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Is HBA1c Value Of 8.6 Mmol A Cause For Concern?
Question: Hi,
I have got my HBA1c result back and its 8.6 mmol. The last checkup which was 3 months ago it was 7.8 mmol. My specialist recommended that I should increase my insulin dose to 3 doses a day. At the moment I have 2 doses of insulin. (one in the morning before breakfast and one in evening before dinner).
He told me since that the morning dose of fast acting insulin Humalog decreases around mid day, that is where he recommended a third dose. The problem is that due to life style factors I'm very use to taking two doses and have been doing it for 21 years now.
I was doing some research and came across metformin. Could metformin help control blood sugar levels for type 1 diabetics who are insulin dependent.
If so, when should it be administered (when blood sugar levels and HBA1c are rising)?
I know it helps with type 2 diabetes, but I have read some journal articles about the positive effects it can have with type 1 diabetics in regards to weight loss because less fat= being more insulin sensitive which can reduce my dose and help stabalize blood sugar levels. So If I did take it around lunch time, can it be a better alternative to a insulin dose?
If not, is there a more flexible alternative that doesn't involve taking needles or pens (excluding the diabetic pump)?
I'm in a healthy weight range, I'm 178cm tall and weigh 78kg.
My insulin is 2 doses a day which are Humolog and Levemir combined. I take 38units of Levemir with 10 units of humalog. In the evening I take 10 units of each.
My thyroid dose is 200mcg per day.
I also have an under active thyroid which makes it difficult to keep my weight stable.
This is one study I found on metformin: XXXX
Thanks,
XXXX
I have got my HBA1c result back and its 8.6 mmol. The last checkup which was 3 months ago it was 7.8 mmol. My specialist recommended that I should increase my insulin dose to 3 doses a day. At the moment I have 2 doses of insulin. (one in the morning before breakfast and one in evening before dinner).
He told me since that the morning dose of fast acting insulin Humalog decreases around mid day, that is where he recommended a third dose. The problem is that due to life style factors I'm very use to taking two doses and have been doing it for 21 years now.
I was doing some research and came across metformin. Could metformin help control blood sugar levels for type 1 diabetics who are insulin dependent.
If so, when should it be administered (when blood sugar levels and HBA1c are rising)?
I know it helps with type 2 diabetes, but I have read some journal articles about the positive effects it can have with type 1 diabetics in regards to weight loss because less fat= being more insulin sensitive which can reduce my dose and help stabalize blood sugar levels. So If I did take it around lunch time, can it be a better alternative to a insulin dose?
If not, is there a more flexible alternative that doesn't involve taking needles or pens (excluding the diabetic pump)?
I'm in a healthy weight range, I'm 178cm tall and weigh 78kg.
My insulin is 2 doses a day which are Humolog and Levemir combined. I take 38units of Levemir with 10 units of humalog. In the evening I take 10 units of each.
My thyroid dose is 200mcg per day.
I also have an under active thyroid which makes it difficult to keep my weight stable.
This is one study I found on metformin: XXXX
Thanks,
XXXX
Brief Answer:
Metformin has off label use in type 1 diabetes.
Detailed Answer:
Hi Mr. XXXXXXX
Thanks for your question.
Noted your concern.
Metformin is off label drug for Type 1 diabetes mellitus, it means it is not accepted as treatment for type 1 diabetes by standard guidelines for the treatment of diabetes.
There are some scientific studies involving limited number of patients, evaluating use of metformin in Type 1 diabetes which showed some beneficial effect in reducing insulin doses, but there is no clear cut evidence of benefit on long term glycemic control (HbA1c).
Also beneficial effect in reducing insulin doses can not be applied to all type 1 diabetes patients.
Considering your height and weight your BMI (Body Mass Index) is 24.6 which can be considered as normal (though it may be moving towards overweight).
With BMI of 24.6, I may not suggest use of Metformin in such cases.
Major side effects with the use of metformin are rare so discuss its use in your case with your treating diabetologist.
At present only accepted treatment for Type 1 Diabetes is insulin only.
For better blood sugar control I may suggest use of SMBG (Self Monitoring of Blood Glucose).
In SMBG blood sugar tested by home glucometer.
One should do at least 2 to 3 reading daily from following 7 readings -
Fasting
2 hours post breakfast.
Before Lunch.
2 hours post Lunch.
Before Dinner.
2 hours post Dinner.
3 am (occasionally) once in 3 to 4 weeks.
Additional readings if there are symptoms of hypoglycemia. Along with it note down time, any variation in meal content or timings, physical exertion.
Depending upon weekly chart appropriate changes in insulin doses its frequency and if required type of insulin can be made for better blood sugar control.
As short acting insulin like Humalog act only upto 4 to 6 hours, I may suggest daily three doses of Humalog for better post-prandial blood sugar control.
Along with this follow diabetic diet and regular exercise.
Hope this helps you.
I will be happy to answer your follow up queries, if any.
Regards,
Dr. Abhay Mali.
Diabetologist.
Metformin has off label use in type 1 diabetes.
Detailed Answer:
Hi Mr. XXXXXXX
Thanks for your question.
Noted your concern.
Metformin is off label drug for Type 1 diabetes mellitus, it means it is not accepted as treatment for type 1 diabetes by standard guidelines for the treatment of diabetes.
There are some scientific studies involving limited number of patients, evaluating use of metformin in Type 1 diabetes which showed some beneficial effect in reducing insulin doses, but there is no clear cut evidence of benefit on long term glycemic control (HbA1c).
Also beneficial effect in reducing insulin doses can not be applied to all type 1 diabetes patients.
Considering your height and weight your BMI (Body Mass Index) is 24.6 which can be considered as normal (though it may be moving towards overweight).
With BMI of 24.6, I may not suggest use of Metformin in such cases.
Major side effects with the use of metformin are rare so discuss its use in your case with your treating diabetologist.
At present only accepted treatment for Type 1 Diabetes is insulin only.
For better blood sugar control I may suggest use of SMBG (Self Monitoring of Blood Glucose).
In SMBG blood sugar tested by home glucometer.
One should do at least 2 to 3 reading daily from following 7 readings -
Fasting
2 hours post breakfast.
Before Lunch.
2 hours post Lunch.
Before Dinner.
2 hours post Dinner.
3 am (occasionally) once in 3 to 4 weeks.
Additional readings if there are symptoms of hypoglycemia. Along with it note down time, any variation in meal content or timings, physical exertion.
Depending upon weekly chart appropriate changes in insulin doses its frequency and if required type of insulin can be made for better blood sugar control.
As short acting insulin like Humalog act only upto 4 to 6 hours, I may suggest daily three doses of Humalog for better post-prandial blood sugar control.
Along with this follow diabetic diet and regular exercise.
Hope this helps you.
I will be happy to answer your follow up queries, if any.
Regards,
Dr. Abhay Mali.
Diabetologist.
Note: For further follow-up, discuss your blood glucose reports with our diabetologist. Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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