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Type 2 Should I be on Metformin?

R

RuthP

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Hope I’m in the right place - this is my first post... I was diagnosed with T2 diabetes around 4 years ago with an HbA1c of 5.9 and put on x1 500mg tablet of Metformin once a day. My HbA1c has gradually crept up into the mid sixes (with no change to the Metformin dose or discussion about diet) and then suddenly 10 weeks ago it came in at 7.5. My GP immediately called me in and chastised me and put me on a 2000mg dose of Metformin which I took for 4 days but stopped after feeling so lousy. Having done some research I started on a LCHF diet with intermittent fasting as soon as I stopped the Metformin. I have been in ketosis for around 8 weeks and I saw a drop in my daily BG numbers (of 8.5 through to 12.2) straight away but I am still getting readings in the high sixes and sometimes sevens in the mornings (sometimes through to lunch time - dawn phenomenon/stress?) and the rest of the time I get readings in the fives (and sometimes up to high sixes after eating). I have not seen my GP or told him what I’m doing yet but I wonder should I be on the Metformin with my BG levels as they are? In many of the posts there seems to be many of you with great BG levels - are any of you still on any meds?
 
My Hba1c came back as 42 a few weeks ago - I too gave up on the medication and rely on low carb.
I think that your blood glucose levels are going to produce something like the same number - that is, normal.
I find that eating twice a day, morning and evening, with a few grams of carbs early - maybe ten, and the rest at night seems to be best for me. If I do not eat breakfast my BG levels go high, and then plummet in late afternoon after eating lunch - your meter should show you when you are most insulin resistant, but being below 8 seemed to be what sorted out my diabetes.
I was lucky in that I have been trying to low carb for decades, and I read Dr Atkins New Diet Revolution book - the 2003 edition, for information on the way of eating - with all the information about diabetes as a bonus.
 
Welcome to the forum @RuthP if you have not seen the excellent advice from @daisy1 she will be along shortly. We can not advise you an medical matters except to say go back to your HCP and discuss any issues with them. If you can not tolerate the metformin prescribed then perhaps the slow release version will be better for you. Why did the GP chastise you when you had not had a discussion about diet? If you take your record of your bg results and diet with you the next time that you have an appointment they will provide a basis for discussion.
 
Thank you both for getting back to me and the welcome. I have been following many of the posts and have seen the helpful advice from @daisy1 thank you. I suppose I really wondered whether others with my sort of BG results are still on medication and whether it helps with dawn rises or are these elevations acceptable in other people’s opinion? I get the impression that it is not necessarily something to worry about (from reading Jason Fung’s work and Virta Health articles) but just wanted some feedback from real people going through the same daunting process. My GP I think assumed I wasn’t following the standard diabetic diet - I was so taken aback with my result and his apparent annoyance that I didn’t question him - I just sheepishly sat there feeling inadequate. I was perhaps a bit harsh about the comment of no dietary advice given as I was in fact given a cardboard cutout of a plate with pictures of meat, dairy, pasta, potatoes, fruit etc some four years ago. I am next due for an appointment in around a month’s time and will discuss my results and diet with him at that time - I guess the HbA1c just prior will reveal my progress to some degree...
 
Hi and welcome. @Rachox will I'm sure be able to offer an insight into metformin. I know that it helps many with lowering blood sugars. I chose not to take it when diagnosed with hba1c of 62 in December. My last reading was 41 in May and it's not offered under 48 (normally).

Can i ask what your typical day of eating would be. I.e. when and what.
 
You're doing perfectly fine without metformin, as are quite a lot of people here. So no, you don't have to be on it. My dawn phenomenon can make my sugars rise quite a bit too, and a wee bit of carbs in the morning will stop my liver dumping; my HbA1c was 34 this past August. (Non diabetic range). Without meds. Your numbers are much better than they were, and your doc's card board EatWell plate was bad advice. So no need to feel inadequate, when their advice actually was. Keep it up, you're doing great!
 
Hi @RuthP and welcome.

Chiming in to agree with the others. Whether to take metformin or not is your decision. Like many on here I chose not to take any meds on diagnosis. My HbA1c was 108 (12%j on diagnosis and has dropped to 30 (4.9%) through a (very) low carb diet.

It seems your BG is dropping nicely and no reason to assume that won’t continue if you stick to what you’re doing. The morning reading is often the last one to come down, so I’d focus on minimising post meal spikes.
 
Thanks everyone I feel a lot better and more confident now so I think I will continue with my plan and what I’ve been doing for the last 9 weeks or so without Metformin and see what the next HbA1c brings. My meals are pretty straight forward - generally my first meal is breakfast/lunch (I always fast at least 12 hours but more often than not, particularly in the week, I’ll fast 18 hours - I’ve done the odd 24 hour and 42 hour fast but I struggle and it doesn’t seem to bring down those morning numbers). Anyway my first meal is usually eggs and bacon and/or sausage, with a little mushroom or tomato done in butter or a cheese and tomato omelette (carbs always come in at less than 4g) and my dinner is usually just some sort of meat such as a pork chop or belly pork, or lamb chops or a high fat homemade burger with around 80g of veg such as broccoli, cauliflower, or courgettes cooked in butter, or a green salad and avocado with olive oil at around 8.30 at night. I’ll also have the odd snack of an ounce of cheese and/or salami and 1/2 an ounce of almonds or a couple of strawberries and double cream. I always aim for less than 7g of carbs in any meal. I also have the odd glass of red wine. What is considered to be a post-meal spike if for example my BG is 5.7 pre-meal?
 
Hi Ruth, thanks for the tag @Debandez . I am on Metformin, I started in 3 x 500mg/day on diagnosis in May ‘17. With it and low carb eating I achieved non-diabetic HbA1c by Sept ‘17 and have maintained my HbA1c in mid 30s since. I did recently drop to 2 x 500mg/day and have only noticed a slight rise in my blood sugars and await a new HbA1c next month. I do tolerate the medication very well and am happy to stay on two tabs a day bearing in mind it’s added benefits. Here’s an article which covers that:
https://www.lifeextension.com/magazine/2001/9/report_metformin/Page-01
 
Your meals look like low carb perfection to me.
A spike is a rise above 2.0 mmol/l. So if you're 5.7 before the meal, you should be at or under 7.7 two hours after first bite.
 
It sounds like you're doing well to me @RuthP

I've been on a similar journey - put on insulin five years ago, switched to metformin about a year ago and came off it about three months ago (my choice).

For me it's been a mix of weight loss (over four stones gone), more exercise, cutting carbs (most days I eat no more than 30g) and fasting (one meal a day most days, but with occasional extended 3/4 day fasts as well).

Fingers crossed your next HbA1C shows that what you're doing is working for you.
 
RuthP said:
I’ve done the odd 24 hour and 42 hour fast but I struggle and it doesn’t seem to bring down those morning numbers).
Click to expand...
You are doing really well. Interesting that you are also struggling with fasting over 18 hours and and don't find it brings the morning blood sugars down. I have decided to stick with 18/6.
 
It looks as if you are doing great and those morning numbers will probably gradually come into line with the others. Some people tolerate Metformin and take it out of choice, others choose not to for as long as possible. It is a matter of choice. You may find that keeping a note of what you have eaten and approximate time will start to show a pattern reflected in the numbers the following morning and be able to tweak your routine.
 
Thank you all for your kind comments and help. I’m afraid I’m still trying to work out how to use the site and forum and not doing very well! I completely lost the thread for a while there and I’m not sure if I’m typing this in the right box!
 

Easy to get lost on this forum, but you will soon get used to it. Yes, you typed in the right box!

You are doing brilliantly, and that diet is spot on perfect. The Metformin decision is entirely yours to make. I have never taken any meds, although to be fair, none have been prescribed for me as my HbA1c on diagnosis was only 53. Metformin makes hardly any difference to blood sugar levels other than a bit of help with Dawn Phenomenon as it helps reduce the amount of glucose made in the liver. It doesn't help with post meal spikes. (2mmol/l and above at 2 hours after first bite) You asked what a spike is - 2mmol/l is the upper limit, it is preferable to keep it a lot less than that.

The Dawn Phenomenon is caused usually by insulin resistance as our insulin is unable to clear all the glucose released by the liver to wake us up and get us going in the morning. As our insulin resistance improves, so will our fasting and morning numbers. There isn't a great deal we can do about it apart from conquering insulin resistance, but we can help stop the levels rising all morning by eating something fatty and/or protein, such as eggs as soon as possible after getting up. Or even a coffee with double cream can help if you don't want a breakfast.
 
You might soon see lower numbers - but be prepared for some bouncing about as your metabolism tries to right itself and staggers about a bit - that was all I could put it down to, part of the process of recovery, when I saw the numbers on my meter.
I ended up with normal results, and have seen them for a year or so, but in the first few months it was - interesting.
 
Well I stuck to my guns - no Metformin and had my HbA1c checked on the 6th November...

On the 13th July, 2018, it was 7.5% (59 mmol/mol) and drum roll... on the 6th November it was 5.1% (32 mmol/mol) without drugs! So just under 4 months of LCHF alone brought my numbers into the realms of “normal” - I’m pretty amazed!

I told my diabetes specialist that I had been following a ketogenic diet and, whilst saying I had good blood work, he told me that I needed to eat some toast for breakfast and potatoes with veg and chicken or fish for lunch and dinner, and of course fruit (because my brain needs carbs). He told me that this was the best way of eating - he said that after all this was the way he ate and he didn’t have diabetes! I nearly pointed out that that was precisely why he was able to eat that way but I just grinned and said OK - realising that he didn’t have a clue. I thought of Gary Taubes. So neither my specialist nor my GP have been of much help or support on this journey.

Other tests that may be of interest:
Total Cholesterol down from 5.3 mmol/L to 4.5
Triglycerides down from 1.3 mmol/L to 0.8 (my understanding is that if less than 1.0 there are no small dense particles of LDL)
LDL down from 3.3 mmol/L to 2.7
HDL constant at 1.4 mmol/L

I asked the GP for an Insulin test but he wouldn’t budge - “we already know you’re insulin resistant” he told me... so I got it done privately along with a fasting glucose test at the same time - results are as follows:

Fasting BG 6.0 mmol/L (still getting a bit of the “dawn phenomenon”)
Fasting Insulin 7 mU/L (less than 10 considered normal insulin sensitivity by the LAB)
Plugging these figures into the HOMA-IR test formula, I haven’t got my calculator on me but from memory, the result was 1.96 - borderline, so still a bit of work to do there. It’s such a shame that I had no previous results against which to compare this - I can only assume it was quite a bit higher.

For anyone still on the fence regarding low carb for Type 2, I hope this gives you inspiration. Oh I almost forgot, whilst not as impressive as some, I have lost 13kg over those 4 months.
 
@RuthP those results are remarkable. Your doctor is an idiot. How else did he suppose you had achieved those results unless it was a low carb diet? And he (and the NHS) still want us to eat bread and potatoes daily, and fill ourselves with fruit. Pffuff. Very well done, have a gold medal.
 
@RuthP
Superstar results indeed and with such a lack of support from your HCP's you have done a sterling job. Well done you for taking control of your life and health.
 
Hi
He was a smart doctor
When he consider this level of hba1c 5.9 diabetes
 
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