Metformin slow release and meal replacement diet

[Henmawson]

Hi there I've decided the weight has to go today, so have started on exante meal replacements (ketosis diet) I've got prediabetes so just wondering if I should continue as normal taking a tablet in the evening. Cheers people.

 

[douglas99]

No one can advise on medication, but I did the 800 calorie a day Newcastle diet, got my BMI back into the normal range, reversed my diabetes, and still decided to stay on 500mg of metformin, as I think metformin has other beneficial effects.
Good luck on the diet, it really worked out well for me.

 

[dbr10]

Hi there I've decided the weight has to go today, so have started on exante meal replacements (ketosis diet) I've got prediabetes so just wondering if I should continue as normal taking a tablet in the evening. Cheers people.

Not sure. But I'm surprised you even got Metformin as pre-diabetic. My doctor wanted to take mine off me straight away after Hba1c fell, but not to that level.

 

[Henmawson]

Not sure. But I'm surprised you even got Metformin as pre-diabetic. My doctor wanted to take mine off me straight away after Hba1c fell, but not to that level.

My HBA1C was 42 last month.

 

[dbr10]

My HBA1C was 42 last month.

I see.

 

[Brunneria]

@dbr10 Metformin is (in some CCGs and clinics) offered to non diabetics with polycystic ovary syndrome. I am sure there must be other uses for it too... It isn't an exclusively D drug.

Regarding Metformin when on very low calorie diets, I am sure I recently came across advice that Metformin should be discontinued with both fasting and very restricted calorific intake - but I am sorry, I have no recollection of where I saw that.

So I went looking. Didn't find the info I was looking for, but I did find this, which is generally informative about Metformin https://www.drugs.com/metformin.html

and this, which is one of the small-print inserts into the Metformin package
http://packageinserts.bms.com/pi/pi_glucophage.pdf
it is a fascinating read, and this is what it says about Metformin (glucophage) on restricted caloric intake:
Hypoglycemia—Hypoglycemia does not occur in patients receiving GLUCOPHAGE or GLUCOPHAGE XR alone under usual circumstances of use, but could occur when caloric intake is deficient, when strenuous exercise is not compensated by caloric supplementation, or during concomitant use with other glucose-lowering agents (such as sulfonylureas and insulin) or ethanol. Elderly, debilitated, or malnourished patients, and those with adrenal or pituitary insufficiency or alcohol intoxication are particularly susceptible to hypoglycemic effects.

@Henmawson - it is probably best you check it with your doc or nurse.

 

[Henmawson]

@dbr10 Metformin is (in some CCGs and clinics) offered to non diabetics with polycystic ovary syndrome. I am sure there must be other uses for it too... It isn't an exclusively D drug.

Regarding Metformin when on very low calorie diets, I am sure I recently came across advice that Metformin should be discontinued with both fasting and very restricted calorific intake - but I am sorry, I have no recollection of where I saw that.

So I went looking. Didn't find the info I was looking for, but I did find this, which is generally informative about Metformin https://www.drugs.com/metformin.html

and this, which is one of the small-print inserts into the Metformin package
http://packageinserts.bms.com/pi/pi_glucophage.pdf
it is a fascinating read, and this is what it says about Metformin (glucophage) on restricted caloric intake:
Hypoglycemia—Hypoglycemia does not occur in patients receiving GLUCOPHAGE or GLUCOPHAGE XR alone under usual circumstances of use, but could occur when caloric intake is deficient, when strenuous exercise is not compensated by caloric supplementation, or during concomitant use with other glucose-lowering agents (such as sulfonylureas and insulin) or ethanol. Elderly, debilitated, or malnourished patients, and those with adrenal or pituitary insufficiency or alcohol intoxication are particularly susceptible to hypoglycemic effects.

@Henmawson - it is probably best you check it with your doc or nurse.

Thanks for all the effort you went to really appreciate it

 

[Brunneria]

Thanks for all the effort you went to really appreciate it

no worries - am genuinely interested! I would LOVE someone to prescribe Metformin for me, but they all say my HbA1c is too low. The party poopers.

 

[JohnEGreen]

The only reason my Dr allowed me back on metformin was as an aid to weight control.

You have to give them a good valid reason that they can agree with.

 

[dbr10]

no worries - am genuinely interested! I would LOVE someone to prescribe Metformin for me, but they all say my HbA1c is too low. The party poopers.

But are they right about that?

 

[dbr10]

@dbr10 Metformin is (in some CCGs and clinics) offered to non diabetics with polycystic ovary syndrome. I am sure there must be other uses for it too... It isn't an exclusively D drug.

Thanks for the info. I think they may also be trialling it now to reduce BG levels in cancer patients to try to stop feeding the cancer cells.

 

[douglas99]

My hba1c has been 37 to 39 for a few years, and I've just been asked would I like to be 'diet only' at my last review.
I said no, and no problem with the metformin still being prescribed, I'm pleased to say.

I can't say it helps my weight control though, only very low calorie diets seem to do that for me.

 

[JohnEGreen]

It is only necessary that the doctor perceives it to be a valid reason that he can justify.

 

[Brunneria]

But are they right about that?

Depends what they are prescribing it for.
If the reason for prescription isn't to do with HbA1c (for example PCOS) then the HbA1c becomes irrelevant.
So I would argue that even with a good HbA1c, having PCOS, insulin resistance and being obese justifies a 3 month trial of Metformin.

In my situation, the endocrinologist reckons I have good enough bg control without Met (through severe LCHF). He chooses to ignore the fact that WITH Metformin I would get lower insulin resistance, possible weight loss, reduced liver dumps, and possibly reduced Dawn Phenomenon while eating a slightly more relaxed diet. I would count all of those as a win.

 

[dbr10]

Depends what they are prescribing it for.
If the reason isn't to do with HbA1c (such as PCOS) then the HbA1c becomes irrelevant.
So I would argue that even with a good HbA1c, having PCOS, insulin resistance and being obese justifies a 3 month trial of Metformin.

In my situation, the endocrinologist reckons I have good enough bg control without Met (through severe LCHF). He chooses to ignore the fact that WITH Metformin I would get lower insulin resistance, possible weight loss, reduced liver dumps, and possibly reduced Dawn Phenomenon while eating a slightly more relaxed diet. I would count all of those as a win.

Yes, you are absolutely right. If you're not allowed to try it, you don't know how much help it might be. I think some HCPs are just blinkered.

 

[Avocado Sevenfold]

When I was diagnosed T2, the doc gave me metformin and told me it would be for life because diabetes is for life. I was bothered at the time, but when she explained that it offered cardiovascular protection, I was happy to take it. Like Douglas, I wouldn't want to give it up now despite having a decent hba1c.

@Henmawson Sorry, don't know the answer to your question. Good luck.

 

[yiannis_]

I'm glad to be off it for now at least. I think it's over prescribe and not particularly useful in lowering hba1c. I doubt many of the other claims for it too, I see too many drug reps peddling drugs with "new" uses particularly when they are not very good at there primary use

 

[douglas99]

I'm glad to be off it for now at least. I think it's over prescribe and not particularly useful in lowering hba1c. I doubt many of the other claims for it too, I see too many drug reps peddling drugs with "new" uses particularly when they are not very good at there primary use

You are a Healthcare Professional?
How many drugs reps do you see on average?
Is that a professional opinion on metformin, as many of us believe it is effective, and provides other benefits, so if we are wrong, do you have any links to studies suggesting we should reconsider?

 

[Freema]

I'm glad to be off it for now at least. I think it's over prescribe and not particularly useful in lowering hba1c. I doubt many of the other claims for it too, I see too many drug reps peddling drugs with "new" uses particularly when they are not very good at there primary use

you could be right , there seem to be a lot of hype about some new kinds of medicine, like all the anti-psychotics that now have turned up to be much more dangerous than earlier told, and also a huge contributer to creating type 2 diabetics... and like the SSRI´s that also now is said to even promote depression in long term users, where it was suposed to help depression, and the same about all the cholesterol lowering medications that has so many dreadful sideeffects and now is big time promoted for lower and lower cholesterol levels.... .......it is really hard to know if all the research has been controled too much by the paying medicine Companies and if there has been a broad enough excamination of what possible sideeffects and synergic bad effects when taken with other medications as well

 

[yiannis_]

You are a Healthcare Professional?
How many drugs reps do you see on average?
Is that a professional opinion on metformin, as many of us believe it is effective, and provides other benefits, so if we are wrong, do you have any links to studies suggesting we should reconsider?

I'm a specialist nurse in another field, so I'm not qualified to give a professional opinion on metformin. My personal opinion (as all my opinions are on this site) is that it is often prescribed very early in the disease process, on the basis of diabetes being a lifelong progressive disease, before other options such as weight loss have been tried. I probably see 3 reps (in my own speciality)per month.