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Cardiologist wants me to take medication. Skeptical.
My latest blood test (fairly in line with recent tests) indicates I have a serum glucose level of 95 which is high normal, not even pre-diabetic. My A1C number is 6.4 which is high pre-diabetes. From what I have read, most medical sources do not recommend medication treatment until the A1C reaches 7.0. My GP who orders the test said nothing about diabetes medication with these numbers. However, my cardiologist wants me take Metaformin 500 MG. When I ask my GP about this,he is evasive. I don’t think he wants to get caught in the middle. I don’t understand why a cardiologist should be ordering diabetes medicine for me rather than my GP.
I have carotid artery disease and have a stent. It has been explained to me that my cardiologist is being aggressive in his treatment because of this. Still, I don’t understand why a person with a glucose range in the normal range should be taking diabetes medication at this point, and with an A1C reading still in the pre-diabetes range. (I also don’t understand why the two readings conflict like this.)
I’m an accountant by occupation, but I’m also a writer of short stories with periodical credits. If an editor wants to make changes to my work on simple editorial matters, I don’t object. But if he or she wants to make substantive changes, then I do object. As the author, I have the final say on such matters. I try to be cooperative with my physicians, but I maintain that when it comes to my body, I have the final say. I worry about taking too many medications and especially taking ones that might seem unnecessary. Any insights would be most appreciated. Thank you.
I have carotid artery disease and have a stent. It has been explained to me that my cardiologist is being aggressive in his treatment because of this. Still, I don’t understand why a person with a glucose range in the normal range should be taking diabetes medication at this point, and with an A1C reading still in the pre-diabetes range. (I also don’t understand why the two readings conflict like this.)
I’m an accountant by occupation, but I’m also a writer of short stories with periodical credits. If an editor wants to make changes to my work on simple editorial matters, I don’t object. But if he or she wants to make substantive changes, then I do object. As the author, I have the final say on such matters. I try to be cooperative with my physicians, but I maintain that when it comes to my body, I have the final say. I worry about taking too many medications and especially taking ones that might seem unnecessary. Any insights would be most appreciated. Thank you.
COMMUNITY LEADER
Hi Bob,
when you start metformin (unless it is extended release), you need to start it slowly. You might start with 1/4 tablet / day for a few days, then 1/2 then 1 whole. Some people get gastric upset /diarrhea when starting metformin. By starting it slowly you can avoid this. For most people this side effect is only temporary.
Let us know how you go.
when you start metformin (unless it is extended release), you need to start it slowly. You might start with 1/4 tablet / day for a few days, then 1/2 then 1 whole. Some people get gastric upset /diarrhea when starting metformin. By starting it slowly you can avoid this. For most people this side effect is only temporary.
Let us know how you go.
As sally said a fasting of 95 is OK BUT an A1c of 6.4 means that you are running high BG after meals. and high BG is not good. Carbohydrates raise BG. Get a BG meter (walmart has a cheep one) and test your BG 1 hour and 2 hours after eating your biggest carb meal of the day and see what is says.
1 Comments
Sally and 86, thanks so much for your thorough and considered remarks. With encouragement here and from my pharmacist, you’ll be pleased to know that I have had the prescription filled this morning. I’m still apprehensive but I’ll give it a go. Thanks again to everyone. This forum is a great resource. Best, Bob
COMMUNITY LEADER
Hi,
Your fasting glucose may be 95, which is still at the high end of normal, but your hba1c of 6.4, gives you an average blood sugar of about 150, which is well above normal. If you wait until your hba1c is 7.0, this will give you an average blood sugar of close to 180, nearly double normal. There is much consensus that the risk of heart disease rises significantly as hba1c increases above 5.0. Given that you already have a history of heart disease, I believe that your cardiologist is quite correct in wanting to be sure that your blood sugar is normalized / as close to truly normal as possible.
Metformin / Glucophage is first line treatment for diabetes. It helps sensitize your body to insulin and seems to be a very helpful drug.
A normal non-diabetic hba1c is < 5.0, with ideal probably being in the mid 4s, with average blood sugars of about 100, which will include fasting numbers of 70 - 90 range, and post eating of 80 - 120 range. Where I am a person can already be officially diagnosed with diabetes with a hba1c of 5.7. The ADA line that people with diabetes can safety have a Hba1c of 7.0 is wrong, though there is new advice that people with diabetes should get their hba1c down as close to normal as they safely can.
Would suggest you take all measures; exercise, low carb diet, medication, to get your hba1c as close as you can to 5, or ideally mid-4s. Further would also suggest that you get a blood sugar meter and starting testing about 1.5 - 2 hours after eating. Your target blood sugar 2 hours after eating should be ideally < 120 (the close to fasting the better), and definitely not higher than 140. The results of your testing after meals will let you see the effects of different foods and help guide your meal choices.
Learn about diabetes, and it's management. Bernstein Diabetes University on U-tube has lectures which can be useful. Bernstein is a very strong advocate of normalizing blood sugars for people with diabetes.
Your fasting glucose may be 95, which is still at the high end of normal, but your hba1c of 6.4, gives you an average blood sugar of about 150, which is well above normal. If you wait until your hba1c is 7.0, this will give you an average blood sugar of close to 180, nearly double normal. There is much consensus that the risk of heart disease rises significantly as hba1c increases above 5.0. Given that you already have a history of heart disease, I believe that your cardiologist is quite correct in wanting to be sure that your blood sugar is normalized / as close to truly normal as possible.
Metformin / Glucophage is first line treatment for diabetes. It helps sensitize your body to insulin and seems to be a very helpful drug.
A normal non-diabetic hba1c is < 5.0, with ideal probably being in the mid 4s, with average blood sugars of about 100, which will include fasting numbers of 70 - 90 range, and post eating of 80 - 120 range. Where I am a person can already be officially diagnosed with diabetes with a hba1c of 5.7. The ADA line that people with diabetes can safety have a Hba1c of 7.0 is wrong, though there is new advice that people with diabetes should get their hba1c down as close to normal as they safely can.
Would suggest you take all measures; exercise, low carb diet, medication, to get your hba1c as close as you can to 5, or ideally mid-4s. Further would also suggest that you get a blood sugar meter and starting testing about 1.5 - 2 hours after eating. Your target blood sugar 2 hours after eating should be ideally < 120 (the close to fasting the better), and definitely not higher than 140. The results of your testing after meals will let you see the effects of different foods and help guide your meal choices.
Learn about diabetes, and it's management. Bernstein Diabetes University on U-tube has lectures which can be useful. Bernstein is a very strong advocate of normalizing blood sugars for people with diabetes.
Caregiver, thank you for your thoughtful and sage advice. I shall indeed consider it carefully.
Happy Thanksgiving to you and all!
Happy Thanksgiving to you and all!
Metformin is a medication with an excellent safety record. It is clear that good control of your blood sugar is essential. I believe your cardiologist is exercising good judgement and you should not hesitate to take the metformin and the benefits outweigh the minimal risks..
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