An additional Metformin if BG high?

[Shas3]

I will ask my doctor next appointment but anyone has any experience?

I am on 1000 mg Metformin XR per day (500mg at breakfast and 500 mg after dinner). However, I notice that after lunch my BG goes quite high sometimes (12 mmol).

A). Would taking my evening dose earlier (after lunch instead of after dinner) make a difference?

B). Would taking an extra 500mg after lunch make a difference?

I know the better approach is to change what i eat, which I will pursue. However if i just find that my BG is running at 12 or 13, would a Metformin make a difference?

 

[DCUKMod]

I will ask my doctor next appointment but anyone has any experience?

I am on 1000 mg Metformin XR per day (500mg at breakfast and 500 mg after dinner). However, I notice that after lunch my BG goes quite high sometimes (12 mmol).

A). Would taking my evening dose earlier (after lunch instead of after dinner) make a difference?

B). Would taking an extra 500mg after lunch make a difference?

I know the better approach is to change what i eat, which I will pursue. However if i just find that my BG is running at 12 or 13, would a Metformin make a difference?

Shas, I have no personal experience of Metformin, but I do understand it works on a therapeutic basis; in other words, it works by building up and being maintained in your system, rather that on a dose by dose basis. I imagine this would be more pronounced on the ST/ER/XR variants.

Your Doc may be happy for you to try it, or he may feel the additional dose could be useful to you anyway, but I couldn't speculate on that.

 

[Guzzler]

No version of Met works on a meal by meal basis. As has been said, it has a cumulative affect. Metformin works mostly in the liver rather than by lowering blood glucose from ingested carbs.

If you see a post prandial reading that you are not happy with look at the meal itself and decide if there is something you can tweak in order get a more pleasing result.

 

[Shas3]

Shas, I have no personal experience of Metformin, but I do understand it works on a therapeutic basis; in other words, it works by building up and being maintained in your system, rather that on a dose by dose basis. I imagine this would be more pronounced on the ST/ER/XR variants.

Your Doc may be happy for you to try it, or he may feel the additional dose could be useful to you anyway, but I couldn't speculate on that.

That is what I thought. So it sounds like “i have more carbs at lunch, so let me have my Metformin at lunch” is not going to work (at least not with XR version). Makes me wonder if an immediate release works any different. I doubt it though, as my understanding was XR versions are mainly aimed at easing side effects.

 

[Shas3]

No version of Met works on a meal by meal basis. As has been said, it has a cumulative affect. Metformin works mostly in the liver rather than by lowering blood glucose from ingested carbs.

If you see a post prandial reading that you are not happy with look at the meal itself and decide if there is something you can tweak in order get a more pleasing result.

Thanks @Guzzler. Clear. So it really is about the meal rather than medication timing (or dosage, i guess). Thanks

 

[Rachox]

I’m on three standard release Metformin per day, I was initially instructed to have one each with breakfast, lunch and dinner. I kept forgetting the lunch time one so my Dr suggested I have two with breakfast and one with dinner. Swapping to that regime made no difference to my lunchtime readings. So as others have said there’s no quick fix effect with Metformin just a cumulative effect.

 

[Shas3]

I’m on three standard release Metformin per day, I was initially instructed to have one each with breakfast, lunch and dinner. I kept forgetting the lunch time one so my Dr suggested I have two with breakfast and one with dinner. Swapping to that regime made no difference to my lunchtime readings. So as others have said there’s no quick fix effect with Metformin just a cumulative effect.

Thanks @Rachox. So till I meet my doc (who I suspect is going to increase it to 3 x 500mg per day) it is 500 x 2 and cut carbs to lowest level at each meal. Thanks

 

[Shas3]

Update: Doctor thinks he may have to add a Gliptin to my Metformin... Apparently it is a DPP4 Inhibitor that prods the pancreas to produce some additional insulin when confronted with too much glucose in blood... not sure... not starting yet.. a few more days and maybe a consultation with endocrinologist before deciding

 

[Rachox]

Update: Doctor thinks he may have to add a Gliptin to my Metformin... Apparently it is a DPP4 Inhibitor that prods the pancreas to produce some additional insulin when confronted with too much glucose in blood... not sure... not starting yet.. a few more days and maybe a consultation with endocrinologist before deciding

Surely the next move drug wise would be to go up to maximum dose Metformin, whilst trying lower carb. I think that’s what I’d ask to try first.

 

[Shas3]

Surely the next move drug wise would be to go up to maximum dose Metformin, whilst trying lower carb. I think that’s what I’d ask to try first.

That is what I thought he may do.

However his point was my spikes (and accompanied discomfort) are from digestive track from carbs that i ate (not sugar released by liver).

He says Metformin is good to “put a lid” on the glucose being released from liver.

I am not sure of accuracy but kind of see what he is getting at.. i am inclined to give low carb and well controlled eating a few more weeks before deciding.

Thanks

 

[Shas3]

And to add (i do like him .. kind of!!).. I think he doesn’t want to add anything to the 1000 mg Metformin.. so he said “if it is really bothering you we can...”. Let’s see. I won’t jump into it yet!!

 

[Stephen Lewis]

From my experience the danger is starting on the drug train. I began on 500 mg Metformin per day and the drugs increased for 10 years. Finally on 2000 mg Metformin, a linagliptin, a diglyceride and Invokana (not sure of the chemical term). The Invokana worked really well for 3 years then apparently caused major kidney failure. Drugs cut and put on insulin a year ago. As stated above the Metformin depresses the liver's production of glucose and is long term. As far as I am aware the only reason for fast or slow release is to help reduce stomach issues. Initially I had very bad indigestion and had to have the slow release. I now have a tablet for acid indigestion and can take the fast release that are much cheaper. But, and I cannot say this loud enough - cut your carbs. Since last July I have cut insulin, cut the Metformin back 2 x 500 mg per day and take 5 mg of linagliptin. My winter A1cs are down from 9.5% to 6.9%. The three main reasons are: trying to follow the Low Carb program, going to the gym at least 4 times a week and prayer at church. I repeat - Cut the Carbs. Should become a mantra for T2 and pre-diabetics.

 

[Shas3]

From my experience the danger is starting on the drug train. I began on 500 mg Metformin per day and the drugs increased for 10 years. Finally on 2000 mg Metformin, a linagliptin, a diglyceride and Invokana (not sure of the chemical term). The Invokana worked really well for 3 years then apparently caused major kidney failure. Drugs cut and put on insulin a year ago. As stated above the Metformin depresses the liver's production of glucose and is long term. As far as I am aware the only reason for fast or slow release is to help reduce stomach issues. Initially I had very bad indigestion and had to have the slow release. I now have a tablet for acid indigestion and can take the fast release that are much cheaper. But, and I cannot say this loud enough - cut your carbs. Since last July I have cut insulin, cut the Metformin back 2 x 500 mg per day and take 5 mg of linagliptin. My winter A1cs are down from 9.5% to 6.9%. The three main reasons are: trying to follow the Low Carb program, going to the gym at least 4 times a week and prayer at church. I repeat - Cut the Carbs. Should become a mantra for T2 and pre-diabetics.

Thanks for your thoughts. Very well put. Your A1C drop looks great. Congrats. Yes, low carbs has to be the absolute mantra!!


The debate always is How low? And does it have to be LC+HF?

My doctor was not terribly excited when I suggested cutting carbs. He was like - Cut them out in dinner but you need them during the day for your brain.

I did not get into “how much”.

 

[Stephen Lewis]

Thanks for your thoughts. Very well put. Your A1C drop looks great. Congrats. Yes, low carbs has to be the absolute mantra!!


The debate always is How low? And does it have to be LC+HF?

My doctor was not terribly excited when I suggested cutting carbs. He was like - Cut them out in dinner but you need them during the day for your brain.

I did not get into “how much”.

The endocrinologist who put me on insulin and kept increasing the dose told me that counting carbs was a 'waste of time' when I presented him with 4 weeks of carb intake/insulin dose! Later he told me, "I can do nothing more for you. You are on your own." That was about 2 months before I went on low carb and stopped taking insulin about 5 months later. I have not intentionally gone to high fat as well. The fats are higher mainly because of bacon and sausages (without many fries). I have read that the brain works better on the fats than the carbs. Even with higher fats (including eggs) all my cholesterol levels were below normal at the last test. My targets are 60 gms of carbs, 80 gms of fat and 80 gms of protein per day. Usually miss at least one just because I like a variety of food. Other people target less than 50 gms of carbs. You have to figure out what works best for you, your brain and your body. This may take several months. Just keep at it and very occasionally have a celebration of success with high carbs things you miss.

 

[Zilsniggy]

I will ask my doctor next appointment but anyone has any experience?

I am on 1000 mg Metformin XR per day (500mg at breakfast and 500 mg after dinner). However, I notice that after lunch my BG goes quite high sometimes (12 mmol).

A). Would taking my evening dose earlier (after lunch instead of after dinner) make a difference?

B). Would taking an extra 500mg after lunch make a difference?

I know the better approach is to change what i eat, which I will pursue. However if i just find that my BG is running at 12 or 13, would a Metformin make a difference?

No. Metformin works by lowering your insulin resistance temporaily and helping what insulin you produce work better. It has no direct effect on blood sugar, so it would be pointless taking extra. Maybe better to look at the carb content of what you eat for lunch and reduce that as that will undoubtedly improve your readings.

 

[Zilsniggy]

And to add (i do like him .. kind of!!).. I think he doesn’t want to add anything to the 1000 mg Metformin.. so he said “if it is really bothering you we can...”. Let’s see. I won’t jump into it yet!!

These drugs are dreadful for exhausting what beta cell function you have left, all they do is force the pancreas to constantly secrete insulin. And...if you continue to take them while still eating low carb, they can cause dangerous hypos(Gliptins that is). I'd be very reluctant to take them, if I were you.
Low carb will have an effect on your b;ood sugars, perhaps you haven't lowered your carbs enough?

 

[Zilsniggy]

My doctor was not terribly excited when I suggested cutting carbs. He was like - Cut them out in dinner but you need them during the day for your brain.

Your doctor clearly has no idea of nutrition at all......you really don't need carbs at all. We can manufacture enough glucose within our own bodies to keep our brains going. And your body functions perfectly well without them. I've been very low carb(less than 20g total a day) for two years now, feel much better than before eating this way, have halved my A1c, and managed to stop retinopathy in its tracks. It's so worthwhile doing, I can't stress the benefits more highly.

 

[Shas3]

These drugs are dreadful for exhausting what beta cell function you have left, all they do is force the pancreas to constantly secrete insulin. And...if you continue to take them while still eating low carb, they can cause dangerous hypos(Gliptins that is). I'd be very reluctant to take them, if I were you.
Low carb will have an effect on your b;ood sugars, perhaps you haven't lowered your carbs enough?

Thanks . Very insightful. No doubt about low carb. Have to do it. Already on that journey. I just wanted to understand your point on hypos. I thought gliptins don’t cause hypos? Or maybe I missed something

 

[Zilsniggy]

Thanks

. Very insightful. No doubt about low carb. Have to do it. Already on that journey. I just wanted to understand your point on hypos. I thought gliptins don’t cause hypos? Or maybe I missed something

If you're eating enough carbs, they won't, but significantly lowering your carb intake can lead to hypos when on these drugs. Basically, the only safe and proven drugs for diabetes so far have been insulin and metformin.

 

[DCUKMod]

To be honest, @Shas3 - my briefest, simplest explanation od how Metformin works is it helps our bodies work better, when dealing with carbs.

Of course it can only go so far in that regard, but personally, if comfortable trimming carbs a bit more, I'd likely want to go that way before I got the pancreatic cattle prod out. Personally, I'd rather use something to ease the strain on my system rather than creating a strain (to produce more insulin) - especially if I knew I was still producing enough insulin of my own.

If your Doc is serious about adding the gliptin, then maybe ask him is he can ascertain your underlying natural insulin levels, to see if they really need boosting or if that's just likely to add more insulin to the mix when the body is already struggling with what it can do for itself.

Not sure I put those last bits at all clearly, but that's my brain dump of the day!