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Advice on metformin

Discussion in 'Type 2 Diabetes' started by keithmarsden, Dec 3, 2017.

  1. keithmarsden

    keithmarsden · Newbie

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    Just started metformin having been diet controlled T2 for 9 years, but H1ac having now risen sharply to 64.

    Doctor therefore put me on one 500mg slow release metformin at breakfast and to move onto a second 500mg tablet with evening meal if bedtime readings don't become less than 10 mml/l.

    After a week bedtime reading 10.6 so will see next week if one tablet is enough. Questions:

    1. Does 10 seem a reasonable bedtime target?
    2. If needed... will it be better to have the two tablets spaced as doc advises... or together with evening meal as manufacturer recommends?
    3. If I'm borderline, rather than go onto a second tablet I might ask to go onto one single 750mg tablet. Logic being I want to keep the two 500mg option for when I need it further down the road.
    4. Is any brand better than any other? I'm on Sakkarto but have heard Glucophage recommended?
    Thanks
    Keith
     
  2. Guzzler

    Guzzler Type 2 · Well-Known Member

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    There is imo no difference in brands, they've become generic. It is better to take the tablets as directed by your GP and as he/she has prescribed the slow release version then it is wiser to take them twice per day. Take the tablets with meals so as to lesson the side effects of Metformin Tummy which some members report (problems with upset tummy and toilet ting).

    Metformin is considered a safe drug but to get the best effect you must take them as directed by your HCP.
     
  3. Bluetit1802

    Bluetit1802 Type 2 · Oracle

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    Hello and welcome to the forum,

    Sorry to read your levels have shot up. Did your doctor recommend a change in diet, or even discuss diet with you? Have you considered that it is diet that is the key to better control? To be absolutely honest, Metformin is a very mild drug that helps in some ways but not by very much in most cases. It may help you eat a bit less as it is an appetite suppressant, and it may help a little with insulin resistance and the amount of glucose your liver produces, but what it won't normally do is stop the spikes after eating. Also, it is a drug that accumulates in your body, so you are unlikely to see any beneficial effects for some time.

    In my opinion, 10 is not a reasonable bedtime target. For someone on Metformin only it is not a reasonable target at any time of day. The NHS guidelines for T2s are between 4 and 7 fasting and before meals, and under 8.5 at 2 hours post meal.

    I will tag @daisy1 as she has an excellent and informative post for newcomers. It is well worth reading and following her links. Meanwhile, have a good read round the forum and see how others are managing to control and keep control. Do ask as many questions as you like.
     
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  4. sally and james

    sally and james Family member · Well-Known Member

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    Welcome to the forum, @keithmarsden . I see you've been T2 for nine years, but, all the same, I'll tag @daisy1 for the newbies introduction. Who knows, there might be something in there that you have missed out on.
    Personally I think that "10" is too high at any time, but my understanding is that Metformin only has the very smallest effect on blood sugar numbers, so don't expect miracles. I would want to see "6" by bedtime, assuming you hadn't eaten within the last hour or so.
    You say that you have been diet controlled for 9 years. Could you tell us what sort of diet you have been on, what is a typical day. There may be some improvements to be made with food, never mind drugs. Just a thought.
    Sally
     
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  5. Rachox

    Rachox Type 2 · Well-Known Member

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    I can’t advise on drug dosages, you’ll need to discuss that with your Dr. However if you’re reluctant to increase your medication, could you adjust your diet instead?
     
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  6. ziggy_w

    ziggy_w Type 2 · Well-Known Member

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    Hi @keithmarsden,

    Since this is your first post, let me welcome you to the forum. I am tagging @daisy1 for some really helpful information for newbies.

    Really well done on controlling T2 for 9 years without medication.

    When I was first diagnosed, I was put on 2 x 1000mg of metformin to be taken in the morning and in the evening. I was fine with it and only had a few problem in the first few days. Generally, the worst side effects seem to be gastrointestinal. If you don't have problems with it, it probably won't matter much if you are on 2 x 500mg or 1 x 750mg. Spacing them out over the day might be easier on the tummy, though. I agree with @Rachox, though, that you should probably talk to your GP/nurse about the dosage.

    I was on a generic form of metformin -- so can't help you with the different forms of metformin. It probably won't make much of a difference as long as you tolerate it well.

    Generally, metformin is a type of diabetes medication that overall has a good profile without too many side effects and tends to bring down blood sugar levels but not by a huge amount. To be honest, 10 mmol before going to bed would be too high for me.

    Have you tried reducing your carbohydrate intake?

    Please ask any questions you may have -- there are many wonderful, knowledgeable and helpful members on this forum. So, just ask away.
     
    • Informative Informative x 1
  7. daisy1

    daisy1 Type 2 · Guru
    Staff Member Retired Moderator

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    @keithmarsden

    Hello Keith and welcome to the Forum :) Here is the Basic Information we give to new members and I hope you will find it useful. Ask more questions when you need to and someone will help.


    BASIC INFORMATION FOR NEW MEMBERS

    Diabetes is the general term to describe people who have blood that is sweeter than normal. A number of different types of diabetes exist.

    A diagnosis of diabetes tends to be a big shock for most of us. It’s far from the end of the world though and on this forum you'll find well over 259,000 people who are demonstrating this.

    On the forum we have found that with the number of new people being diagnosed with diabetes each day, sometimes the NHS is not being able to give all the advice it would perhaps like to deliver - particularly with regards to people with type 2 diabetes.

    The role of carbohydrate

    Carbohydrates are a factor in diabetes because they ultimately break down into sugar (glucose) within our blood. We then need enough insulin to either convert the blood sugar into energy for our body, or to store the blood sugar as body fat.

    If the amount of carbohydrate we take in is more than our body’s own (or injected) insulin can cope with, then our blood sugar will rise.

    The bad news

    Research indicates that raised blood sugar levels over a period of years can lead to organ damage, commonly referred to as diabetic complications.

    The good news

    People on the forum here have shown that there is plenty of opportunity to keep blood sugar levels from going too high. It’s a daily task but it’s within our reach and it’s well worth the effort.

    Controlling your carbs

    The info below is primarily aimed at people with type 2 diabetes, however, it may also be of benefit for other types of diabetes as well.

    There are two approaches to controlling your carbs:
    • Reduce your carbohydrate intake
    • Choose ‘better’ carbohydrates
    Reduce your carbohydrates

    A large number of people on this forum have chosen to reduce the amount of carbohydrates they eat as they have found this to be an effective way of improving (lowering) their blood sugar levels.

    The carbohydrates which tend to have the most pronounced effect on blood sugar levels tend to be starchy carbohydrates such as rice, pasta, bread, potatoes and similar root vegetables, flour based products (pastry, cakes, biscuits, battered food etc) and certain fruits.

    Choosing better carbohydrates

    The low glycaemic index diet is often favoured by healthcare professionals but some people with diabetes find that low GI does not help their blood sugar enough and may wish to cut out these foods altogether.

    Read more on carbohydrates and diabetes.

    Over 145,000 people have taken part in the Low Carb Program - a 10 week structured education course that is helping people lose weight and reduce medication dependency by explaining the science behind carbs, insulin and GI.

    Eating what works for you

    Different people respond differently to different types of food. What works for one person may not work so well for another. The best way to see which foods are working for you is to test your blood sugar with a glucose meter.

    To be able to see what effect a particular type of food or meal has on your blood sugar is to do a test before the meal and then test after the meal. A test 2 hours after the meal gives a good idea of how your body has reacted to the meal.

    The blood sugar ranges recommended by NICE are as follows:

    Blood glucose ranges for type 2 diabetes
    • Before meals: 4 to 7 mmol/l
    • 2 hours after meals: under 8.5 mmol/l
    Blood glucose ranges for type 1 diabetes (adults)
    • Before meals: 4 to 7 mmol/l
    • 2 hours after meals: under 9 mmol/l
    Blood glucose ranges for type 1 diabetes (children)
    • Before meals: 4 to 8 mmol/l
    • 2 hours after meals: under 10 mmol/l
    However, those that are able to, may wish to keep blood sugar levels below the NICE after meal targets.

    Access to blood glucose test strips

    The NICE guidelines suggest that people newly diagnosed with type 2 diabetes should be offered:

    • structured education to every person and/or their carer at and around the time of diagnosis, with annual reinforcement and review
    • self-monitoring of plasma glucose to a person newly diagnosed with type 2 diabetes only as an integral part of his or her self-management education

    Therefore both structured education and self-monitoring of blood glucose should be offered to people with type 2 diabetes. Read more on getting access to blood glucose testing supplies.

    You may also be interested to read questions to ask at a diabetic clinic.

    Note: This post has been edited from Sue/Ken's post to include up to date information.

    Take part in Diabetes.co.uk digital education programs and improve your understanding. Most of them are free.
    • Low Carb Program - it's made front-page news of the New Scientist and The Times. Developed with 20,000 people with type 2 diabetes; 96% of people who take part recommend it... find out why
    • Hypo Program - improve your understanding of hypos. There's a version for people with diabetes, parents/guardians of children with type 1, children with type 1 diabetes, teachers and HCPs.
     
  8. keithmarsden

    keithmarsden · Newbie

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    Update:
    9years T2 diet controlled, pretty much all diet, exercise, weight options exhausted.
    Just started metformin 1x500mg slow release.

    After 1 week on taking tablet with breakfast, fasting 7.4 and bedtime 10.6
    After 2nd week ( now taking with dinner) , fasting 5.9 ( better than expected)and bedtime 10.4(worse than expected)

    Do I give it another week?
    Follow docs advice to move to 2 tablets taken one at breakfast, one at dinner?
    Or:
    Go back to docs and ask to try intermediate dose of 750mg?

    (are the slow release , slow release over 12 or 24 hours?)
    Any advice much appreciated.Keith
     
  9. Rachox

    Rachox Type 2 · Well-Known Member

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    If you’re reluctant to increase medication, is there room to tweak your diet? Lower your carb intake perhaps?
     
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  10. Pinkorchid

    Pinkorchid Type 2 · Well-Known Member

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    Yes it is better to split the dose between two meals. I think you should go with what your doctor has said and see how it goes It does take time to work as it is not an immediate effect
     
  11. sally and james

    sally and james Family member · Well-Known Member

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    @keithmarsden Metformin isn't a drug that has immediate effects, it's more of a build up over weeks. Doesn't matter, as far as blood sugars are concerned, if you take the lot before dinner or spread out or after your meal.
    You haven't said what your diet was that kept you diabetically controlled over many years. Was this Low Carb? Or was it a NHS "balanced" diet/ "EatWell Plate", low calorie, slow release sugars type diet? It would help us all to know what has and has not worked and we might be able to help you to keep your drug intake low. Do tell!
    Sally
     
  12. Art Of Flowers

    Art Of Flowers Type 2 · Well-Known Member

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    Metformin does not reduce blood sugars much. If you are at 10.6 then metformin may help you get down to about 9.0. If you want to get down to non diabetic levels around 5.5 then consider a low carb diet.

    At diagnosis I had blood glucose of 13. After about five weeks of metformin and cutting out high sugar food this reduced to 9.8. Cutting out high carb foods helped me to reduce it much further.
     
    #12 Art Of Flowers, Dec 4, 2017 at 3:52 PM
    Last edited: Dec 4, 2017
  13. Ross.Walker

    Ross.Walker Type 2 · Well-Known Member

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    Take a little time to let the medicine get to a therapeutic level. One, two Three four weeks will show you if any changes you have made are working with the medicine in harmony with your lifestyle.

    I can only suggest that the not knowing/having too many options is causing more stress than it should, we have all done it.
     
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