I was diagnosed with type 2 diabetes last year and was prescribed 500mg metformin daily. But I decided to overhaul my lifestyle by eating healthily and, as a result, have lost 2st and my HbA1c score has dropped from 92 to 36. So should I keep taking metformin, or can I stop?
Des Pike, Pontypool, Torfaen.
What an outstanding achievement and I applaud your effort and commitment.
Type 2 diabetes is a serious condition that is affecting rising numbers of people in the UK, thanks mainly to surging obesity rates.
The condition causes blood sugar (glucose) to rise to dangerously high levels.
While many people experience few, if any, symptoms, these high levels can cause major complications if not controlled — including damage to the eyes and nervous system, along with increased risk of heart disease through rapidly accelerating atherosclerosis (where the arteries become furred up).
In type 2 diabetes, the body stops responding properly to insulin, a hormone that helps mop up glucose from the blood, transporting it to the muscle cells where it’s used for energy. Instead, glucose builds up in the body, causing long-term damage.
Type 2 diabetes is a serious condition that is affecting rising numbers of people in the UK, thanks mainly to surging obesity rates
One marker of diabetes is sugar in the urine. A blood sugar test may then be carried out to confirm the diagnosis.
But this is a snapshot result, and a more telling result comes from an HbA1c blood test, which gives a measure of your average blood sugar level over the previous two or three months.
People diagnosed with type 2 diabetes are recommended to get their HbA1c level below 48mmol/mol.
Your outstanding self-control has lowered yours from 92 to just 36mmol/mol, effectively placing you in ‘remission’.
But you will need to stick to your lifestyle and diet plan or your weight will increase again and your diabetes could return.
As for whether or not you should keep taking metformin, you must accept the advice of your GP, but I would anticipate the prescription will cease if regular HbA1c tests confirm your readings remain in the safe zone.
Your outstanding self-control has lowered yours from 92 to just 36mmol/mol, effectively placing you in ‘remission’. But you will need to stick to your lifestyle and diet plan or your weight will increase again and your diabetes could return
I have Barrett’s oesophagus. I have phlegm in my throat constantly and seem to be coughing all the time. I was prescribed Beconase which doesn’t help much. Any ideas?
Ian Balloch, Grangemouth.
Barrett’s oesophagus, as I hope has been explained to you, occurs as a result of gastro-oesophageal reflux disease (GORD), where acid leaks from the stomach up the oesophagus, leading to heartburn and possibly a recurrent cough.
Over the long term, the constant exposure to acid can cause cells at the base of the oesophagus to change, and so the lining becomes red and thickened. In a small proportion of cases (less than 1 per cent), these altered cells may become cancerous.
The conventional treatment for Barrett’s is proton pump inhibitors (PPIs), drugs such as omeprazole that suppress acid production. However, between 10 and 40 per cent of patients continue to experience symptoms despite taking prescribed medication.
It is likely that your symptoms — coughing and phlegm in the throat — are due to continuing reflux, so-called ‘silent’ reflux at night.
Previously, this has been a subject of some debate but the balance of opinion now is that GORD can indeed result in nasal disorders such as sinusitis in some people. The fact that you’ve been prescribed Beconase (generic name beclomethasone) steroid nasal spray to reduce inflammation, suggests this is what your doctor thinks you have.
However, as this hasn’t helped you, I have two suggestions for you to discuss with your GP.
First, you may need to be prescribed a stronger steroid nasal spray, such as fluticasone, to be used night and morning. And secondly, it may be that your current dose of PPI is not enough to suppress your acid production. Sometimes 40mg or even 80mg once daily is needed by some patients.
Write to Dr Scurr
Write to Dr Scurr at Good Health, Daily Mail, 2 Derry Street, London W8 5TT or email drmartin@dailymail. co.uk — include your contact details. Dr Scurr cannot enter into personal correspondence. Replies should be taken in a general context and always consult your own GP with any health worries.
In my view… Patients do better with the same GP
Imagine if there were a simple approach that improved patient satisfaction, led to better management of long-term conditions, and cut the need for hospital referrals and admissions.
In fact, it exists — it’s the ‘named GP’ system, under which every NHS patient is allocated a GP responsible for overseeing their care.
But a recent study found that only half of patients now see the same GP.
And this isn’t set to improve, as there aren’t enough GPs to go round.
This is a long-standing problem. Our leaders need to be thinking not just about now, but 20 years from now: we need more medical school places and greater incentives to go into general practice.
The doctor/patient relationship is not a luxury: it saves both money and lives.
Imagine if there were a simple approach that improved patient satisfaction, led to better management of long-term conditions, and cut the need for hospital referrals and admissions