What happens if metformin etc doesn't work?

[RobsterinSheff]

My GP keeps telling not to worry that my levels are only coming down very slowly, that this is actually for the best - he's probably correct!

Mine not down at all yet- mid teens would be great!

Glad you had your operation 8)

 

[tree-peony]

mine only went down when I ditched the NHS diet advice, went low carb and started exercising more! My fasting this morning was 16.2 which is quite good for me!

 

[RobsterinSheff]

Reading list:

Most of the sensible advice I listen to involves replacing artificial trans-fats with "healthy" natural fats such as animal fats or coconut fat. I steer away from grain based vegetable oils too.

Thanks- great stuff.

I am supposed to be marking today but somehow I don't think I will be :wink:

 

[RobsterinSheff]

mine only went down when I ditched the NHS diet advice, went low carb and started exercising more! My fasting this morning was 16.2 which is quite good for me!

I have a feeling now that my bio will be the same...

 

[andrewk]

did you go on all of these medications and then- post low carb- are currently not on ANY of them?

The medication increased over time from 2005 to July 2011 in an attempt to keep my blood sugars at a reasonable level. At my annual review (HBA1C - 8.9), my GP increased the prescription by adding another 2mg of glimepiride. He did say that it was the end of the line as far as medication went and the next stop was insulin injections if my BGs continued to deteriorate.

I started on the Dukan diet (low carb, low fat) at the 3rd week in July 11. Within a very few days, my BGs fell to pretty much normal levels. Whilst away on holiday in August, I had one or two hypos - and one or two more when I got back home. In early/mid September during hypos, I measured BGs of 3.4 and 2.5 - so decided that I had to drop the glimepiride If I was to carry on driving safely. I also reviewed my diet and decided that the Atkins approach made more sense.

I continued with Atkins (low carb) but maybe ate too much (especially cheese), so my weight loss slowed - but I had lost about 3.5 stones by Xmas 2011. I was still on 4x500mg metformin at that stage. My HBA1Cs in October 11 and March 2012 were 6.7 and 6.8, a big improvement (Cholesterol and triglycerides improved too, despite the cheese). After reading about the Newcastle diet, I decided that I really must give it a go and see if my diabetes could be reversed.

I halved the metformins at the beginning of March 2012, with no real change in my blood sugar levels during March. After I dropped the last of them at the beginning of April, my BGs rose a little during April - fasting BG was 7-7.5 mmol/l by the end of April, after having been in the low to mid 6's during March. From then onwards, I have not taken ANY diabetic medication at all. I started on the Newcastle diet near the end of April (see progress in my diary thread: Newcastle comes to Oldham). My fasting BG this morning was 5.8 mmol/l

Andrew

 

[RobsterinSheff]

did you go on all of these medications and then- post low carb- are currently not on ANY of them?

The medication increased over time from 2005 to July 2011 in an attempt to keep my blood sugars at a reasonable level. At my annual review (HBA1C - 8.9), my GP increased the prescription by adding another 2mg of glimepiride. He did say that it was the end of the line as far as medication went and the next stop was insulin injections if my BGs continued to deteriorate.



I halved the metformins at the beginning of March 2012, with no real change in my blood sugar levels during March. After I dropped the last of them at the beginning of April, my BGs rose a little during April - fasting BG was 7-7.5 mmol/l by the end of April, after having been in the low to mid 6's during March. From then onwards, I have not taken ANY diabetic medication at all. I started on the Newcastle diet near the end of April (see progress in my diary thread: Newcastle comes to Oldham). My fasting BG this morning was 5.8 mmol/l

Andrew

Absolutely fascinating- thanks!

 

[ashi]

I have similar problems im on statins as well.

I also tried wheat-grass which helped with my bloods, but you have tot take it quite often.

 

[hanadr]

200g carbs per day is too much for Metformin. Drop it to under 100 or even 50 and it might work.
Hana

 

[xyzzy]

Cheers- would really appreciate links being posted (short cuts my own search).

I have to admit that I am cautious about the "fried bacon and eggs with a glass of full fat milk" notion of very low carb diets = as my cholesterol level is 7.0 and my GP says if it goes up again I need an increase in my statins! Already on 40mg and really don't want any more...

Yes this low carb high fat thing is counter intuitive to start but really all you are doing is going back to the diet that was recommended to diabetics prior to the 1980's. During the 1980's and later it became "fashionable" to recommend the same high carb low fat diet to everyone be they diabetic or not. Nothing wrong with a healthy high carb low fat regime but as carbohydrate is what makes BG's rise dangerously in a diabetic it does seem to be like advocating that an alcoholic drinks vodka. At the moment the standard recommendation in the UK is a 50% carbohydrate diet with at least 33% coming from starchy carbs.

I do around 60g carbs a day and obviously make up the difference with a higher fat diet including bacon and eggs which are nigh on zero carb but not a glass of milk that is not. I was diagnosed 4 months ago with an HbA1c of 11.3% and at that time my cholesterol was 5. I have been on a statin (40mg) for coming up to 18 months having started at 7.something. On a low carb high fat diet I now have an HbA1c of 5.3% and "normal" cholesterol levels and my good cholesterol went up on the high fat diet. My BG's normally now run between around 4.5 to 5.5 (even at 2 hours after eating) most of the time but started out in the 20's. Look at my sig for the numbers.

200g carbs is probably too high. Since the beginning of the year the Americans now recommend a RDA of 130g max. See their official position statement doc http://care.diabetesjournals.org/content/35/Supplement_1/S11.full.pdf+html

It should be noted that the RDA for
digestible carbohydrate is 130 g/day and
is based on providing adequate glucose as
the required fuel for the central nervous
system without reliance on glucose production from ingested protein or fat

An idea of what a reasonable low carb high fat diet can be found here. This doctors diet is the kind of regime the Swedes recommend for their "moderate restricted carb diet" http://blogg.passagen.se/dahlqvistannika/?anchor=my_lowcarb_dietary_programe_in for diabetics

For a beginners guide to LCHF try http://www.dietdoctor.com/lchf

I visited my GP yesterday to specifically talk to him about LCHF as my DSN wanted me to tell him how I'd done so well. She even booked the end of the day double appointment to maximise the time I had. His attitude was that since I have put my diabetes "in remission" I should continue eating at what ever level of carbs it takes to keep it there. If that means LCHF fine as long as he sees my cholesterol and blood pressure are normal and and that my weight is okay. I have already lost 20kg or 3 stone in 4 months by eating "bacon and egg" and my target is to lose around another 15kg to end up at a BMI of 22. Currently its 24.5 so "normal". It started at just under 30. Exercise wise I just wlak my dogs for around an hour most evenings so not a great deal.

 

[Daibell]

Hi. Sadly even keeping the carbs right down below, say, 150gm/day for some people including me it still isn't isn't enough and additional medication will be needed. I had Gliclazide added and then Sitagliptin; the latter being the most useful. One day perahps onto insulin. I'm assuming you are not young and possibly a T1 LADA candidate? So, go with the lowest carb diet you can reasonably live with and if your Hba1c is still too high then discuss further meds with your GP. BTW I often have fried egg and bacon for breakfast; don't worry too much about fats as long as you keep them reasonable and unsaturated as far as reasonable.

 

[RobsterinSheff]

One week since I started 500mg metformin x2 per day/ minimum 3 days per week 1 hour exercise (actuality was 4 days in last week): and two days since I cut carbs back to max of 150g per day (having read many interesting posts and links in this thread). Actual carbs of thursday and Friday were 152 and 141. Previous 5 days to carb ceiling reduction 206, 197, 191, 199, 202

This morning using IBGstar monitor was 14.9 mmol (a1c=10.9) down from 18.7 mml (a1c 13.5) last Saturday. I have also lost 2.9 kilos.

That is a 30% BG reduction in a week. I'm soooo relieved that this thing can be impacted by my own actions!!

As far as the regime goes: welcome to the rest of my life. "Thems the breaks" = but at least you can manage this. 8)

 

[RobsterinSheff]

erratum: sorry typo = 20% reduction in a week.

 

[borofergie]

erratum: sorry typo = 20% reduction in a week.

That's a great start. Your BG will get lower with time. I love the fact that you are counting every single carb.

Good work man, you'll have this thing beaten in no time. :thumbup:

 

[RobsterinSheff]

That's a great start. Your BG will get lower with time. I love the fact that you are counting every single carb.

Using 'my net diary pro' iphone/ ipad app = uses camera to scan barcode on food items. About 85% of foods are automatic/ already in the database. Where they aren't, you add manually and foto nutritional information and upload it and its put on database within 36 hours.

You literally can count everything not just the carbs ! It gives a range of graphs and tables as well.

Excellent little app 8)