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Will they want to take me off Metformin?

M

Mrs SLD

Well-Known Member
Messages
55
Type of diabetes
Type 2
Treatment type
Tablets (oral)
Hi all, if you are interested I have posted many times about my journey since diagnosis in July 2025, but here is a brief summary:

43f with history of PCOS but no symptoms of diabetes (BMI normal) except for a wound on my toe which wasn't healing well, so podiatrist recommended to get my a1c checked. Came back at 107 which was a huge shock and really scary for me.

Was suggested to start glicazide straight away but decided to try dietary changes and Metformin first. On a fairly strict low carb diet and 2g Metformin and self funding CGMs I bought my a1c down to 47 by end of October. I was congratulated at the time and told I would have a follow up in May 2026. I stopped self funding CGMs shortly after as I felt I was no longer really learning anything, I was 100,% in range all the time.

Fast forward to now and I have been doing finger prick tests most days, focussing on after meals and sometimes fasting. I have also relaxed my diet slightly to include a few more carbs when I can see they don't impact me too much. My finger prick tests continued to be really great, however I missed having the full range of data with a CGM so purchased one to have another 2 weeks of information, especially now I am allowing myself to be relaxed more on carbs, I wanted to see a clearer picture on the impact.

The latest CGM is showing I now have an average glucose of 5.8mmol and is estimating my a1c to be 34 as a result. I know this is only an estimate but the cgm was very similar to my actual a1c results last year when I was tested. Most days I am actually having periods of low glucose (3.7-3.8) particularly before meals and overnight (not compression lows as I can see they are steady rather than dips). I have validated the day time lows with finger pricks that these lows are correct. I know these levels are not dangerous as I am not on insulin, but it surprises me to see them.

I guess I am rambling, but I am just wondering what this means for the future. If my a1c is confirmed in this range in May, will they try me without Metformin? I am a little anxious with how this all happened and worried everything will shoot up again if I stop the meds.

Thanks as always
 
The mid point of "normal" HbA1c is 38ish. If yours proves to be 34, then your BG is now normal and I would expect at your next review there would be a consideration of what medication, if any, is needed.

Metformin lowers HbA1c, but only by a fairly small amount. I have no experience of it myself, but I can't recall anyone on these forums achieving the huge BG reduction you have by metformin alone. I would expect that your dietary changes have been the most influential by far. Bilous and Donnelly in their Handbook of Diabetes are clear that the biggest influence on BG is the food eaten, in particular the amount of carbohydrate and therefore glucose.

I guess what I'm trying to say is that it may well be that you have shown that you can manage your condition perfectly well without metformin - the question about whether you should or not is one you would need to discuss with your prescriber.
 
KennyA said:
The mid point of "normal" HbA1c is 38ish. If yours proves to be 34, then your BG is now normal and I would expect at your next review there would be a consideration of what medication, if any, is needed.

Metformin lowers HbA1c, but only by a fairly small amount. I have no experience of it myself, but I can't recall anyone on these forums achieving the huge BG reduction you have by metformin alone. I would expect that your dietary changes have been the most influential by far. Bilous and Donnelly in their Handbook of Diabetes are clear that the biggest influence on BG is the food eaten, in particular the amount of carbohydrate and therefore glucose.

I guess what I'm trying to say is that it may well be that you have shown that you can manage your condition perfectly well without metformin - the question about whether you should or not is one you would need to discuss with your prescriber.
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Thank you so much for such a detailed reply! That is helpful to know about Metformin, I think I am seeing it as a bit of a security blanket after feeling so traumatised by the results last year. I look forward to discussing properly with the nurse specialist
 
Metformin lowers Hba1c by about 1-1.5%, which doesn't sound much but is actually slightly higher than many other diabetic meds eg Dapagliflozin is in the 0.8-1.2% range.
It can become a bit of a crutch, and if it's not required because things are under control, then it's one less drug to put in your system.
 
You may come off it gradually as in form 4 tablets to 3 a day then 2 then one ask your DN if you are concerned
personally I begged to come off MF hated the side effect I do however use 2 insulins as weel
 
First things first, please don't rely on the estimated Hab1c. I had a call with my team last week and my Hab1c from the blood result they had just received was 62, which is under the 69 I need to get my knee replacement done. Whilst she was on the phone I checked the estimated Hab1c according to the Libre app, was 54, so err on the side of caution with it.

My team have gradually been reducing my Metformin from 4, down to 3, and now down to 2 tablets. I have not noticed any difference with the reduced dosage. I keep a "diary" of what I eat, along with the carb value for each meal as given on any information for the food in question. I record my BG before every meal, estimate the carb value and inject insulin according to those carbs. I then scan my sensor 1 hour and 2 hours after that meal to ascertain what effect the insulin had on my meal.

My diabetes team have me on Mounjaro to reduce my weight, but I was warned it could lower my BG too. So far so good, but the Mounjaro is having to compete with all my Asthma, Diabetes and Myeloma cancer drugs, but I have lost 3st 6lb and I'm under 17st for the first time in 30 years.
 
Grandadfatboy said:
First things first, please don't rely on the estimated Hab1c. I had a call with my team last week and my Hab1c from the blood result they had just received was 62, which is under the 69 I need to get my knee replacement done. Whilst she was on the phone I checked the estimated Hab1c according to the Libre app, was 54, so err on the side of caution with it.

My team have gradually been reducing my Metformin from 4, down to 3, and now down to 2 tablets. I have not noticed any difference with the reduced dosage. I keep a "diary" of what I eat, along with the carb value for each meal as given on any information for the food in question. I record my BG before every meal, estimate the carb value and inject insulin according to those carbs. I then scan my sensor 1 hour and 2 hours after that meal to ascertain what effect the insulin had on my meal.

My diabetes team have me on Mounjaro to reduce my weight, but I was warned it could lower my BG too. So far so good, but the Mounjaro is having to compete with all my Asthma, Diabetes and Myeloma cancer drugs, but I have lost 3st 6lb and I'm under 17st for the first time in 30 years.
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Thanks for your reply, but firstly, and as I mentioned in my post, I do fully know the a1c estimation in the CGM is not necessarily accurate and am not relying on it. However, what I can see what my average blood glucose is (now 5.7) which is significantly lower than what it was last time I used a CGM, so I just wanted to anticipate what happens next. I have decided to have a private a1c test done now to satisfy my curiosity, so I will see what that says.

I am not on any drugs other than Metformin and my BMI is 22 so no weight loss requirements. I will definitely monitor any impact on my BGs closely should I start tapering off the Metformin. Thanks for sharing your experience.
 
Mark Rawlinson said:
You may come off it gradually as in form 4 tablets to 3 a day then 2 then one ask your DN if you are concerned
personally I begged to come off MF hated the side effect I do however use 2 insulins as weel
Click to expand...
Thankfully I have had zero side effects of the Metformin (aside from the first few days) so have no immediate desire to stop it. But will see what they say when I see them in may
 
lessci said:
Metformin is prescribed "off licence" in some circumstances for PCOS, maybe as about staying on a reduced dose?
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Good shout thanks! I was actually prescribed it 15 years ago when I was preparing for fertility treatment to help settle my cycles, I had no signs of insulin resistance at the time so I guess it was this off licence scenario.
 
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