Prescribed Metformin but wondering I can do this on diet alone

[DCUKMod]

The side effects might settle. Some might be unrelated. I'm in a bad place, emotionally, right now, and looking for stuff to blame, and perhaps metformin is an easy target. It definitely gave me the runs, massacred my appetite and left an unpleasant taste in my mouth. Only the first of those three things seemed to clear up after the first week. Add in the paranoia of what can go wrong when mixed with alcohol (I don't drink ridiculously most of the time, but like a good blow-out every now and again) and I don't think it's worth it for the 0.2 to 0.5 mmol/L reduction it's given me after a week. Perhaps that gets even better over time, but various Googlings suggest that it's 48 hours before anything happens, and about 7 days before the bulk of the effect is seen.

I'm averaging 6.9 mmol/L according to Libre, which is probably more like 6 by blood. That puts my HbA1c in the range of 35 to 42 without metformin. Do I really need it?

Nicola - I wouldn't be in a position to make any suggestion about Metformin, but if you took it for a week, and noticed a change of X, then knowing it works by therapeutic dosing, you would not have seen it's full benefit for another week, by my reckoning.

Secondly, please don't put too much energy into the Libre for guestimating your HbA1c. I have used many Libre, where I always have an estimated A1c of 19-21, whereas my labs dance around 30. My running range, at the lab, is 27-31. To me, that's a material difference.

I'm not saying any of that to put a downer on anything, but if you want to make conclusions about the impact on your A1c, I'd suggest investing £29 is a test at MonitorMyHealth, or any other of the cost efficient routes, if your NHS test isn't due.

MMH did suspend testing for a couple of weeks, due to the move of the UK Roche facilities, but I would imagine if they haven't resumed, it can't be far off.

https://www.diabetes.co.uk/forum/threads/what-have-you-eaten-today.75781/

I have no relationship with MMH aside from being a happy user - for my thyroid issues. They're pretty efficient.

I did clarify though that their Cholesterol panel is the full shebang, not just total, so the Heart Health at £39 adds lipids to an A1c for £10.

 

[Nicole T]

Nicola - I wouldn't be in a position to make any suggestion about Metformin, but if you took it for a week, and noticed a change of X, then knowing it works by therapeutic dosing, you would not have seen it's full benefit for another week, by my reckoning.

Secondly, please don't put too much energy into the Libre for guestimating your HbA1c. I have used many Libre, where I always have an estimated A1c of 19-21, whereas my labs dance around 30. My running range, at the lab, is 27-31. To me, that's a material difference.

I'm not saying any of that to put a downer on anything, but if you want to make conclusions about the impact on your A1c, I'd suggest investing £29 is a test at MonitorMyHealth, or any other of the cost efficient routes, if your NHS test isn't due.

MMH did suspend testing for a couple of weeks, due to the move of the UK Roche facilities, but I would imagine if they haven't resumed, it can't be far off.

https://www.diabetes.co.uk/forum/threads/what-have-you-eaten-today.75781/

I have no relationship with MMH aside from being a happy user - for my thyroid issues. They're pretty efficient.

I did clarify though that their Cholesterol panel is the full shebang, not just total, so the Heart Health at £39 adds lipids to an A1c for £10.

I've got a phone GP appointment today over a separate issue, so I'm going to ask about the A1c test. The diabetes nurse from the hospital said she'd schedule me one 'in a couple of months' and that was a couple of months ago. Obviously she didn't. If my GP refuses, then I'll probably go for a paid test.

Back to speaking with the girlfriend again. We're going to give it another go over the weekend. One of the 'conditions' (more a kind of mutual support thing) is that she keeps off the cigarettes and I take my metformin. So I've popped a couple more this morning. I'm going to try another full week on 1000mg in the morning. My Libre has expired and the new one hasn't arrived yet, but 6.0 on blood this morning, which isn't bad for me (I'm almost always 6's first thing.)

Obviously, I'm hoping my result will come back low enough for my GP to say 'ditch the metformin' anyway.

 

[Alexandra100]

best to increase your Metformin dose very slowly to avoid the digestive upsets so many get with it.

I forgot to ask, are you taking the Extended Release version? Most seem to find that easier on the digestion. Otherwise, at least make sure to take your Metformin with food? Apologies if this ground has already been covered.

 

[Nicole T]

I forgot to ask, are you taking the Extended Release version? Most seem to find that easier on the digestion. Otherwise, at least make sure to take your Metformin with food? Apologies if this ground has already been covered.

Standard release at the moment. Always taken in the morning, with at least some food (a block of cheese, today.) Diarrhoea for a couple of days, but that seems to have cleared up. The lingering problems are the funny taste in my mouth sometimes, the loss of appetite, and potentially effects on sexual performance. None of which would be addressed by slow release, I don't think.

I've got an HbA1c test booked for Monday. That'll be after 1 week on 500mg and 1 week on 1000mg, but since it gives the average over the last 2-3 months (though more greatly influenced by more recent levels) and metformin doesn't seem to have dropped my daily average more than 0.5 mmol/L as yet, I think it should still be a good indicator of how I've been handling this without medication.

 

[Andydragon]

Standard release at the moment. Always taken in the morning, with at least some food (a block of cheese, today.) Diarrhoea for a couple of days, but that seems to have cleared up. The lingering problems are the funny taste in my mouth sometimes, the loss of appetite, and potentially effects on sexual performance. None of which would be addressed by slow release, I don't think.

I've got an HbA1c test booked for Monday. That'll be after 1 week on 500mg and 1 week on 1000mg, but since it gives the average over the last 2-3 months (though more greatly influenced by more recent levels) and metformin doesn't seem to have dropped my daily average more than 0.5 mmol/L as yet, I think it should still be a good indicator of how I've been handling this without medication.

I’m sorry you’ve been having issues. Ive been on metformin of various dosage for over a decade so am one of those who tolerated but as I have mentioned in other posts I have to have modified release. It has impacted my vitamin levels so supplement folate and vitamin B, actually take a all in one vitamin plus vit C. Not sure if it’s sensible but I do anyway

I occasionally notice the taste in the mouth but it isn’t very often and the appetite suppression is a side effect that helps with the weight loss so is also a reason it is prescribed.

the 0.5 you are seeing, hard to say in error margin if it is having lesser or greater impact. Personally, I’d want to see how it has changed 3 months later at hba1c, but problem is, changing other things could also impact.

Not sure on the impact on testosterone. Will look into that, I’m on 2000mg but also bloods are averaging below 5 since the changes so may reduce that. It’s first of heard about it but is a slight concern

it’s such a balancing act though. Too high bloods also impacts performance in other ways. As does stress and we all are living in a weird world

I hope it works out for you!

 

[Alexandra100]

metformin doesn't seem to have dropped my daily average more than 0.5 mmol/L as yet

I'm passionately pro Metformin. I schemed and fought to get put on it, max dose. BUT at the same time I agree with very many here in believing that lifestyle, principally a low carb diet, is far more effective in lowering bg than any amount of Met. It is sometimes said that the brand Glucophage works better and is more easily tolerated than the generic. Followiong the published advice of Dr Bernstein, that is what I take. Btw did you realise that raised bg over time is a well-known cause of impotence in men? Not saying that your bgs have been high enough to have this effect, but another possible complication to bear in mind when calculating choices.

 

[Alexandra100]

It seems the (undocumented in the patient literature) feature of metformin in lowering testosterone

@Nicole T I happened upon this article and thought of you!
https://www.t-nation.com/diet-fat-loss/tip-the-two-fats-that-boost-testosterone

 

[Nicole T]

Tee2+ arrived today. Working just fine except it won't Bluetooth pair to my phone. 2 parallel tests, and both times it's read significantly higher than my old GlucoRx-Q. HbA1c tested Monday night and results were supposed to come back yesterday, but no sign of them on Patient Access yet.

These figures are after driving to the sorting office to collect it, and driving normally gives me a bit of a spike.

 

[Nicole T]

Results are finally on Patient Access. I was expecting low 40s and hoping for mid to high 30s. Happy with this result.

That's diet, moderate exercise and some weight loss only, apart from 1 week of 500mg metformin. So glad I found this site and the brilliant advice about low carb diet. 76 originally, so cutting carbs has pretty much halved it.

 

[Antje77]

WHOOPWHOOP!
Congratulations and keep it up!

And let us know the reaction of your HCP

 

[Andydragon]

Results are finally on Patient Access. I was expecting low 40s and hoping for mid to high 30s. Happy with this result.

That's diet, moderate exercise and some weight loss only, apart from 1 week of 500mg metformin. So glad I found this site and the brilliant advice about low carb diet. 76 originally, so cutting carbs has pretty much halved it. View attachment 45517

Your level drop is very similar to mine, well done!

Need to revisit in December actually now I’ve been a good month off the bydureon, good remind

 

[Sezzle]

Great results.. I have my first blood tests tomorrow after 7 weeks so fingers crossed. I’m on 1000g met and low carb... and exercise as best I can, I’ve also lost 1 and half stone.. so scared it won’t have come down from 94..
I do have an app where I’m putting in everything I eat and drink... interested that my daily grams carb intake is still there from veg and a handful of oats in morning... is there a guide as to target daily carb level to keep it low enough? Hope that makes sense!!

 

[HSSS]

Great results.. I have my first blood tests tomorrow after 7 weeks so fingers crossed. I’m on 1000g met and low carb... and exercise as best I can, I’ve also lost 1 and half stone.. so scared it won’t have come down from 94..
I do have an app where I’m putting in everything I eat and drink... interested that my daily grams carb intake is still there from veg and a handful of oats in morning... is there a guide as to target daily carb level to keep it low enough? Hope that makes sense!!

It’s incredibly individual how many work. How many does your app say you’re having? If your results tomorrow are not what you’d hope for I’d suggest ditching the oats. They are not low carb. Also test before and after meals to see what individual things do to your levels. Fingers crossed for you.

 

[Antje77]

is there a guide as to target daily carb level to keep it low enough? Hope that makes sense!!

The easiest way to find out if your carb level is low enough is using a glucose meter to test before a meal and 2 hours after. That way you can directly see if your body can handle the amount of carbs in that meal.

How many carbs people can eat and still keep healthy numbers is highly personal, some need to go as low as 20 grams a day while others can eat 150 grams.

 

[ziggy_w]

Brilliant achievement, @Nicole T. Very happy for you.

 

[Goonergal]

Great result @Nicole T

 

[Sezzle]

The easiest way to find out if your carb level is low enough is using a glucose meter to test before a meal and 2 hours after. That way you can directly see if your body can handle the amount of carbs in that meal.

How many carbs people can eat and still keep healthy numbers is highly personal, some need to go as low as 20 grams a day while others can eat 150 grams.

Thanks that helpful, on the app it splits it down to carbs, fibre and then sugar - is it just carbs I need to look at or the sugar one? So confusing!!

 

[JoKalsbeek]

Thanks that helpful, on the app it splits it down to carbs, fibre and then sugar - is it just carbs I need to look at or the sugar one? So confusing!!

In the US, fibre is counted in the total carb count in nutritional information. In the UK, Europe etc, the fibre isn't included, but listed separately. (They are carbs, but they don't get into the bloodstream). So you want to know total carbs, and if in the US, you subtract the fibre. In the rest of the world, don't.

 

[Nicole T]

Thanks that helpful, on the app it splits it down to carbs, fibre and then sugar - is it just carbs I need to look at or the sugar one? So confusing!!

You'll normally see a figure for "carbohydrate" and a lower figure below it for "of which sugars."

Sugar is carbohydrate, but then so is starch. Short chain carbohydrate molecules taste sweet, and longer chain ones don't, but they both have the same effect on your body. That's why a decent sized portion of rice or potatoes can hit you even harder than two spoons of sugar in a cup of tea. It's the carbohydrate figure you're interested in. You can ignore the sugar one.

It's further complicated by how quickly or slowly things release. If I carefully prepare rice (rinse away most of the starch part way through cooking) then I can get impressively low readings 2 hours after finishing a meal, but then it goes on to increase my average for at least the next 12 hours, which obviously isn't ideal.

And even more complicated, there are undigestible carbs. Some artificial 'sugar alcohol' sweeteners, for example, are 100% carbohydrate, but they're effectively 0% for our purposes because our bodies are incapable of converting them to blood sugar.

As @JoKalsbeek says above, US convention is to include non-digestible fibre in the total carbs figure (so you subtract it) but pretty much everywhere else excludes it, giving a more meaningful number. But I've purchased ingredients mail order in the UK that have used the US convention, so you need to have your wits about you. Similarly, some products give you a carbs figure for cooked weight rather than uncooked. In the case of rice, this can make the difference between 80g carbs per 100g (dry weight) and 35g per 100g (cooked weight.) I've seen both dry and cooked weights listed on different brands. Perhaps some even list both.

 

[Daphne917]

Well done @Nicole T