Am I on the right medication?

[Pierrelad]

Hi, I’m on 4 metformin a day, 2 in the morning & 2 at night. This week I’ve been sick in the night 3 times. Nearly always about 2am in the morning. Wake up feeling full and a bit sweaty. Sometimes I go a few weeks without being sick. No particular pattern.... sometimes I may have eaten a bit too quickly because I’m hungry, maybe eaten slightly too much or if I’ve had 1 or 2 pints of lager only. Nothing eccentric I don’t think. I play sport everyday & am very active. Approx 160k steps a week. I was told to stop testing as I don’t need to...but I do sometimes. My morning readings are around 9. My blood test average was 6.8. My dr is only interested in my blood test results. I’ve been on metformin for 18months now. Should I still be sick & should I have better morning readings having taken 2 tablets at night?
Thanks all.

 

[urbanracer]

Hi and welcome to the forums.

Metformin shouldn't really be used like "pop these pills and carry on as you were", although many people do this and then get surprised when their condition worsens.

Medical advice can also be woefully inadequate in this area.

You should be taking a look at what you're eating. @JoKalsbeek has some good advice about this. In the meantime, try to work out how much carbohydrate you eat on an average day.

 

[Tophat1900]

You do need to test. Please ignore the ignorant advice not to. It is illogical to say the least, you will have no idea what your levels are unless you test. Not good to be sitting down to a meal if you are already high, but don't know it. Not testing is a bit like driving a car without the steering wheel, doesn't make much sense does it? Next time you feel ill as you have mentioned, test your blood glucose and see what it is.

 

[Pierrelad]

Thanks for the welcome & advice. Being a sportsman my calorie intake can be high sometimes. I eat healthily, but finding meals that fill me up and have long lasting energy & low carb can be tricky. 2 Eggs on toast for breakfast. 2 slices of bread (meat salad sandwich) for lunch, hummus, carrots & a packet of crisps. Dinner, meat veg & pots or soup if I’m eating late.

 

[Pierrelad]

You do need to test. Please ignore the ignorant advice not to. It is illogical to say the least, you will have no idea what your levels are unless you test. Not good to be sitting down to a meal if you are already high, but don't know it. Not testing is a bit like driving a car without the steering wheel, doesn't make much sense does it? Next time you feel ill as you have mentioned, test your blood glucose and see what it is.

Dr said not to become reliant on it as the metformin should be what controls it and didn’t want me to destroy my fingers early on. Everyone I meet says I’m a type 1 except the dr. I’m not sure if he’s just trying to get the most out of my pancreas with metformin before it eventually goes and I end up on insulin? (My guess). I’m 6ft & 10stone 2lbs.
I have tested when I’ve been sick or feel sick. There’s no pattern. Sometimes I’ve come back from exercise and my level is 7 before eating. I’m hungry & need to take a tablet....somethings not right but the dr just goes on my average blood test!

 

[JoKalsbeek]

Hi, I’m on 4 metformin a day, 2 in the morning & 2 at night. This week I’ve been sick in the night 3 times. Nearly always about 2am in the morning. Wake up feeling full and a bit sweaty. Sometimes I go a few weeks without being sick. No particular pattern.... sometimes I may have eaten a bit too quickly because I’m hungry, maybe eaten slightly too much or if I’ve had 1 or 2 pints of lager only. Nothing eccentric I don’t think. I play sport everyday & am very active. Approx 160k steps a week. I was told to stop testing as I don’t need to...but I do sometimes. My morning readings are around 9. My blood test average was 6.8. My dr is only interested in my blood test results. I’ve been on metformin for 18months now. Should I still be sick & should I have better morning readings having taken 2 tablets at night?
Thanks all.

If the side effects of metformin don't go away after 2 weeks, they're not going to. 18 months in? Not a chance. Your doc's being quite inconsiderate, keeping you on met when it obviously doesn't agree with you. Not like there's nothing else out there to try. Also, good on you for testing anyway. Seeing 9's when fasting indicates your blood sugar control isn't what it could be, so yeah.... Might be time to take the bull by the horns and just do something on your own accord. (And while I can't advice you to quit taking metformin, you might... Forget... To take it for a while, and see how you fare when you let diet do the work. You might be surprised. Not to mention your doc. He'll fall off his chair, I think!).

All in all, give this a read: https://josekalsbeek.blogspot.com/2019/11/the-nutritional-thingy.html It'll basically tell you how to change your diet so you can do without medication and being ill. There's lots more to read online, but it's a quick-start-guide so you can dive in quick without spending weeks studying the subject.

Good luck!
Jo

 

[Pierrelad]

Thanks jo, will have a look and see what I can change!

 

[JoKalsbeek]

Thanks for the welcome & advice. Being a sportsman my calorie intake can be high sometimes. I eat healthily, but finding meals that fill me up and have long lasting energy & low carb can be tricky. 2 Eggs on toast for breakfast. 2 slices of bread (meat salad sandwich) for lunch, hummus, carrots & a packet of crisps. Dinner, meat veg & pots or soup if I’m eating late.

Dr said not to become reliant on it as the metformin should be what controls it and didn’t want me to destroy my fingers early on. Everyone I meet says I’m a type 1 except the dr. I’m not sure if he’s just trying to get the most out of my pancreas with metformin before it eventually goes and I end up on insulin? (My guess). I’m 6ft & 10stone 2lbs.
I have tested when I’ve been sick or feel sick. There’s no pattern. Sometimes I’ve come back from exercise and my level is 7 before eating. I’m hungry & need to take a tablet....somethings not right but the dr just goes on my average blood test!

Okay, couple of things to add:
Calorie intake doesn't matter. It's the carbs that raise blood sugars. Eggs with bacon'd be fine, but the toast isn't. Bread's a no-no, as are the crisps/spuds and underground veggies, maybe pulses (hummus) too... You're better off upping your fat and protein intake, and see a minor miracle happen to your blood sugars. As for the metformin, it doesn't do anything for your pancreas. It reduces hunger, it makes you a little more sensitive to your own insulin, and it tells your liver not to dump too much glucose in the morning. Now, if you were on Gliclazide, that WOULD wring out your pancreas until it quits completely and you need insulin shots. Not the case with metformin though.

As for, everyone you meet says you're a T1? Why? Are you slim? Because not all T2's are overweight. Some are what is known as TOFI (thin outside, fat inside), where basically your pancreas and liver are packed in a layer of fat, which you can only see through an ultrasound. Not visible to the naked eye. You could be in that 10% of diabetics that were never overweight to begin with. Also... I think if you were a T1 you would've known by now. Needed insulin or been hospitalised with DKA, as metformin isn't going to do all that much for a T1.

You're in for a surprise, I really do think... You can be doing a whole lot better than you are right now.
Good luck!
Jo (who couldn't take metformin either)

 

[Pierrelad]

Thanks. I am slim and can’t afford to lose anymore weight. I never gain weight, only lose it if I’ve done more exercise than normal.

 

[EllieM]

Thanks. I am slim and can’t afford to lose anymore weight. I never gain weight, only lose it if I’ve done more exercise than normal.

If you think you might be T1 then push your GP for c-peptide and GAD tests. But there are thin T2s out there. There are also other types of diabetes than T1 and T2 (eg MODY if you've got a fair few diabetics in your family, or T3c if your pancreas has been damaged).

didn’t want me to destroy my fingers early on.

As a T1 for 50 years, my fingers get very punctured when I do 50 tests a week. They also recover completely after I've had a month on a cgm with only a couple of tests a day. Destroying fingers is a very dubious argument.

In your position I'd give low carb a try and push your doctor about the metformin side effects. There is a slow release version which some people tolerate better. But, assuming you are T2, it's quite likely that reducing your carbs would let you get your desired blood sugar levels without any medication at all.

And definitely get a meter, it will tell you how your body is coping with what you eat.

Good luck.

 

[JoKalsbeek]

Thanks. I am slim and can’t afford to lose anymore weight. I never gain weight, only lose it if I’ve done more exercise than normal.

Then, if you truly are a T2, don't go for intermittent fasting. Just low carb, high fat, high protein, in 3 meals and 3 snacks a day. That should melt the fat off your pancreas and liver without you becoming emaciated.

 

[Tophat1900]

Dr said not to become reliant on it as the metformin should be what controls it and didn’t want me to destroy my fingers early on. Everyone I meet says I’m a type 1 except the dr. I’m not sure if he’s just trying to get the most out of my pancreas with metformin before it eventually goes and I end up on insulin? (My guess). I’m 6ft & 10stone 2lbs.
I have tested when I’ve been sick or feel sick. There’s no pattern. Sometimes I’ve come back from exercise and my level is 7 before eating. I’m hungry & need to take a tablet....somethings not right but the dr just goes on my average blood test!

You won't destroy your fingers, that's rubbish. Metformin doesn't control your glucose levels, but it limits the glucose the liver makes, but that won't solve the problem alone of highs post meals. Eliminating bread sure will help. If metformin is such a problem for you, ask about the slow release version. Good luck.

 

[ianf0ster]

I'm a little surprised that @JoKalsbeek appears to suggest up to 3 snack per day. If you aren't hungry, then don't eat because any carbs win your food will raise your Insulin and so fuel your diabetes.
As a TOFI myself, though never as slim as you, I would say its best to eat a full satisfying meal so that you aren't hungry until the next meal.

When I went LCHF, I increased my calorie intake by swapping out carbs and replacing them with natural traditional fats (not spreads, seed oils etc) and a little extra protein.
After a few weeks I became 'fat adjusted' and so could switch from using food for fuel to using my own fat stores apparently instantly. Then I found I was no longer hungry at breakfast time and so now I usually eat 2 meals per day (sometimes only 1 meal).

 

[JoKalsbeek]

I'm a little surprised that @JoKalsbeek appears to suggest up to 3 snack per day. If you aren't hungry, then don't eat because any carbs win your food will raise your Insulin and so fuel your diabetes.
As a TOFI myself, though never as slim as you, I would say its best to eat a full satisfying meal so that you aren't hungry until the next meal.

When I went LCHF, I increased my calorie intake by swapping out carbs and replacing them with natural traditional fats (not spreads, seed oils etc) and a little extra protein.
After a few weeks I became 'fat adjusted' and so could switch from using food for fuel to using my own fat stores apparently instantly. Then I found I was no longer hungry at breakfast time and so now I usually eat 2 meals per day (sometimes only 1 meal).

I said snacks, not carbs. Olives, cold cuts, cheese etc, you know, fats and protein. Just in case the OP loses weight fast on low carb and doesn't want to.

 

[Daibell]

Hi and welcome. Your Dr is talking rubbish about your fingers etc. Yes, don't be obsessive about testing but do test occasionally. After 18 months the Metformin should have settled or won't ever. It never does that much so be prepared to stop it if needed. I would do a test doing without it for a few days and see whether it is the cause. If so tell the GP that you will be stopping it. GPs think of Metformin as the miracle cure for diabetes when it isn't. I've been on it for 15 years and know the small effect it has on BS. As you are slim, T1 becomes a possibility if your BS keeps going up. T1 can come on in middle age with widely varying timescales; it's been 8 years or so for me with a very long honeymoon period before my insulin. BTW do ask the GP for Metformin SR (Slow Release) as it may help the sickness; the GP should know that. Keep going with a low carb diet but have enough Fats and Proteins to keep you feeling full and to help with your exercise regime.

 

[BigNorsk]

With today’s lancets, I could easily test five times a day on the upper side of my left hand and never destroy my fingers. Double it using the bottom, double it again using the right. Bif you test more than that get a continuous glucose monitor. Bmatter of fact get one anyway, amazing what you learn following it.