“I am a diet-only treatment woman with diabetes, but my blood sugar levels have gone up from 47 to 52. My doctor wants me on metformin but it can have nasty side effects, which I desperately want to avoid. Does anyone know if it is possible to lower blood sugar levels without it? And how?”
Dr Sarah Jarvis says: “Type 2 diabetes is very different to type 1 diabetes. Type 1 diabetes is an autoimmune disease, where your body’s own immune system, which usually helps you fight off disease, recognises some of the cells in your own pancreas as an ‘enemy’ and attacks them. That means you can’t reduce your risk of developing it by changing your lifestyle, it’s nothing to do with being overweight or eating too much sugar, and you’ll need insulin for life from the day you’re diagnosed
Type 2 diabetes is largely to do with insulin resistance – your body can’t process insulin as efficiently as it used to. Your pancreas tries to produce more and more insulin to make up for this, and in time it can’t keep pace with your body’s demands. Diet, lifestyle and weight play a major part in this type of diabetes – both in stopping developing it in the first place and in reducing the rate at which it progresses. Being of South Asian origin and having type 2 diabetes in the family also increase your risk, but obviously you can’t do anything about these risk factors. However, over 80% of people diagnosed with type 2 diabetes are overweight and about 50% are obese (compared to the average in the adult UK population of 65% and 25% respectively). Even losing a few pounds, and keeping them off, can delay rises in your blood sugar which would mean your doctor would be more concerned about getting you on to medication.
Metformin is always our first-choice drug for controlling blood sugar in type 2 diabetes, except in rare situations like severe kidney problems. It can cause side effects (usually nausea and diarrhoea) but these are often temporary and can be reduced by starting with a low dose of metformin and building up gradually. You would usually be prescribed a ‘standard-release’ version, but if you get significant side effects on this you can speak to your doctor about changing you to a slow-release version.
Metformin works in two ways – partly by reducing the amount of sugar released by your liver and partly by making your body more sensitive to the effects of insulin. It has been very widely used for decades for good reason – as well as being effective at controlling blood sugar, it may also reduce your risk of heart attack and stroke, both of which are increased in type 2 diabetes.
Even though you may not notice any symptoms related to mildly raised blood sugar in the early stages of type 2 diabetes, it is still very important to keep your blood sugar levels well controlled. High blood sugar greatly increases the risk of ‘microvascular’ complications in the long term, including damage to your eyes, kidneys and nerves. Your doctor will both monitor your blood sugar and do a test called HbA1c, which gives and idea of the average sugar levels in your blood over about the previous three months.
When you’re first diagnosed with type 2 diabetes, you should be referred for a structured education programme. This offers advice tailored to you on how to improve your lifestyle, lose weight and bring your blood sugars, cholesterol and blood pressure under control. I suggest that if you haven’t been referred, you speak to your GP – the team at the programme could help you build a personalised plan to lose weight, change your diet and exercise more often. All of these will help you to avoid medication in the short term if you want to, and to reduce the need for more medication – and the risk of complications – in the longer term.”
̶ Dr Sarah Jarvis