Prescribed Metformin but wondering I can do this on diet alone

[Nicole T]

It finally settled and started broadly agreeing with my meter yesterday morning. Identical readings on both, and they're 0.2 apart this morning, giving the Libre 15 minutes to catch up.

Should I be worried about that drop in the night? I woke briefly and tested at 2.4. I didn't feel at all unwell. Still not on any medication, so hypos really shouldn't be a thing for me. Is this just what happens if you sleep on the sensor? Or is something else strange going on here?

 

[HSSS]

It’s really common to see these lows overnight when you sleep on the sensor. You say tested at 2.4? I’m assuming you mean on the libre. More than likely the fingerpricks would have shown something quite different.

 

[DCUKMod]

It finally settled and started broadly agreeing with my meter yesterday morning. Identical readings on both, and they're 0.2 apart this morning, giving the Libre 15 minutes to catch up.

Should I be worried about that drop in the night? I woke briefly and tested at 2.4. I didn't feel at all unwell. Still not on any medication, so hypos really shouldn't be a thing for me. Is this just what happens if you sleep on the sensor? Or is something else strange going on here? View attachment 44169

Hi Nicole - when you say you tested at 2.4, was that a Libre scan or a blood test?

When using a Libre, I always end up going Lo (so immeasurable) for significant periods during the night. My bloods can runlow, but from my perspective, I just go with the flow, provided I feel OK.

To be honest, most of the time I know nothing about it, as I'll be asleep.

For clarity, I am not taking any diabetes related medication. My only medication is for my thyroid gland, which has lost the plot. For anyone taking meds to push their blood glucose down, the should finger prick test in these circumstances, and where a true low is found, treat it, according to their standard protocols.

 

[Nicole T]

Hi Nicole - when you say you tested at 2.4, was that a Libre scan or a blood test?

When using a Libre, I always end up going Lo (so immeasurable) for significant periods during the night. My bloods can runlow, but from my perspective, I just go with the flow, provided I feel OK.

To be honest, most of the time I know nothing about it, as I'll be asleep.

For clarity, I am not taking any diabetes related medication. My only medication is for my thyroid gland, which has lost the plot. For anyone taking meds to push their blood glucose down, the should finger prick test in these circumstances, and where a true low is found, treat it, according to their standard protocols.

I should have been clearer. Yes, it was 2.4 on the Libre. I assumed it was a misread, and didn't bother to do a blood test.

But that's 4 hours spent below 4.0 according to the Libre, and while I tend to sleep on my side, I alternate between them throughout the night.

 

[Nicole T]

And it's all gone Pete Tong. Getting false hypo readings during the day as well, now. That last read of 2.7 is 8.5 according to my meter. Less than an hour after eating, so I'd expect it to be around this level.

Which is a shame, because I've had a couple of days of staying almost flawlessly below 8.5 according to the Libre. I was finding that quite reassuring until this happened.

Time to contact Abbott perhaps?

 

[Antje77]

And it's all gone Pete Tong. Getting false hypo readings during the day as well, now. That last read of 2.7 is 8.5 according to my meter. Less than an hour after eating, so I'd expect it to be around this level.

Which is a shame, because I've had a couple of days of staying almost flawlessly below 8.5 according to the Libre. I was finding that quite reassuring until this happened.

Time to contact Abbott perhaps? View attachment 44195

Yes, do some more double checks, leave the sensor on your arm as they might ask you to check even more and give them a call!

 

[Nicole T]

It's now reading 'LO' rather than giving any figure at all. I've recently adjusted the band of the protector I had on it, which may have been a bit snug. I'm going to let it breathe for a while and then test again, but if it still isn't making sense, I'll contact them in the morning.

 

[Antje77]

It's now reading 'LO' rather than giving any figure at all.

Very annoying but perfect for them believing you without a hassle

 

[shelley262]

It's now reading 'LO' rather than giving any figure at all. I've recently adjusted the band of the protector I had on it, which may have been a bit snug. I'm going to let it breathe for a while and then test again, but if it still isn't making sense, I'll contact them in the morning.

Hiya ring them up in the morning but have some comparison figures ready for them so you can show the discrepancy between the actual blood done on your meter as compared to the sensor. Ive had this happen lots and theyve been good about replacing them BUT do want lots of figures from you to show the inaccuracy! I had one once that dived up as well as down whilst the bg meter gave a similar reading to that expected for the time of day!! My trends are for quite low readings overnight and think it seems to struggle more when it goes below 4. Good luck and write stuff down before you ring

 

[Antje77]

@Nicole T, have you encountered @Sarbak 's threads yet? For instance this short one: https://www.diabetes.co.uk/forum/threads/asking-for-a-friend-phnarr-phnarr.176966/#post-2310475 or this very long one: https://www.diabetes.co.uk/forum/threads/questions-confusion-and-frustration.176955/#post-2310468?

I find I'm starting to have to look twice to see which one of you is posting (both of you being critical of whatever you are told, you're both witty, friendly, and both of you seem to have an enquiring mind), and I think you're at comparable points in your diabetes journeys. Both of you may like to read eachother's threads.
And if I'm mistaken, simply stop reading

 

[Nicole T]

New sensor on the way, with a prepaid envelope to return the old one. Though told that unless I buy directly from them, future ones might not have the same cover. £54 from Amazon, though I can claim around £10 VAT back if I can be bothered. £48 ex VAT to buy direct. It's probably worth the extra as insurance.

 

[Nicole T]

New sensor seems to be behaving a lot better. I'm staying in range (which I have decided for myself is 4.0 to 8.5) pretty much 99% of the time as long as one don't eat anything stupid. I would say the lows are more worrying than the highs, and I wonder what the occasional 3.8 (such as the one I had midnight last night, after half a bottle of wine and two measured double G&T's) would be like if I were on Metformin. So right now, I think diet only is the safest route for me, even if a very occasional act of stupidity might take me to 13 or so.

One thing I'm noticing with Libre is that individual readings can sometimes fall outside of the recorded history. For example seeing a 13.2 on a test, but the dot sitting above the peak of 12 on the graph.

 

[bikerman1955]

Wow! I came back to see if there was a response, and I have three. Thank you all. I'd read the intro, but not the low carb higher fat advice. All good stuff to take on board.

Of course they've hit me with the triple whammy of worrying about cholesterol and blood pressure as well, though the latter's come out at a not too scary 144 over 80. Keeping everything crossed for the cholesterol results coming back as acceptable. I don't fancy statins, either.

I've just been shopping and bought the supermarket own brand wholemeal rather than the white I usually buy. Slower carb release, so less of a spike effect, if I'm understanding this correctly. Bypassed the snacks aisle completely (there'd normally be at least four packs of Toffifee in my trolley at this point) and bought some carrots to chop up and snack on, so I'm quite proud of myself there. I think my main issue is "if it's there, I'll eat it." Thankfully, living alone most of the time, I can just resist the temptation to buy junk food.

Upgrade to real butter? I think I could do that. Shame I've just bought a 2Kg tub of low fat spread, though.

Once again, thank you. With the information that's out there, it's hard to get any perspective on what's achievable. Everywhere just seems to want to talk hard figures of levels before and after food and make anything over 8.5 sound scary.

Hi I've been type two since 1999 and initially controlled it through diet and exercise for at least five years but slowly the numbers crept up.
It got to a point about 18 months ago they crept up to more than 75 and thought I needed to try and take more control but did know how, I was following all the guidelines from dietitians and nutritionists but still they weren't coming down.
Eventually I went to the internet and started following a low carb regime which brought my level down to 61 and then went on to keto and last reading was 43 and I have lost over 4 stone. So yes diet alone can help you tremendously but I would cut out as many carbs as you can as so called wholemeal/wheat can have as many carbs as the other stuff main thing read your labels hope this helps and wishing you lots of luck

 

[ianf0ster]

New sensor seems to be behaving a lot better. I'm staying in range (which I have decided for myself is 4.0 to 8.5) pretty much 99% of the time as long as one don't eat anything stupid. I would say the lows are more worrying than the highs, and I wonder what the occasional 3.8 (such as the one I had midnight last night, after half a bottle of wine and two measured double G&T's) would be like if I were on Metformin. So right now, I think diet only is the safest route for me, even if a very occasional act of stupidity might take me to 13 or so.

One thing I'm noticing with Libre is that individual readings can sometimes fall outside of the recorded history. For example seeing a 13.2 on a test, but the dot sitting above the peak of 12 on the graph. View attachment 44416

Hi @Nicole T The lows should be of no concern for you as a T2 on no diabetes medication, even if you were on Metformin they would still not be a concern. Lows are only a concern for Type 1Ds and those Type 2d's on Insulin, Glic or other powerful BG reducing medication.

The explanation for your lows is that Alcohol you consumed. Because alcohol is toxic the body prioritises dealing with it rather than converting carbs into Blood Glucose. But alcohol only delays this conversion of carbs eaten into Blood Glucose so it can cause delayed BG spikes several hours , so it's not a way of 'cheating'.

 

[Nicole T]

Hi @Nicole T The lows should be of no concern for you as a T2 on no diabetes medication, even if you were on Metformin they would still not be a concern. Lows are only a concern for Type 1Ds and those Type 2d's on Insulin, Glic or other powerful BG reducing medication.

The explanation for your lows is that Alcohol you consumed. Because alcohol is toxic the body prioritises dealing with it rather than converting carbs into Blood Glucose. But alcohol only delays this conversion of carbs eaten into Blood Glucose so it can cause delayed BG spikes several hours , so it's not a way of 'cheating'.

I'm sure I'd read that, even only on Metformin, hypos were a risk up to 24 hours after consuming alcohol. Googling suggests that Metformin "doesn't usually" result in hypos unless combined with other medication, but "doesn't usually" doesn't fill me with confidence. I'm mostly concerned from a driving point of view. I suppose I could always do a finger prick test and make sure I have some fast acting carbs if I read below 5, before driving.

My figures seem to be all over the place within the range of 4 to 8.5, but staying within those limits as long as I stick to a low carb regime. Even the occasional small portion of chips with a meal doesn't hit me hard. Then again, 5 chicken pakoras spiked me massively the other day, whereas 6 (from the same packet) on a previous occasion gave me no rise in blood sugar at all. There doesn't seem to be any logic to this.

One of the reasons I bought a Libre was to see if, when and how badly alcohol spikes me. I don't seem to pay for the carbs later on, even with beer. Thursday, I went out with friends and must have spent about 6 or 7 hours in the pub. No idea how many pints I had, but there were 3 of us, and I bought 5 of the rounds, checking my contactless transactions. I still stayed within range the whole time, and right the way through the following day.

 

[HSSS]

I'm sure I'd read that, even only on Metformin, hypos were a risk up to 24 hours after consuming alcohol. Googling suggests that Metformin "doesn't usually" result in hypos unless combined with other medication, but "doesn't usually" doesn't fill me with confidence. I'm mostly concerned from a driving point of view. I suppose I could always do a finger prick test and make sure I have some fast acting carbs if I read below 5, before driving.

My figures seem to be all over the place within the range of 4 to 8.5, but staying within those limits as long as I stick to a low carb regime. Even the occasional small portion of chips with a meal doesn't hit me hard. Then again, 5 chicken pakoras spiked me massively the other day, whereas 6 (from the same packet) on a previous occasion gave me no rise in blood sugar at all. There doesn't seem to be any logic to this.

One of the reasons I bought a Libre was to see if, when and how badly alcohol spikes me. I don't seem to pay for the carbs later on, even with beer. Thursday, I went out with friends and must have spent about 6 or 7 hours in the pub. No idea how many pints I had, but there were 3 of us, and I bought 5 of the rounds, checking my contactless transactions. I still stayed within range the whole time, and right the way through the following day.

If the lows are associated with alcohol (and metformin) then surely you won’t be driving anyway?

 

[RFSMarch]

I'm sure I'd read that, even only on Metformin, hypos were a risk up to 24 hours after consuming alcohol. Googling suggests that Metformin "doesn't usually" result in hypos unless combined with other medication, but "doesn't usually" doesn't fill me with confidence. I'm mostly concerned from a driving point of view. I suppose I could always do a finger prick test and make sure I have some fast acting carbs if I read below 5, before driving.

My figures seem to be all over the place within the range of 4 to 8.5, but staying within those limits as long as I stick to a low carb regime. Even the occasional small portion of chips with a meal doesn't hit me hard. Then again, 5 chicken pakoras spiked me massively the other day, whereas 6 (from the same packet) on a previous occasion gave me no rise in blood sugar at all. There doesn't seem to be any logic to this.

One of the reasons I bought a Libre was to see if, when and how badly alcohol spikes me. I don't seem to pay for the carbs later on, even with beer. Thursday, I went out with friends and must have spent about 6 or 7 hours in the pub. No idea how many pints I had, but there were 3 of us, and I bought 5 of the rounds, checking my contactless transactions. I still stayed within range the whole time, and right the way through the following day.

I find, with my Libre, wine makes the numbers go down. A cheeky shandy after a round of golf goes up (lemonade and beer being the sugary baddies)... but I also have to resort to a jelly baby at around about Hole 13-15 where I suddenly start to flag a lot in a round. I also find that my BG drops when I exercise (I know a lot of people rise) - just goes to show how different we are!

I ended up having to use mine to determine exactly what spiked me and in what quantities due to the nature of the job (at least... in normal times!). Now I am using it once a month just to check things are ok given I can exercise to a decent routine and cook LCHF the majority of the time.

I often get low readings and LOs on mine because I do tend to sleep from side to side and end up sleeping on it at some stage in the night. So long as during the day it gives me a decent read on my levels - then that's ok.

GP advising me to brave the walk-in blood-letting department soon for updated bloods, but with COVID levels rising in my area (allegedly, according to the app) then I might just hold off and go with Libre readings unless they suddenly spike up.

 

[Antje77]

I'm mostly concerned from a driving point of view. I suppose I could always do a finger prick test and make sure I have some fast acting carbs if I read below 5, before driving.

Driving rules only concerns diabetics on glucose lowering medication, which does not include metformin.
Readings in the higher 3's are perfectly normal in non diabetics, and for pregnant T1's the goal seems to be ranging from 3.5 nowadays, on insulin!
Without glucose lowering meds you have no obligation to test whenever, although I'd not drive if you FEEL hypo.
Feeling hypo can happen even at numbers above 10, if your body has become used to much higher numbers While those false hypo's apparently aren't dangerous, physically, it is of course dangerous to do things like driving or navigating stairs when you feel like you are dying and your brain doesn't work properly.

The reason you see everything below 4 counted as hypo is because this is the norm for T1's on insulin, the threshold of 4 is chosen to give us a bit of a safety net before dropping to dangerous levels. Of course this makes sense for T2's on insulin or sulfonylurea's like gliclazide as well.

Random fact: Countries using mg/dl instead of mmol/l use 70mg/dl as the hypo threshold. Which translates to 3.9, not 4. People like clear numbers for important things.

A 3.8 in a non diabetic or a T2 on diet only, or diet and metformin is no reason for concern, it's a perfect number!
The 3.8 being measured with a Libre also means it might well have been higher than that, and even with a fingerprick it could have been well above 4, seeing as there is a margin to the readings.

 

[Nicole T]

If the lows are associated with alcohol (and metformin) then surely you won’t be driving anyway?

I've had an AlcoDigital AL7000 breathalyser for well over a year now. It's apparently the most reliable sub-£100 unit you can buy. I use it mostly for morning after testing, and won't drive unless it shows me less than half the legal limit (and preferably zero.)

If it's a case of "you won't go hypo once the alcohol is out of your system", then happy days. I'm probably flapping over nothing.

I perhaps don't fully understand the workings of Metformin, either. I understood that it boosts insulin sensitivity, but also reduces the amount of sugar your liver releases. It's that second part that worries me, if it reduces it when I need it, since the Libre is already showing me dipping below 4 sometimes.

 

[DCUKMod]

I've had an AlcoDigital AL7000 breathalyser for well over a year now. It's apparently the most reliable sub-£100 unit you can buy. I use it mostly for morning after testing, and won't drive unless it shows me less than half the legal limit (and preferably zero.)

If it's a case of "you won't go hypo once the alcohol is out of your system", then happy days. I'm probably flapping over nothing.

I perhaps don't fully understand the workings of Metformin, either. I understood that it boosts insulin sensitivity, but also reduces the amount of sugar your liver releases. It's that second part that worries me, if it reduces it when I need it, since the Libre is already showing me dipping below 4 sometimes.

Nicole, I think you would have a way to go, well under 4 before you would be having in form of medically concerning hypo. Our livers are pretty decent at throwing out a glucose safety net.

My numbers tend to run fairly tightly, and I have numbers in the 3s virtually daily. When I dip into the 2s, I am usually very hungry, and almost always it's around a mealtime, when the gap has been quite lengthy since my last eating episode.

If my meal is ready, I just eat. If my meal isn't quite ready, and I dind myself wanting to eat a table eg, I'll just have a cup of tea, with a bit of milk in it, just to nudge me very gently upwards and stop the hunger. I'll then enjoy my meal - enthusiastically.

Whilst you're not taking any meds, I'd suggest you relax about it, unless you feel unwell.