Type 2 Meds for fasting sugar on low-carb

[finsit]

Hi there. In the absence of central obesity and insulin resistance as a type-2 diabetic, do you see your fasting sugar levels go to 80's (4's mmol) using metformin or any other medication for that matter? I am doing pretty low-carb but my baseline fasting sugars are close to 6 mmol. I have no fatty liver, my fasting sugars are not affected by dawn phenomenon as well. Based on my reading, metformin mainly helps in prevent liver dumping the sugar by impacting glucagon. I am using a CGM to optimise my BG levels. I can manage a fasting to postprandial raise within 2 mmol if i keep low carb but im little concerned about the baseline. Ideally the fasting BG in non-diabetics is at 4.7 mmol. So if i can stay close to 5, i am mimicking a non-diabetic. Its more important for me because of my G6PD deficiency which put me under 5 fold more oxidative stress is my BGs go higher than 5.5. I am just thinking of taking any safe medication that can keep my baseline close to 5. I need to discuss this with my GP, but i thought i will learn from your experience if any that will help me discuss my options with the GP. I am thinking of incretin mimetics vs metformin, any suggestions?

 

[Rachox]

I don’t know anything about incretin mimetics, but I do take Metformin. However I have taken Metformin from diagnosis and continue five years later. As you can see from my signature I bought my diagnostic HbA1c of 70 down to non diabetic levels quickly and have stayed there ever since. I have talked with my GP about stopping or continuing Metformin and I have chosen to continue. So all I can really say is that my fasting blood glucose ranges between 4.5 - 5.5 mmol/l. I doubt your GP would commence you on any meds whilst your HbA1c is in the non diabetic range though.

 

[finsit]

I don’t know anything about incretin mimetics, but I do take Metformin. However I have taken Metformin from diagnosis and continue five years later. As you can see from my signature I bought my diagnostic HbA1c of 70 down to non diabetic levels quickly and have stayed there ever since. I have talked with my GP about stopping or continuing Metformin and I have chosen to continue. So all I can really say is that my fasting blood glucose ranges between 4.5 - 5.5 mmol/l. I doubt your GP would commence you on any meds whilst your HbA1c is in the non diabetic range though.

Great thanks. Can you share how your PP BGs look like normally and how fast they are back to fasting levels? Just need to understand how Metformin is affecting your fasting levels (2-3 hours after meals).

 

[Rachox]

Great thanks. Can you share how your PP BGs look like normally and how fast they are back to fasting levels? Just need to understand how Metformin is affecting your fasting levels (2-3 hours after meals).

Post breakfast (10g carbs) my PP at 2 hours is between 4.8 - 5.7.
I don’t eat lunch!
Pre and post dinner are very similar to pre and post breakfast.
I take 1000mg Metformin with breakfast and 500mg with dinner, not that I think the Metformin has a direct effect on each meal, it works in a more cumulative way. I just take it with meals to avoid any stomach upset.

 

[AndBreathe]

Great thanks. Can you share how your PP BGs look like normally and how fast they are back to fasting levels? Just need to understand how Metformin is affecting your fasting levels (2-3 hours after meals).

Finsit, Metformin works when a therapeutic dose is achieved. It isn't fast acting, so taking one or two tablets is unlikely to have much impact at all (aside from those unfortunate enough to find themselves tethered to the loo).

Whilst your A1c is running in the mid-low 30s my suggestion would be that you get on and enjoy life, rather than perpetually chasing marginal improvements. Save medications for times when they are clinically necessary.

I believe there comes a point when our bodies hit our personal sweet spot. Of course we probably will never know exactly when that it, but I do know that we have to get on with living our best lives, with decent quality of life, shared with loved ones, doing the things that make us happy. All too soon enough something will happen to us, or those we love that makes these marginal gains seem totally irrelevant.

I don't say any of that to be mean or nasty, but because you seem haunted by the prospect you could be missing out on an A1c one or two points down.

 

[finsit]

Finsit, Metformin works when a therapeutic dose is achieved. It isn't fast acting, so taking one or two tablets is unlikely to have much impact at all (aside from those unfortunate enough to find themselves tethered to the loo).

Whilst your A1c is running in the mid-low 30s my suggestion would be that you get on and enjoy life, rather than perpetually chasing marginal improvements. Save medications for times when they are clinically necessary.

I believe there comes a point when our bodies hit our personal sweet spot. Of course we probably will never know exactly when that it, but I do know that we have to get on with living our best lives, with decent quality of life, shared with loved ones, doing the things that make us happy. All too soon enough something will happen to us, or those we love that makes these marginal gains seem totally irrelevant.

I don't say any of that to be mean or nasty, but because you seem haunted by the prospect you could be missing out on an A1c one or two points down.

I believe to the bone what you are saying but its not achieving a perfect a1c, its due to my G6PD deficiency that puts me 6 fold more oxidative stress if my BGs are running higher than 5.5 mmol. After my first year of remission, i started experimenting and let it lose a bit to enjoy life as you said as i thought it wont differ from 31 to 35 for a1c, but i was wrong. I developed neuropathy, background retinopathy and few more symptoms that i used to have when i was running very high BGs, so i had to much more careful not to let me go down the rabbit hole again. So what you said i completely agree, but for me this marginal improvement is as important as keeping my BG in range to enjoy my life

 

[finsit]

Post breakfast (10g carbs) my PP at 2 hours is between 4.8 - 5.7.
I don’t eat lunch!
Pre and post dinner are very similar to pre and post breakfast.
I take 1000mg Metformin with breakfast and 500mg with dinner, not that I think the Metformin has a direct effect on each meal, it works in a more cumulative way. I just take it with meals to avoid any stomach upset.

Great, thanks. its encouraging. So I believe you have been taking this since 2017, so did you see metformin affect diminishing or it stayed the same all along?

 

[Goonergal]

@finsit

Have you considered looking at this another way? It seems from the numbers you give it’s only the FBG that’s concerning you. Rather than go down the route of medication for a perhaps marginal gain, how about looking at when you eat? It could well be that a shift in your eating window so that it ends earlier might have the desired effect?

 

[AndBreathe]

.... puts me 6 fold more oxidative stress....

What does that actually mean? Is it a 6-fold risk or six times the oxidative stress?

Clearly, it is entirely up to you to decide how to live your life, but in many ways, I would be horrified if a GP would prescribe medications, designed to improve blood sugars to someone more that 10 points under the diagnostic threshold for diabetes.

 

[Yulkuy]

Hey, I might be a bit off topic because I was only diagnosed as a prediabetic, but after going from 100 kg to 87 kg of body mass, my HOMA-IR on 2x850 mg metformin twice a day in the middle-closer to the end of a meal was 1.2 with 4.3 fbg and 6.4 insulin.

1 week-off metformin and in 3 weeks after that result with metformin, my HOMA-IR was 1.44 with 6.6 insulin and 4.9 glucose.

In another 4 weeks after my off-meformin test, my HOMA-IR was 1.4 with 4.9 glucose and 6.4 insulin. Lost a bit of weight, like 3 kg between those tests.

After dropping metformin I've experienced a short period of my blood glucose adjusting, my first day-off metformin fbg was 5.1-5.3, second day was like 5.0 - 5.2 and then dropped into 4.x. Might be useful information for someone.

I absolutely think there is some 0.2-0.3 mmol difference when using metformin even with normal glucose levels. I had a few 3.8 - 3.9 readings on my glucometer in the morning while on it, and haven't seen anything below 4.0 - 4.1 off metformin, except a few 3.7-3.8 values in a few hours after carb-heavy meals. I also think that because of me eating metformin during the meal its effect on me was a bit blunted, true effect might be bigger. At least I didn't have explosive diarrhea except 2 times I was smart enough to drink diet coca cola with my meal.

I had 5.1 HOMA-IR in february when I was 100 kg with bmi of 30 and just got rid of covid in January

 

[finsit]

@finsit

Have you considered looking at this another way? It seems from the numbers you give it’s only the FBG that’s concerning you. Rather than go down the route of medication for a perhaps marginal gain, how about looking at when you eat? It could well be that a shift in your eating window so that it ends earlier might have the desired effect?

Thanks, yes that is what i am exploring and weighing metformin in a hope of adding some more fun to life

 

[finsit]

What does that actually mean? Is it a 6-fold risk or six times the oxidative stress?

Clearly, it is entirely up to you to decide how to live your life, but in many ways, I would be horrified if a GP would prescribe medications, designed to improve blood sugars to someone more that 10 points under the diagnostic threshold for diabetes.

I know its a catch 22 situation, neither do i want to go that route, its just that when loosened things a bit last few months, i got diabetic symptoms even though as you said i was in healthy a1c range. Regarding oxidative stress, people with G6PD and diabetes have 6 times more oxidative stress as compared to someone who is just diabetic.

 

[AndBreathe]

I know its a catch 22 situation, neither do i want to go that route, its just that when loosened things a bit last few months, i got diabetic symptoms even though as you said i was in healthy a1c range. Regarding oxidative stress, people with G6PD and diabetes have 6 times more oxidative stress as compared to someone who is just diabetic.

Were your oxidative stress levels tested at all, particularly when you had the symptoms you relate?

Doing a little (and I admit it is a very little) reading around oxidative stress it seems to be one of those things that can be implicated with high carb diet, but also aerobic exercise, so one might say a no-win situation.

Whilst I wholeheartedly embrace that prevention is better than cure, unless you know your oxidative stress is increased, and meaningfully increased - i.e. not a blip and inexplicable, in your shoes I think I'd be getting on with my life, looking after myself, but enjoying my life (which for me doesn't necessarily include higher carb treats).

Those living with diabetes are at significantly increased risks of cardiovascular disease, stroke, and kidney issues, to name but a few, without getting into gender, genetic or familial.familial risks. I can't say I look at my everyday living to focus on preventing those. I try to find some balance.

 

[finsit]

Were your oxidative stress levels tested at all, particularly when you had the symptoms you relate?

Doing a little (and I admit it is a very little) reading around oxidative stress it seems to be one of those things that can be implicated with high carb diet, but also aerobic exercise, so one might say a no-win situation.

Whilst I wholeheartedly embrace that prevention is better than cure, unless you know your oxidative stress is increased, and meaningfully increased - i.e. not a blip and inexplicable, in your shoes I think I'd be getting on with my life, looking after myself, but enjoying my life (which for me doesn't necessarily include higher carb treats).

Those living with diabetes are at significantly increased risks of cardiovascular disease, stroke, and kidney issues, to name but a few, without getting into gender, genetic or familial.familial risks. I can't say I look at my everyday living to focus on preventing those. I try to find some balance.

No i have not tested but this study reveals and I could correlate all metabolic classic symptoms and my BGs were non-diabetic https://bmcendocrdisord.biomedcentr... the oxidative stress status,levels (p<0.001).

 

[Fenn]

Finsit, Metformin works when a therapeutic dose is achieved. It isn't fast acting, so taking one or two tablets is unlikely to have much impact at all (aside from those unfortunate enough to find themselves tethered to the loo).

Whilst your A1c is running in the mid-low 30s my suggestion would be that you get on and enjoy life, rather than perpetually chasing marginal improvements. Save medications for times when they are clinically necessary.

I believe there comes a point when our bodies hit our personal sweet spot. Of course we probably will never know exactly when that it, but I do know that we have to get on with living our best lives, with decent quality of life, shared with loved ones, doing the things that make us happy. All too soon enough something will happen to us, or those we love that makes these marginal gains seem totally irrelevant.

I don't say any of that to be mean or nasty, but because you seem haunted by the prospect you could be missing out on an A1c one or two points down.

Were your oxidative stress levels tested at all, particularly when you had the symptoms you relate?

Doing a little (and I admit it is a very little) reading around oxidative stress it seems to be one of those things that can be implicated with high carb diet, but also aerobic exercise, so one might say a no-win situation.

Whilst I wholeheartedly embrace that prevention is better than cure, unless you know your oxidative stress is increased, and meaningfully increased - i.e. not a blip and inexplicable, in your shoes I think I'd be getting on with my life, looking after myself, but enjoying my life (which for me doesn't necessarily include higher carb treats).

Those living with diabetes are at significantly increased risks of cardiovascular disease, stroke, and kidney issues, to name but a few, without getting into gender, genetic or familial.familial risks. I can't say I look at my everyday living to focus on preventing those. I try to find some balance.

I have no idea if this is good advice to finsit, but it’s generally excellent for everyone advice, it articulates how I feel very nicely… just saying

 

[boggle]

Just wanted to say this topic is of interest to me. My fasting bg is always high in the morning and stays high for a while (7am - 1pm) , even with a zero carb day. I'm experimenting with eating times to see if it helps. I'm not on any medication, but I think I will need a high dose of a sulfonylurea, or maybe a incretin mimetic. I had background retinopathy with hba1c of 104. Still have the retinopathy a year later, despite low hba1c's (although getting another next friday). Generally bg is slowly creeping up.

 

[finsit]

Just wanted to say this topic is of interest to me. My fasting bg is always high in the morning and stays high for a while (7am - 1pm) , even with a zero carb day. I'm experimenting with eating times to see if it helps. I'm not on any medication, but I think I will need a high dose of a sulfonylurea, or maybe a incretin mimetic. I had background retinopathy with hba1c of 104. Still have the retinopathy a year later, despite low hba1c's (although getting another next friday). Generally bg is slowly creeping up.

Hi thanks for showing your interest. In 2020 when i was diagnosed with a1c of 78 my eye exam was all clear. After a year when i went to a1c in non-diabetic range, my eye exam showed some background retinopathy (this March), that is where i started reading again and found how G6PD can increase oxidative stress and could aggravate neuropathy as well. I am not certain though was it because of my letting lose my diet a bit, like some indulgence off and on or because i lowered my a1c rapidly and some times that could cause small vessels in the eyes to rupture. @boggle i have similar situation and doing similar trial with timings and portions and type of food i eat. I have noticed when i reduce my portion size and reduce saturated fats in diet and EXTREMELY important the last meal (before 7 pm) then my morning BGs don't go high. So now in the last 2-3 days, i am seeing that my morning BGs are within 5 range all day long (i was fasting) so this time my fasting BGs didn't creep up. So the bottom line is that as long as my glycogen reserves are not full, my liver won't be dumping lot of sugar, and that happens with early last meal. Just thoughts.