New to metformin Advice please

Ricky

Well-Known Member
Messages
295
Type of diabetes
Prediabetes
Treatment type
Diet only
Hi experienced ones.
A brief history. - which you can ignore and go straight to the next paragraph if you wish. I have managed genetic type 2 for 18 years on diet (initially low carb now keto) + exerecise successfully to keep my HbA1c down and although my results last week were 46 (6.4) my life is impossible as I eat via my meter . I'll explain- I get Dawn Phenomenon and my fasting numbers are usually in the middle to high 7's even up to 8.6. Despite this up until last November in 4 hours (lunchtime) my numbers were down to middle 5's but now I have to wait 7+ hours for it to go down to low 6's. This means not eating lunch until after 3 pm which is totally unsocial. I have refused lunch dates with friends and wouldn't even go away for the weeknd to stay with famiy because of this. (by the evening it is downto 5's which is fine.) I am not overweight and I do high impact gym classes 6 nights out of 7. Also a brisk 20 mins walk used to bring down my bs but now a 9 kms walk down the sea front does nothing to help!! I have got to the limit of what I can do.And yes I have tried every herbal solution out there . Some actully worked for a week or 2!!

Fast forward to today. My doctor has agreed to put me on 1 tablet of Metformin a day. Now I am terrified of getting the usual side effects . He suggested taking the Metformin 30 mins before evening meal and see if that helps or 30 mins before Breakfast. Now from what I have researched I see that to avoid side effects take DURING a meal. So this is why I am asking your advice . You are the experienced ones. Which of these options (take at dinner or breakfast) do you think will be best to get my high fasting number back down to the 5's in 4 hours before lunch? From what I gather metformin doesn't often work on the fasting numbers. Thanks so much for reading
 

Brunneria

Guru
Retired Moderator
Messages
21,889
Type of diabetes
Type 2
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Diet only
It looks like your doc thinks that Metformin acts to suppress blood glucose rising with food, which would explain their suggestion to dose before food intake.

That isn’t how it functions. Instead, it acts to lower insulin resistance (a bit) and to reduce the amount of glucose released from the liver - amongst other functions. So timing the dose before a meal doesn’t affect its efficacy.

However, if you have a look at the patient information sheet that comes with the Metformin, it usually suggests that you take the tablet with food, and not to take it when fasting.

The purpose of this is to reduce the gastrointestinal effect that some people get from Metformin. The food in the stomach acts as a kind of buffer and they experience less gut upset (if they experience any gut upset at all). My own brief experience of Metformin was that taking the tablet in the middle, or at the end of the meal was helpful.

You may be one of the lucky ones who doesn’t get any side effects, and even if you do, they usually disappear within a week or so of increasing the dose.
If they don’t, you can ask your doc for the slow release version (which can be taken on an empty stomach, since it is gentler on the guts.
 

EllieM

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9,208
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At this point I would be asking the doctor for a cpeptide test to see how much insulin you are still producing... Managing via diet and exercise for 18 years is awesome but at this point I'd be asking whether the issue is typical T2 insulin resistance or long term T2 reduced insulin production. And given the steps you have been taking, I wouldn't rule out the possibility that you have always been a misdiagnosed LADA (Certainly happens for ten years.)

Not a T2 so happy to be corrected if I am misunderstanding the situation. The timing of the metformin may reduce the likelihood of gastro issues but not much else.
 

JoKalsbeek

Expert
Messages
5,937
Type of diabetes
I reversed my Type 2
Treatment type
Diet only
Hi experienced ones.
A brief history. - which you can ignore and go straight to the next paragraph if you wish. I have managed genetic type 2 for 18 years on diet (initially low carb now keto) + exerecise successfully to keep my HbA1c down and although my results last week were 46 (6.4) my life is impossible as I eat via my meter . I'll explain- I get Dawn Phenomenon and my fasting numbers are usually in the middle to high 7's even up to 8.6. Despite this up until last November in 4 hours (lunchtime) my numbers were down to middle 5's but now I have to wait 7+ hours for it to go down to low 6's. This means not eating lunch until after 3 pm which is totally unsocial. I have refused lunch dates with friends and wouldn't even go away for the weeknd to stay with famiy because of this. (by the evening it is downto 5's which is fine.) I am not overweight and I do high impact gym classes 6 nights out of 7. Also a brisk 20 mins walk used to bring down my bs but now a 9 kms walk down the sea front does nothing to help!! I have got to the limit of what I can do.And yes I have tried every herbal solution out there . Some actully worked for a week or 2!!

Fast forward to today. My doctor has agreed to put me on 1 tablet of Metformin a day. Now I am terrified of getting the usual side effects . He suggested taking the Metformin 30 mins before evening meal and see if that helps or 30 mins before Breakfast. Now from what I have researched I see that to avoid side effects take DURING a meal. So this is why I am asking your advice . You are the experienced ones. Which of these options (take at dinner or breakfast) do you think will be best to get my high fasting number back down to the 5's in 4 hours before lunch? From what I gather metformin doesn't often work on the fasting numbers. Thanks so much for reading
Hello,

I'm going to do a total stab in the dark here, but high impact gym classes most nights might be a reason for the high fasting blood sugars the following morning? If the goal of the gym classes is to get your heart pumping rather vigorously, it might also be triggering your liver into dumping glucose to give you energy to do it. And maybe the walks should be less a matter of brisk, and more a matter of relaxing, taking in the environment while moving about. Stress triggers the liver, whether physical or mental, so... Bit of a mindful stroll instead? Like I said, just a stab in the dark, but considering what and how you eat, it isn't likely to be the food that is the issue. If it's not the gym classes, maybe some tests to check insulin production would be in order.

Also, I took to just having a mug of tea or tall glass of sparkly water when other people eat. Then I'm still at the table having SOMETHING (which makes them more comfortable and makes me feel less left out), and hey, the bulk of human beings snack around 3 or 4, so I doubt they'd give you grief for eating. People who care about you might make an effort to understand your way of eating. (And those who don't, well... Maybe do avoid meals/mealtimes with them, then...)

As for metformin, keep in mind that side effects can last up to 2 weeks before they abate. If they last longer, they're not going anywhere, most likely. Then slow release metformin could be an option instead? Metformin does actually work on the fasting numbers, as those go up mainly due to Dawn Phenomenon, which is, again, the liver dumping glucose, so... If that's the main problem here, it would help, I think. (Or you might want to skip gym for a bit. Maybe go swimming or walking instead and see what happens before the metfomin starts?)

Anyway, I hope some of the answers on here end up helping.
Hugs!
Jo
 

Ricky

Well-Known Member
Messages
295
Type of diabetes
Prediabetes
Treatment type
Diet only
At this point I would be asking the doctor for a cpeptide test to see how much insulin you are still producing... Managing via diet and exercise for 18 years is awesome but at this point I'd be asking whether the issue is typical T2 insulin resistance or long term T2 reduced insulin production. And given the steps you have been taking, I wouldn't rule out the possibility that you have always been a misdiagnosed LADA (Certainly happens for ten years.)

Not a T2 so happy to be corrected if I am misunderstanding the situation. The timing of the metformin may reduce the likelihood of gastro issues but not much else.
I have no idea what LADA is but will research it - Thanks for that information. I can try re the cpeptide test but don't hold much hope as they have eve stopped Vit D3 testing!! The doctor did mentin insulin resistance but I have never heard about 2 different types . Can you please explain the difference?
 

Ricky

Well-Known Member
Messages
295
Type of diabetes
Prediabetes
Treatment type
Diet only
Hello,

I'm going to do a total stab in the dark here, but high impact gym classes most nights might be a reason for the high fasting blood sugars the following morning? If the goal of the gym classes is to get your heart pumping rather vigorously, it might also be triggering your liver into dumping glucose to give you energy to do it. And maybe the walks should be less a matter of brisk, and more a matter of relaxing, taking in the environment while moving about. Stress triggers the liver, whether physical or mental, so... Bit of a mindful stroll instead? Like I said, just a stab in the dark, but considering what and how you eat, it isn't likely to be the food that is the issue. If it's not the gym classes, maybe some tests to check insulin production would be in order.

Jo
Thanks for you informative answer.
As I was doing a HIIT class toight I realised I had only been back to doing these high intensity classes every eveing for the last 3 weeks as during lock down I only did 1 a week in the evening and 1 on a Sunday morning. The increase in the fasting numbers started in about October with 7's now and again ,then went to all the time and now gone to high 7's and the odd 8+. I only used to get these sort of numbers if I had an infection. i.e. good thinking but I don't think the exercise in the evenings is a causation. I will mention the Cpeptide test when I have my next blood test in 8 weeks as the Dr wants. Can it be tested by a blood test?
I also discussed high Cortisol levels at night with him but he said this is so difficult to get the timing right to test!!
 

JoKalsbeek

Expert
Messages
5,937
Type of diabetes
I reversed my Type 2
Treatment type
Diet only
Thanks for you informative answer.
As I was doing a HIIT class toight I realised I had only been back to doing these high intensity classes every eveing for the last 3 weeks as during lock down I only did 1 a week in the evening and 1 on a Sunday morning. The increase in the fasting numbers started in about October with 7's now and again ,then went to all the time and now gone to high 7's and the odd 8+. I only used to get these sort of numbers if I had an infection. i.e. good thinking but I don't think the exercise in the evenings is a causation. I will mention the Cpeptide test when I have my next blood test in 8 weeks as the Dr wants. Can it be tested by a blood test?
I also discussed high Cortisol levels at night with him but he said this is so difficult to get the timing right to test!!

C-peptide and GAD tests (the ones you'll want) are both blood tests, so hopefully your doc'll be of assistance! Far as I know HOMA-R might be useful too, but a lot of GPs have never heard of that one, and C-pep and GAD should probably tell you enough as it is.

Good luck!
Jo
 

Ricky

Well-Known Member
Messages
295
Type of diabetes
Prediabetes
Treatment type
Diet only
C-peptide and GAD tests (the ones you'll want) are both blood tests, so hopefully your doc'll be of assistance! Far as I know HOMA-R might be useful too, but a lot of GPs have never heard of that one, and C-pep and GAD should probably tell you enough as it is.

Good luck!
Jo
Thanks for that
 

Ricky

Well-Known Member
Messages
295
Type of diabetes
Prediabetes
Treatment type
Diet only
Update- Fasting blood sugar 7.3 this morning which is low for me. Took the metformin this morning together with breakfast at about 8,30. Half way thrugh the morning I felt slightly nauseous. At 1.45 pm I took my blood sugar and could not believe it was only 5.4. Can't believe this has worked the way I wanted it to on the first day of taking it!! Onwards and downwards!!!!
 
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