Metformin and not having to test!

Darly
By Darly Latest Reply 2009-11-16 18:59:15 -0600
Started 2009-11-09 16:26:04 -0600

I wen to my Doctor today,he put me on 850mg. of metformin 2x a day! I asked him about testing my sugar levels,he said that I didn't have to as when I get my A1C's done it will tell how my levels are. I went for A1C,kidney function,and urinalysis today. The Doctor said I am not diabetic and insurance will not cover cost of meter,strips and such,they will cover metformin as it is cheap drug! I really do not understand,why would he put me on this diabetic drug at that dose 2x a day if I was not diabetic. He knows how high my sugar levels can go,that is why he put me on it. I told him how fatigued and lousy I have been feeling and sleeping in until 10-11am every morning for the past month or so,he said it could be from high sugar levels. He asked if I had any blurry vision,I told him I did on & off during the day,he said it could be from high sugar levels,told him I had gone for eye exam because of it but had 20/20 vision! When I picked up my metformin I asked the pharmacist what was it for,she said diabetes,I told her what he had said, she told me I had to test my sugar levels to make sure they do not go too high or too low,and,also added "find another Doctor!"…I asked about the extended release,he said they were both the same,pharmacist said he was wrong. I have no clue as to what is going on or what to do. Thank God someone here was kind enough to supply me w/a meter and test strips or I think I would be in trouble. I told the Doctor my insurance covers all diabetic supplies,he said I have not been diagnosed,my fasting level was high but not at 126 to be considered diabetic,it was "121" on that one day…I am just so confused right now it isn't funny,I think this is all crazy!…Thank you for taking the time to read this.

Darlene


39 replies

Sarguillo
Sarguillo 2009-11-10 16:40:33 -0600 Report

hi Darly,

Glad you had your visit.
Its strange that the doctor put you on diabetes meds and still says you are not diabetic.

I did like the comments about eating a high carb meal before going to do your test.
If your system is not working correctly, it would show as a high number.

Well, Keep testing. Take your meds, eat right, find a new doctor.

Good luck.
I wouldnt steer you wrong.

Darly
Darly 2009-11-10 17:28:11 -0600 Report

Hi Luis! I don't understand either,really got me down. The fact that he put me on 850mg. of metmorfin 2x a day really confused me. I would have had a high carb meal before doing test but he made me go right down to lab,put on lab sheet "Today"…I decided to start off with just 1 pill a day,just to make sure it doesn't have nasty side effects,took one last night and feel fine today,just some bad leg cramps.

I just took my level as to see where it was at,because my son will be making dinner soon…my sugar level was 155,all I had was about 3-4 Tablespoons of mac & cheese he made about 4pm,then I had a coffee w/2 sugars,fat free cream about an hour ago.

I will be doing just what you said.

I know you would never steer me wrong,you have been great to me and I appreciate it so much!

Sarguillo
Sarguillo 2009-11-11 18:58:07 -0600 Report

Metformin comes in 500mg and 850 mg. Weird that if he wanted you on a lower dose, he chose the higher dose for you. I wonder if it comes in even higher doses?

Good luck. it will all work out in the end.

Darly
Darly 2009-11-15 15:35:07 -0600 Report

My friend who was diagnosed 2 years ago is on 750mg. twice daily. She was very confused as to why he put me on 850mg,told me I was not "diabetic" because that 1 day fasting blood sugar was "121". He has my records from therapist showing all my numbers,which are diabetic numbers. I have only taken the metformin once a day,except for one day, my numbers after my largest meal are still not lower than 130,135,140,150,153,157. I have to say since taking this medicine I have had more energy,been having an appetite,just feeling better all around. I do need to test to see where my levels are at. I called my insurance Co., told them I need a new Dr., told them about not being diagnosed because of one day level was "121" and about Dr. giving me high dose of diabetic medication,then telling me I did not need to test and Insurance would not cover,the woman I spoke to told me the Dr. just has to write script for meter and supplies,I bring it to this place,and,have it filled!…She did take the time to give me several Doctor's office's to call. I told her nothing to do with the clinic I was going to…thank you all for your concern and input!

By the way, my A1C was 5.6 (surprisingly!) non fasting glucose was 66 that day,I know that was too low,nurse said it was fine! She never gave me results on kidney function or urinalysis. I tend to agree with KDroberts about things affecting A1C levels, I have no idea why but this time is was 5.6 down from 5.7 with self testing numbers in diabetic range for sure. I have learned a lot and I know I am diabetic…look at how metmorfin has made me feel,from being constantly fatigued,not feeling well to feeling better than I have in months!

Darly
Darly 2009-11-16 09:26:50 -0600 Report

Last evening I was at my Grandson's hockey game,I started to feel a little nausea's and dizzy, I felt like my BS level was low, I had my son share his twix bar w/me as I had only 3 breath savers and was not sure if that was enough sugar. I got home 45 min. later, my BG level was 81 at that time,I had to have been hypoglycemic at the game and luckily caught it…Thank God I had the meter and strips.

I am going to discuss this with my therapist this morning,see what she thinks about "not having to test" maybe she can write a script as she is a nurse practitioner also,or,she can task a letter to my Doctor,only way to get a hold of him!

dc72
dc72 2009-11-16 13:01:28 -0600 Report

Your FBS of 121 is not diagnostic of diabetes.A confirmed FBS of 126 or greater is needed to diagnose Diabetes. you have impaired fasting glucose. This means that you are at increased risk of progressing to diabetes. You can reduce the risk of progression by weight loss if your are overweight ( about 10% of your body weight), exercise ( walking about 30 minutes /day) and by taking metformin. Your home glucose test willmost likely be normal. Home test are not a useful diagnostic tool .Finger stick glucose test tend to read a little high. Getting a repeat laboratory fasting glucose done is probable the best way to follow this problem. Exercise and frequency of testing shoud be discussed with your pyysician

Darly
Darly 2009-11-16 13:42:48 -0600 Report

I am aware of this,as I said the Dr. went by one fasting level that happened to be "121" that day,as he said. My next level, on the 9th was at 2:30pm,non fasting,it was 66, as I have been told this is hypoglycemic level as it was non fasting…I do know what the ADA goes by,which is the fasting level of or greater than "126"…thank you for your response!

Darly
Darly 2009-11-16 18:01:18 -0600 Report

This text just came from my therapist:Darlene,u should continue to take metformin if it makes u feel better,u do not have diabetes,just insulin resistance,it isn't an ADA Insurance/Medical necessity to test blood sugars. There's more to the picture than face value, he prob. didn't explain it entirely,we will talk about it at length,but keep taking the metformin! It does alot of good for other related health issues! Trust me on that!

Very interesting,time to throw in the towel here I guess.

Sarguillo
Sarguillo 2009-11-16 18:29:57 -0600 Report

Darly, dont throw in the towel just yet. if you are going up and down, its more than they say it is. Test as much as you can for as long as you can. Better to be safe then sorry.

If I remember correctly, you had a fasting number of 221 not too long ago. Please remember to point that out to the doctor.

Good luck. It may take time, but at least they admit you are pre-diabetic.

Darly
Darly 2009-11-16 18:59:15 -0600 Report

Hi Luis, the fasting level was 121,it was about a month ago,the Doc. did say "pre-diabetic although the level was high" I will continue to test as long as I can. I agree my levels are up and down on a daily basis.

I love the way she put "just insulin resistant!"…

Thank you

Andrew S. Rhinehart
Andrew S. Rhinehart 2009-11-09 19:54:16 -0600 Report

I am a physician specializing in the treatment of people with diabetes and I would agree this is a bit confusing but if I had to guess what happened it would be as follows. You had fasting lab work done and it came back 1 or 2 days later and you doctor saw that your fasting glucose was elevated into the Pre-Diabetes range (100-125 mg/dl) so he decided to treat this with metformin. but based on that glucose level you could not be diagnosed with diabetes thus the payment issues occurred with your medication and testing supplies.
What I belive should have been done differently is that you should have had either an A1c to diagnose diabetes as based on a concensus statement by experts from the American Diabetes Association and the European Association for the Study of Diabetes. An A1c>6.5% can be used as a diagnostic test for type 2 diabetes mellitus and better yet an oral glucose tolerance test (OGTT) is the gold standard diagnostic test. In an OGTT you would have a fasting glucose test and then drink a 75 gram carbohydrate drink followed by a glucose test 2 hours later.
Once again, you need to have a diagnostic test to see if you have type 2 diabetes or pre-diabetes (these tests need to be done after you have been off of the metformin) then and only then can treatment and self-monitoring of blood glucose (SMBG) decisions be made.
SMBG in pre-diabetes can be done infrequently (once a week or so) while diet or oral medication controlled diabetes can be typically be managed with once or twice daily SMBG. People taking insulin ideally need to SMBG 3-6 times daily.
Please visit my website for more information www.TheDiabetesExpert.com

kdroberts
kdroberts 2009-11-09 20:22:43 -0600 Report

There is more to this story. Several things that have happened in the past that have suggested the doctor is either not looking at things or is clueless. Like a fasting reading of 166, blood sugar levels being recorded near 200, traces of protein and ketones in urine, tingling in hands and feet and high cholesterol and triglycerides, all put together would suggest closer monitoring of blood sugars would be a very good idea.

Also, I was under the impression that no guideline regarding using the A1c as a diagnostic tool had been agreed on because of the multiple factors that play into the result and the lack of a standard across different labs. earlier in the year I heard the 6.5% cut off point discussed but not agreed on. Has that changed or is this something you go by on your own? I also think it would be hard for anyone on insulin to properly use insulin testing any less than 6 times a day and even people who just use diet can benefit hugely by testing 6 times a day dropping back to 3-4 after several months. After all, there is no better feedback about how a food affects your blood sugar than eating and testing once you find your peak times.

Andrew S. Rhinehart
Andrew S. Rhinehart 2009-11-09 21:13:37 -0600 Report

Here is a link to one of the the ADA's scientific journals "Diabetes Care" with the article regarding A1c as a diagnostic tool from July 2009.
http://care.diabetesjournals.org/content/32/7...
There are numerous scientific studies suggesting SMBG may actually be of no benefit in T2DM on diet or oral medications alone http://care.diabetesjournals.org/content/29/8...
and here is a quote from the International Diabetes Federation's 2009 Guidelines for SMBG in non-insulin treated T2DM
"After sufficient glucose profiles have been obtained and addressed, it would therefore be reasonable to review the SMBG frequency and intensity. SMBG could be reduced to performing pre- and postprandial testing 2 to 3 times per week as a way to monitor glucose control and identify problems as they emerge. Also, periods of no SMBG could be prolonged if there is stable and ‘good’ metabolic control." and here is a link to the full guidelines.
http://www.idf.org/webdata/docs/SMBG_EN2.pdf

kdroberts
kdroberts 2009-11-10 08:50:27 -0600 Report

I've read the studies about blood testing, none have done it in a logical way where one group was taught how to use results to change diet and exercise in order to gain better control of their blood sugars. Testing just to get a number is useless, testing to get a number that you can and do use is invaluable. If you eat a meal every day that spike your blood sugar to 200 and are just relying on a test every 3-4 months that's a lot of damage done. If you test for each meal you see the spike and either change that meal or don't eat it. It seems illogical to recommend not monitoring blood sugar when so much damage and medication can be avoided by doing it right.

Andrew S. Rhinehart
Andrew S. Rhinehart 2009-11-10 09:12:50 -0600 Report

I don't believe anyone is truly advising not to do SMBG at home as you have implied. I am merely quoting scientific data regarding SMBG and guidelines for SMBG from numerous national and worldwide diabetes associations such as the ADA, EASD, ACE, IDF, & AACE and generally these would be exactly what I stated before - once or twice daily for people not taking insulin and 3-6 times daily for people using insulin to manage their diabetes.

kdroberts
kdroberts 2009-11-10 10:20:34 -0600 Report

I know, I've read the studies and the advice and I (and many, many other) think it's just plain wrong and doing more harm than good. I think that really goes for a lot of the generic advice that is given buy authorities because a) if it tuns out to be causing more harm than good it's not the authorities that suffer it's the people who listened to them and b) it would be very embarrassing for them to admit they got it wrong and change their advice.

I only have limited resources when looking for studies since I am not signed up to medical professionals only resources but I haven't found a single study or piece of advice that was based on a study that actually studies USING SMBG results as part of their treatment plan. At best a doctor reviews once in a while and makes suggestions, at worst they just make a pointless log book.

Darly
Darly 2009-11-10 11:09:33 -0600 Report

Thank you very much Kdroberts! Your first reply to Andrew was very correct,that is what has happened to me! I already have the tingling in legs,hands,feet…have poor circulation, post meal spikes close to 200 etc..I have had fasting levels up to 166 also! This Doctor told me he went by the fasting level of "121" and said "that happened to be just under diabetic range,but,on that one day!". He also asked if I ever had a glucose tolerance test, I told him no, did he order it, no,he did not!…I do not agree with Andrew on his advice at all..I am sorry but I have read up on it and I refuse to let my body get anymore damage than it already has…yes, my cholesterol levels are through the roof, and, yes…Kdroberts was right about this and the traces of ketones & protein in my urine!…Once again,thank you Robert!

Andrew S. Rhinehart
Andrew S. Rhinehart 2009-11-10 11:29:55 -0600 Report

I hate you disagree with my advise but regarding what? SMBG? I would just advise you to get a correct diagnosis to start and then if you have T2DM, which I believe you do, then you need to get diabetes self-management education from a nurse and dietitian regarding every aspect of diabetes care including SMBG.

Darly
Darly 2009-11-10 11:54:22 -0600 Report

I am sorry Andrew. You have no idea what I have to deal with at this clinic. They only allow you a 15 min. visit,you can't get hold of your doctor when you need to. I had the A1C done yesterday and will have results today I was told. If I even mention anything about these classes,dietitian, he will say I don't need it,he is the worst doctor I have ever been to. I can not say a word,makes me just listen to him, this is not right at all.

Andrew S. Rhinehart
Andrew S. Rhinehart 2009-11-10 12:02:03 -0600 Report

Don't you dare apologize. You are in a very difficult situation and I just hope I can help a little bit. Along with my 4 diabetes educator I run a diabetes care center and all we do is treat people with diabetes. You definitely need a new provider as diabetes self-management education is probably the most important part of diabetes care. Good luck & feel free to contact me with any questions.

Andrew S. Rhinehart
Andrew S. Rhinehart 2009-11-10 11:25:52 -0600 Report

I agree that providers need to review log book but more importantly patients need to receive diabetes self-management education with a nurse and dietitian so than can make changes on a day-to-day basis based on their SMBG results. This is something that does have proven improved outcomes and all patient should receive this type of education. We will agree to disagree regarding the legitimacy of scientific research and the use of this data to generate treatment guidelines.

kdroberts
kdroberts 2009-11-10 11:47:44 -0600 Report

No, I agree that learning to evaluate SMBG results and use that information is critical and is probably the most important aspect of managing diabetes. You can't do it to its full potential when you only test a couple of times a day is my point.

Andrew S. Rhinehart
Andrew S. Rhinehart 2009-11-10 11:58:24 -0600 Report

Okay. I believe that no different than treatment decisions & treatment goals SMBG needs to be individualized. Every patient I see is different with a different situation whether it be financial, life expectancy, medications, etc.; therefore, I need to see patients as individuals and make recommendations based upon that. I use treatment and SMBG guidelines as a place to start and then individuals recommendations based on each patient. If someone has no diabetes related complications, is on diet alone, does not have insurance coverage to pay for testing strips, has checked frequently when first diagnosed, and is now doing well with an A1c
You need to find a good provider and an education team to help guide you and help you to achieve good glucose control and find the best treatment and testing regimen for you.

Darly
Darly 2009-11-10 13:49:56 -0600 Report

I agree with that statement also Andrew!! I know,and,told my doctor that I checked an my insurance covers testing supplies and all other related treatment!…Thank you for clarifying this up for me…Darlene

Darly
Darly 2009-11-10 13:45:54 -0600 Report

I agree with this also…I know I am not getting right treatment,have been through way 2 much already. Hopefully when he gets A1C today,he will see that I need all that Andrew said.

kdroberts
kdroberts 2009-11-09 19:39:42 -0600 Report

Here's the thing, if bad things happen to you they happen to you, not your doctor. He's sitting there knowing that he isn't going to get eye damage, kidney damage, nerve damage, etc. You have to get a doctor that listens to your concerns and addresses them, not brush them off. A doctor works for you as your adviser, if they aren't doing the job then you have to find a new one.

ptsparkle
ptsparkle 2009-11-09 19:38:57 -0600 Report

Test several times a day, and find another Dr. Check your bs in the morning fasting, then 2 hrs. after a meal. Your Dr. sounds like a nut case. Hope you find the right solution.
Jim

Lanore
Lanore 2009-11-09 19:36:14 -0600 Report

I have to agree…testing is a very important part of take meds and being diabetic. I am not sure I understand why your Dr told you that you did not have to test. You are having some trouble,
Think about finding an other Dr maybe. Wishing you all the best. Lanore =-D

hbkunkel
hbkunkel 2009-11-09 19:30:08 -0600 Report

Darlene,
Get yourself another doctor ASAP!!! If neccessary eat a huge carb meal the night before your next blood test and if your reading goes up them you may get the help you need and deserve. By the way, why would your doctor order an A1C if you are not a diabetic? Daily testing helps all of us to stay on our toes and keep ourselves in a good range. Guessing does not work with diabetes. The drug needs to be taken as you start your meal. Good luck and keep us posted. But do something to help yourself by getting another doctor as soon as possible.
Hugs, Betsie

alanbossman
alanbossman 2009-11-09 18:37:09 -0600 Report

Darly, you should take the metformin with food. It might still upset your stomach, some people it does still upset there stomach. The metformin will take a few weeks to level your bs. hang in there we are all hear to help you

Alan

SkipT
SkipT 2009-11-09 18:01:24 -0600 Report

The doctor is one of those that just makes me want to scream. His arrogance in incredible. You definately need to find a different doctor. He knows nothing about diabetes.

Darly
Darly 2009-11-09 18:13:48 -0600 Report

Thank you both for your input,it means a lot to me as I said, I am so very confused and upset right now!…He didn't even give me any instructions on how to take this medication. How long does it take until you feel any of the nasty side effects,if you were to get them? I don't even know. He had me waiting 45 min. for my appt. then,after the usual 15 min. said he had to hurry to next patient! I left there so let down,once again!…Thank you to all my DD friends!

Darlene

alanbossman
alanbossman 2009-11-09 17:44:06 -0600 Report

Darly, you need to get another doc. I would test at least 3 times a day and watch what you eat. Hope things work out for you.

Alan