Increase Metformin Dosage? A1c Good But Not Good Enough

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Increase Metformin Dosage? A1c Good But Not Good Enough

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Old 07-09-2012, 19:03   #1
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Default Increase Metformin Dosage? A1c Good But Not Good Enough

Hi All,

Qualifier - I know the forum is not for medical advice. It's the process I'm trying to grasp.

Here's the background:

My A1c, newly dx'd was 9.1 on 2/29/2012. On 6/14/2012 I was 5.9. 500mg Metformin 2x daily. Low carb and exercise of course. OK that is moving in the right direction.

My family doc suggested taking me off Metformin if my next A1c in September is as low or lower. ???? I thought normal is an avg BG of 85, not 120. My meter is always seems to be at 97-106, lower after exercise, seldom higher; however, I want to be at 85 and no higher than 100. At this point, exercise and diet cannot permanently be improved.

Is increasing Met dosage a valid discussion? Can anyone share their story on how they approached this? Is this where a philosophical difference with your provider means that you move on? BTW, we have not yet discussed this yet.

Thanks in advance for your comments.

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Old 07-09-2012, 19:32   #2
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The ADA recommends <7%, so many doctors are delighted when they see an A1c in the 5% range at all. A 5.9% is a good A1c for a diabetic, but if you feel that you'd like to aim for something closer to normal (low 5% range, maybe even <5%), then that's great. That's my goal, as well.

Metformin is probably the safest diabetic oral medication on the market. If you're not experiencing any side effects or low blood sugar - which is extremely rare, anyway - on this medication, then I don't see any reason to stop it, especially if it's helping you control your blood sugar right now. You could even go up on your dosage.

As for my experience, I have a major philosophical difference with my doctor. I lost a bunch of weight, she insisted I'm cured, and wanted to take me off Metformin. When I said I'm not having hypoglycemia, that it's helping my blood sugar, and maybe my weight loss, she could only said, "You shouldn't be using Metformin for weight loss." We had a brawl in her office over this issue and she finally conceded that she'll continue to prescribe it and that I should lower the dose as I feel comfortable over the next few months. I explained that I didn't want to suddenly go off my medication and that I'd test the waters by reducing slowly.

Maybe you can work out an arrangement with your doctor like that. I don't know. Make sure to show him your BG logs so that he knows you aren't going low. My doctor was so afraid of that. She assumed my A1c (4.9%) was a result of hypoglycemia, as though no one can get that A1c without low blood sugar.

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Old 07-09-2012, 19:46   #3
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Where we want our blood sugar is a personal decision, and every body seems capable of different numbers. You're knowledgeable enough about ranges and what your own goal is, so I'll address only my own:

My A1C is in the high 5's, I'd like it to be in the low 5's but am frankly more concerned about keeping my bs curve during the day as flat as possible. Mostly, I don't want spikes. So my goal is to keep my bs <100 fasting, and I'm most happy when I'm in the 80's though that seems to be only half the time. I don't like being >120 ever and rarely am now.

I do take 1000 mg metformin daily, but continue considering dropping it to see if I can keep my numbers where they are without it. Why? I'm happiest when I don't need medication at all, and have been dropping any meds in my life that I can - not because metformin is a bad drug, there are many good things about it, but if I can do without a med it's my first choice.

In this post Daytona gives links to some good info on what the A1C actually is, what it measures and what it doesn't.

Welcome to the forum.

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Dx'ed Feb 2011 w/ BS > 600
A1C: . . . . . . . . . . . . . . . Other Stuff
2/13/11 .. 14.7 . . . . . . Trig/HDL ratio .. 5.5 to 2.2 in 6 mo
5/23/11 .. 6.2 . . . . . . . Low-carb/high healthy-fat diet
9/8/11 .... 5.6 . . . . . . . No meds, No statin
2/24/16 .... basal/bolus insulin 2-3 days/wk due to steroids

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Old 07-09-2012, 20:05   #4
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There is a whole lot of variables to think of when considering elevated BG levels. Its not always not enough insulin, to much glycogen. Your brain will respond to any stimulus it receives from your nerves with a release of glucose to heal what ever it thinks may be wrong. Things I did to get that final push to the lower numbers. Aspirin therapy, aspirin changes the environment around your pancreas and stimulates growth of beta cells by reducing inflammation. I started out taking 2- 325mg a day, worked my way up to 6 a day until my ears were ringing to bad to continue then backed down slowly to 2 a day, then one a day. The whole process took about a month. It dropped my baseline 10-15 pts. The next thing I checked was my Testosterone. You have to check free testosterone, total makes no difference in how you feel or how your body is equipped to handle glucose. Mine was low and I am now on injectable testosterone. What a difference this had made in my life, mood, drive, glucose handling, emotions, everything. My base line dropped again, but it was my PP numbers that responded the best. Usually back under 100 in less then 2 hrs.

Control is with Diet modification, exercise, supps.
A1C, Dxed 11, 5.6, 4.8, 4.6
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Old 07-09-2012, 20:46   #5
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Last year I got my HbA1c down to 5.3, but my doc still kept me on the 2550mg of metformin. I also have lost all the weight I needed to lose and am very fit. But even using the metformin my bgs crept back up especially in the morning (DP). Last April it was 6.1. So for some of us we have to face the fact that we will always be on some type of med.

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low carb organic diet
3 T of Coconut Oil daily
moderate exercise- mostly walking 3-5 miles, tennis - 4 hours per week, weight training, hiking on weekends and vacations 7-10 miles

HbA1c 5.3 3/11
HbA1c 6.1 5/12

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Old 07-09-2012, 22:14   #6
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My doc's opinion of Metformin was "and it might even help you lose weight!" in a positive sense. I would rather stay on it and keep my numbers down!


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Old 07-09-2012, 23:22   #7
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Originally Posted by Miss_Blue View Post
She assumed my A1c (4.9%) was a result of hypoglycemia, as though no one can get that A1c without low blood sugar.
slightly concerning that your Doc does not understand how averages work

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