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Questionable diagnosis...?

B

bigalxyz

Active Member
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44
Hello forum,

I'd be interested in anyone's thoughts on this (in advance of me discussing with my new GP on Monday):

* 42yo male. No family history of diabetes at all.

* Blood test in May 2011 showed HbA1c of about 9.5% and sharply elevated blood glucose (17ish IIRC). Repeat test a couple of days later showed virtually the same results.

* GP immediately said "this is type 2 diabetes - here's a prescription for 1500mg of metformin daily". I was gutted & quite angry too (although I'm not sure what or who the object of my anger was - probably me, for allowing myself go to seed so badly).

* Took the metformin - some stomach cramping for the first month or so but otherwise well tolerated, no side effects.

* Repeat blood test 3 months later showed HbA1c down to 6.3%. Repeat blood test another 3 months later showed HbA1c down further to 6.1%.

GP happy with the fall in the numbers but then started talking about cholesterol, statins, etc. He seem very keen to medicate aggressively (I eventually was able to convince him via home monitoring that my BP is ok).

A number of unanswered questions in my mind:

* in the period running up to the diagnosis, I was - for various reasons (long and boring story) not taking care of myself at all. I was smoking, drinking very heavily and my diet suffered too. And I took almost no exercise - a walk to the end of the street was a major outing. I rarely got out of bed, in fact - didn't wash, didn't change clothes, didn't clean my flat, empty the bins, etc. - nothing.

* I never had any of the textbook symptoms except - for some reason - a period of about 2 weeks where I was unexpectedly extremely thirsty, drinking 12-15 pints of liquid daily (and peeing like a racehorse!). This resolved itself quite quickly though, but I still don't know what caused it. It coincided with stopping smoking, but I've no reason to think that the two are causally linked.

* I was also taking duloxetine, a med which I've heard can cause blood sugar levels to rise

* I've been led to believe that the metformin wouldn't by itself cause such a big fall in blood sugar as that that I've observed

* I was never offered a glucose tolerance test

* I've read since that some cases of hyperglycemia can be temporary, transient - caused by infections, stress, medications, etc.

* I've quit smoking, become much more physically active (can now walk 20+ miles), tightened up on my diet (very low carb) and - with a few rare exceptions - I've stopped drinking alcohol. I've lost weight too (inevitably I suppose, given the other changes I've made).

I'm left wondering if there is a bit of a question mark over the T2 diagnosis. Could I have a point here, or am I just in denial & desperately clutching at straws?! Is there any sense in which type 2 diabetes is 'temporary', partially or completely reversible, etc.?

Thanks
Alan
 
Hi Alan

Whatever the case it looks like you're well under control so well done on that!

The heavy thirst and peeing are classic symptoms of diabetes.

You are correct that Metformin won't make your BG's fall that much but adopting a low carb diet certainly will. People on the forum who do go low carb can get the same results as you have done within just a few weeks, some have done it in days. Metformin will reduce your BG's by around 1 to 2 pts. Its biggest benefit is that it helps to stop your blood sugars spike after eating. It's a safe and effective drug and doesn't put any additional stress on your pancreas.

Even though your HbA1c is now 6% thats still above the normal non diabetic who would be in the high 4's. At 6.1% you're averaging BG levels of just over 7 again a non diabetic range would be somewhere in the low 5's.

What I would do is buy a blood glucose meter and test yourself before and at +2 hours your main meals for a while and see if you keep below the magic 7.8 max number. If you are low carbing (like me) you probably will so you need to give yourself a fair test and try and eat a few "normal" carb or sugary things and see what your meter says.

You can pick up a good meter on eBay. Called an SD CodeFree from healthcare.co.uk eBay shop. With 50 test strips it will cost you less than £20. If you get one make sure you buy the UK mmol/l model and not the US mg/dl model or the numbers that come up will confuse everyone!

Other BG magic numbers to think about if you test.

19 out of 20 non diabetics would get a score of less than 6.5 on an average carb meal.
3 out of 4 non diabetics would get a score of less than 5.5 on an average carb meal.

Even if you are diabetic and end up having to pretty much lowish carb from now on you can still get those non diabetic scores so its not the end of the world and if you continue to lose weight it maybe that you will recover some of your carb eating ability as your insulin resistance will begin to drop.
 
Like a crocodile, you are in denial (de Nile). :lol:

Original tests confirm T2.

Subsequent results show that you can make a major difference to your health by diet and exercise, which coupled with Metformin can improve your BG control enormously.

HbA1C of 6.1% is good for a person with diabetes, but non-diabetics should see 3.5%-5.5% and people on this forum have got down into the 5s by following good regimes.

You can achieve levels similar to people without diabetes, but that does not mean you are not diabetic - you are just a very well controlled diabetic.

However, being a very well controlled diabetic is not a bad thing.

Cheers

LGC
 
I am definitely diabetic, but have Never had a glucose tolerance test. They are not always performed, nor are they always necessary. An HbA1c of 9% is diagnostic of diabetes, especially if repeated and consistent. I believe that quite often HbA1c of 7% is considered diagnostic. since that is a target for "Good Control" that is something I'd question.
Hana Rous
 
Thanks all.

*sigh*

GP is throwing statins at me (simvastatin 40mg daily) as well but they seem to have made me feel quite unwell - tired, listless, depressed. If this is the price I have to pay for a small reduction in mortality, I'm not sure it's worth paying! To be raised with new GP (after recent house move) next week. Am somewhat cynical about the medical professions obsession with cholesterol.

Am taking 4 different prescription drugs at the moment - 3 years ago I felt as fit as a fiddle & wasn't taking anything. Am a bit fed up of popping pills all day. I can live with the metformin & I don't doubt its usefulness. As for the other stuff - not so much...
 
Hi Alan! :wave:

Are you still taking the Duloxetine? And, if you've stopped was it a gradual stop? There are some quite nasty side effects of stopping this drug abruptly, so I wondered if that, rather that the Statins/Metformin, was making you feel bad. Could your diabetes meds be reacting with anything else you take? MH is on so many meds he fairly rattles, but the GP was meticulous in checking all of the combinations for complications.

MH was told to take his statins at night as this would render them more effectual and he would, hopefully, sleep through any side effects.

Julia
 
Hello Julia - no, I'm not taking the duloxetine any more - I stopped with that almost a year ago - didn't have any withdrawal effects (or any effects at all, in fact - for me they were totally inert).

My prescription says take the simvastatin at night as well, and I've done that, but my concern about the side-effects remains. Have had a few instances of memory loss recently as well - nothing major, just inability to recall certain things, more than usual. Everything else about my medication 'regime' has been constant for 6 months or more.
 
Alan,

I would definitely bring these things up when you see your new GP. MH has had memory problems for sometime, but we now think that these were symptoms of the diabetes before we knew he had it. I'm hoping he'll start to finish his sentences and have some recall of where he's put things (my glasses), or what he's doing in a certain room......the best instance of that was walking into the lavatory and forgetting what he went in there for :wink:

I think you're doing hugely well, and the posts suggest that, since your initial diagnosis, you've come a long way. If you've beaten those demons, you can beat this one with good diet and exercise too. I most certainly think you have the determination.

MH was diagonsed about three weeks back and told last week that he could stop taking any diabetes medication permanently if he continues with his diet and loses weight. Our GP is all for this plan, although Nurse Death is a drugs fanatic and wants him to take more and more Metformin. I think she's on a retainer from the drugs companies....

Julia
 
bigalxyz said:
Thanks all.

*sigh*

GP is throwing statins at me (simvastatin 40mg daily) as well but they seem to have made me feel quite unwell - tired, listless, depressed. If this is the price I have to pay for a small reduction in mortality, I'm not sure it's worth paying! To be raised with new GP (after recent house move) next week. Am somewhat cynical about the medical professions obsession with cholesterol.

<snip>.
Click to expand...

Ask your GP for a different statin.

Simvastatin reduced me to a virtual zombie - I was having to lie down and sleep in the middle of the day to get through a full day. Mind wooly, fed up etc.

I stopped the Simvastatin and immediately felt loads better - it was like someone turning the light back on.
You might consider stopping the statins for a few days to see if you feel better without them.

If you follow the Low Carb High Fat (LCHF) route then statins can be your friend if you are on a brand which you can tolerate.

I am now on Pravastatin which seems to be O.K. for me.

Cheers

LGC
 
Thanks. Have stopped for a few days a couple of times & both occasions I've felt better with 24 hours and MUCH better within 48 hours. Swap to another statin may be a possibility - I'm not ruling that out & if GP suggests it, I'll keep an open mind.

Still...

The latest I've heard - from a Cochrane Collaboration systematic review - was that the difference in overall mortality in people without pre-existing heart disease (ie when statins are used for primary prevention, not secondary prevention) is very small for men (arguably not worth it given given the potential for side-effects) and zero for women. At least I *think* that's what the review said - I guess I should double-check because it's a while since I looked.

One wonders if the same would be true if a study was carried out but restricted either (a) to diabetics (b) to T2 diabetics or (c) to *well-managed* T2 diabetics - but I haven't seen those numbers (yet!). Might paint a slightly different picture I suppose.

The evidence of benefit for secondary prevention (ie where heart disease is already known to be present) is rather stronger, I gather, but I'm not in that camp and I hope it stays that way!
 
you're not alone in the pill taking Alan.... I'm not even 40 yet and I tell people I think I'm rattling. It's a sad affair when your life revolves around what time is it? oh I to take my pills, or inject, or whatever. lol. Thankfully I've not been put on cholestrol meds as yet... but I am on a blood pressure med, ramipril. My GP and endo advised me that their job is to protect me and prevent serious complications. Although here you can't get on cholestrol medication without paying a bomb unless you're over 6.5 cholestrol reading. I've always been under that, so I haven't qualified. I believe cardiologists here are lobbying the government for discounted meds for diabetics. hmmm.... just means if I'm placed on statins I get to pay $35 per month instead of $100 or something. I've not heard good things about those statins anyhow.
 
Yeah it's a little easier in the UK - diabetics can get an exemption certificate which means that (AFAIK) every prescription med I ever need again (for any illness, not just diabetes) for the rest of my life will be free of charge. That's quite a perk!

My cholesterol has usually been 5.5-6 ish which is not out of the ordinary at all but most doctors seem to be paranoid about it (and I think they receive extra government funding if they're able to demonstrate that they're getting their patients' cholesterol levels down) and throw statins around like sweets. Have just read Malcolm Kendrick's book "The Great Cholesterol Con" where he argues - pretty persuasively IMHO - that cholesterol has very little to do with heart disease & that we shouldn't really worry about it - while conceding that statins can still be useful (albeit for reasons unrelated to their effects on LDL cholesterol) for certain groups - typically men with pre-existing heart disease.
 
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