T2 diabetes diagnosis. Metformin or..?

[NosyMcParker]

Morning all,

I have recently been diagnosed with T2 diabetes and have an appointment tomorrow to discuss meds. I know Metformin still seems to be the first line drug but have heard there are others for higher BMI which can better support weight loss. My mum has been on Metformin for years and her kidneys are slowly failing and I’m not sure of the connection but it worries me. She has been told there are other drugs now which protect kidneys better she can’t be offered them as her BMI is too low. Mine is over 30 so wondered if there are other drugs people are using for T2 which I could ask about other than Metformin?

Thank you!

The only thing I've ever experienced or heard about with Metformin is how unwell it can make you feel. I was so ill, I felt exhausted taking it, like a shadow of myself, no energy, constantly sick.

I've never heard that metformin harms kidneys but I have heard that if your kidneys aren't great then they can't deal with metformin very well and your risk of serious side effects is higher.

One interesting thing is suggestions I've heard that metformin might actually slow ageing.

It's a conversation to have with your doctor but IMO the side effects in most circumstances are less scary than with some other drugs.

Personally I don't get any side effects from it, except some temporary diarrhoea when I started it.

There are many drugs used for type 2. Metformin is the recommended firstline treatment in national guidelines. There is also quite a lot of evidence that diabetes can be put in remission/reversed for some by losing around 15kg in weight. Be sure to ask at your appointment about NHS support for this approach. Diabetes.org.uk has lots of clear information, the book “Life without diabetes” is a well written easy to read book by the doctor based in Newcastle that did a lot of the work in the field. Just think no diabetes and no tablets either!

Metformin can result in B12 deficiency after a while; were you taking it for long before you started feeling like that?

I was diagnosed in September with a very high HBa1c of 109 so they started me on Gliclazide which is a very strong drug. I started with twice a day and now down to half a tablet once a day. Also taking metformin.
There is lots of Information out there (websites, Facebook groups etc) and it can be overwhelming so good luck.

Thank you. Yes I’m absolutely working on this too. I’ve lost over 1.5 stone since 8th Jan so doing the right things there. My HBA1C was 61 when diagnosed so fairly high to get down to not needing meds at all maybe but am absolutely doing my damndest and will continue to do so.

Thanks for the other input re Metformin so far.

I wondered is anyone on anything else other than Metformin at all? Not saying I don’t want Metformin necessarily-just wanting to know what the options are so I can ask about them too.

Thank you!

It’s not too late for you to reverse T2 diabetes. From Diabetes.org.uk
‘The strongest evidence we have at the moment suggests that type 2 diabetes is mainly put into remission by weight loss. Remission is more likely if you lose weight as soon as possible after your diabetes diagnosis’

In your position I would be looking to reverse it rather than accept it and go on drugs for life. I was pre-diabetic a couple of years ago and have reversed it by weight loss, the diagnosis finally gave me the motivation to take charge of my health.

What is your hba1c? I was diagnosed around 4 years ago with a level of 50 (over 48 is classed as diabetic), they wanted to start me on meds but I refused and opted to try control by diet. I cut my carbs, increased my water intake, and increased my exercise, I lost nearly 7 stone and put my diabetes into remission.

Cross posted with you OP - well done on your weight loss so far - I would keep going with that for a few months rather than go on drugs straightaway though. My GP gave me 3 months to lose weight rather than starting interventions - although my HBA1C was not as high as yours. Good luck!

Thanks very much. I’ve actually already done that - HBA1C was 70 last year and has come down to 61 although the diet and weight loss weren’t as successful during that time (Christmas etc) as I’m managing to be now. My doctor wrote on my notes when I said could I discuss meds before being out straight on Metformin that I need meds now as my HBA1C has been in the diabetic range for 4 years! Wtf! That has scared me into going on meds quickly now and maybe trying to come off them if I sort my HBA1C rather than delaying any longer. What can it have done to my body already?

I don’t feel it’s been managed by the GP well at all. I didn’t know at all about pre-diabetes or anything until my 70 reading last year. I think Covid had an impact on it when I look back and maybe that’s why I had no info/support until last year despite my blood results being bad back then, but now I feel I need to take control…

I take Metformin (slow release) and Empagliflozin (Jardiance) with type 2 diabetes. The slow release helped with terrible diarrhoea when I first took the 'usual' Metformin. The Jardiance helps with peeing out any excess sugar. Losing weight can (but not always) put type 2 in remission. I haven't heard of either drug interfering with kidney function.

Wait — they've known you were diabetic for FOUR YEARS and have only just bothered to tell you so?

I was diagnosed with a hba1c of 88 almost five years ago . I was on slow release metformin for three months.

However I upped my exercise , lost weight and ate a low carb diet which I stick to to this day.

I went down to 36 hba1c at next blood test , came off metformin and have been in diabetic remission ever since.

If I don't eat low carb my hba1c will go up and I will need meds , but it's my lifestyle now.

Type 2 does get progressively worse but the longer I can stave off meds and keep a healthy blood sugar by diet and exercise I will do.

Nice one @Lollygaggle thats exactly what my sister did, she lost six stone about 15 years ago. She has put one stone back on but overall has done well. It’s changing habits forever, she had a stressful year last year.

In essence yes. I got a text message in late 22 telling me my last HBA1C result had been slightly raised and they wanted to redo it. I now know the rest they meant was done in 2020 (probably just before Covid) and I wasn’t told. I faffed around and didn’t realise/look into the significance enough and didn’t do anything until 2023 when it was 70, and then asked could I have some time to work on it myself and then just after Christmas did another test and it was 61. When I said could I discuss which meds, and speak to someone face to face rather than on the phone, the doctor wrote on my notes I have had diabetic range HBA1C for four years and am insisting on a face to face appointment. I have never had pre-diabetes mentioned to me, just that one text message saying my HBA1C (taken two years prior!) was ‘slightly raised’ and they wanted to redo the test. Definitely partly my fault for reacting too slowly to that, but the seriousness wasn’t impressed on me in my opinion.

Amazing! That’s my plan definitely. I’ve been scared into going on meds for now but will do all I can myself to reverse this.

That's really shit. I'm sorry they didn't inform you the first time, or explain the significance of the results, or follow up on the retests. I hope you can get on top of this and minimise and problems, and that they've scheduled you things like eye screening and foot sensation checks.

Metformin is a pretty amazing drug op. It’s been around for a very long time, and that’s meant that over time other benefits, besides glucose reduction, have been discovered. Its main side effects are gastric upset. That mostly settles down over a few weeks, but if it is really problematic then a slow release version is often better tolerated. It’s metabolised by the kidneys, so as kidney function significantly worsens (as is a potential complication of diabetes) a reduction in dose of metformin might be necessary. Studies have actually shown that taking metformin reduces the risk of significant kidney disease in diabetes (as well as cardiovascular disease, another potential diabetes complication).

Im sorry your surgery have been so poor in your care so far, I hope they get on the ball now. Good luck with your diabetes management going forward op.

That's true @HowDoWeDoThisPlease — the other benefits of an old drug are that it's fairly well known what the side effects are (unlikely now to be any nasty surprises like with e.g. rosiglitazone) and it's been out of patent for a long time so you can be reasonably sure that it's not getting prescribed because of marketing hype.

All this remote stuff is terrible medicine IMO. Though probably more convenient for doctors…

When they told me I was diabetic (I'd had some bloods done after a kidney infection) I was called in for a face-to-face appointment and the doctor gave me the news in person. At which point I burst into tears and it took two GPs (the one my appointment was with, and another GP who was the practice lead for diabetes) at least three quarters of an hour to put me back together again. They let me go out the back way, so I didn't have to walk past the entire waiting room of people I'd been holding up I'm sure it would've been much easier for them to just text me a cryptic string of letters and numbers and not bother explaining anything, though.

I've been T2 for 25 years and the GP surgery were actually quite good at helping me manage it for the first 20! Blood tests every six months, and would give me a chance to change diet/exercise whenever it went over the threshold, but if still high a second time, they'd increase the drugs.

It all went to shit with covid. They didn't do any blood test for a year (2020) and then it became yearly, with just a random HCA taking the blood, followed a week or so later by a very brief text saying something like the blood test was normal/acceptable, so I just assumed I was still within the limits. These texts were from random diabetic "specialist" nurses apparently.

Went to my GP for an appointment for something else around 3 months ago and just casually asked him for my HBAIC blood test readings as I always used to make a note of them, but didn't know the lastest 2/3 years. He read out stupidly high readings (in the 70s/80s/90s). So I questioned whether they were within acceptable limits as I'd always worked to around 55! He said, no, they were far too high, and he'd get a colleague to contact me! He couldn't answer why I'd been told that levels were fine for the past 2/3 years when clearly they weren't fine at all! I've since spoken to 3 of their "specialist" diabetic nurses who are about as useful as chocolate fireguards - still not got any additional drugs prescribed as they don't seem to know what to do, so just keep fobbing me off, and then it's someone different who phones a few weeks later!

I think diabetes control is one of the things that GP surgeries have let fall aside during and after covid. They seem more interested in answering a few questions on the phone, obviously filling out a questionnaire, but don't seem to listen to the answers and don't offer any advice anymore. Probably just filling the questionnaire to claim the additional funding they receive for allegedly providing diabetic management!

The eligibility criteria for different type 2 diabetes drugs in your area should be available online.

The injectables like ozempic for weight loss generally require you to already be on multiple other diabetes drugs (2 or 3) with blood sugars remaining too high and bmi remaining too high as well

I can't quite remember but no I don't think so, within the week I started to feel unwell. I think it really just disagreed with me. I stopped taking it after about 6 weeks

Metformin can decrease your Vit B12 levels, so a good idea to monitor it.

https://www.gov.uk/drug-safety-update/metformin-and-reduced-vitamin-b12-levels-new-advice-for-monitoring-patients-at-risk

I am on Metformin, gliclazide and emapliflozin, though might be dropping one of those at next review. Metformin is fine for me - no gastric issues, but we are all different. Losing weight and low carbing has been most effective for me.

I have been low on B12 at times, and get prescribed supplements if do. They also check my kidney function with one of the tests. Not had any issues there so far.

Metformin is well-established and widely used. People have different levels of tolerance for it. It is usually the first option with T2 - for good reason. (Plus it's cheap, but that's a consideration for NICE, rather than you.)