So, this metformin....

[TeddyTottie]

When I was diagnosed with a HbA1c of 87, I was immediately prescribed 4x 500g metformin a day. Or rather, told to work up to this dose over a couple of weeks.

I see people on this site with a wide range of HbA1c values and there really doesn’t seem to be any consistency in prescribing practices. Some on the same dose, some on less, some on none at all and there seems to be no correlation between dosage and HbA1c.

It’s a bit weird, aren’t there supposed to be guidelines, eh?

 

[sno0opy]

Metformin is usually given to support the major life style changes you need to do to avoid the more agressive medications.

Generally if your levels don't drop faiely quickly due to life style changes and Metformin they will put you on the next set of medicine at your next review.

I think they try to give you the chance of making changes without resorting to the harder medications.

2000mg is the standard dose for a higher hba1c, I was told it was driven by studies which show it's the maximum they see a benefit from. So dr's start with a lower dose and build up, or start with a lower dose and don't built up if the hba1c score comes down

 

[Resurgam]

If I was being cynical I'd say that Metformin is prescribed in the hope of punishing those really bad diabetics who have fought against the well conceived advice to eat a low fat high carb diet and protested that it made them feel ill.
I had to stop the tablets as I felt so dire, and then found that it is perfectly possible to control type two, of the boring kind I seem to have, just by not eating the carbohydrates.
Some years on I am still doing it, and feel a lot better all round.

 

[Andydragon]

If I was being cynical I'd say that Metformin is prescribed in the hope of punishing those really bad diabetics who have fought against the well conceived advice to eat a low fat high carb diet and protested that it made them feel ill.
I had to stop the tablets as I felt so dire, and then found that it is perfectly possible to control type two, of the boring kind I seem to have, just by not eating the carbohydrates.
Some years on I am still doing it, and feel a lot better all round.

Again... For many people, including myself, Metformin or Metformin slow release works well and doesn't have the dietary issues that some have. I do find that you need balance when you discuss drugs. Putting people off before even trying is not a good approach, but ensuring the information is provided is sensible. It sounds like I'm picking on you but I don't mean to, just some threads on here really do seem to sell that picture of it

I had some issues with normal version, slow release was fine.

Yes there are alternatives to try, and I personally am trying to reduce if not coMe off completely but it is far from the "devil drug" that some on here make it out to be. I also agree it is not the miracle drug doctors say either. There are other drugs that are significantly worse when it comes to side effects

 

[Andydragon]

Metformin is usually given to support the major life style changes you need to do to avoid the more agressive medications.

Generally if your levels don't drop faiely quickly due to life style changes and Metformin they will put you on the next set of medicine at your next review.

I think they try to give you the chance of making changes without resorting to the harder medications.

2000mg is the standard dose for a higher hba1c, I was told it was driven by studies which show it's the maximum they see a benefit from. So dr's start with a lower dose and build up, or start with a lower dose and don't built up if the hba1c score comes down

Trouble is that some doctors don't properly explain that it needs changes as well. So there can be a misinterpretation that Metformin solves it, keep doing what you normally do... That leads the view that it's progressive unfortunately

 

[RFSMarch]

It is interesting - while the muppet GP who diagnosed me and the nicer GP at the same practice have VERY different views about self-monitoring my hba1c, they are both firmly on the "take this tablet lots" train...

I think at diagnosis I was on three of the standard release, but it caused the usual running to the lavatory issues many people have when I got to three. So I switched to the slow release (which annoyingly now has the opposite effect but that's another story).

I now see much more understanding GP regarding my circumstances (well at least before coronavirus/lockdowns/travel issues hit)... and he does sort of gently nag me to take four, citing its apparent properties of helping heart related issues, and generally apparently bringing about World Peace and returning the One Ring to Rule Them All back to Mordor. *

*I might have exaggerated a tiny bit on the last two points...

 

[bulkbiker]

So I switched to the slow release (which annoyingly now has the opposite effect but that's another story).

Oddly enough I experienced the same thing.. constipation with the SR version followed by an explosive experience that was not pleasant.. beware!

 

[Resurgam]

Again... For many people, including myself, Metformin or Metformin slow release works well and doesn't have the dietary issues that some have. I do find that you need balance when you discuss drugs. Putting people off before even trying is not a good approach, but ensuring the information is provided is sensible. It sounds like I'm picking on you but I don't mean to, just some threads on here really do seem to sell that picture of it

I had some issues with normal version, slow release was fine.

Yes there are alternatives to try, and I personally am trying to reduce if not coMe off completely but it is far from the "devil drug" that some on here make it out to be. I also agree it is not the miracle drug doctors say either. There are other drugs that are significantly worse when it comes to side effects

The tablets were prescribed with no advice, no warning - nothing.
I know now some people can take them. Some people can't. It would really have been helpful on the three occasions I was considering killing myself.

 

[Andydragon]

The tablets were prescribed with no advice, no warning - nothing.
I know now some people can take them. Some people can't. It would really have been helpful on the three occasions I was considering killing myself.

I'm sorry it affected you like that! I also am disappointed thay you weren't given the correct (or any) advice. It's good that we have this site and are able to get the info we need and can give to others.

 

[RFSMarch]

Oddly enough I experienced the same thing.. constipation with the SR version followed by an explosive experience that was not pleasant.. beware!

eeeek!!! Honest to god it is like a lavatorial minefield!!!!

 

[Rachox]

I feel I have to defend Metformin. Everyone is different so it’s worth a try if you want to, ask your Dr or Nurse questions, read the patient info leaflet and make an informed decision.
I have been on 3 x 500mg standard release per day since diagnosis. With Metformin plus low carb diet and self monitoring I have maintained an HbA1c in the low to mid 30s for over three years. I like that I have a ‘margin for error’ if something unexpected rocks my blood sugars (I have had a few operations since being diabetic and a family bereavement which put my sugars up temporarily but still remained in the non diabetic range), and I don’t have to compromise my diet beyond what keeps me happy.

 

[Hotpepper20000]

I feel I have to defend Metformin. Everyone is different so it’s worth a try if you want to, ask your Dr or Nurse questions, read the patient info leaflet and make an informed decision.
I have been on 3 x 500mg standard release per day since diagnosis. With Metformin plus low carb diet and self monitoring I have maintained an HbA1c in the low to mid 30s for over three years. I like that I have a ‘margin for error’ if something unexpected rocks my blood sugars (I have had a few operations since being diabetic and a family bereavement which put my sugars up temporarily but still remained in the non diabetic range), and I don’t have to compromise my diet beyond what keeps me happy.

I have to agree with you. Thank you for putting it better then I could.
Metformin is an aid that can help. But it does need to be in addition to dietary changes, in instead of.
I have PCOS and it is the only medication that helps with the symptoms and for me just a diet change wasn’t enough.
This forum is great but the anti medication slant worries me.
Medication should not be the only course of action but it can help if used properly.

 

[Andydragon]

I have to agree with you. Thank you for putting it better then I could.
Metformin is an aid that can help. But it does need to be in addition to dietary changes, in instead of.
I have PCOS and it is the only medication that helps with the symptoms and for me just a diet change wasn’t enough.
This forum is great but the anti medication slant worries me.
Medication should not be the only course of action but it can help if used properly.

Agreed also as I said earlier in the thread. I think the aim to find alternatives to medication is a good aim. I'm trying to reduce myself. However, I do find sometimes there is a distinct anti-metformin slant on these forums I find unfortunate. It's important to explain potential issues but it is helpful to many

 

[bulkbiker]

eeeek!!! Honest to god it is like a lavatorial minefield!!!!

Yep that's why I ditched them entirely and changed what I ate.

 

[mo53]

I need to lose weight to help with my diabetes and overall health, I have found that SR metformin reduces my appetite which is very helpful. Using a low carb diet I reduced both my weight and Habc1 and I came off the metformin but then I gradually succumbed to carbs which resulted in my Habc1 increasing to 60. I am now back on my low carb diet and metformin but I am determined to use both to reduced my weight and Habc1.

 

[BigNorsk]

I have to take the SR with a meal or problems show up.

 

[RFSMarch]

Yep that's why I ditched them entirely and changed what I ate.

Yes - and I believe you are completely aware why that was not an option for me at the time.

 

[RFSMarch]

I feel I have to defend Metformin. Everyone is different so it’s worth a try if you want to, ask your Dr or Nurse questions, read the patient info leaflet and make an informed decision.
I have been on 3 x 500mg standard release per day since diagnosis. With Metformin plus low carb diet and self monitoring I have maintained an HbA1c in the low to mid 30s for over three years. I like that I have a ‘margin for error’ if something unexpected rocks my blood sugars (I have had a few operations since being diabetic and a family bereavement which put my sugars up temporarily but still remained in the non diabetic range), and I don’t have to compromise my diet beyond what keeps me happy.

Exactly this.

 

[Daibell]

GPs tend to worship Metformin as the diabetes solution. In general it only ever has a small effect and the dosage isn't critical; like most meds the effect isn't linear with respect to dose. Few GPs warn about bowel problems and I believe the SR version should be prescribed for everyone (NICE says no). In my experience a lot of tablet prescribing by GPs for diabetes involves a lot of guesswork and not enough specific testing such as C-Peptide tests in addition to HBa1C. Insulin seems to be prescribed too often to overweight T2s when a low-carb diet might be a better solution

 

[Andydragon]

GPs tend to worship Metformin as the diabetes solution. In general it only ever has a small effect and the dosage isn't critical; like most meds the effect isn't linear with respect to dose. Few GPs warn about bowel problems and I believe the SR version should be prescribed for everyone (NICE says no). In my experience a lot of tablet prescribing by GPs for diabetes involves a lot of guesswork and not enough specific testing such as C-Peptide tests in addition to HBa1C. Insulin seems to be prescribed too often to overweight T2s when a low-carb diet might be a better solution

I assume there is a price difference between the 2 and across millions of diabetics it may well make a significant sum

To be fair. A lot of drugs have side effects and are not described at point of prescription but are left for the pharmacist or the user to check. I have been asked by the pharmacist before if I have taken pills before

Diabetic wise, I was warned about the thrush aspect of daplaflaglozin, the only drug I was warned about specifically. maybe as it is so common an effect?

I know we hear a lot about the dietary issues of Metformin but I wonder how common it really is.

Interested about the linear comment. I started on 500mg and only increased to 2000 over a few years as my levels increased. So for me it appeared higher dose had more impact. Is this not the case?