday Inn Express for some bacon and sausage (no bread) for breakfast, and they gave me 4 of each. Can't imagine the bacon was responsible for this...

 

[HSSS]

I can't say I've noticed it lower afterwards. But then my levels are generally all over the place in the range of around 4 to 8mmol/L.

New lesson today: never trust a sausage unless you can read the nutritional label. I asked the Holiday Inn Express for some bacon and sausage (no bread) for breakfast, and they gave me 4 of each. Can't imagine the bacon was responsible for this... View attachment 44766

Sausages are notoriously variable. And I can’t imagine they use high meat content ones with few carb laden fillers.

 

[Goonergal]

I can't say I've noticed it lower afterwards. But then my levels are generally all over the place in the range of around 4 to 8mmol/L.

New lesson today: never trust a sausage unless you can read the nutritional label. I asked the Holiday Inn Express for some bacon and sausage (no bread) for breakfast, and they gave me 4 of each. Can't imagine the bacon was responsible for this... View attachment 44766

I learned a similar lesson not long after diagnosis in a hotel in York. Sausages almost always off the agenda away from home.

 

[Hotpepper20000]

I never have sausages when I’m out. In my experience, especially in hotels the sausages are not high quality.
Bacon or Canadian bacon is my go to.
Also I don’t have omelettes either.
I’m never sure if flour or corn starch is added to make it “fluffy”

 

[KK123]

I think it is unfortunate (although totally understandable) that general rules are applied to everyone.

T1s are given guideline levels based on time in target, standard deviation, and upper and lower bg limits, because of long term complication risks. For them, the risk is less about beta cell damage (they are already gone or going), and more about damage from high blood glucose and - possibly - hyperinsulinemia, depending on their level of resistance.

Yet no one in orthodox medicine seems to recognise that T2s benefit from tighter targets. T2s don't just have to factor in hyperinsulinemia and long term damage from high blood glucose. They also need to know that every single blood glucose spike above (approx) 7.8mmol/l is likely to be killing beta cells (called glucotoxicity) and causing progressive damage with the knock on effect that their diabetes will worsen over time. Some people (I think it is Bernstein) argue that beta cell damage begins even lower, and suggest staying under 6.6mmol/l at all times.

If anyone wants to see the research on this, then the www.bloodsugar101.com website has links to the studies and analysis of them, and Bernstein discusses bg targets and the reasoning behind it repeatedly in his books and videos.

Consequently, in my opinion assigning an upper target of over 7.8mmol/l for any length of time whatsoever, is likely to lead to a progressive worsening of T2.

Sorry to be the bearer of bad news, and feel free to ignore me! But I feel (quite strongly) that looking for ways to expand and extend target ranges will (over time) backfire badly causing cumulative damage. This includes the brief spikes that are usually considered 'acceptable' in the 2 hours after eating.

I sometimes wonder whether the targets set for any type is more to do with what they think the 'average' person will be able to achieve! Similar to the wonderful eat well plate that is hardly a target to be aiming for for anybody, but it's what the 'experts' think is all anyone can manage or aspire to. In my opinion they don't give the general public much credit and assume it will all be too hard for us. I do understand the sentiment behind it but they really should widen it somewhat or at least advertise that there can be many different approaches. x

 

[Nicole T]

I sometimes wonder whether the targets set for any type is more to do with what they think the 'average' person will be able to achieve! Similar to the wonderful eat well plate that is hardly a target to be aiming for for anybody, but it's what the 'experts' think is all anyone can manage or aspire to. In my opinion they don't give the general public much credit and assume it will all be too hard for us. I do understand the sentiment behind it but they really should widen it somewhat or at least advertise that there can be many different approaches. x

I think it's more statistics than individual's wellbeing driven. When you crunch the numbers, you probably find that chucking drugs at people and suggesting easily made modifications to diet is the most cost-effective way of managing diabetes at a national level.

Of course as the person who has to deal with the real world consequences of your own illness, you want a better than average outcome. You ideally want the best possible outcome for you, or realistically a good compromise between that and a reasonable quality of life in other areas.

It does seem we're stuck with tailoring our own solutions if we want to be on the good side of the bell curve. I thought I was doing well staying below 8.5, 95%+ of the time most days, but a few people (even outside of these forums) have told me I should be aiming to keep my figures in the 4's and 5's, and shouldn't be satisfied with the high 6's to 7's that I'm getting most of the time.

 

[MrsA2]

I was reading on another forum that in the US, Dairy Queen, a well know chain, adds pancake batter to its omelette. If you are keto or low carb you have to request "omelette with real egg"!!!!!

 

[mojo37]

I was reading on another forum that in the US, Dairy Queen, a well know chain, adds pancake batter to its omelette. If you are keto or low carb you have to request "omelette with real egg"!!!!!

It comes to something when you have to ask for an omelette to be made with real egg !

 

[Andydragon]

It comes to something when you have to ask for an omelette to be made with real egg !

Well doesn't America do cheese in a can?
Hopefully this amazing trade deal, ahem, keeps all of that fake food a long way away from us

@Nicole T yes aiming for lower than 8.5 is a good aim, that's averaging 52 in the hba1c and whilst not exact of course, with margins of error is somewhat high given NHS recommendation for type 2 is 48 or below (more like 7.8 on the finger tests).

https://www.diabetes.co.uk/hba1c-to-blood-sugar-level-converter.html

If possible to get lower and out of diabetic range then it's even better.

But we all have to decide our best approach and I'm surprised the doctors haven't told you want they want to see. Although to be honest, they aren't always right either!

What I found was running higher tends to keep increasing as your body is under more is more strain. Not scientific but my bloods kept increasing, as did my drugs. I couldn't maintain without major changes.

It's cause we care

 

[mojo37]

Well doesn't America do cheese in a can?
Hopefully this amazing trade deal, ahem, keeps all of that fake food a long way away from us

@Nicole T yes aiming for lower than 8.5 is a good aim, that's averaging 52 in the hba1c and whilst not exact of course, with margins of error is somewhat high given NHS recommendation for type 2 is 48 or below (more like 7.8 on the finger tests).

https://www.diabetes.co.uk/hba1c-to-blood-sugar-level-converter.html

If possible to get lower and out of diabetic range then it's even better.

But we all have to decide our best approach and I'm surprised the doctors haven't told you want they want to see. Although to be honest, they aren't always right either!

What I found was running higher tends to keep increasing as your body is under more is more strain. Not scientific but my bloods kept increasing, as did my drugs. I couldn't maintain without major changes.

It's cause we care

yuk cheese in a can ! is that to go with the bleached chicken I wonder :***:

 

[Nicole T]

Well doesn't America do cheese in a can?
Hopefully this amazing trade deal, ahem, keeps all of that fake food a long way away from us

@Nicole T yes aiming for lower than 8.5 is a good aim, that's averaging 52 in the hba1c and whilst not exact of course, with margins of error is somewhat high given NHS recommendation for type 2 is 48 or below (more like 7.8 on the finger tests).

https://www.diabetes.co.uk/hba1c-to-blood-sugar-level-converter.html

If possible to get lower and out of diabetic range then it's even better.

But we all have to decide our best approach and I'm surprised the doctors haven't told you want they want to see. Although to be honest, they aren't always right either!

What I found was running higher tends to keep increasing as your body is under more is more strain. Not scientific but my bloods kept increasing, as did my drugs. I couldn't maintain without major changes.

It's cause we care

The nurse at my GP practice told me to try to keep it below 9. Researching it myself, that's wrong for a T2, and is the UK recommendation for a T1.

If you maintained a steady 8.5, then that would equate to the 52. However (as I understand it) the UK recommendation for Type 2 is to not exceed 8.5, ignoring spikes immediately after meals. The US one is not to exceed 10, but that's including after-meal spikes. Since these are upper limits, your average should be somewhere below them, as long as you stick to them most of the time.

My current Libre (which tends to overread) has seen me peak around 8.5 once already this morning, however my average for the last 24 hours is currently 6.5, and it typically sits in the range mid 6's to low 7's.

 

[Nicole T]

Another 7+ blood reading this morning. Nuts to it, I'm going to try the Metformin, probably starting Monday. Hopefully a minimal dose will tweak things down somewhat.

 

[Nicole T]

An interesting experiment last night, and I'm wondering what others' thoughts are on the results. I made a paella, of which my portion was 75g of dry rice (not sure of the cooked weight) but I boiled the rice for 5 minutes, before thoroughly rinsing in cold water, to try to flush out a lot of the starch. I got a spike according to Libre, but on blood, my 2 hour PC was only 0.3 mmol/L elevated from my AC immediately before eating. Sounds like a pretty good result so far.

But...

I can normally manage at least 95% in range (4 to 8.5 mmol/L) on my Libre. Some days I even manage 100%. Right now (around 20 hours after having this meal) I've spent only 69% in range over the last 24 hours, though look to have peaked lower than 11.5 at all times. My average over the period is 8 mmol/L when I can usually keep it in high 6's to low 7's.

Libre seems to be running around +1 mmol/L against blood at the moment, which falls within the usual +0.5 to +1.5 range I'm finding with it.

My girlfriend is here, which means we're drinking strong coffee by the bucketload, too (I'm not a big coffee drinker when I'm on my own.) So perhaps that's part of it, too. I certainly wouldn't have thought it was possible for a single meal to spike me for that long, but I can't think what else would have done it.

 

[Andydragon]

An interesting experiment last night, and I'm wondering what others' thoughts are on the results. I made a paella, of which my portion was 75g of dry rice (not sure of the cooked weight) but I boiled the rice for 5 minutes, before thoroughly rinsing in cold water, to try to flush out a lot of the starch. I got a spike according to Libre, but on blood, my 2 hour PC was only 0.3 mmol/L elevated from my AC immediately before eating. Sounds like a pretty good result so far.

But...

I can normally manage at least 95% in range (4 to 8.5 mmol/L) on my Libre. Some days I even manage 100%. Right now (around 20 hours after having this meal) I've spent only 69% in range over the last 24 hours, though look to have peaked lower than 11.5 at all times. My average over the period is 8 mmol/L when I can usually keep it in high 6's to low 7's.

Libre seems to be running around +1 mmol/L against blood at the moment, which falls within the usual +0.5 to +1.5 range I'm finding with it.

My girlfriend is here, which means we're drinking strong coffee by the bucketload, too (I'm not a big coffee drinker when I'm on my own.) So perhaps that's part of it, too. I certainly wouldn't have thought it was possible for a single meal to spike me for that long, but I can't think what else would have done it.

When I have high carbs for evening meal, like pizza or fish and chips, I read higher than usual first thing in the morning, over 12 hours later as well as 2 hours after eating. I don’t have libre or anything but I could easily imagine that it isn’t just a short term rise

which given food takes quite a while to digest, maybe isn’t that unexpected (not a biologist, this may be rubbish!)

 

[DCUKMod]

An interesting experiment last night, and I'm wondering what others' thoughts are on the results. I made a paella, of which my portion was 75g of dry rice (not sure of the cooked weight) but I boiled the rice for 5 minutes, before thoroughly rinsing in cold water, to try to flush out a lot of the starch. I got a spike according to Libre, but on blood, my 2 hour PC was only 0.3 mmol/L elevated from my AC immediately before eating. Sounds like a pretty good result so far.

But...

I can normally manage at least 95% in range (4 to 8.5 mmol/L) on my Libre. Some days I even manage 100%. Right now (around 20 hours after having this meal) I've spent only 69% in range over the last 24 hours, though look to have peaked lower than 11.5 at all times. My average over the period is 8 mmol/L when I can usually keep it in high 6's to low 7's.

Libre seems to be running around +1 mmol/L against blood at the moment, which falls within the usual +0.5 to +1.5 range I'm finding with it.

My girlfriend is here, which means we're drinking strong coffee by the bucketload, too (I'm not a big coffee drinker when I'm on my own.) So perhaps that's part of it, too. I certainly wouldn't have thought it was possible for a single meal to spike me for that long, but I can't think what else would have done it.

Leaving aside the specifics of the numbers, that's almost exactly what pasta used to do to me. No alarming rise, just low, slow and prolonged.

Having never been a huge pasta consumer (although lasagne was extremely convenient at times), I just gave it up. Nw gluten-free, there's no going back anyway.

It's up to you where you set you acceptability and risk dials, and therefore what numbers are "OK" for you, but with those numbers, in my world, rice would either be a once in a while, or not at all option

 

[Nicole T]

Well I've invested in a new Libre (just waiting for it to settle in - still getting some crazy readings) and filled my prescription for Metformin. I'm going to start taking one a day with breakfast and see if it impacts my averages, which seem to settle just below 7 unless I do something stupid. I appear to be stuck waking up to 6's and 7's, otherwise, and while that's keeping below 8.5, it's higher than ideal. This morning's figures aren't good at all, but I've spent most of the night sweating and shivering with either mild food poisoning or a water infection (I was getting symptoms of both.) Probably not the best time to start an experiment.

Still more than a little nervous about alcohol interaction, both from the perspective of going hypo and lactic acidosis. Though the latter seems to be an almost theoretical possibility, with the one study I found failing to record a single case of it. The trouble, of course, is the NHS using every opportunity at its disposal to shove its "thou shalt not have more than two units of alcohol per day" mantra at you. All it will advise is that it's okay to drink in moderation. Like a lot of people, it's not unusual for me to get through several beers on a Friday or Saturday night. Maybe up to 10 on a night out, once the virus allows it again.

I suppose I wanted to save medication for when I really needed it. But if my current levels (even staying below 8.5, 95%+ of the time) are slowly harming me, maybe the time for it is now. And surely 500mg of Metformin a day must be lower risk than 2000mg. Anyway, let's consider this an experiment. If 500g actually brings down my averages significantly, then I decide where I go from there. If it doesn't, then I'll just stop taking them.

I probably need to change my sig, now.

 

[OB87]

I wanted to save medication for when I really needed it too and tried for a couple of weeks without it but I've now decided to take one 500mg metformin tablet in the evening with dinner and it has helped. My readings 2 hours after dinner are usually between 5 and 7. I've reduced carbs but not completely restricted. My fasting levels are higher between 6 and 7.5 sometimes abit more. I'm only 3 weeks in so I'm hopeful if I can lose weight that will help as well. I'm considering taking another dose of the metformin though to help reduce the fasting levels

 

[DCUKMod]

Well I've invested in a new Libre (just waiting for it to settle in - still getting some crazy readings) and filled my prescription for Metformin. I'm going to start taking one a day with breakfast and see if it impacts my averages, which seem to settle just below 7 unless I do something stupid. I appear to be stuck waking up to 6's and 7's, otherwise, and while that's keeping below 8.5, it's higher than ideal. This morning's figures aren't good at all, but I've spent most of the night sweating and shivering with either mild food poisoning or a water infection (I was getting symptoms of both.) Probably not the best time to start an experiment.

Still more than a little nervous about alcohol interaction, both from the perspective of going hypo and lactic acidosis. Though the latter seems to be an almost theoretical possibility, with the one study I found failing to record a single case of it. The trouble, of course, is the NHS using every opportunity at its disposal to shove its "thou shalt not have more than two units of alcohol per day" mantra at you. All it will advise is that it's okay to drink in moderation. Like a lot of people, it's not unusual for me to get through several beers on a Friday or Saturday night. Maybe up to 10 on a night out, once the virus allows it again.

I suppose I wanted to save medication for when I really needed it. But if my current levels (even staying below 8.5, 95%+ of the time) are slowly harming me, maybe the time for it is now. And surely 500mg of Metformin a day must be lower risk than 2000mg. Anyway, let's consider this an experiment. If 500g actually brings down my averages significantly, then I decide where I go from there. If it doesn't, then I'll just stop taking them.

I probably need to change my sig, now.

Nicole, be aware that Mettformin works on a therapeutic dose basis, so it usually takes a while to have any impact on your symptoms or numbers.

 

[Alexandra100]

I never have sausages when I’m out. In my experience, especially in hotels the sausages are not high quality.
Bacon or Canadian bacon is my go to.
Also I don’t have omelettes either.
I’m never sure if flour or corn starch is added to make it “fluffy”

Upsettingly, if you check the packets, most bacon has sugar added. I think only the best quality, probably organic, will not. I was horrified when a diabetic friend told me about a recipe for omelette he was enthusiastic about trying, which included some flour. I told him I had never heard of putting flour in an omelette. He thought it was to make it set, but of course heat alone will make eggs set. Sadly, I think he didn't believe me. In the end the omelette wasn't even nice! I suppose fried eggs would be safe from flour, but will often be from battery hens. However I notice that cafés frequented by students (often vegetarian or vegan) advertise that their eggs are indeed free range.