May 19, 2003
Daily Care, Type 2
Question from Singapore:
I was diagnosed with diabetes a month ago and went to see the endocrinologist who gave me a prescription for metformin (500 mg — 2 tablets twice per day). At that time my fasting glucose was 8.3 mmol/L [144 mg/dl]. Somehow the thought of having to be on medication scares me, so I didn’t take the tablets. I saw the dietitian, and the nurse educator and quite understood about what I had to eat and doing exercise.
I followed the diet that the dietitian laid out for me and did the treadmill for 20 minutes five times per week. My sugar level came down to 4.5-10.6 mg/dl [81-180 mmol/L] when I did all the exercise and controlled of food intake, and my weight just stayed the same.
Can I continue controlling my diabetes by diet and exercise like this without metformin?
Answer:
One of the first issues in a patient-physician relationship is honesty. You need to tell your physician what has happened and discuss the choices. I am glad your sugars have come down some. On the other hand, they are all not down into the normal range. It should be pointed out that there are no safe levels of high blood sugars.
I suggest you speak with your physician again. It may be that the dose of the metformin does not have to be increased to such a high level. Metformin, initiated at the high dose you indicate, may have gastrointestinal side effects, including loose stools or diarrhea. It may be that you can take a lower dose of the metformin. It is not a victory if you need the medication and do not take it.
JTL
