Can I take metformin if I have not taken evening dinner as occasionally I skip evening dinner?

A. Metformin is a drug that should be taken consistently for optimal results in blood glucose control. It is usually prescribed twice a day to provide spread across the day. Some individuals are only prescribed it once a day with their main meal (usually if their HbA1c is near their target).

It is best taken with food, because a small percentage of individuals develop some gastric side effects such as bloating, diarrhoea or abdominal discomfort. Most people are side effect free, and hence it is reasonable to take metformin with no food occasionally if you choose to skip dinner.

If you are one of the few individuals who develop side effects, and you are prescribed a twice a day regime, it is best to take them with two of your meals e.g. breakfast and dinner, or even breakfast and lunch if choosing to skip dinner.

I have recently been diagnosed with type 2 diabetes after having lung disease and taking steroids. I am a vegetarian and finding it difficult to find healthy snacks when craving for sweet food all the time.

A. We’re sorry to hear about your recent health problems but pleased that you have reached out to us for support. Finding heathy alternatives for snacks can really help to support diabetes management.  

Please take a look at our healthy snacking page here which provides a variety of healthy snack recipes for you to try.  

I have been diagnosed with type 2 diabetes. I see that most of the recommendations are to reduce carbs in food. I am not overweight but need to gain weight. How can I choose food which allows me to gain weight without causing any issues for diabetes?

A. Weight management is an important part of diabetes control. In your case, the answer would be to maintain your calorific intake sufficiently by consuming a good mix of proteins, good fats and complex (slow release) carbohydrates. You can maintain your weight whilst reducing carbohydrate intake.  

It can also be useful to build muscle through resistance exercises, this will keep your energy burning capacity high allowing you more flexibility with food in the longer term. 

How much Metformin is needed to bring blood sugar levels down to a safe number? 

A. The amount of any medication required depends very much on the individual situation. Metformin is a common first line medication in type 2 diabetes management. It acts by increasing the effectiveness of your body's insulin and reduces the amount of glucose released from the liver. 

The dose of metformin varies according to your HbA1c level, age, kidney function and other medication. There is no fixed rule to dose and impact, it is a fluid process of management. 

  I was prescribed Trulicity in July and I feel that my diabetes has greatly improved, possibly reversed, but have not had a follow up to see if my blood sugar has improved. Should I contact my GP? I don't attend diabetes clinic

Many thanks for writing in and good to hear this! 

You don’t mention whether you are taking any other medications. Trulicity (also known as Dulaglutide) is a GLP-1 Analogue injectable therapy. 

This type of medication works by increasing the levels of hormones called ‘incretins’. These hormones help the body produce more insulin only when needed and reduce the amount of glucose being produced by the liver when it’s not needed. They reduce the rate at which the stomach digests food and empties, and can also reduce appetite and be very effective in helping people to lose weight. 

We would definitely advise that you contact your GP for an annual review of your diabetes. It is even possible that having seen such big improvements in your diabetes, you may no longer need the GLP-1 (this would involve a discussion with your GP). 

 I have a question about injecting long-acting insulin. Can you tell me some alternative areas other than top of the thighs? This is where I have been injecting for many years.

It is important to rotate where you inject your insulin and choose a different spot each time. By using a new injection site each time you inject, you will reduce the risk of developing fatty lumps under the skin and the insulin will be absorbed effectively and consistently. Common injection areas are: 

• Stomach (at least 5cm away from the belly button) 
• Buttocks (the upper external part of the thigh) 

Another tip is to always use a new insulin needle for every injection.

  After say 4 hours of no food my blood glucose has gone from ~ 7 to above 9 and stayed there for some time. Then dropped. This type of pattern I haven’t seen before. I follow my blood glucose with a freestyle libre.

A. One of the functions of our liver is to release glucose and this is called gluconeogenesis. The release of glucose from the liver is inhibited by the hormone insulin which our body releases from the pancreas.

You don't mention your type of diabetes. However, the most common type of diabetes is type 2 and people with type 2 diabetes often cannot produce enough insulin to prevent glucose from being released from the liver.

It would be good to contact your GP practice for a diabetes review and for some blood tests such as your HbA1c.

Metformin is the most widely used treatment for type 2 diabetes and it works by reducing the amount of glucose your liver releases. This also helps the body’s insulin work better and improves insulin resistance.

Check out the link below for what you should expect to get as part of your care for diabetes 

https://www.knowdiabetes.org.uk/know-more/type-2-diabetes/15-healthcare-essentials/ 

 Is beer something to avoid when you have diabetes?

A. People with diabetes do not need to avoid alcohol. The government guidelines for alcohol are the same for everyone with and without diabetes which is 14 units per week.

However, there are a number of factors to consider regarding alcohol and how it impacts your diabetes management. These include:

1. Gaining weight: alcohol contains a lot of hidden calories and sugar so it can be a cause of weight gain.

2. Insulin resistance: drinking too much alcohol can reduce your body’s sensitivity to insulin, which means that it doesn’t break down sugar as well as it should. This will result in higher blood glucose levels, which can make your diabetes more difficult to manage.

It’s important to remember that alcohol can come in different strengths, so something that has a higher percentage of alcohol will also be higher in units.

If you’d like to find out more about alcohol and how it impacts Diabetes management, please take a look at our Alcohol and Diabetes page here.

 When is the best time of the day to test blood sugar levels? Before or after food ...or on an empty stomach/morning?

A. Thanks for your query, 

Generally speaking the best time to check your blood glucose is first thing in the morning  before breakfast and also pre meals. 

However this will depend on factors such as your type of diabetes, whether you inject insulin or are taking tablets or non- insulin injectables and what you are working towards. 

When you test your blood sugar will be determined by what you are trying to  achieve and it's a good idea to discuss this with your diabetes care provider. 

If you are focusing on getting your fasting or early morning blood sugar ‘ to target’ you will probably be checking first thing in the morning before breakfast. 

Having a blood sugar that is ‘in target’ (between 4-7) first thing in the morning is important because it indicates that  overnight blood sugar has also been ‘in target’. 

Having blood sugar ‘within target’ overnight, generally makes it easier to stay on target for the rest of the day. 

Also as this is a prolonged period of time it is important that blood sugar is not elevated. 

For some people with Type 1 diabetes or with any type of diabetes in pregnancy you may be checking blood sugar both pre and post meals.

The key message is that the frequency and timing of your blood sugar tests will depend on what you are setting out to achieve, with the support of your diabetes care provider. Click here for more information about checking your blood sugar levels.

If the person has a low blood glucose overnight (hypoglycaemia), it can cause the body to react by increasing glucagon (a blood glucose increasing hormone). 

This forces the liver to push out glucose in response to the low blood glucose and you can wake up with a higher blood glucose than when you went to sleep. 

If this is happening to you it is important to speak to your diabetes care provider as soon as possible for support.

You may need to reduce or change the timing of your insulin.  You should discuss with your diabetes care provider the possible reasons you are having low blood glucose with a plan to reduce or stop them. 

There are many potential causes of overnight low blood glucose such as exercise, alcohol, weather, hormones etc.

  I am a heart patient. How can I be careful about my condition by not getting diabetes?

A. To prevent Type 2 Diabetes, there are two key messages to understand, particularly if you have prediabetes / non-diabetic hyperglycaemia (NDH). 

1) Lose weight if you are overweight or obese. Even losing as little as 5kg or around 11lbs will make a huge difference to your risk 

2) Minimise carbohydrates (including sweet things such as biscuits and cakes as well as starchy carbohydrates such as bread, pasta, rice and potatoes). 

The main risk factors for diabetes include age, diet, physical activity, family history, ethnicity. Obviously you can only change some of these (diet, weight, physical activity) and not others (age, ethnicity, family history). 

Many people who are overweight and have prediabetes (non-diabetic hyperglycaemia or NDH) are focusing on losing weight, which also improves blood glucose levels, blood pressure and reduces the risk of more severe disease. 

Check out the Know Diabetes pages about low carbohydrate meals and healthy eating, staying active and the Type 2 diabetes remission pages. Whilst the Type 2 remission pages and videos aren’t specifically aimed at those with prediabetes /NDH, the key information about weight loss, appetite and carbohydrates still hold true. 

Read more about diabetes prevention here. 

It is important for you to maintain good heart health, normal cholesterol and triglyceride levels by maintaining a healthy diet; to prevent diabetes. You can find more information here.

Diabetes can develop in people who are overweight or obese and in whom glucose metabolism is impaired - meaning their blood sugar levels rise because the insulin generated by their pancreas is not adequate to regulate blood sugar levels. Having diabetes puts you at a significantly greater risk of developing or worsening your heart disease due to the damage that sugar does to all the blood vessels in our body. So it is important to prevent diabetes. For more info on Type 2 diabetes please click here.

For information on diabetes and heart disease please click here, or have a look at the British Heart Foundation website.

Please continue discussing any concerns with your cardiologist or GP and monitor your health status regularly for good health, wellbeing and quality of life.

Please also visit our ‘Be Healthier’ section of our website for tips on making healthier lifestyle choices to prevent type 2 diabetes.

  Stress is always with me and I can feel it’s damaging my life.

A. Feelings of stress and anxiety are quite common, especially given what we have been through over the last two years the pandemic. We have not just been worried about ourselves and our loved ones, but also more generally with lockdown restrictions, work and wider family and personal commitments.  It may be of some comfort to know that so many other people living with diabetes share your concerns.

Please take a look at our resources on mental health and wellbeing which we hope can support you. However, if you feel that your stress is unmanageable and impacting on your daily activities, please do contact your GP for further support.