# What happens if it doesn't work?



## Icey (Apr 18, 2013)

I'm really not very 'clued' up with the whole diabetes thing, even being diagnosed for 3 and a bit years I really do not have any idea, I feel I really do not understand the condition fully and what happens if certain things don't work.

2009 : Diagnosed and told to control with diet and exercise.

2013 : Prescribed Metformin because diet/exercise wasn't working out.

Now, what if the Metformin doesn't work out? What would be the next step?

I'm now on two a day Metformin and have been told to check my levels three times a week which I haven't seen any improvement in. By next Wednesday I will be on the full three a day, will I see changes immediately or will this be the matter of months until a change?

I know I should be probably asking the doctor these questions, and I will when I see him next (told me to go back in 5 weeks, another 4 to go....) but I figured someone here could answer my questions.


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## Mark T (Apr 18, 2013)

What advice did they give you for diet and exercise - sometimes the advice given is about as much use as a chocolate teapot!

In theory the NHS guidelines that that they will move you onto second level treatment next, gliczades and then after that I think insulin - which is obviously because you have been a naughty diabetic 

Which is of course rubbish, since some times our genetics like to have a laugh at us and we end up on insulin regardless of how good or bad we have been.


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## LeeLee (Apr 18, 2013)

Hi Icey, metformin can take a while to get working and for the side-effects to reduce.  It works by reducing insulin resistance so that the insulin you produce is used more effectively.  It can also help with weight loss because it can have effect on appetite, and weight loss also helps reduce insulin resistance.  

If metformin doesn't work, perhaps because your pancreas isn't producing enough insulin, there are drugs that can boost insulin production.  I will leave advice on those to others who have been prescribed them.


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## Lauras87 (Apr 18, 2013)

Not to upset you but when all else fails you get put on insulin.

Insulin ain't all bad trust me, I have it 5 times a day but I am T1.

Please try not to label yourself a bad or naughty diabetic due to taking metformin 3 times a day.

Remember it's your wonky pancreas's fault not yours


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## mcdonagh47 (Apr 18, 2013)

Icey said:


> I'm really not very 'clued' up with the whole diabetes thing, even being diagnosed for 3 and a bit years I really do not have any idea, I feel I really do not understand the condition fully and what happens if certain things don't work.
> 
> 2009 : Diagnosed and told to control with diet and exercise.
> 
> ...



 The usual treatment algorhythm for T2 diabetes is ...
 ...D&E ( very few T2s can sucessfully control it with just this)
 ...D&E plus introductory metformin working up to effective doses
... D&E plus maximum metformin 2000 - 2400mg
 ...D&e plus metformin plus a sulf e.g Gliclazide ( and don't listen to urban myths about them wearing out your pancreas)
 ...D&E plus metformin plus a sulf plus a TZD ( the sulf might be dropped)
 ...D&E plus metformin plus byetta or victoza
 ...D&E plus metformin plus an introductory insulin regime ( e.g. single dose of lantus at bedtime or a mix twice a day ( e.g Humalog Mix 25)
 ...D&E plus metformin plus a true physiological insulin regime ( basal/bolus)


at least that was the usual track until a couple of years ago. Byetta and victoza seem to be being introduced at random now. A couple of years ago you could only go on them after you had maxed out on met and glic and were still having problems. Their weight loss properties have led T2s clamouring for them. Also the TZDs ( such as Rosiglitazone) are looked at askance now after heart scares, the TZD stage might be by-passed now.

As you can see you are just setting off on the foothills of this treatment path but many T2s are actually one or two steps behind where they should be on it, which explains a lot of the control problems many T2s experience.

There other meds such as sitagliptin and acarbose that are also occasionally seen as well.


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## Icey (Apr 19, 2013)

> What advice did they give you for diet and exercise - sometimes the advice given is about as much use as a chocolate teapot!



Well, I saw a dietician who, didn't seem to take my diabetes into consideration much, I saw her for about a month or so and didn't loose weight. The only advice for exercise was just exercise. Nothing more. I feel when they are giving advice they don't seem to take everything about you into consideration (other illnesses that could effect things etc).

I don't feel ashamed of myself for being a diabetic, but I do sometimes sit and wonder if it is my fault for being overweight. I wouldn't say I was massively overweight either especially considering my 'build'.

Also. Screw BMI - it doesn't take into consideration anything like your bone structure, just damned height. I think it's the absolutely stupid way of measuring if someone is at a 'healthy' weight.

I've been following a 1500 cal. intake for around a month and trying to walk at least twice a day (burning between 300 to 700 per day). Yet I'm not seeing any loss or improvement. Bleh.

Thank you for all the responses, I feel I get a better response of asking questions here than I would from the Dr. and I can sit and think through everything properly.

Sorry if I rambled a bit and went off on a tangent


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## Caroline (Apr 19, 2013)

Lauras87 said:


> Not to upset you but when all else fails you get put on insulin.
> 
> Insulin ain't all bad trust me, I have it 5 times a day but I am T1.
> 
> ...



when all else fails you get put on insulin, but this is a last resort after everything else has been tried.


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## Caroline (Apr 19, 2013)

I was on metformin, which went up to three a day the gliclizide ten another pill. Three kinds of pill is the maximum they can give you. If that fails the next step is insulin.

I think that some type 1s are in metformin too as it helps reduce insulin resistence (as others have already pointed out)

the advice given by many doctors is as much good as a chocolate teap pot or a sieve in a sinking boat. Look in the books section as there are many good books full of helpful hints and advice.

See if your doctor will send you on a DESMOND or similar course to help you get a handal on things.


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## everydayupsanddowns (Apr 19, 2013)

Hi Icey

Have you made much reduction to your overall carb intake?

Sugar is often targeted/singled out for special mention by HCPs as it can significantly push BGs up, but _all_ carbs will do that... and many of them will do so just as fast as sucrose (sugar).

Many T2s here seem to find that reducing their carb intake (not just calorie intake) has beneficial results for their weight, cholesterol profile and BGs even if they are eating a higher proportion of various fats.


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## Caroline (Apr 19, 2013)

everydayupsanddowns said:


> Hi Icey
> 
> Have you made much reduction to your overall carb intake?
> 
> ...




Good point about carbs. I also find if I eat too many carbs it affects my tummy. I'm never sure if it is just the carbs or the reaction of carbs and metformin that does it, but I feel better with fewer of them.


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## mcdonagh47 (Apr 19, 2013)

Icey said:


> Thank you for all the responses, I feel I get a better response of asking questions here than I would from the Dr. and I can sit and think through everything properly.
> 
> Sorry if I rambled a bit and went off on a tangent



The treatment algorhythm for Type 2 diabetes is also presented as a Decision Tree in Nice Type 2 Guidelines, it's page 23 on this link.... ( perhaps should be a sticky Admin ?)
... it shows how your (so-called) care team is thinking and what advice they should be following ....and where you are headed ....

http://www.nice.org.uk/nicemedia/live/11983/40803/40803.pdf


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## Icey (Apr 19, 2013)

everydayupsanddowns said:


> Hi Icey
> 
> Have you made much reduction to your overall carb intake?
> 
> ...



I really couldn't tell you. I try to eat low carb meals but when it comes to it, I'm very clueless about it. I've been throwing some low gi recipes into my weekly dinners, and have cut out pretty much all of my bread intake.

I'm struggling with finding an evening meal that suits both myself and my partner, we can't afford to eat different dinner meals as it would cost too much. 

Meh. Feeling fairly useless about the carb side of things. 

Thank you for the link mcdonagh47 - It's nice to have it written out infront of me what they are (suppose) to be doing. I've found my pharmacist more helpful than my doctor with regards to metformin and information about how to be taking it and that I shouldn't be paying for it.


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## Caroline (Apr 19, 2013)

Icey said:


> I'm struggling with finding an evening meal that suits both myself and my partner, we can't afford to eat different dinner meals as it would cost too much.
> 
> Meh. Feeling fairly useless about the carb side of things.



I'm pretty useless with carb counting too.

One of my solutions is to not have potatos or pasta or rice but have extra veg instead.

I quite like sweet potatos which are less carby and you can do pretty much the same with them as you can with ordinary spuds. I like them mashed with ordinary protato on things like cottage pie


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