will diabetes type 2 worsen

Contralto said:

Brunneria,

It would be really helpful if you would look up those "anecdotal references" before posting them on a drug where the experience isn't yours but people might follow your advice because you're a moderator. Some people fail to notice that you haven't the same experiences as most of us. I can't quite remember but wasn't it something like you were once diabetic for a a couple year? And reactive hypoglycemic for a longer period ? Or thought you were? Not belittling your experiences, but some of us are really struggling, going no carb is not a good idea for some of us, and the medications we take have to be really cautiously and carefully considered.

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You are right, my personal circumstances and my experience with my personal glucose dysregulation gives me a unique perspective - just like every other unique member on the forum. And we share our experiences in order to see the differences. Let’s face it, if we were all identical, we would have nothing to discuss and wouldn’t be able to swap ideas and learn from each other. That is one of the strengths of this forum.

References are great things (and I often encourage people to provide them) but when the information is a memory, a personal opinion, an anecdote, or a personal theory, and is clearly described as such, then that is perfectly acceptable.

Just one more comment though - i am a bit concerned about your comment that ‘no carb is not a good idea for some of us’. I totally agree, and i don’t actually believe a ‘no carb diet’ is possible or sustainable for most people, so I think it would be a bad idea for someone to try it without a lot of research. If you see anyone promoting such a diet, and are concerned, then please raise a Report. As you know (from a recent discussion on another thread) i am currently eating carnivorously, but that still has some carbs in it - as discussed on the same thread, with an interesting debate on achieving good nutrition by that way of eating. So i completely agree with you that eliminating carbs entirely is both difficult, and unwise - unless people educate themselves thoroughly beforehand.

Contralto said:

Right, you stated that you remembered from somewhere or someone or another. Your gluten challenges are special but the thread did not concern gluten challenges. I was pointing out that as a monitor, people are more likely than not to take your advice as trustworthy, so when it is not your experience and you are kinda sorta recalling it, you have a little more responsibility to track that recollection of someone or another, my opinion.

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I must admit that as the poster that was being responded to. then I too found it confusing to have an opposing POV referring to unspecified others, but without any cross reference. I have taken part in many discussions on Metfartin and the after effects, and yes, there are many who cannot stomach it. Generally the advice is to switch to the extended or SR release, and occasionally posters give the established advice that the med should be taken with food, but I do not have the same recollection that @Brunneria has, so a reference is IMO necessary

Here is the patient info for Metformin. Other sites like webmd have similar info
https://patient.info/medicine/metformin-for-diabetes#nav-2
https://www.drugs.com/dosage/metformin.html

Contralto said:

Right, you stated that you remembered from somewhere or someone or another.

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Absolutely! I become strangely less keen to hunt out, cut and paste references when I am accessing the forum from my bed, using my mobile phone's small screen. Such are the limitations of technology.

However, since it is now morning, and I am back at my desk, I have spent a whole 10 seconds typing 'Metformin too many carbs' into Google. Top of the list is this one:

https://www.diabetesdaily.com/forum/type-2-diabetes/37241-metformin-carbs/
where the first few posts on the thread demonstrate a whole range of different reactions to Metformin and carbs, including people saying that they find it necessary to keep carbs low, to avoid intestinal upset.

Then further down:
https://thefastdiet.co.uk/forums/topic/metformin-and-52/
where post #11 states
20 May 16
I spoke to my endocrinologist about this and she said: 1. Metformin is not the kind of drug where you have to take the same dosage every day. So one could skip their metformin on fast days or lower the overall dosage everyday as a way of avoiding the symptoms i was experiencing (day after diarrhea). 2. Eating too many carbs causes the diarrhea when on metformin. I was shocked to hear that.

And a specific search on DCUK yielded this:

Metformin and carb intake

I found this one particularly relevant since it is one of @Oldvatr 's own posts.
low carb diet and metformin

All anecdotal, and either word of mouth, or personal opinion, as I stated in my first post on the subject.

Brunneria said:

Absolutely! I become strangely less keen to hunt out, cut and paste references when I am accessing the forum from my bed, using my mobile phone's small screen. Such are the limitations of technology.

However, since it is now morning, and I am back at my desk, I have spent a whole 10 seconds typing 'Metformin too many carbs' into Google. Top of the list is this one:

https://www.diabetesdaily.com/forum/type-2-diabetes/37241-metformin-carbs/
where the first few posts on the thread demonstrate a whole range of different reactions to Metformin and carbs, including people saying that they find it necessary to keep carbs low, to avoid intestinal upset.

Then further down:
https://thefastdiet.co.uk/forums/topic/metformin-and-52/
where post #11 states
20 May 16
I spoke to my endocrinologist about this and she said: 1. Metformin is not the kind of drug where you have to take the same dosage every day. So one could skip their metformin on fast days or lower the overall dosage everyday as a way of avoiding the symptoms i was experiencing (day after diarrhea). 2. Eating too many carbs causes the diarrhea when on metformin. I was shocked to hear that.

And a specific search on DCUK yielded this:

Metformin and carb intake

I found this one particularly relevant since it is one of @Oldvatr 's own posts.
low carb diet and metformin

All anecdotal, and either word of mouth, or personal opinion, as I stated in my first post on the subject.

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Yes I did respond in that thread as you point out, and I was at that time looking at the possibility that the manufacturers info leaflets may not have been properly reflecting the LC dieters needs and maybe needs updating. I note that through the whole thread in question there is only ONE respondent who states they find high carbs causes gastric distress, but does not elaborate on it so we do not have any real idea of what diet they were following apart from that it is most likely an LC diet of sorts. As I said in an earlier post in the current thread, the content of the LC diet in terms of fat intake, dairy intake, fibre content, along with certain meds can also influence this outcome

And yes I did make an anecdotal reference in that post, but I did not draw any conclusions based on that as evidenee, and was in fact trying to open up the discussion instead. That whole thread was to explore the use of Metformin with LC diets, so it was appropriate to air anecdotal evidence connected with that topic, The thread we are currently in is a general T2D thread and not so specific about Metformin. so unassigned references here are out of context and unclear, hence the confusion.

Edit to add: @Brunneria posted a link to an external site that was discussing the use of intermittent (5:2) fasting when used in conjunction with Metformin.

To prevent derailment of this topic here, I have created its own thread since it is something I have not seen discussed on DCUK
https://www.diabetes.co.uk/forum/threads/metformin-and-fasting-diets.144056/

Oldvatr said:

Yes I did respond in that thread as you point out, and I was at that time looking at the possibility that the manufacturers info leaflets may not have been properly reflecting the LC dieters needs and maybe needs updating. I note that through the whole thread in question there is only ONE respondent who states they find high carbs causes gastric distress, but does not elaborate on it so we do not have any real idea of what diet they were following apart from that it is most likely an LC diet of sorts. As I said in an earlier post in the current thread, the content of the LC diet in terms of fat intake, dairy intake, fibre content, along with certain meds can also influence this outcome

And yes I did make an anecdotal reference in that post, but I did not draw any conclusions based on that as evidenee, and was in fact trying to open up the discussion instead. That whole thread was to explore the use of Metformin with LC diets, so it was appropriate to air anecdotal evidence connected with that topic, The thread we are currently in is a general T2D thread and not so specific about Metformin. so unassigned references here are out of context and unclear, hence the confusion.

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Always good to get these things resolved.

Hi everyone, so I was reading this discussion after a long time. I left this discussion about 2-3 weeks ago. I see that you people are discussing about metformin and my doctor has also prescribed me metformin-500mg and I have to take it twice a day. When I researched about metformin I found this: https://zovon.com/drugs/drug-by-condition/drugs-treating-type-ii-diabetes/

They have mentioned many side-effects of using metformin, however I only experienced diarrhea and abdominal pain in the first week of my diagnosis. After that it's been fine by now, I've improved reading in just one month of diagnosis. Also, talking about carbs in my diet, I've recently shifted from traditional diet for diabetes and following the keto diet to keep up with the situation.

Also, y'all are invited to my thread to talk about your progress stories: https://www.diabetes.co.uk/forum/threads/progress-toward-a-healthy-life-with-type-2.143828/

Diabetes, in general, has doubled in the UK for the last 20 years and is likely to triple within the next 20 year. I have been type2 diabetic for the last more than 25 years and one of the major issues under-discussed in the forums I have joined for the purpose of information and support is lack of information in the collaboration between the health service providers, dieticians, psychologist, psychiatrist including others like weight loss etc.Diabetes intervention is better tackled from all areas of human life if the population of diabetics is to come down. Medical doctors must learn how to smaltinously refer their patients to other relevant support systems available with psychiatrist, psychologist, dieticians etc as the patient continues to take medication. The world governments and societies should be involved in the mass education of the importance of treatment and prevention of this killer disease as part of the service they render to humanity.

geff said:

Diabetes, in general, has doubled in the UK for the last 20 years and is likely to triple within the next 20 year. I have been type2 diabetic for the last more than 25 years and one of the major issues under-discussed in the forums I have joined for the purpose of information and support is lack of information in the collaboration between the health service providers, dieticians, psychologist, psychiatrist including others like weight loss etc.Diabetes intervention is better tackled from all areas of human life if the population of diabetics is to come down. Medical doctors must learn how to smaltinously refer their patients to other relevant support systems available with psychiatrist, psychologist, dieticians etc as the patient continues to take medication. The world governments and societies should be involved in the mass education of the importance of treatment and prevention of this killer disease as part of the service they render to humanity.

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Nice sentiment, but while the NHS is funded the way it is, then it will always be fighting the fires, and never able to support preventative measures. There are, to be blunt, no resources available to allow doctors either the time or the tools to do this since their eyes are always on the clock like a chess master. Even when presented with opportunities to save the NHS money long term, their short term goals prevent them taking it up.

For exaample, take T2D self monitoring initiative (SMBG). Three years ago I was being referred for insulin therapy since my bgl was going offscale, I managed to persuade my GP to fund my SMBG habit for a month, which I would use to take control. If I succeeded he would support me long term, else I go on the needle. I succeeded in this argument by pointing out that if I fail then the overal cost to the NHS of training, support, medication and kit, togther with an increased risk of either hypo or DKA requirimg A&E admission, and long term increased risk of amputations etc would be very significant. He said yes. but..... the funding for insulin dependancy would not come from his GP budget, but the cost of the meter and consumables did, so for him I was increasing his costs. So I countered this with the obvious parry - that as an ID patient, I would be using more test strips per day than I do as a T2D on orals, so there was negative equity in his argument. I still get my SMBG support, but that may change tomorrow when I get my annual review with my latest HbA1c being 42.

My experience with SMBG has been very effective, and if this was extended to more T2's then the NHS would save in the long term. It won;t suit everybody, but should be an option to be offered when HbA1c is above a certain threshold, i,e for a condition that is clearly going down the pan, and where the patient is showing a desire to take back control. Secondly there needs to be better support for lifestyle and diet issues, anf that could be just some simple literature handed out when DX has been confirmed. It could even be just a list of websites or books to read on a sheet of paper, with warnings about Dr Google etc. Not everybody needs an expensive course like DESMOND when only on orals, ID needs are more complex and frightening so do benefit from tuition.

Well done @millenium 's dad, and well done you for helping and supporting him so well. That is wonderful news.

Oldvatr said:

looking at the figures for Metformin efficacy, then it is clear that Metformin has a limited hypoglycemic effect. i.e. it does Sweet ***** Arbuckle to reduce circulating bgl levels, possibly 1 or 2 mmol/l benefit if at all, no matter how many of the pills you pop.

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It doesn't reduce blood glucose per se, the effect of metformin is to reduce insulin resistance.

For years I was put on metformin (Risidon / Janumet) without any insulin treatment. It only aggravated my liver and kidney problems, further worsening my heart conditions after a mitral stenosis.

Zilsniggy said:

It doesn't reduce blood glucose per se, the effect of metformin is to reduce insulin resistance.

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https://www.diabetes.co.uk/insulin/diabetes-and-metformin.html

Zilsniggy said:

https://www.diabetes.co.uk/insulin/diabetes-and-metformin.html

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My experience since dropping my Metformin dose by 1 gram two months ago, and my average bgl has jumped by a massive 0.4 mmol/l e.g. from 6.3 to 6.7 so I stand by what I said that Metformin has very limited capability in lowering bgl levels.

DCB 2 said:

I use the following formula to estimate my A1C:

A1C = (46.7 + average_blood_glucose) / 28.7

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Coming at this a bit late, but what is that based on? It would give me an imposssibly low HbA1c of 1.78% (assume it’s the % being calculated otherwise I’d be in minus territory).

Goonergal said:

Coming at this a bit late, but what is that based on? It would give me an imposssibly low HbA1c of 1.78% (assume it’s the % being calculated otherwise I’d be in minus territory).

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I believe the units are US based, mg/dl instead of mmol/L

https://professional.diabetes.org/diapro/glucose_calc

kokhongw said:

I believe the units are US based, mg/dl instead of mmol/L

https://professional.diabetes.org/diapro/glucose_calc

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Thanks, that explains things.

kokhongw said:

There's 2 types of long term damages to consider.
1) Damages due to glucose spikes or elevated levels.
2) Damages due to insulin spikes or elevated levels.


FBG of 6.5 would still suggest elevated insulin levels...and is considerably higher than the magical 4.6 mmol...

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According to my DVLA restricted licence a mmol reading below 5 disallows you to legally drive. Seems to be a conflict here.

confusedtohell said:

According to my DVLA restricted licence a mmol reading below 5 disallows you to legally drive. Seems to be a conflict here.

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This ruling only applies to people on glucose lowering medications, such as insulin, which puts you at risk of hypos.