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type 2 medication advice please

Discussion in 'Ask A Question' started by spaglemon, Feb 1, 2012.

  1. spaglemon

    spaglemon · Active Member

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    i was diagnosed type 2 at the end of october with an hba1c of 10% ( 86 mmol ) was put on 1000mg metformin daily ( 500mg morning and night ) began very low carb diet and just had my first hba1c results since being diagnosed which was 5.8% (40 mmol ) my weight has reduced by nearly 4 stone ( still want to lose another 2 stone though )

    the diabetic nurse has made a gp appointment for me as she says the doctor may want to review my medication, tried explaining to her that the diet i'm following at present is not going to be my long term diet going forward, i'm not looking to radically alter it but i will be adding some more fruit and veg once i'm at a weight i'm comfortable with and will also begin regular testing to see how my body reacts to different foods, so i really don't want to reduce or come off the metformin at the moment because of this.

    does anyone think my gp will try to stop my medication ?

    they are happy with an hba1c of 7% or less but i want to get it as low as possible and am worried if i come off the metformin my hba1c will rise and as long as it's under 7% they might be happy but i won't.

    i also have no idea what has helped me reduce my hba1c result so much, diet, meds or losing weight ? i suspect it's mostly diet but i've no idea how much the dose of metformin i'm on has helped ?

    any advice on how to deal with my gp at the appointment would be much appreciated


    thanks
     
  2. xyzzy

    xyzzy Other · Well-Known Member

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    Congrats on the 5.8% brilliant!

    I have a similar concern and would sum it up like this. I can see that my medication (Metformin) IS helping to control spikes (I can eat more g's of carb with it and therefore it's expanding what I can eat and improving my quality of life). I can also see that it isn't particularly reducing my fasting average all that much.

    I would actually like my GP to prescribe me something like Galvus that looks to be a background BG reduction drug and passive like Metformin but have the same worry that all I'll be told is well done you don't need drugs anymore.

    So similar advice on handling the gp please
     
  3. borofergie

    borofergie Type 2 · Well-Known Member

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    Yes. That's almost exactly what happened to me.

    Diagnosis HbA1c=10.2%.
    After 3 months low-carb plus 1000mg Metformin HbA1c=5.6%

    At my 3 month review my GP said, if you keep your HbA1c that low then I'll take you off metformin.

    Anticipating that he was going to pull me off the metformin anyway, I didn't bother picking up my next prescription of metformin a month later.

    At my 8 month review my now metformin-free HbA1c was 5.1% and he took away my prescription.

    The thing is, like you, I'd really like some metformin. I work hard at my low-carb diet, and I'd really appreciate the extra 1mmol/l worth of carb that I could eat. I also find that my weight loss was much better on metformin.
     
  4. hallii

    hallii · Well-Known Member

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    My last A1c was 5.3% and I am still on Metformin. I told the DSN that whilst I might manage without it I would prefer to stay on it. She had no problem with that.

    I suggest that you explain how you feel about things and request that you stay on Metformin, it is a cheap drug and has an appetite suppressing effect so you are quite justified in requesting to stay on it.

    H
     
  5. xyzzy

    xyzzy Other · Well-Known Member

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    That's depressing news. Can't you go back and argue that because the NHS diabetic dietary guidelines say that you need to eat more carbohydrate than you are currently able to achieve safely you need Metformin or Galvus or Januvia or all of them because otherwise on your current BMR calculation you are gradually starving to death because you can't eat enough calories and worse it means you can do no exercise because that will make you starve faster.

    That's going to be my first approach I think.
     
  6. spaglemon

    spaglemon · Active Member

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    thanks for the replies, i did have a thought i'd like to run by people in a similar situation ?

    if i can stall my gp from taking me off the metformin for another few months until my next hba1c and knowing that your diet as you get closer to your test becomes more critical to your result, would it be a stupid and irresponsible idea to go a bit carb crazy for the 2 weeks before my test to push my hba1c level up artificially as it were, no idea how i'd be able to estimate how many carbs i'd need to eat to accomplish a couple of percent increase though ?

    my initial goal was to come off meds and control my diabetes by diet alone but as the low dose of metformin i'm on isn't really causing me any trouble i would like to stay on it so i can relax my diet slightly at some point in the future, hopefully everyone reading this realises that i don't mean this as in " i want to take metformin to allow me to eat more of what i'd like to eat " it's more that i want to have a diet that keeps me below 7% ( where the gp wants me to be ) but with the metformin this reduces to below 6% which is where I want to be, by the way if a non diabetic level is 3.5% - 5.5% what's it actually possible for a type 2 to get down to ?


    thanks again
     
  7. borofergie

    borofergie Type 2 · Well-Known Member

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    Honestly I tried everything. My GP wasn't budging.

    I even considered spiking my HbA1c by carbing up in the weeks before the test (as spaglemon suggested).

    Funny how the GP who always told me "that I need to eat more carbs" is the same one that is not limiting my carb intake by pulling me off the metformin. As you have all noted, there are lots of good reasons to stay on, but I think Doctors are rather fundamentally opposed to prescribing medication where non is (strictly) necessary.

    I suppose you could say that we are all victims of our own success...

    Stephen
     
  8. xyzzy

    xyzzy Other · Well-Known Member

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    Classic!

    No I wouldn't recommend this but if you want to estimate your HbA1c from your own BG readings you can do the following. I do it in my excel spreadsheet that I use to monitor myself with. This mirrors the methodology they used to calculate HbA1c from the sample of test data they got from loads of people.

    Measure 7 times a day, a fasting level when you wake up then pre and post + 2 hours each meal (I actually do 7 readings but as my fasting is the same as my pre breakfast so I do an extra at +4 hr in the evening)

    At present I do not have 120 days of readings and and so until then I am estimating by taking 75% of the average of the last 30 days and adding to that 25% of my overall average. If you have got 120 days of readings you can hunt down the exact weightings to use on line or I'm sure someone will tell us once they read this.

    Anyway after working out the weighted average an HbA1c ESTIMATE can be calculated using.

    HbA1c = (AVERAGE_BS *18.05 +46.7)/28.7

    To convert to the new IFCC measure take the HbA1c you have calculated and use

    IFCC =(hbA1C-2.15)*10.929

    My spreadsheet currently projects me to be at an HbA1c of 5.8% from an initial start of 9.9%. Will be interesting to see how close the estimate is to real life in a few weeks time.
     
  9. hanadr

    hanadr · Expert

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    Not many healthcare professionals like the low carb approach . they truly believe it might harm you. They don't seem to think of the fact that ANY medication they prescribe might harm you too. Just think of the ones that have been taken off the market in the last few years.
    I think Bernstein's approach iws right. The less medication you use, the better.
    I also read David Mendosa and I'm sure he says he's even dropped off Metformin and has excellent numbers just from his strict diet.
    I know i could do that, but with a family it's so much harder.
    hana
     
  10. Grazer

    Grazer · Well-Known Member

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    Hi xyzzy. I'm a geek with a spreadsheet too. I have calcs on it taking average BGs using a model to look at areas under curves after meals etc. My calc said HbA1C of 5.6, actual came back 5.9 One thing I did find on weighting - you can almost ignore the first 30 days of a 90 day period, and the last TWO WEEKS seem to have more affect than you'd think. I'd say 90% of effect ( for ME) came from last month, with 65% of that from last 2 weeks. We might all be different in how we glycate though - you'll find out I guess!
     
  11. xyzzy

    xyzzy Other · Well-Known Member

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    Yes I agree everyone is different - that should be my mantra! I think my formula is a bit optimistic though. btw what's a geek :?:
     
  12. Grazer

    Grazer · Well-Known Member

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    Geek - someone who enjoys numbers and analysis of those numbers? Someone who enjoys scientific research followed by sensible conclusion. Someone who is normally pictured as wearing out of date clothes and needing thick lenses glasses, but seldom looks like that. Someone who appears boring to those who don't understand the interpretation of data. Just my definition! :thumbup:
     
  13. viviennem

    viviennem Type 2 · Well-Known Member

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    My HbA1c was 6.5 on diagnosis 2 years ago, and I was very overweight. I asked to be put on Metformin because it is known to help weight loss in some people. Since then I've learned that it has a protective effect against cardio-vascular disease, stroke etc (I won't take statins) and most recently it seems to have a protective effect against some cancers.

    2 years on I've lost 4.5 stones (maybe as much as 5.5 stones still to go), my BG readings are almost always within non-diabetic range (except over Christmas :oops: ), and my HbA1cs are in the mid to low 5s.

    There has not been any suggestion of reducing my metformin, and I hope there won't be. I'm not sure how much effect it's having on my BG levels, but I'm happy with it for the other reasons listed above. If needed I shall use those as an argument against coming off it.

    Viv 8)
     
  14. Unbeliever

    Unbeliever · Well-Known Member

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    I think the problem is once again, financial. Metformin is a cheap drug I know but being prescribed metformin allows people to have free prescripions {?} .

    There may be pressure on certain doctors or practices o reduce the number of patients on meformin .
    There may be other targets and financial pressures .too

    I have a strong feeling that the diabetes "epidemic" will be solved by moving the goalposts rather thsn
    by oher means.

    My recently diagnosed friend, slim, active, good diet, was assured by the practice Nurse the other day that a post-prandial reading of 11 was fine.
     
  15. xyzzy

    xyzzy Other · Well-Known Member

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    Here's an alternate explanation.

    "Someone who everyone one else should be b****y grateful to for making their lives better as without them those who aren't "the g word" or "the n word" would still be living in caves."

    Think my explanation is far more accurate :D

    Now you've started me off! Here's a personal example of why I hate the "G" and "N" words.

    Back in 1999 I was heading up a team of software developers for a very well known financial services company. Like the rest of the computer programmers around the world a significant fraction of our working year was to ensure that on Jan 1st 2000 the world didn't end. Remember the "Millennium Bug". We along with 99.9% of other computer programmers in this country did it. The world did not end on Jan 1st 2000. Now what thanks did we get....

    If I had been an American my president stood up on national TV and thanked me for all my efforts.

    In this country? Headlines in all the media including the broadsheets and BBC saying how the whole thing had been a complete hoax and that I and my kind were less than dirt.

    This country needs to recognise the value and encourage its children to become "G's" and "N's" or else it will simply become a third world state within 100 years.

    Sermon over...
     
  16. xyzzy

    xyzzy Other · Well-Known Member

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    Thought about this some more and maybe it's not so crazy if you do it this way.

    For a week or so before your appointment do a full BS testing regime (fasting then pre and post at +2 hours). Meticulously record what you eat, when you ate it, how many carbs, when you took your meds and your BS levels. The aim is to show that the diet and the metformin you are on keeps you in safe levels and that you understand what control is all about. Then on say 2 of those days up your carb intake just enough to start taking you close to or outside safe levels. I'm pretty confident you will not approach the NHS carb intake guidelines. In this situation you can actually argue you need more drugs rather than less and you will have the evidence to prove it as you can say you tried to eat more carbohydrate like the NHS wants you to but you can't. Alternatively you could argue the other way round and say "but as you can see I need the metformin to keep me in a safe range. If you take it away I'll have to eat even less carbs which can't be good for me". The key is to have the evidence with you and use it to your best advantage.

    If that still doesn't work ask them to refer you to your local diabetic clinic as you are not confident or happy that they know what they're talking about.

    Just a thought...
     
  17. Unbeliever

    Unbeliever · Well-Known Member

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    Re your post about the "G " and "n" words I have to say that when I read Grazer's post my thought was "thank God for geeks" For all the reasons stated above and more!

    The "carbing" up may work as suggested but whether the Dr accepts it is another matter. Impossible to know unless you have some inside knowledge of how the Practice works.

    It is always worthwhile taking in a record of readings etc. Even when I did not test regularly I always made sure i did as you suggest[re readings and food diary}, for at least a week prior to appointments. For my own protection.

    Much of the time ,without this information the doctor must be guessing. It can save a great deal of time and trouble ,
     
  18. Grazer

    Grazer · Well-Known Member

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    I trust you do know that I classified myself as a geek and didn't knock them? Just checking! :thumbup:
     
  19. xyzzy

    xyzzy Other · Well-Known Member

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    Yes realised that no problem. :)

    I realise that people may not be use to a "G" having a go back, standing up for science and scientific values but tough. The quacks, creationists and hippy trippy alternative brigade have had it far too easy for the last few years to the extent that "progress" is now threatened by their combined unproven, self serving, pocket lining drivel. Up the revolution! Knowledge is 8)
     
  20. xyzzy

    xyzzy Other · Well-Known Member

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    Yes I take the point that the GP may try and ignore you but my point is try the calm rational approach and if that fails don't take any c**p. Complain, ask to be referred because you don't trust his diagnosis, write to your local PCT asking why they don't follow NICE guidelines etc. This is your future that's at stake.

    Actually does anyone know when PCT's will cease to exist? I think they are disappearing with the NHS reforms the gov is doing?

    Also does anyone know if the change to NICE guidelines being MANDATORY as opposed to currently just ADVISORY has come into force yet? There is no way out for a GP re test strips etc. if that is now in effect imo.
     
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