Questions about Hba1c

[Tearsinheavens]

I started metformin after diagnosis a few months ago with a Hba1c of 53 - I have my review coming up and I'm wondering what level of Hba1c would they recommend insulin? And could 3 months of metformin be enough to take it down under 49 again? Unlikely I'm sure without weight loss and low carbing.

I was prescribed insulin based on finger prick tests in hospital not the HbA1C, my readings were all over 20 n/mol though even hours after eating. I was on 8 units of insulin twice a day and 4 x 500mg metformin tablets a day before I was able to get my readings to be mostly (not always) within the normal range. That was with having reduced carbs to just green veg and a small amount of basmati rice, and started swimming 3 times a week. About 6 weeks after diagnosis they put me on Mounjaro which was amazing. Within a couple of weeks I was able to stop the insulin and reduce down to 1 x slow release metformin a day. 3 months after diagnosis I had a repeat HbA1c and my result had reduced from a starting level of 97 to 55. 3 months after that it had reduced to 39 and I was told I was now in remission. I have also last 4 and a half stone.

They are unlikely to prescribe insulin as a first treatment. It is not typically used for t2 especially in early stages or at lower range hba1c and there are many alternative medications starting with metformin. You may well find with that and any lifestyle changes you are reducing the levels already.

I'm just worried the metformin isn't working well as I'm getting high finger prick readings in the mornings before eating (between 7-8) ironically they are much better for the rest of the day (between 5-7) but those fasted readings are consistent even though I take my evening metformin dose late after my evening meal (which I do eat fairly late admittedly)

My HbA1c was over 90 and I wasn't prescribed insulin; I had metformin twice daily and lost a significant amount of weight to eventually put my diabetes into remission

Why are you finger pricking if you were diagnosed at 53? Bs does fluctuate naturally with activity and food.

I am finger pricking to try to understand if certain types of foods cause bigger spikes than others.

It might be easiest to cut back on known triggers such as carbs, processed sugars, alcohol, fruit juices to start with.

high morning readings will be influenced by eating later in the evening. Try not eating after 7pm OP

You mention low carb so clearly know about already. Is there any reason you have been put off that as a solution? There are now Lots of us who have completely reserved full type II diabetes by low carbing. Lost weight and much more full of energy to really enjoy life. High blood sugars kept me feeling lethargic for years before I understood about low carb.

Hope you find what works for you ?

DP's hba1c at diagnosis was 119! They were not prescribed insulin, only metformin. In addition to taking metformin they changed their diet - basically eliminated cakes, biscuits, white bread, rice and choccy bars and increased intake of fruit, veg, pulses, nuts and seeds.

Three months after diagnosis hba1c was down to 50. Nine months after diagnosis it was down to 38. They're now gradually reducing the Metformin dose.