Getting off medication? Type 2 diabetes.
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sparky00721
Posts: 113 Member
Under what circumstances would it be appropriate to expect medical support for a decrease of medication, or even complete eventual withdrawal, in circumstances where improved lifestyle changes (better diet choices, finally exercising, etc) result in lowered A1C and fasting glucose numbers?
Do medical professionals tend to look to a particular range, or a particular period of time of good control before they may be supportive of reducing or eliminating say metformin or jardiance on a trial basis?
I am nowhere near there myself, but am keen on having some sort of target or similar to look forward to. Thanks for any thoughts.
Do medical professionals tend to look to a particular range, or a particular period of time of good control before they may be supportive of reducing or eliminating say metformin or jardiance on a trial basis?
I am nowhere near there myself, but am keen on having some sort of target or similar to look forward to. Thanks for any thoughts.
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My doctor officially wants my A1C in the 7.0 to 7.2 range. I got mine in the 6's on metformin and the keto diet (which I was using to lose weight as well). He cut my metformin dose in half. The next A1C was in the high 5's. He had me stop metformin completely (my only diabetes med). My next A1C was in the mid 5's just with the diet and the weight loss. My meter predicts a 5.4 based on current readings, so my next A1C should still be in the normal range for non-diabetics.
FWIW, I am pretty sure all mine cares about is the A1C and does look at the fasting number.
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Thanks 2t9nty, very helpful information which gives me some hope and motivation. Congratulations on your success in dealing with diabetes.2
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sparky00721 wrote: »Thanks 2t9nty, very helpful information which gives me some hope and motivation. Congratulations on your success in dealing with diabetes.
You are welcome. I probably should have said it has been 2 years since the diagnosis. All those A1C's were six months apart, so it did not happen right away. I could tell from the trend on the meter that I was heading in the right direction, and that gave me a lot of encouragement.1 -
I saw my doctor yesterday to touch base after my most recent A1C reading (6.6, down from 9.0 three months ago). He suggested continuing my medication regime of Jardiance (25 mg once per day plus 2000 mg metformin (2 x 500 mg twice a day), but spontaneously said he would like to start reducing my medication in another three months time if I can get my A1C down a little lower, which is promising.0
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sparky00721 wrote: »I saw my doctor yesterday to touch base after my most recent A1C reading (6.6, down from 9.0 three months ago). He suggested continuing my medication regime of Jardiance (25 mg once per day plus 2000 mg metformin (2 x 500 mg twice a day), but spontaneously said he would like to start reducing my medication in another three months time if I can get my A1C down a little lower, which is promising.
So now you have some idea of his targets.
My meter gives a predicted A1C if you have had 21 readings in the previous week. Mine has had good predictions. You might be able to track the predicted A1C between the blood draws for the lab.0 -
sparky00721 wrote: »I saw my doctor yesterday to touch base after my most recent A1C reading (6.6, down from 9.0 three months ago). He suggested continuing my medication regime of Jardiance (25 mg once per day plus 2000 mg metformin (2 x 500 mg twice a day), but spontaneously said he would like to start reducing my medication in another three months time if I can get my A1C down a little lower, which is promising.
So now you have some idea of his targets.
My meter gives a predicted A1C if you have had 21 readings in the previous week. Mine has had good predictions. You might be able to track the predicted A1C between the blood draws for the lab.
Thanks for all the continuing advice, much appreciated.
I do not test my blood on my own and have not yet purchased a meter for at-home testing. I had thought about doing so if my latest 3 month results had been still very high. Having read a number of posts here and information elsewhere, I see the advantage of being able to check to see what effects certain foods may have on my blood sugar, but for now, I am going to just wait out my next 3 month reading.
I have been really impressed with how effective low carb eating has been for a number of you. I do not presently think I could stick with a low carb lifestyle on an ongoing basis. I have worked out a diet approach which so far has been effective in resulting in weight loss but which occasionally results in 200g+ per day of carbs.
My present plan is to continue with this approach and hopefully continue to lose weight and to see if I can drive the numbers down enough to get off medication just with weight loss and exercise, without having to reduce my carbs. That is, rightly or wrongly I am more concerned from a diabetes perspective about dropping my excess weight now than my carb intake; based on attempts over the years with Atkins, etc, I worry that I would fall off a low carb diet approach and stall my weight loss.
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I have been wondering this myself. My next appointment is exactly a year from diagnosis. For the first six months I was an ideal patient, lost ~25 pounds, got my numbers to reasonable (low 6, as I recall). Then over the summer I went off the rails and was back up to about 8 and regained all.the weight. In November, I tried Ozempic to disastrous results. Well, not a complete disaster, hardly eating anything for two months means that my blood glucose numbers are looking great, like in the 80s or 90s. Even now that I am eating a bit more, fasting and postparandrial are excellent.
If my A1C is good (not guaranteed, as I have only had these stellar readings for about a month), are they likely to take me off Metformin with such a mixed record?0 -
Normally it's up to you. If your numbers and weight are good tell your doc you want to get off metformin. You'll then go for a few months without it and then see what happens with your HbA1c.
This was my experience. After I told the doctor I wanted to get off metformin, he said "We will monitor the A1C and talk about that when it comes down." After he left, the nurse said, "Just so you know - no one ever goes off diabetes meds. They add new ones. It is a progressive disease." I said, "OK."
When I got the A1C down, the doctor initially cut the metformin dose in half. My next A1C was still good, and he took me off it.
I will have my one-year-off metformin appointment next week.4 -
It has been a year that I have been off the Metformin. My A1C at today's appointment was 5.4...5
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I had an A1c of 11 at diagnosis. Prescribed metformin, also glimeperide. Added exercise and lost some weight, 3 months later next reading was 4.9. I actually wanted to stay on the meds (in order to be able to eat more carbs without fear, since I was eating a very strict diet at the time) but doctor took me off the glimeperide anyway, and it was fine. Next reading 4.7. Doctor said I could come off the metformin but I asked to stay on it since I have no side effects with it, and it works as an appetite suppressant. With just weight loss, exercise, diet averaging 150g net carbs and eating to the meter, plus metformin, I have stayed consistently under 5.
Basically if you are within target range your doctor will probably want to lower your meds. But there are some reasons you may not want to get off all meds. As @tsazani pointed out there are reasons you may want to be on them. Metformin promotes lean muscle and suppresses appetite and there have been some studies that found people who lost weight on metformin kept it off while on it, but regained the weight when it was stopped. I also keep a supply of glimeperide for sick days, when my bg spikes - for example I had to have a steroid shot following a minor surgery and my fasting bg spiked into the 150s. Taking glimeperide for a couple of days allowed me to bring it back under control.
A lot of doctors also want all diabetics to be on a statin, since diabetics have a much greater incidence of cardiovascular incidents. My lipids are just okay, but I would prefer to stay off the statin since I do have side effects with it. And my blood pressure since I took up running is excellent, 70/110, so no need for a bp med.
I do recommend getting a meter and testing after different meals - there is literally no downside, and it's not scary once you get used to it. By knowing how my body reacts to exercise timing and different foods I can eat big plates of spaghetti, French fries, and other treats without worrying that my sugars are too high. And I know to avoid even small amounts of bread and tortillas, which do spike me. Since everyone is different it's much easier with reliable data.8 -
I am now 19 months off Metformin, and my A1C today was 5.4. I have stayed keto to manage the BG numbers.5
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I was diagnosed 6 years ago and put on Metformin 500mg/day. I am now 71 years old and my A1c has steadily risen from 6.2 after starting Metformin to 7.6 now, despite gradually increasing Metformin to now 2,000 mg/day. I have heart valve disease and can walk 20-25 min/day, but that's about it. I have recently started a diet based on ADA guidelines, but no improvement in daily monitor reading yet. My question is, how long should it take for diet change to result in lower readings? Any other suggestions also much appreciated.0
