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What are the prescribing guidelines for metformin

J

janeecee

Well-Known Member
Messages
248
Type of diabetes
Other
Treatment type
Diet only
I doubt I will be able to control my levels with diet alone. I'm not eating very much at all to keep my levels within the accepted ranges and even then I can be too high at 2 hours. I can't exercise due to ME/CFS, though I'm trying to increase my activity levels without exacerbating my ME symptoms. It isn't enough to make an impact. I have very little weight to lose and from what I've read losing weight only helps if you're overweight. I'm not yet diagnosed but already I'm showing protein traces in the urine.


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Sent that before I finished…

What I want to ask is what are the criteria for prescribing medication. My fasting BG has masked my (pre?) diabetes for years, and I've already developed neuropathies and protein in urine. I've had numerous investigions for these symptoms but the real cause was missed. I need to be proactive in my treatment.


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Great question, but one I feel you should direct to your diabetes care team or specialist in particular. I know some people may have experienced similar issues, but we are all different and unique and while symptoms may be the same, the primary cause may be due to a different reason. I'm not avoiding your question, but any medical advice or prognosis should be made by a healthcare professional. Good luck and please feedback with how you get on as it may help encourage others who find themselves with the same kind of issues to visit their care team. I don't know your physical condition or how easy it is for you to get to the hospital/clinic, but I hope you resolve your concerns very soon and your mind is put at rest and the problem treated if necessary.

Good luck and sorry I can't help specifically on this occasion.

Mart.
 
Thanks, I understand you can't give medical advice, just wondered if there was a general protocol but obviously one size does not fit all.

I'm seeing the GP next week. I can't see the nurse at the surgery who treats people with diabetes because I'm not yet diagnosed. My 'normal' FBG isn't picking up my post prandial highs which have been in the 7s, 8s, 9s and 10s this week. I've no weight to lose, no bad dietary habits to give up and I'm unable to exercise, so I fear that this is as much 'control' as I can reasonably have. The usual advice dished out to prediabetics won't be much use to me. I'm not happy to be left to drift. I really need to be proactive now.


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I think you need to go to the NICE Diabetes website and look at the Diabetes Pathways document. It has a flow-chart showing the various HBa1C levels at which different medication should be prescribed. The document is very good and sensible. I wouldn't worry too much about FBG as it can be affected by the overnight liver dump. The HBa1C and some sample 2 hours after eating tests can be more useful. What was your last HBa1C reading?
 
Janeecee and I are I are in exactly the same boat. Undiagnosed, KNOW our numbers aren't normal, can't really lose much weight (I just got out of anorexia ***)

She wouldn't have had a HbA1c test because a doctor wouldn't order one. (well until she becomes a full blown diabetic no one will notice)

Hun, I've just ordered a private HbA1c straight from a lab and waiting for a date they can send a nurse to take blood. I'd recommend you do the same so you have something to how the doc, then again there are diabetics here with deceptively low HbA1c (and general numbers lower than ours...) Worth a shot if you can scrape together £25 or so.




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Hi LW

My GP said bloods normal, fasting lab test 5.1, and that my high post prandial readings were 'normal' and 'nothing to worry about'! Wasn't interested in my own figures which I brought all printed out in a table. Well, what can I say? I'm seeing the practice nurse next week for the NHS health check and once again I'll take my own figures with me. She does the diabetes clinics so she might have more of a clue.

I've been looking for an affordable Hba1c. Myrios did one but don't seem to do it any more. Otherwise it's a private blood test costing in the region of £150, which is a bit much. 25 quid is affordable, where/how is it done?


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What are your post readings? Is it the 2 hour you are worried about or (I think this is just as important) a massive spike in the between period

My fasting readings have only just started creeping up really, what they should look at first is what's going on with your phase 1 insulin response starting to fall apart IMHO instead of waiting for phase to to get slower and slower and less adequate.

I googled to find [email protected]

You can ask one of their phlebotomists to take your blood seeing as you can't get it done at the GP but they will have to send your results to the GP not you. Should get their attention and get you on track. If you feel like you are already doing all the right things and at a good weight then hopefully if they do throw pills at you you'll be a nice stable bunny. It was the faint spells, mood swings, nausea and basically being comatose after a meal that I'm hoping I'll be rid of..


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8s 9s and 10s, if I'm lucky I'm in the 7s, and this is on a modified diet. The GP gave me the "you're normal, don't worry" routine. I've cut back on carb portions to see if it helps but it hasn't so far. I don't have a lot of weight I can afford to lose either. BMI is currently 20.4. I could lose a few pounds to see if it helps but I don't have much leeway. My next step is seeing the practice nurse next week for my NHS healthcheck pep talk. I'll bring my figures and see if she can offer any suggestions.


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Those are my spikes. They aren't mega but my 2 hour post prandial numbers are rarely under 7.8, and frequently over 8.5 ie the diabetic recommended limit. Fasting test at the doc's was 5.1 and the guideline for a GTT test is 6.1–6.9, so no way will they act on 5.1. Apparently they have me an HBA1c (I didn't know at the time) but I was told 'normal' and 'no further action required'.

So these figures aren't catching the spikes. I need a GTT test but at the moment I'm just a nut case as far as the GP's surgery is concerned. Even so, I'll see what the practice nurse reckons as she does the diabetic clinic too. I'm doing everything I can to tame these spikes but if anything they are getting worse. I've cut down the carbs, I'm making an effort to be more active and I've lost 2-3 lbs over the past couple of weeks. I don't have much weight to shift and my diet was pretty good before anyway. I've cut down on my fruit from 3 portions a day to just 1, and halved the carbs, but it's made no impact. The same meal that gave me 6.5 a couple of weeks ago gave me 8.9 last night. I could scream.


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At the risk of being sent to the naughty corner, I'm beginning to wonder if too few carbs are actually increasing my blood sugar levels, and possibly increasing insulin resistance. I think there is a difference between (pre)diabetes in overweight as opposed to lean people. If we cut the carbs then the body targets the muscle for more fuel instead of fat stores. But I don't know…perhaps I'm clutching at straws.


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Hi Janeecee. I think you will find that the body goes for body fat before muscle. If you find difficulty in keeping 2 hour readings below 8, are slim and on a low-carb diet then your pancreas is probably not performing at 100%. Your next HBa1C will be a good guide, but it looks like you currently have a long way to go before you need any medication.
 
Yes, I've thought of that too :'-(

I don't appear to be the classic case. There are very few 'lifestyle options' for me to apply as I wasn't committing too many dietary sins to begin with and I don't have a lot of fat to spare. My numbers were a bit better before I cut the carbs. I'm only talking about over the past 2-3 weeks. I get stupefied with hunger too. I don't think it's right for me.

As you rightly pointed out, I'm not yet in the zone for treatment so my diet has to work—for me, I mean. Other people need to do what's right for them.








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