Questions around HbA1c and Type 2 management

[RyJames]

Hi all,

First time posting on this forum - although I've been lurking for a number of years and have found lots of useful information and perspectives here.

I was diagnosed with Type 2 in November 2020 aged 33 during a routine blood test as I was generally feeling unwell. At the time of diagnosis my HbA1c was 54 so diagnosis was instant and I was then advised on how to alter my diet and lifestyle to best combat this.

At the time I was 14.5 stone (I'm 5ft 11) so not massively overweight - but I lost 1.5 stone in around 3-6 months and managed to get my HbA1c down to 42 through diet alone.

Fast forward to later in 2021 and I was advised to start on Metformin to lower my HbA1c further and protect myself in the long term, which at the beginning lowered it to 40.

During my annual check up in November with my NHS consultant, my HbA1c had risen to 42 and I was advised to up my dose of metformin to 500mg x4 a day and to begin Dapagliflozin 10mg alongside. The rationale of the consultant was that as both my parents have type 2 and also grandparents, that I'm at a very high genetic predisposition to this condition and that it would be best starting me on a higher dose as early as possible to manage this effectively.

Also to note I have hypertension (another family trait) which was currently controlled at 120/80 with a daily dose of indapamide - which the consultant advised me to drop and that the Dapagliflozin would act as a substitute combatting both my blood pressure and blood glucose in one.

I'm just curious if anyone else has been started on such high doses so early on and also if I should be alarmed at an increase in my HbA1c from 40/42 over approximately 18 months (I hadn't been eating as well as I should have been prior to the higher figure) and I'm wondering if some fluctuation is normal..

 

[ajbod]

42 is just prediabetic. I cannot understand the rush to up medication. I don't know what you eat, but i do know reducing carbs has more effect than metformin, most low carbers improve their blood pressure also. how come you are seeing a consultant, i presume for something other than diabetes. a rise from 40 to 42 is insignificant really.

 

[ianf0ster]

Hi @RyJames Such a small increase in HbA1C over 18 months if not being quite so careful about your eating would seem quite expected to me. I had a bigger increase than that when I had a tummy bug which took a total of 4 3 day doses of antibiotics (over a 1 month period because of needing to wait to see if they worked). Lots of things can increase BG on a temporary basis and some can last long enough to show up on the HbA1C as well.
I can't help with you questions about Dapagliflozin, as I have always been 100% lifestyle controlled into remission (so have never even taken Metformin).

 

[TriciaWs]

I also do not understand why with an HbA1c of 40 anyone thought you needed drugs? Apart from that what is your diet like?

My mother had T2, the grandparents on her side died young so no idea what their risk would have been but yes probably the genetic risk came from at least one of them.
My BP along with my triglycerides improve when I started low carb, in spite of dire predictions that the 'high fat' would make them worse.

 

[RyJames]

42 is just prediabetic. I cannot understand the rush to up medication. I don't know what you eat, but i do know reducing carbs has more effect than metformin, most low carbers improve their blood pressure also. how come you are seeing a consultant, i presume for something other than diabetes. a rise from 40 to 42 is insignificant really.

Thanks for the response - I was initially HbA1c 54 when I was diagnosed. Down to 42 with diet and then 40 on meds - back at 42 currently.

I’ve been under the care of the diabetes team at the hospital since then. I just presumed this was normal.

 

[RyJames]

Hi @RyJames Such a small increase in HbA1C over 18 months if not being quite so careful about your eating would seem quite expected to me. I had a bigger increase than that when I had a tummy bug which took a total of 4 3 day doses of antibiotics (over a 1 month period because of needing to wait to see if they worked). Lots of things can increase BG on a temporary basis and some can last long enough to show up on the HbA1C as well.
I can't help with you questions about Dapagliflozin, as I have always been 100% lifestyle controlled into remission (so have never even taken Metformin).

Thanks - that’s reassuring!

 

[RyJames]

I also do not understand why with an HbA1c of 40 anyone thought you needed drugs? Apart from that what is your diet like?

My mother had T2, the grandparents on her side died young so no idea what their risk would have been but yes probably the genetic risk came from at least one of them.
My BP along with my triglycerides improve when I started low carb, in spite of dire predictions that the 'high fat' would make them worse.

Thanks for the reply - I’m not too sure why I was instantly advised about metformin.

I do have high blood pressure and a mitral regurgitation so was advised to take metformin by the endocrinologist I saw (recently a different one who concurred and advised I up my dosage as it’s now more commonplace to treat earlier with medication rather than later, or so I was told).

Thanks

 

[HSSS]

Thanks for the response - I was initially HbA1c 54 when I was diagnosed. Down to 42 with diet and then 40 on meds - back at 42 currently.

I’ve been under the care of the diabetes team at the hospital since then. I just presumed this was normal.

Absolutely not normal in the nhs. Type 2 don’t usually get a consultant unless it is complex or another type of diabetes is suspected (33 and not overweight isn’t typical I admit). 54 wasn’t especially high and 42 is barely into prediabetes. And generally doesn’t even get metformin let alone a 2nd line drug under NICE guidance. Whilst genetics (fixed risks) undoubtedly play a role so do copied eating styles and patterns (modifiable risk), and it’s very hard to differentiate the two on the face of it.

I’m another one voting to exhaust more dietary efforts by way of reducing carbs before even considering a second drug (they all have side effects as well as benefits).

 

[RyJames]

Absolutely not normal in the nhs. Type 2 don’t usually get a consultant unless it is complex or another type of diabetes is suspected (33 and not overweight isn’t typical I admit). 54 wasn’t especially high and 42 is barely into prediabetes. And generally doesn’t even get metformin let alone a 2nd line drug under NICE guidance. Whilst genetics (fixed risks) undoubtedly play a role so do copied eating styles and patterns (modifiable risk), and it’s very hard to differentiate the two on the face of it.

I’m another one voting to exhaust more dietary efforts by way of reducing carbs before even considering a second drug (they all have side effects as well as benefits).

Thanks for the reply - have to admit I’m quite startled that none of what I’ve experienced would be classed as normal procedure. I was myself hoping to come off medication and not take more of it. The reason I may have had a direct consultation on numerous occasions was that I was referred to the endocrinologist was an autoimmune tendency (alopecia at the time) along with the fact that I’d been tested for a plethora of conditions, again due to a strong family link with MS.

I’ll pick this up with my GP and see if they can shed any further light. Thanks again

 

[VashtiB]

hello and welcome @RyJames

What sort of diet did you adopt to bring your levels down immediately?

I have gone the low carb route and that brought my levels back into the normal range.

I also have 2 parents and at least 1 grandparent who had type 2 diabetes. My grandmother lost an eye to it. My feeling is to try to manage on diet alone as long as possible. As someone who is insulin resistant I don't want to increase the resistance if there is another option.

I used Metformin (1 tablet a day) for a while but no longer need that.

Good luck and welcome

 

[RyJames]

hello and welcome @RyJames

What sort of diet did you adopt to bring your levels down immediately?

I have gone the low carb route and that brought my levels back into the normal range.

I also have 2 parents and at least 1 grandparent who had type 2 diabetes. My grandmother lost an eye to it. My feeling is to try to manage on diet alone as long as possible. As someone who is insulin resistant I don't want to increase the resistance if there is another option.

I used Metformin (1 tablet a day) for a while but no longer need that.

Good luck and welcome

I went super low carb and actually quite low calorie initially which got my down to 42. So is there any reason that I shouldn’t be comfortable taking metformin etc alongside a strict diet (is this making me more susceptible and less about to function naturally) long term?

Thanks again all

 

[VashtiB]

I went super low carb and actually quite low calorie initially which got my down to 42. So is there any reason that I shouldn’t be comfortable taking metformin etc alongside a strict diet (is this making me more susceptible and less about to function naturally) long term?

Thanks again all

I don't know of any reason not to feel comfortable taking Metformin. Some people do get reactions- I didn't once I changed the time I was taking it. My reason for nit taking it is my mental difficulty with having to remember to take it every day. I will admit I was also experimenting with whether I could keep my levels in the normal range without it. At the moment the answer seems to be yes provided I am low carb enough. I figure I have hopefully a few more decades to go so want to try to keep my options as wide as possible for as long as possible. I am not currently having a real problem with very low carb. I found it really difficult at first but it's now my new normal. At this stage that seems to be enough.

 

[HSSS]

I went super low carb and actually quite low calorie initially which got my down to 42. So is there any reason that I shouldn’t be comfortable taking metformin etc alongside a strict diet (is this making me more susceptible and less about to function naturally) long term?

Thanks again all

Not sure about other aspects but one to keep an eye on is b12 which can be diminished by Metformin and minimum range levels are notoriously low (compared to optimal) so it’s a long time before the nhs will take action.

 

[RyJames]

Not sure about other aspects but one to keep an eye on is b12 which can be diminished by Metformin and minimum range levels are notoriously low (compared to optimal) so it’s a long time before the nhs will take action.

Thanks - the metformin has definitely made my bowels a lot more active and my stomach a fair bit more sensitive to certain foods, otherwise I can’t say I’ve noticed any side effects whatsoever.

I didn’t know that about B12 so that’s very useful for me to keep an eye on.

 

[Weight]

Hi all,

First time posting on this forum - although I've been lurking for a number of years and have found lots of useful information and perspectives here.

I was diagnosed with Type 2 in November 2020 aged 33 during a routine blood test as I was generally feeling unwell. At the time of diagnosis my HbA1c was 54 so diagnosis was instant and I was then advised on how to alter my diet and lifestyle to best combat this.

At the time I was 14.5 stone (I'm 5ft 11) so not massively overweight - but I lost 1.5 stone in around 3-6 months and managed to get my HbA1c down to 42 through diet alone.

Fast forward to later in 2021 and I was advised to start on Metformin to lower my HbA1c further and protect myself in the long term, which at the beginning lowered it to 40.

During my annual check up in November with my NHS consultant, my HbA1c had risen to 42 and I was advised to up my dose of metformin to 500mg x4 a day and to begin Dapagliflozin 10mg alongside. The rationale of the consultant was that as both my parents have type 2 and also grandparents, that I'm at a very high genetic predisposition to this condition and that it would be best starting me on a higher dose as early as possible to manage this effectively.

Also to note I have hypertension (another family trait) which was currently controlled at 120/80 with a daily dose of indapamide - which the consultant advised me to drop and that the Dapagliflozin would act as a substitute combatting both my blood pressure and blood glucose in one.

I'm just curious if anyone else has been started on such high doses so early on and also if I should be alarmed at an increase in my HbA1c from 40/42 over approximately 18 months (I hadn't been eating as well as I should have been prior to the higher figure) and I'm wondering if some fluctuation is normal..

 

[Weight]

Medication seems very strong for an HbA1c of 42. Going from 40 to 42 seems normal over several months. 42 shows very good control. These comments are based on my own experiences. I am a few years further on. Best of luck.

 

[RyJames]

Medication seems very strong for an HbA1c of 42. Going from 40 to 42 seems normal over several months. 42 shows very good control. These comments are based on my own experiences. I am a few years further on. Best of luck.

Thanks that's reassuring - I was panicking at 42 as I thought it was a sign the metformin wasn't working due to the 2pt increase. Having read this forum more extensively I now see metformin doesn't have a huge effect on Hba1C so it was clearly my sloppy diet for a few months that caused the spike. I'm now going super low carb again and in addition these meds, hopefully I can get into the 30's and away from the PRE stage.

 

[marco2002]

Hi I've been doing low carb since 2020 and hba1c went from 52 to 41. Currently hba1c is 43. I am trying to get over the line into the normal range. Had a break from low carb at Xmas. I've been on Metformin for the last 8 years 2x500mg(am) and 2x500mg(pm). My diabetic nurse doesn't seem to want to have a conversation about reducing the dose of Metformin? I can recommend intermittent fasting too did the 16:8 and that worked well for me. My blood pressure was a lot better too. I have the white coat syndrome too lol....

 

[RyJames]

Hi I've been doing low carb since 2020 and hba1c went from 52 to 41. Currently hba1c is 43. I am trying to get over the line into the normal range. Had a break from low carb at Xmas. I've been on Metformin for the last 8 years 2x500mg(am) and 2x500mg(pm). My diabetic nurse doesn't seem to want to have a conversation about reducing the dose of Metformin? I can recommend intermittent fasting too did the 16:8 and that worked well for me. My blood pressure was a lot better too. I have the white coat syndrome too lol....T

Thanks - that's very similar to my Hba1c and to my dosage. I have been considering fasting, I'll do some research on it.

 

[Vince01]

Hi, just been reading some posts about creon capsules, I'm taking them and am now a little confused, on the "pot" it says creon 25000. But underneath (in very small letters) it says pancreatic 300mg, can anyone please help and let me know how much i am taking and is it a high dosage?.
Many thanks.

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