Steady rise in HBA1C - no change in diet?

[1970clea]

Hi all,

I was diagnosed 10 years ago and switched my way of eating to LCHF, which I have maintained along the way. I changed doctors and consequently my Metformin SR was changed to to the cheaper Sukkarto option. Since then my HBA1C has gone up by a couple of points every time it has been tested and in December came back with an HBA1C of 50. Neither my diabetic nurse or myself were happy about that and I briefly raised my concerns about the generic medication. She said it could be changed back to Metformin but first wanted me to try Forxiga.

Once I had put the phone down and researched the drug I was less happy with that as the side effects do not look nice. Having read around, I take a cranberry supplement and drink lots during the day - so far so good - no ill effects. I worry that on my return to school (teacher) I will find it considerably harder to maintain the increased fluid intake. Also I have been testing more than I had been and until yesterday (13th day of Forxiga) couldn't see any change in my bgs. However, yesterday was finally a good day. Should it be taking this long to kick in? I cannot stress enough that my diet has not changed - I do not eat bread,pasta,rice, potatoes. The occasional biscuit had crept in and I have been a lot stricter with that since the HBA1C came in.

Any thoughts, anecdotal evidence, help? It would be appreciated. I am 50 years, hypothyroid (medicated), reasonably active - again less so than I used to be, 142lb. Ask me if there is anything else you need to know.

Thanks,
1970clea

 

[bulkbiker]

I'd suggest trying to keep a detailed food diary for a week and checking how many carbs you are really having.
The little devils can slip in all over the place.
Then you could maybe take some steps to reduce them in an attempt to come off the meds?

 

[1970clea]

I'm really not sure what else can come off my diet - I eat meat, vegetables, cheese, eggs, greek yoghurt, nuts - all food is home prepped so things can't sneak past - so on the odd occasion I am consuming something I shouldn't I do know I am doing so. I learnt how to do this way of eating from US Diabetes Forum and it has served me well - that was my point I absolutely have not changed my way of eating - I would 'fess up to it if I had! Promise. It is not always the case that people struggling can be fixed with dietary changes - and I already keep a food diary with my bgs.

 

[JoKalsbeek]

I'm really not sure what else can come off my diet - I eat meat, vegetables, cheese, eggs, greek yoghurt, nuts - all food is home prepped so things can't sneak past - so on the odd occasion I am consuming something I shouldn't I do know I am doing so. I learnt how to do this way of eating from US Diabetes Forum and it has served me well - that was my point I absolutely have not changed my way of eating - I would 'fess up to it if I had! Promise. It is not always the case that people struggling can be fixed with dietary changes - and I already keep a food diary with my bgs.

Have you had your thyroid checked recently? Dosage needs may change as time goes by, and can have an impact on blood sugars too. If you're certain it's not a dietary thing, and it sounds like you are, has something else changed? Medication (statins, steroids) for other conditions, maybe a brand change, any bug or infection hit you lately? (Covid can leave blood sugars up for a long time). Have you been extra stressed, sleeping badly etc? All those things can make your blood sugars rise. For now, maybe go ultra low carb, see if that makes a difference (meat, fish, poultry, eggs, hard cheeses, basically zero carb. So no nuts and such), while you try to figure out what's causing the rise.

Good luck!
Jo

 

[LittleGreyCat]

Sadly, it may just be that as a slim T2 your Beta cells are just getting less able over time.

I can see a similar slow rise in my BG levels coming up for 13 years after diagnosis.
I don't seem to be able to deal with small excursions into carbohydrates as well as I used to.
I'm waiting for a 6 month check to see if my higher HbA1c is still there, and then I will unfortunately have to consider the second stage of medication if it hasn't improved.
2,000 mg Metformin at the moment.

 

[Daibell]

Hi. You need to be aware that slim 'T2s' who have ever increasing HBA1C may possibly be mis-diagnosed late onset T1 (LADA). I am one of those. Note that Sukkarto is a brand name version of Metformin. Both can come in SR (Slow Release) forms or standard; the former may cause less stomach/bowel upset. So, they are all the same thing. Metformin never has that much effect but does help. GPs love it as it makes them appear to be doing something useful. You might suggest to your GP that they do the two tests for T1 i.e. GAD which tests for antibodies and C-Peptide which measures your natural insulin output. The latter test is the most use as it can help tell you the best medication approach. Forxiga is one of the newer drugs which I've never had and it may be useful.

 

[LittleGreyCat]

I have this recurring question.
How long is a honeymoon period at maximum?
I am coming on for 13 years diagnosed (so probably more before diagnosis) and my BG control is slowly getting worse.
If I managed to string it out until 20 years (for the sake of argument) using second stage medication to supplement my reducing insulin production would I then still be categorised as a mis-diagnosed T1?

T1 definition is obviously complicated.
Is T1 solely an auto immune disease, as some claim?
If so, and assuming that my decrease in Beta cell functionality is an ongoing process, there should be antibodies.
If there are no antibodies then perhaps it is just the slow failure of an organ due to age, and not an auto immune disease.

I don't think many really care much because a failed pancreas is a failed pancreas and the treatment is much the same regardless of the cause.
However it is often helpful to have a tag to explain your condition.

 

[1970clea]

Have you had your thyroid checked recently? Dosage needs may change as time goes by, and can have an impact on blood sugars too. If you're certain it's not a dietary thing, and it sounds like you are, has something else changed? Medication (statins, steroids) for other conditions, maybe a brand change, any bug or infection hit you lately? (Covid can leave blood sugars up for a long time). Have you been extra stressed, sleeping badly etc? All those things can make your blood sugars rise. For now, maybe go ultra low carb, see if that makes a difference (meat, fish, poultry, eggs, hard cheeses, basically zero carb. So no nuts and such), while you try to figure out what's causing the rise.

Good luck!
Jo

Yep, thyroid was checked and is fine - middle of the range. Stress - for sure, who isn't at the moment?! No COVID as yet - although probably just a matter of time now - teacher! Sleep 7-8 hours most nights so good on that front. Medication change happened when the rises started to occur - will raise again with my db nurse. No statins - I am a refuser of those things! Being strict with diet right now
Thanks

 

[1970clea]

Sadly, it may just be that as a slim T2 your Beta cells are just getting less able over time.

I can see a similar slow rise in my BG levels coming up for 13 years after diagnosis.
I don't seem to be able to deal with small excursions into carbohydrates as well as I used to.
I'm waiting for a 6 month check to see if my higher HbA1c is still there, and then I will unfortunately have to consider the second stage of medication if it hasn't improved.
2,000 mg Metformin at the moment.

These were my thoughts - nice to have some similarity - thanks

 

[1970clea]

Hi. You need to be aware that slim 'T2s' who have ever increasing HBA1C may possibly be mis-diagnosed late onset T1 (LADA). I am one of those. Note that Sukkarto is a brand name version of Metformin. Both can come in SR (Slow Release) forms or standard; the former may cause less stomach/bowel upset. So, they are all the same thing. Metformin never has that much effect but does help. GPs love it as it makes them appear to be doing something useful. You might suggest to your GP that they do the two tests for T1 i.e. GAD which tests for antibodies and C-Peptide which measures your natural insulin output. The latter test is the most use as it can help tell you the best medication approach. Forxiga is one of the newer drugs which I've never had and it may be useful.

Certainly something to consider - I will raise it at my 3 month review. Thank you.

 

[bulkbiker]

Certainly something to consider - I will raise it at my 3 month review. Thank you.

Might be worth asking for a c-peptide test to see how much endogenous insulin you are producing?

 

[1970clea]

Numbers have quite suddenly returned to where they should be - had a lovely day BG wise yesterday and a 5.6 fasting this morning. Long may this continue.
In work today, marking entrance exams, had to spend the whole 2 hours sitting in front of sandwich platters, biscuits and fruit. So much easier at home. I did not indulge but it just makes it more of a challenge.

 

[JoKalsbeek]

Numbers have quite suddenly returned to where they should be - had a lovely day BG wise yesterday and a 5.6 fasting this morning. Long may this continue.
In work today, marking entrance exams, had to spend the whole 2 hours sitting in front of sandwich platters, biscuits and fruit. So much easier at home. I did not indulge but it just makes it more of a challenge.

Next time, maybe bring your own? Dunno if you have a say in what's catered? Snack sausages, cold cuts, deviled eggs, that sort of stuff. I love your cat by the way, our Vicky could be a sister!

 

[1970clea]

That's Floyd, he's snuggled up by my leg right now

 

[Oldvatr]

Hi all,

I was diagnosed 10 years ago and switched my way of eating to LCHF, which I have maintained along the way. I changed doctors and consequently my Metformin SR was changed to to the cheaper Sukkarto option. Since then my HBA1C has gone up by a couple of points every time it has been tested and in December came back with an HBA1C of 50. Neither my diabetic nurse or myself were happy about that and I briefly raised my concerns about the generic medication. She said it could be changed back to Metformin but first wanted me to try Forxiga.

Once I had put the phone down and researched the drug I was less happy with that as the side effects do not look nice. Having read around, I take a cranberry supplement and drink lots during the day - so far so good - no ill effects. I worry that on my return to school (teacher) I will find it considerably harder to maintain the increased fluid intake. Also I have been testing more than I had been and until yesterday (13th day of Forxiga) couldn't see any change in my bgs. However, yesterday was finally a good day. Should it be taking this long to kick in? I cannot stress enough that my diet has not changed - I do not eat bread,pasta,rice, potatoes. The occasional biscuit had crept in and I have been a lot stricter with that since the HBA1C came in.

Any thoughts, anecdotal evidence, help? It would be appreciated. I am 50 years, hypothyroid (medicated), reasonably active - again less so than I used to be, 142lb. Ask me if there is anything else you need to know.

Thanks,
1970clea

I had a switch to Sukkato by my practice behind my back. and my bgl rose as a result. I looked into this, and found out that whereas the extended Metformins uses a cellulose based agent to provide the matrix and the slow acting agent to give the delayed release, Sukkarto uses shellac, which is a lacquer / varnish used by artists to protect paintings and drawings, and this has very different effects. For a start I was on a PPI med to protect my tummy from the acidic blood thinners I was prescribed. and this reduced my srtomach acid. Consequently, I found I was not dissolving the pills at all, and the evidence duly appeared in the bowl one day. So I was taking a medicine that I was not able to absorb.

I got my GP to put me back on the extended Glucophage ER and this bought my bgl back down again.

 

[1970clea]

Thank you, I did wonder if it might be something to do with that.

 

[Andydragon]

I’d be very cautious about being on an SGLT2 and a very low carb diet. Both induce ketosis which can lead to DKA. - look up NICE guidelines or BNF.

SGLT2s are becoming a bit of a wonder drug, there’s dapa, empa and cana. They’re finding they protect both your heart and kidneys from diabetes-related damage. When the New NICE guidelines come out they’re expecting SGLT2s to be first-line choice.

They also have other significant side effects compared to the usual starting drug of metformin. Thrush, back ache, and even worse (gangrene and increased risk of amputations in worst cases)

it’s not a drug I was happy being on but I guess it was another push to get off them!

 

[Oldvatr]

They also have other significant side effects compared to the usual starting drug of metformin. Thrush, back ache, and even worse (gangrene and increased risk of amputations in worst cases)

it’s not a drug I was happy being on but I guess it was another push to get off them!

The genital gangrene is indeed a recorded side effect, and another one is pancreatitis and a possible association with pancreatic cancer. Also, not listed in BNF, but associated, is the knock-on effects that some UTI's can lead to if they progress up the canal to the kidneys and bladder tissue. These beauties are not as benign as we often consider them to be.

 

[1970clea]

On the plus side, and not wanting to tempt fate, I've been on them for 18 days now and so far no side effects. I am taking a Cranberry Supplement and drinking as much fluid as I can manage (more than I was for sure). BGS dropped dramatically at around day 12. Checking for ketones sporadically.

 

[1970clea]

Update: started having hypos in the afternoon the past 2 days. Down to 3.5 and treated with Jelly babies x 5 and a biscuit. Got back up to 8 then down again to 4.6 an hour after supper. Keeping an eye on ketones there are trace most days and on Sunday up to 1.5 so retested after drinking water and eating.
I have a 12 hour day ahead of me today work-wise and a little apprehensive about not having the time to manage bgs properly so took half a Forxiga this morning rather than the full amount. Bgs are now 4-5.8 90% of the time, with these afternoon issues.
I know you are not supposed to low carb with these pills but it has been my way of eating for 10 years and I can't seem to force myself to change. I like the way of eating.