Question for diabetics

[samhexum]

22 minutes ago, FreshFluff said:

I had been thin all my life

  Gee... and I always liked you.  

😝😇😜

[+ FreshFluff]

19 minutes ago, samhexum said:

  Gee... and I always liked you.  

😝😇😜

Well, you can like me now!

[SFGateboy]

13 hours ago, FreshFluff said:

Latest A1C is 4.9 (keeps decreasing?), fasting insulin is 6.4 but WTH.  If the side effects kill me, we'll try something else. 

Isn't 4.9 really good for an A1c value?

[Guest]

16 hours ago, FreshFluff said:

My endocrinologist told me there's no downside to trying Metformin for appetite control, so I'm going to give it a try. I had been thin all my life and am still in the normal BMI range, but I'm going in the wrong direction. Latest A1C is 4.9 (keeps decreasing?), fasting insulin is 6.4 but WTH.  If the side effects kill me, we'll try something else.  
 

The endo said she would prescribe Ozempic if needed, but the risk seems greater than the benefit for non-diabetic people with a normal BMI. My peers, including some thinner than I am, are all on it though,

 

Holy Moly. Your weight and blood sugars are completely normal, and you're considering taking metformin or even semaglutide? Yikes. Neither of these medications has been studied for safety in people with normal weight and blood sugar, so your endocrinologist has absolutely no basis for saying "there's no downside." This type of attitude reminds me of that of Michael Jackson's disgraced former doctor. This sounds completely unethical. Even in diabetics, semaglutide is associated with the risks of pancreatitis and medullary thyroid cancer. 

Prescribing metformin in people because they want to have a lower than normal BMI is bizarre enough, but to prescribe semaglutide for this reason would be even more outrageous. Sounds like a shady endocrinologist. 🤨

[+ FreshFluff]

4 hours ago, Unicorn said:

Holy Moly. Your weight and blood sugars are completely normal, and you're considering taking metformin or even semaglutide? Yikes. Neither of these medications has been studied for safety in people with normal weight and blood sugar, so your endocrinologist has absolutely no basis for saying "there's no downside." This type of attitude reminds me of that of Michael Jackson's disgraced former doctor. This sounds completely unethical. Even in diabetics, semaglutide is associated with the risks of pancreatitis and medullary thyroid cancer. 

Prescribing metformin in people because they want to have a lower than normal BMI is bizarre enough, but to prescribe semaglutide for this reason would be even more outrageous. Sounds like a shady endocrinologist. 🤨

I have knee problems and doctors have advised me to stay lower in the normal BMI range--like 21 or 22. I also want to avoid climbing out of the normal range altogether.  My endo is concerned about this too, which is why we're looking for a way to stop the trend. She wants to try Metformin first because it's very safe.

This is all gard for me as my BMI has been 18.5-20 for most of my life. I am trying other solutions first.  Over the pasr few months, I've tried to incorporate more protein for better satiation. Now I'm trying fiber too. 

Also, this is the first time you're hearing about people with a BMI under 25 taking Ozempic? It's been all over the media. For me, the motility issues, thyroid cancer risk in rats, and widespread telogen effluvium (which, anecdotally,  appears to be more prevalent than in bariatric surgery patients) are dealbreakers for now. 

Edited May 13, 2023 by FreshFluff

[+ FreshFluff]

7 hours ago, SFGateboy said:

Isn't 4.9 really good for an A1c value?

Yes. It was 5.3 a few years ago though, then 5.1.  This makes no sense given my diet. 
 

Edited May 13, 2023 by FreshFluff

[Danny-Darko]

21 hours ago, FreshFluff said:

I have knee problems and doctors have advised me to stay lower in the normal BMI range--like 21 or 22. I also want to avoid climbing out of the normal range altogether.  My endo is concerned about this too, which is why we're looking for a way to stop the trend. She wants to try Metformin first because it's very safe.

This is all gard for me as my BMI has been 18.5-20 for most of my life. I am trying other solutions first.  Over the pasr few months, I've tried to incorporate more protein for better satiation. Now I'm trying fiber too. 

Also, this is the first time you're hearing about people with a BMI under 25 taking Ozempic? It's been all over the media. For me, the motility issues, thyroid cancer risk in rats, and widespread telogen effluvium (which, anecdotally,  appears to be more prevalent than in bariatric surgery patients) are dealbreakers for now. 

So if you're not diabetic then, so why don't you try exercise at a gym then? There are trainers who specialize in working with seniors and people with health issues. For all the years I was on Metformin it NEVER controlled my appetite nor did it seem to for anyone else I've known on it. My appetite and food cravings only began to be controlled when I got on Ozempic. The side effects weren't pleasant, but I eventually adjusted to the medication and don't have them anymore. But if you are in normal BMI range and 4.9 and decreeing A1C then whyever would you be on diabetic medication if you're not diabetic nor obese?! 

Edited May 14, 2023 by Danny-Darko

[+ FreshFluff]

37 minutes ago, Danny-Darko said:

So if you're not diabetic then, so why don't you try exercise at a gym then? There are trainers who specialize in working with seniors and people with health issues. For all the years I was on Metformin it NEVER controlled my appetite nor did it seem to for anyone else I've known on it. My appetite and food cravings only began to be controlled when I got on Ozempic. The side effects weren't pleasant, but I eventually adjusted to the medication and don't have them anymore. But if you are in normal BMI range and 4.9 and decreeing A1C they whyever would you be on diabetic medication if you're not diabetic nor obese?! 

This is good to know. It's sometimes prescribed for weight loss, as GLP-1 antagonists are. 

[+ FreshFluff]

Just now, FreshFluff said:

This is good to know. It's sometimes prescribed for weight loss, as GLP-1 antagonists are. 

The unexplained degeneration on my kneecaps and neck though. I can never run again. One doctor wants me to do pool aerobics. 😱

[Danny-Darko]

15 minutes ago, FreshFluff said:

The unexplained degeneration on my kneecaps and neck though. I can never run again. One doctor wants me to do pool aerobics. 😱

Pool and other exercise makes far more sense, and therapy can help you with that. Also you might try a very good chiropractor. But diabetic medication for somebody who's not diabetic nor obese makes no sense. 

[Danny-Darko]

21 minutes ago, FreshFluff said:

This is good to know. It's sometimes prescribed for weight loss, as GLP-1 antagonists are. 

But you're not obese or overweight, why then??? Sorry, but don't understand your situation nor the reasoning behind weightless and diabetic meds for somebody who has neither problem. I have a sibling who has been very thin their whole life. But because of age and muscle mass loss the doctor recommended working out in a gym to retain and build muscle mass. 

[+ FreshFluff]

1 hour ago, Danny-Darko said:

But you're not obese or overweight, why then??? Sorry, but don't understand your situation nor the reasoning behind weightless and diabetic meds for somebody who has neither problem. I have a sibling who has been very thin their whole life. But because of age and muscle mass loss the doctor recommended working out in a gym to retain and build muscle mass. 

I appreciate the advice  Despite my best efforts, I'm now at nearly 100% risk of becoming overweight. Even my current weight is taking a toll on my knees, not to mention my self-image. I’m already doing weekly PT and walking. Lifting weights would be great but it’s tough because of my knee/neck issues. I’m looking for any solution. I doubt Metformin will work, but it’s cheap and safe. 

Btw, the “normal” BMI range is very broad. Life at a BMI of 24 is very different from life at 21. 

 

Edited May 14, 2023 by FreshFluff

[Danny-Darko]

22 minutes ago, FreshFluff said:

I appreciate the advice  Despite my best efforts, I'm now at nearly 100% risk of becoming overweight. Even my current weight is taking a toll on my knees, not to mention my self-image. I’m already doing weekly PT and walking. Lifting weights would be great but it’s tough because of my knee/neck issues. I’m looking for any solution. I doubt Metformin will work, but it’s cheap and safe. 

Btw, the “normal” BMI range is very broad. Life at a BMI of 24 is very different from life at 21. 

 

There are other forms of exercise and weight training that doesn't involve lifting that could hurt your knees. Healthy eating has helped me a lot and making new food choices while still eating and drinking well and enjoying fine meals. "Runing the risk" doesn't mean you will get xyz either. I have no more to say or add. All the best to you! 

[Guest]

19 hours ago, FreshFluff said:

I have knee problems and doctors have advised me to stay lower in the normal BMI range--like 21 or 22. I also want to avoid climbing out of the normal range altogether.  My endo is concerned about this too, which is why we're looking for a way to stop the trend. She wants to try Metformin first because it's very safe.

This is all gard for me as my BMI has been 18.5-20 for most of my life. I am trying other solutions first.  Over the pasr few months, I've tried to incorporate more protein for better satiation. Now I'm trying fiber too. 

Also, this is the first time you're hearing about people with a BMI under 25 taking Ozempic? It's been all over the media. For me, the motility issues, thyroid cancer risk in rats, and widespread telogen effluvium (which, anecdotally,  appears to be more prevalent than in bariatric surgery patients) are dealbreakers for now. 

I have heard of overweight and obese people taking Ozempic even though they're not diabetic, but I certainly haven't seen stories of people with normal BMI's taking Ozempic. I suppose it would have to be done by some pretty wealthy people, considering it's $900/month, and I can't imagine insurance paying for that. Once again, you are being advised incorrectly. I remember you once told us you had to hire 4 physicians until you received the opinion you wanted to hear, and I wonder if that's what's happening here. 

While there is some evidence from prospective (observational) studies that outcomes, primarily as measured by total knee replacement rates, that if obese (and maybe overweight) patients lose weight, they'll do better. While there are no randomized controlled trials, I would certainly say it's a good idea for the obese, and probably the overweight, to lose weight if they have hip or knee OA to lose weight. 

There is no evidence going from a BMI of 24 to 21 has any benefit. In fact, in the prospective studies, a weight loss of 7.5% was needed for a benefit to be noted; lesser amounts of weight loss had no benefit:

Does weight loss reduce the incidence of total knee and hip replacement for osteoarthritis?—A prospective cohort study among middle-aged and older adults with overweight or obesity

WWW.NATURE.COM

---

International Journal of Obesity - Does weight loss reduce the incidence of total knee and hip replacement for osteoarthritis?—A prospective cohort study...

"...Compared to weight-stable, weight loss of >7.5% was associated with reduced risk of TKR after adjusting for age, sex, BMI, socioeconomic and lifestyle factors (hazard ratio 0.69, 95%CI 0.54–0.87), but had no association with THR. Weight loss of 5–7.5% was not associated with altered risk of either TKR or THR. Weight gain was associated with increased risk of THR after adjusting for confounders, but not TKR..."

(THR is total hip replacement, and TKR is total knee replacement)

Edited May 14, 2023 by Unicorn

[+ FreshFluff]

1 hour ago, Unicorn said:

I have heard of overweight and obese people taking Ozempic even though they're not diabetic, but I certainly haven't seen stories of people with normal BMI's taking Ozempic. I suppose it would have to be done by some pretty wealthy people, considering it's $900/month, and I can't imagine insurance paying for that. Once again, you are being advised incorrectly. I remember you once told us you had to hire 4 physicians until you received the opinion you wanted to hear, and I wonder if that's what's happening here. 

While there is some evidence from prospective (observational) studies that outcomes, primarily as measured by total knee replacement rates, that if obese (and maybe overweight) patients lose weight, they'll do better. While there are no randomized controlled trials, I would certainly say it's a good idea for the obese, and probably the overweight, to lose weight if they have hip or knee OA to lose weight. 

There is no evidence going from a BMI of 24 to 21 has any benefit. In fact, in the prospective studies, a weight loss of 7.5% was needed for a benefit to be noted; lesser amounts of weight loss had no benefit:

Does weight loss reduce the incidence of total knee and hip replacement for osteoarthritis?—A prospective cohort study among middle-aged and older adults with overweight or obesity

WWW.NATURE.COM

---

International Journal of Obesity - Does weight loss reduce the incidence of total knee and hip replacement for osteoarthritis?—A prospective cohort study...

"...Compared to weight-stable, weight loss of >7.5% was associated with reduced risk of TKR after adjusting for age, sex, BMI, socioeconomic and lifestyle factors (hazard ratio 0.69, 95%CI 0.54–0.87), but had no association with THR. Weight loss of 5–7.5% was not associated with altered risk of either TKR or THR. Weight gain was associated with increased risk of THR after adjusting for confounders, but not TKR..."

This study is interesting. I have what my ortho calls beaten-up kneecap, with moderate to severe cartilage defects all over.   An ortho told me that every pound I can lose will be helpful for minimizing further wear tear on it. 
 

And yeah, semaglutide is being prescribed to relatively thin people now, largely via telehealth. I simplyspoke to my endo about pros and cons; she is the only doctor I have spoken to about this issue. As for me, I'm trialing one last non-Rx option before taking the leap into Rx stuff. The risks of semaglutide make Ozempic a no go (my endo pointed out a few extra ones too), but it's hard to see so many people losing weight effortlessly.

Edited May 14, 2023 by FreshFluff

[Guest]

The evidence of the help for weight loss for obese/overweight in regular osteoarthritis is there, though not great. I don't think there's any evidence of benefit for "beat-up kneecap," much less in those of normal weight. The New Yorker article was "fluffy," as their articles often are, and gave no indication of how prevalent Ozempic use is among those with normal weights. My advice would entail water/pool-based exercises and continuing physical therapy, of which hopefully you've had some physical therapists advise you on. Any benefit from further weight-loss in someone with a BMI of under 25 is purely conjectural at best (has never been demonstrated). 

Also conjectural is what the long-term effects might be of someone with a normal BMI taking metformin. It is known that when diabetics get treated too aggressively, mortality increases (especially when Hgb A1c's go under 6). Low blood glucose seem to strain the body. How this translates to non-diabetics is anyone's guess. I don't think it's even being studied. 

[+ FreshFluff]

Interesting about Metformin. Dosage is low for this indication, but I too am concerned about driving A1c too low. 
 

About Ozempic, the percentage of people on it whose BMI is under 25 is likely small. Anecdotally, it has become more widespread over the past year, and Canadian pharmacies began to ship it to the US for about half the price. The manufacturer's silence on all this speaks volumes. 
 

As for me, I don't have a pool handy and I like to listen to music while I exercise, which is hard to do in a pool. My ortho thinks walking is ok as long as I wear heavily cushioned shoes. I am in an area filled with beautiful hiking trails, and would like to hike again someday soon. 

Edited May 14, 2023 by FreshFluff

[Guest]

15 hours ago, FreshFluff said:

.... As for me, I don't have a pool handy ...

If you can afford to pay for Ozempic, even at Canadian prices, you can afford membership in a facility which has a pool. Interestingly, I heard on the radio that California finally passed a law requiring MediCal (the state's indigent program) and its HMO's to pay for gym memberships. I always thought it was absolutely nuts that insurance would pay for a $900/month medication, but not for a gym membership which might obviate the need for said medication. Of course, I think payment for the gym should be contingent on the patient going there at least twice per week, but if the patient is willing to put in the effort, it's crazy not to offer that as a benefit. 

[Danny-Darko]

20 hours ago, FreshFluff said:

Interesting about Metformin. Dosage is low for this indication, but I too am concerned about driving A1c too low. 
 

About Ozempic, the percentage of people on it whose BMI is under 25 is likely small. Anecdotally, it has become more widespread over the past year, and Canadian pharmacies began to ship it to the US for about half the price. The manufacturer's silence on all this speaks volumes. 
 

As for me, I don't have a pool handy and I like to listen to music while I exercise, which is hard to do in a pool. My ortho thinks walking is ok as long as I wear heavily cushioned shoes. I am in an area filled with beautiful hiking trails, and would like to hike again someday soon. 

You seem sold on this. So there seems to be nothing anyone can tell you more than what you've already heard. I myself would have gotten second and third opinions for specialists, but that's me. Good luck to you is all I can add! 

[Guest]

42 minutes ago, Danny-Darko said:

You seem sold on this. So there seems to be nothing anyone can tell you more than what you've already heard. I myself would have gotten second and third opinions for specialists, but that's me. Good luck to you is all I can add! 

Well, history has told us that FF will get loads of opinions from physicians--until she finds one who at least purports to align with hers... 😉

[+ FreshFluff]

Did either of you read my post? As I said, I'm trying non-Rx options first. I'm a normal person trying to fight my metabolism without resorting to Ozempic.

Enough with the bullying already

Edited May 16, 2023 by FreshFluff

[+ FreshFluff]

8 hours ago, Danny-Darko said:

You seem sold on this. So there seems to be nothing anyone can tell you more than what you've already heard. I myself would have gotten second and third opinions for specialists, but that's me. Good luck to you is all I can add! 

You told me yesterday that you had nothing more to say to me, but here you are again. 

[Guest]

11 hours ago, FreshFluff said:

Did either of you read my post? As I said, I'm trying non-Rx options first. I'm a normal person trying to fight my metabolism without resorting to Ozempic.

Enough with the bullying already

Dio mio. We present the research on the subject at hand, and try to introduce some factual matters, hopefully to help prevent a possible mistake, and we're "bullying" you? Lordy. If you're not interested in hearing any facts which don't jibe with your pre-conceived but non factually-based opinions, why ask for advice?

[+ FreshFluff]

On 5/15/2023 at 1:09 PM, Unicorn said:

Well, history has told us that FF will get loads of opinions from physicians--until she finds one who at least purports to align with hers... 😉

The post above, on the other hand, presents no research on the subject at hand and offers no useful insights.
 

Danny-Darko posted that if he were me, he would seek out multiple opinions on Metformin. I sought out only one doctor’s opinion on this. And yet you insist that I will seek multiple opinions because I did so year's ago on a different (and more serious) issue. 

When you present research, I read it and take it seriously. But the post above is simple bullying -- logic-free bullying.

Edited May 16, 2023 by FreshFluff

[+ Lucky]

My Ozempic experience so far:

I started in February at the non-therapeutic dose of .25 weekly. In late March that was doubled to a .5 dose. I am still on that all these weeks later.

Ozempic has, to date, done nothing for me. My glucose has risen and I haven't lost any weight or seen a decreased appetite.

I will start this week on a dose of 1.0 and hope for better results. Just wanted to post this so people know that Ozempic does not always give great results.