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Medical Forum / Diseases and Disorders / Diabetes / July 2004igt - doc won't prescribe enough metformin
I've been igt for about six months now, self-diagnosed. I can still pass the fasting bg test most of the time, and never go over 110 on arising, so by my HMO's criteria, I am not pre-diabetic. After phoning an endocrinologist colleague, my internist gave me a prescription for 250mg daily metformin, I think primarily to humor me. It didn't do a thing, so I put the pill cutting device in a drawer and upped it myself to 500mg. per day. This seems to have had some effect: my meter readings are slightly lower now, but I still can reach 175 or so at the 2 hour mark, and definitely can at one hour pp., especially if I follow the ADA diet. When I told the doctor that I'd read the minimum effective dose is 1,000 to 1,500mg, he said he could not give me that much because he was prescribing off-label. He also said that my goals (as recommended by this group) of 140 at one hour, 120 at two are unnecessary, that the ADA limits of 180-140 are adequate. So this leaves me with only the option of going low carb, which I really don't want to do. I've basically given up simple carbohydrates (refined, white stuff), but from everything I've read about nutrition, complex carbs (including fruit) are essential to good health. I know some of you are successfully low-carbing; hats off to you, but I absolutely do not want to do this unless I must. Actually I'd rather shoot insulin. So my question is: How do I convince this guy to prescribe an adequate dose of metformin? He's been my primary care physician for nearly fifteen years and, for the most part, I've been pleased with him, given the HMO's constraints on his time (15 min. for an appointment, usually). Whenever he can, he will prescribe what I ask for, so I presume it's a matter of policy that prevents him from upping my dosage. Does anyone have any suggestions? Do I need to change doctors, with all the accompanying agony that entails? Should I buy more metformin from Canada, even though I'm paying $450 a month for my insurance? Thanks in advance for any good advice. Barbara >Does anyone have any suggestions? Yeah, go low carb, sorry. There are a variety of ways to do so, and even a good quality pasta that most folks can tolerate. If you can manage your health with diet and exercise (critical component) you're better off doing so. With your numbers, though, I don't know why you're having trouble being diagnosed diabetic. Susan >I've been igt for about six months now, self-diagnosed. I can still >pass the fasting bg test most of the time, and never go over 110 on [quoted text clipped - 22 lines] >So my question is: How do I convince this guy to prescribe an adequate >dose of metformin? Get a new Dr. If he is not doing his job why would you want to convince him anyway? Ronnie Ruff www.ronnieruff.com/blog/index.html www.ronnieruff.org > I've been igt for about six months now, self-diagnosed. I can still > pass the fasting bg test most of the time, and never go over 110 on [quoted text clipped - 32 lines] > > Barbara Barbara, if you ask me a family physician isn't equipped to handle each and every illness fully, which is why there are specialists. If I were you I would go to an endocrinologist. That would be your best bet to find out what your situation truly is.  SignatureRegards, Evelyn (to reply to me personally, remove 'sox") If your goal is to get your Dr. to prescribe more metformin, you could carb up before the tests so they will be high enough to get him to make the desired diagnosis. I'm not suggesting you do this, but since you seem to be taking your treatment in your own hands, it would be one way. > I've been igt for about six months now, self-diagnosed. I can still > pass the fasting bg test most of the time, and never go over 110 on [quoted text clipped - 32 lines] > > Barbara > I've been igt for about six months now, self-diagnosed. I can still > pass the fasting bg test most of the time, and never go over 110 on [quoted text clipped - 32 lines] > > Barbara Barbara, I think you need to do what I did when my internist wouldn't prescribe metformin for me at *all*, which is to find an endocrinologist. Your PCP doesn't know what he's doing. You need someone who knows at least as much as you do, which is what you don't have right now. Priscilla > I've been igt for about six months now, self-diagnosed. I can still > pass the fasting bg test most of the time, and never go over 110 on [quoted text clipped - 13 lines] > the ADA limits of 180-140 are adequate. So this leaves me with only > the option of going low carb, which I really don't want to do. Or get a decent doctor. Whose body is this anyway? I think you have read enough to realise he is feeding you BS. I've > basically given up simple carbohydrates (refined, white stuff), but > from everything I've read about nutrition, complex carbs (including > fruit) are essential to good health. I know some of you are > successfully low-carbing; hats off to you, but I absolutely do not > want to do this unless I must. Nothing to do with receiving hats off, we low carb because we need to keep bg's in control. What price quality of life? > Actually I'd rather shoot insulin. That is one way, but you may end up shooting megaloads of insulin to control what you could do with more dietary modifications, extra exercise and a new doctor. > So my question is: How do I convince this guy to prescribe an adequate > dose of metformin? He's been my primary care physician for nearly [quoted text clipped - 6 lines] > more metformin from Canada, even though I'm paying $450 a month for my > insurance? Thanks in advance for any good advice. I wouldn't self medicate, I would try a different doc who is more progressive and up to date. I have two doctors, one for the simple treatments like sore throats etc, one for my diabetes care (plus an endo). My first doc sounds like your current doc. If you are already on a med and you are still getting high numbers, don't you think it is time to question your doctor's diagnosis? <snip> > That is one way, but you may end up shooting megaloads of > insulin to control what you could do with more dietary > modifications, extra exercise and a new doctor. She's right about the megaloads of insulin. I was self medicating 2 years ago, I had to shoot 25 units of regular 30 minutes before each meal to prevent spikes. I also shot 20 units of Ultralente 2 times a day. That is 115 units of insulin every day. This is much more than most Type 1s have to shoot. It takes a lot of insulin to overcome IR in a type 2. Now I get better control with 2000g of Glucophage XR, 120g Starlix before each meal and limiting carbs to 100g a day. > I wouldn't self medicate, I would try a different doc who is > more progressive and up to date. I have two doctors, one [quoted text clipped - 3 lines] > getting high numbers, don't you think it is time to question > your doctor's diagnosis? I was self medicating because I didn't trust any of the doctors. My wife had died of diabetic complecations under the care of 2 doctors. After a year of self medicating, I found a good doctor that I trust. You should look until you find one. Anon Barbara, Insist on having a glucose tolerance test. Any value over 200 on a GTT is diagnostic of diabetes. The fasting plasma glucose test is a scandal. It fails to diagnose diabetes in 48% of older men and 72% of older women who test diabetic on the GTT. But that said, metfomin may not solve your problem. I'm up to 1500 mg a day right now and my fasting is exactly the same as when I started taking it a couple months ago--106 this morning. Cutting way back on carbs is a much more effective technique for a person at your stage of blood sugar deterioration. As far as health goes, I started out with blood sugars only a bit worse than where you are six years ago and have seen no deterioration in my health thanks to low carbing and the use of Precose, a drug that slows down carb digestion. Precose has been shown in well-regarded studies to delay the progression to diabetes, so maybe you can get a doctor to prescribe it. It works a lot better for me than the other drugs. -- Jenny - Low Carbing for 4 years. Below goal for weight. Type 2 diabetes, hba1c 5.7 . Cut the carbs to respond to my email address! Low carb facts and figures, my weight-loss photos, tips, recipes, strategies for dealing with diabetes and more at http://www.geocities.com/jenny_the_bean/ Looking for help controlling your blood sugar? Visit http://www.alt-support-diabetes.org/Newly%20Diagnosed.htm > I've been igt for about six months now, self-diagnosed. I can still > pass the fasting bg test most of the time, and never go over 110 on [quoted text clipped - 32 lines] > > Barbara If she's already on metformin, how meaningful would a GTT actually be? Jon > If she's already on metformin, how meaningful would a GTT actually be? He would have to give her a diabetes dx which he hasn't done already and would have to give her the extra metformin dose he is not giving her now. >>If she's already on metformin, how meaningful would a GTT > [quoted text clipped - 3 lines] > already and would have to give her the extra metformin dose > he is not giving her now. What I mean is: that since she is on metformin already she might pass the test because the metformin supresses the spikes. Jon >> He would have to give her a diabetes dx which he hasn't done >> already and would have to give her the extra metformin dose >> he is not giving her now. >> > What I mean is: that since she is on metformin already she might pass > the test because the metformin supresses the spikes. I doubt Metformin would suppress the spikes of a glucose load. Even without the load, any diabetic drug is just to assist with keeping bg's lower, it won't work on it's own without some sort of dietary control. cc'd by email RUN do not walk to the nearest new doctor. Even if the doctor should be correct (and I don't think anyone here thinks so) you need a physician who can explain things in a way YOU can agree with. YOU are the one who treats diabetes, not the physician. THEY are your best adviser and helper. If you can't get it together, go elsewhere. http://care.diabetesjournals.org/cgi/content/full/27/suppl_1/s5 for info on diagnosis > I've been igt for about six months now, self-diagnosed. I can still > pass the fasting bg test most of the time, and never go over 110 on [quoted text clipped - 32 lines] > > Barbara Signature"...in addition to being foreign territory the past is, as history, a hall of mirrors that reflect the needs of souls observing from the present" Glen Cook > I've been igt for about six months now, self-diagnosed. I can still > pass the fasting bg test most of the time, and never go over 110 on > arising, so by my HMO's criteria, I am not pre-diabetic. (snipped) Ask this doctor if he can tell you the current official standards for a dx of Diabetes Mellitus, pre-diabetes (Impaired Glucose Tolerance- IGT) and Impaired Fasting Glycemia - IFG. You can read about it yourself at; http://www.sdspathology.com.au/newsletter/diab_4aug.htm Note that these are the recommendations of the World Health Authority (WHO), and have been adopted by most western countries. If he cannot tell you, then seek a doctor who can! If he fobs you off with a lot of self-justification or such, or an incomplete explanation, he is, at best, out of date. You seem to fall into the last category, and he should at least have followed up with an oral glucose tolerance test (OGTT), to determine your true status. You certainly seem to be at risk, IMHO, so I encourage you to go get the help you need. Soon! All the best, Annette > I've been igt for about six months now, self-diagnosed. I can still > pass the fasting bg test most of the time, and never go over 110 on [quoted text clipped - 6 lines] > reach 175 or so at the 2 hour mark, and definitely can at one hour > pp., especially if I follow the ADA diet. I'll defer to the others, but add that I am prediabetic on the highest dosage of metformin. It does not bring post-prandial numbers down for me without strict control of diet and exercise. I've found that using the glycemic index and eating a lot more fish and cutting out processed foods (including so-called "fat-free" foods) has really helped me keep the numbers down. > When I told the doctor that I'd read the minimum effective dose is > 1,000 to 1,500mg, he said he could not give me that much because he [quoted text clipped - 8 lines] > want to do this unless I must. > Actually I'd rather shoot insulin. I don't count carbs at all, but I choose foods according to the glycemic index and it seems to work well. I usually eat smaller amounts of higher-glycemic foods as part of a meal rather than snacks, since they can otherwise lead to spikes for me. > So my question is: How do I convince this guy to prescribe an adequate > dose of metformin? He's been my primary care physician for nearly [quoted text clipped - 6 lines] > more metformin from Canada, even though I'm paying $450 a month for my > insurance? Thanks in advance for any good advice. Metformin is just one part of a solution for some people. I'd focus on your symptoms and do what works for you. If you have a good relationship with your doctor, can you request a referral to an endocrinologist? If he's good at prescribing, maybe he'll also be good at referring. Good luck! |
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