Okay - I know we all waited with baited breath for this appointment.

Slight history - I made an appointment with this endocrinologist because my GP mailed me esults and said come back in three months. I was ale to get a meter from him.

So, I went today to receive a second opinion. He was understanding, receptive and he appears pretty proactive.

He said that one A1c of 6.5% isn't considered a diagnosis for diabetes. I would also need a randon blood glucose of 200mg/dl and a fasting blood glucose of over 127mg/dl. I'm not sure if I would need all three for an official diagnosis. However, he did say I'm at the precipice of a diagnosis. You say to may toe, I say to mah toe.

He feels I should have been given Metformin because he thinks it could prolong pregression or diagnosis for 5-10 years. He gave me a prescription and wants me to start taking 500mg in the evening slowing working towards 2,000mg daily split between morning and evening. He warned to take it on a full stomach and siad that if I have GI problems cut back and if it doesn't stop to not hesitate to call him. I asked about extended relief but, he felt the data wasn't there to support GI problems being reduced. He was willing to switch me if the regular causes me problems.

Thankfully, I fasted and he took A1c, FBG, lipid profile, thyroid. As you may have figured out, I have no results yet. I'm curious because I have been low carbing for just about three months and I'm down 21 lbs.

I asked him if diabetes was progressive and he said yes and no. He said it is for many because many don't have tight control but, he felt that if I progress the way I have, I could easily prolong or stop the progression.

One thing I did not agree with was him telling me to test once a day. He said to get a meter with a data port and change the timing of my testing daily. I don't know what he is going to graph with one number daily. Anyway, I feel a LOT better testing frequently and to be honest - it keeps me on the straight and narrow with food choices/exercise.

I'm going to Maui the last week of October and I am considering starting the Metformin when i get back. I got food poisoning the last time we went to Hawaii and I really don't want to spend another week in the can.

Overall - I felt a positive vibe from him and it looks like he is at least willing to work with me even if I don't agree with everything. He wants to see me in 6 weeks or whenever I'm on Metformin full dose for a month.

I wasn't able to ask him everything I wanted to, including checking my Vitamin D levels. There seemed like so much to cover and although he didn't rush me - they don't love sitting for two hours educating people. I figure one step at a time in the right direction is a good start?

Any thoughts or critiques?

~Danielle

If regular Metformin gives you GI problems,Metformin ER(extended
release) probably would fix that.My doctor prefers Metformin ER over regular Metformin.
You're right to be a little taken back by only testing once a day.
Best wishes
Eddie

Usually - I would edit this kind of stuff but man was that a freudian slip or what!

That would be me asking about extended RELEASE which will, apparently, bring me extended relief.


Thanks Eddie!

Sounds like you found a decent doctor.

Re testing, the big problem is the expense of the strips, and insurers don't like to pay for them for people who do not have a diagnosis. So he is suggesting a perfectly reasonable way to test with limited strips.

Metformin is a safe, helpful diabetes drug which is well worth a try. It works VERY well in partnership with a low carb diet.

If it doesn't lower your blood sugar, then it is time to escalate treatment, since the people for whom metformin doesn't work are usually people who are insulin deficient not insulin resistant. But for most Type 2s it is very helpful. And it has a 20+ year safety record (it was approved in Europe before it was approved here in the U.S.) he single major side effect it was suspected of causing (lactic acidosis) turns out not to arise in people taking metformin any more frequently than in the general population. (Very infrequently.) So even though it may cause digestive disturbances (usually only at the outset) it is well worth trying.

Thank you Jenny.

He mentioned the 20+ year safety record.

My insurance company had no problem giving me strips. I was originally given three a day but, Medco (my insurance) signed me up for the three month mail supply and I was then able to up it to four strips a day. So, I at least have a years worth of 4x daily strips coming my way. I still think it's a bit silly to be willing to give me Metformin (as a preventative measure according to endo) or another drug without question from insurance but, they question a test strip that is in many ways more valuable or equally so as a preventative measure.

~Danielle

Metformin costs your insurer less than $4 a month. Name brand strips even with discounts cost them $80-90 per hundred.

The other problem is that there are a bunch of studies showing that testing doesn't help people who are not on insulin lower their blood sugars. They are lousy studies--they told people to test only once a day fasting and gave them no information about how lowering carb intake lowers blood sugar, so fundamentally their testing was useless to them.

But still, since there have been a couple of these studies published, insurers can say, "Testing is worthless for Type 2s."

And as long as the ADA fights against teaching people with diabetes the role of carbohydrates in raising their blood sugar that probably won't change.

We see a lot of people online learning about carbs and blood sugar, but out there in the world probably 85% of people with diabetes have never done an online search about it. They do what their doctors tell them, which means testing once a week, fasting, and eating low fat diets.

So doctors keep seeing that "testing doesn't lower blood sugar for Type 2s."

Excercise, lifestyle and even some herbs have been shown in studies to be equivalent to metformin in reducing insuline resistence. For a lot of people metformin doesnt even work.

I dont want a diagnosis of diabetes in my record just because if at all I ever try to work on my own i dont need to pay a fortune for insurance.

But anyway my blood sugar levels are perfect now . I got a test kit by myself..I do test once a week now since there isnt much i am learning from doing it every day.

Jenny -

Is there anything we can do to change this? I keep thinking what can the "little guy" do to make an impact and turn this in the right direction. It really pains me to know that people are not given the information they need to live.

Chandbaby1-

I can understand why you you wouldn't want a diagnosis on record. I haven't fully decided if I am going to take the Metformin but, in all likelihood, I will try it. If it really can prolong the progression and gives me another 5-10 years of quality life, I don't know how I could say no. If I start them, I will do so upon coming home from my trip at the end of October.

~Danielle

chandbaby1 what herbs are you talking about?

bittern melon, cinnamon, gymnema sylvester, turmeric, fenugreek.

All really helps. I had morning Blood sugar of 100s before now I consistently have it between higher 80s or early 90s. It is like I am getting better at it as time goes.

If you have close to normal BG control, you will slow down or entirely prevent progression. Bad BG control is why the disease does harm. If you have normal BG's you have normal expectations for your future health.

As you become less insuline resistent and lose weight, the amount of insuline required by the body decreases . In some people the requirement drops in half . Although it has been well documented that metformin prolongs the incidence of diabetes. There has been a lot of cases in which insuline resistence does not progress to diabetes at all.

So I would put it this way. Keeping blood sugar low and decreasing the need for insuline would help prevent diabetes. Is it aguaruntee ...no... but this is the best bet now.

Thank you so much for all the responses and input. It means a lot to me. It keeps me grounded and focused on the goal.

~Danielle

[QUOTE=CantEven]

Chandbaby1-

I haven't fully decided if I am going to take the Metformin but, in all likelihood, I will try it. If it really can prolong the progression and gives me another 5-10 years of quality life, I don't know how I could say no. If I start them, I will do so upon coming home from my trip at the end of October.


Taking metformin will probably help control BG, but I think to say that it will give quality life is an over expectation of it.... If someone is pre-diabetic, that is a diabetic condition, just as much as being a type 1 or type 2, it won't go away, and can only be held at bay with effort. Considering the seriousness of diabetes as I know it now, not when I first had it, I'd depend on a lot of methods to control diabetes than just depending on Metformin.

Also, in a single month, health can go from pre-diabetes to full blown type 2 diabetes. If it is known now that caution needs to be taken, delaying the use of caution is sort of a denial. I can't say this LOUD enough, but a day late is a dollar short and you'll never get that day again.......

Take whatever steps it takes to avoid becoming a diabetic. If a person gets an early warning, they're very lucky. A second warning may not come.....

I don't mean to harp..... I just wish someone would have let me know how serious diabetes is a long time ago and gotten my full attention.....

Ron

Not that I disagree with everything else but, this really struck home. I went through an angry period because when I was *JUST* (sense sarcasm) PCOS/IR my doctor had the attitude that "I wasn't even prediabetic". He did hand me a printout of diabetes but, it really only said exercise and lose weight. Anytime, I spoke to him about how difficult it was to lose weight. I got really no response and perhaps a bit of "yeah right" attitude. The thinking is that if you are obese or have significant weight to lose, you are lazy with poor eating habits. Now, grant it, I need to take some responsibility. I could have done better with both but, I really didn't sit around gorging on forbidden junk food.

There was a time that I alked 5 miles a day, did water aerobics 3 or more times weekly, strength trained with my husband and took yoga. My yoga teacher looked at me like I was nuts because with all that, one would think I was slender but, not even close.

I went to PCOS boards and got the standard advice of trying IR Diet which basically matches carbs w/protein. It didn't work either so, I eventually tried VL Calorie dietng and starving didn't work. By that point, I figured I was destined to be overweight forever and that when I hit a bad diabetic level, I'd have WLS.

I really wish I was taken aside and told the seriousness of it all. If you are IR/metabolic syndrome, I say, consider yourself an early diabetic even if you never get to that official diagnosis and I pray one doesn't. Then tackle it as a diabetic. Which of course requires the ADA and the like to adjust their suggested diet. I can understand that everyone requires or handles carbs differently but start people off at a Low GI/Zonish like diet and help them adjust the carb level until they reach their goals. It's far better than becoming hopeless on the current diet given most diabetics.

LOL - sorry for the small rant. It just really urks me that so many people are being misguided needlessly.

~Danielle