3000g Metformin, single dose

Hi,

I feel I should warn you that no one here is a position to give you medical advice, or recommend any changes to your prescription or medication. Although we can, of course, talk about our own experiences and discuss medication information.

My recommendation to you would be to read the Patient Information leaflet contained in your Metformin packaging. That often gives good advice on when and how to take medication. If you are still in doubt after that, a call to your surgery for advice should give you a clear answer.

Have you been prescribed the SR version because the standard Metformin upset your tummy? If so, the SR releases more slowly, and then spreading the dose across the day spreads the slow release even more, which is probably even gentler on the tummy. You may find that a single large dose, even if SR, has tummy impact, if you see what I mean.

Welcome. I see you’re new to the forum. I’m afraid I can’t answer your medication questions but @Brunneria is spot on in her advice.

Have you heard about low carb eating? It helps many of us keep our numbers down and often reduce or even eliminate medications. Do you test your own blood? I believe on gliclazide you should have been given a meter as it has the potential to take you low and maybe hypo. I’m going to tag a couple of members who have some great posts to introduce you to some ideas @daisy1 for a general welcome and @JoKalsbeek for low carb info and https://www.diabetes.co.uk/forum/threads/what-have-you-eaten-today.75781/ for food ideas also dietdoctor.com for food ideas and general info.

IMPORTANT: if you lower your carbs then your meds need to be adjusted accordingly to make sure you aren’t taking more than your new diet requires. It can cause a hypo if you have more gliclazide than your carb intake requires. Ideally do this with your dr.

and don’t be put off by an ill informed out dated rubbishing of low carb diets or being told you should eat carbs to match meds. It’s the other way round!

Scriobh said:

I've been taking 3000g of Metformin SR 3 times a day. I start with 4 30g doses of Gliclazide and 1 1000g tablet of Metformin in the morning. Can I take the Metformin in a single dose in the morning with my Gliclazide?

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Hi @Scriobh , and welcome,

I was tagged into this conversation for my little nutrition talk, but let's talk about the metforin first. Is there a reason you're splitting the doses? Was there gastric trouble? May be worth checking the leaflet. You're spreading it out now, while taking everything in one go could have some side effects. (You'll never leave the loo again, possibly.) Also, if you do read the leaflet, odds are it'll also say metformin is to be considered after 3 to 6 months of the patient attempting dietary change. (If it's not in the patient's leaflet, it is in the version meant for medical professionals, should you want to peruse that. https://www.medicines.org.uk/emc/product/6298/smpc). So hey, you might be able to come off meds entirely, should that be something you want. Looking at your profile pic, you're a bit young to be on meds-only already, honestly. Not being age-ist or anything, but if you're only going on medication, in quite high doses, and not on any dietary change -you didn't mention it in any case- then diabetes is a progressive condition, and you'll only need more medication as time goes by. And considering my guesstimate of your age, I'd think that'd mean insulin, eventually, as you've got quite a few years/decades to go yet. Which you may want to avoid. (Insulin, not the living to a ripe old age of course. ) Dunno if that's the case, and not trying to wind you up or anything... Just want to give you stuff to think about.

If you do want to consider a change in lifestyle/diet, be careful of the gliclazide. It can cause hypo's, and as one of our members recently found out after mixing a low carb diet with Glic, they're not fun. So don't change anything unless you have a meter and you've talked to your doc about dosage first. Anyway, here's my little thingy:

There’s a few things you should know.

1. Practically all carbs turn to glucose once ingested, so not just straight sugars, but starches too. Food doesn’t have to taste sweet to make your blood sugars skyrocket.

2. A meter helps you know what foods agree with you, and which don’t. Test before and 2 hours after the first bite. If you go up more than 2.0 mmol/l, the meal was carbier than you could handle. (It’s easy to remember, as you’re a T2: all 2’s, all over the place!)

3. In case you didn’t know already, this isn’t your fault. It’s genetics, medication, decades of bad dietary advice, and basically all manner of things, but nothing you can actually blame yourself for.

4. Diabetes T2 is a progressive condition, unless you (also) change your diet. So you have options. Diet-only, diet with medication, or medication only. But that last option will most likely mean more medication over the years. (And there is more than just metformin, so if it doesn’t agree with you, there’s lots of others to try). So even if going really low carb isn’t for you, you might consider moderately low carb an option, with meds to assist.

5. Are you overweight? 90% of T2’s are. Yeah, that means 10% are slim and always were. If you did gain weight, it was the precursor of this metabolic condition. We make loads of insulin, but become insensitive to it. So carbs we eat turn to glucose, and normally, insulin helps us burn that glucose for fuel. When it doesn’t, that glucose is stored in fat cells instead. When those fat stores are full, the glucose remains in our bloodstream, overflowing, into our eyes, tears, urine, saliva… And then we’re T2’s. So weight gain is a symptom, not a cause. This also means that “regular” dietary advice doesn’t work for us. The problem lies in our inability to process carbs. And most diets focus on lowering fats and upping carb intake. Which is the direct opposite of what a T2, or prediabetic, for that matter, needs.

6. There are 3 macro-nutrients. Fats, protein and carbohydrates. Those macro’s mean we get the micro-nutrients we need: that would be vitamins and minerals. So… If you ditch the carbs, you should up another macro-nutrient to compensate, to make sure you don’t get malnourished or vitamin deficient. Carbs make our blood sugars rise. Protein too, but nowhere near as bad as carbs do, so they’re alright in moderation. Fats however… Fats are as good as a glucose-flatline. Better yet, they’ll mitigate the effects of any carbs we do ingest, slowing down their uptake and thus the sugar-spike. Contrary to what we’ve been told for decades; fats are our friends.

7. Worried about cholesterol? On a low carb diet, your cholesterol may rise a little as you start to lose weight. That’s a good thing though. (Believe it or not). What was already there, stored in your body, is starting to head for the exit, and for that it’ll go into your bloodstream first. So when you have lost weight and it stabilises, so will your cholesterol. And it’ll probably be lower than what it was before you started out.

8. You’ll lose weight on a low carb diet. Weight loss will help with your insulin-resistance, and not only that… Going low carb might help with other issues as well, like non-alcoholic fatty liver disease and depression.

9. Always ask for your test results. You don’t know where you’re going, if you don’t know where you’ve been.

10. Last, but certainly not least: If you are on medication that has hypoglycemia listed as a side-effect, like Gliclazide for instance, do NOT attempt a LCHF diet without a meter nor your doctors’ knowledge/assistance. You can drop blood glucose levels too far, too fast, if your dosage isn’t adjusted accordingly. This could mean a lower dose in stages or even stopping medication completely. Never do this without discussing it with your doctor first!


So what raises blood sugars? Aside from the obvious (sugar), starches raise blood glucose too. So bread, and anything made with grain/oats flour, rice, potatoes, pasta, corn, cereals (including all the “healthy choices”, like Weetabix and muesli), most beans and most fruits. So you’ll want to limit your intake, or scratch them altogether.

Which food items remain on the shopping list? Well, meat, fish, poultry, above ground veggies/leafy greens, eggs, cheese, heavy cream, full fat Greek yoghurt, full fat milk, extra dark chocolate (85% Lindt’s is great!), avocado, (whole) tomatoes, berries, olives, nuts, that sort of thing… Meal ideas? Have a couple:

Scrambled eggs with bacon, cheese, mushrooms, tomato, maybe some high meat content sausages?
Eggs with ham, bacon and cheese
Omelet with spinach and/or smoked salmon
Omelet with cream, cinnamon, with some berries and coconut shavings
Full fat Greek yoghurt with nuts and berries
Leafy green salad with a can of tuna (oil, not brine!), mayonnaise, capers, olives and avocado
Leafy green salad with (warmed goat's) cheese and bacon, maybe a nice vinaigrette?
Meat, fish or poultry with veggies. I usually go for cauliflower rice or broccoli rice, with cheese and bacon to bulk it up. Never the same meal twice in a row because of various herbs/spices.

Snacks? Pork scratchings, cheese, olives, extra dark chocolate, nuts.

Of course, there’s loads more on the web, for people more adventurous than I. (Which is pretty much everyone). Just google whatever you want to make and add “keto” to it, and you’ll get a low carb version. There’s a lot of recipes on the diabetes.co.uk website, as well as on www.dietdoctor.com where you’ll also find visual (carb content) guides and videos. And I can wholeheartedly endorse Dr. Jason Fung’s book The Diabetes Code. It’ll help you understand what’s going on in your body and how to tackle it, whilst not being a dry read. Not only that, but you’ll know what to ask your doctor, and you’ll understand the answers, which is, I believe, quite convenient.

Scriobh said:

Ever since I went on Glick, over a year ago, with my Metformin I've been seeing remarkable readings. 4s and 3s are common throughout the day now.

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This makes me think you need to book a 20 minutes appointment with your GP and clearly present these readings to the GP. Don't reduce carbs or become more active until you have seen the GP.

(And if your GP does not see a risk, maybe you need a new GP, or maybe it is a problem with your meter etc)

Scriobh said:

Thanks @Brunneria for that. Ever since I went on Glick, over a year ago, with my Metformin I've been seeing remarkable readings. 4s and 3s are common throughout the day now. My diet is excellent but the low readings can make me think I'm bullet proof and I do drop my guard now and again, but nothing too radical, a scone or desert after eating out.

To try and counteract a recent outbreak of Rosacea (I think) I've been looking at changing when I take my metformin. I've gone from 8am, 12.30pm and 4.30 pm to every 7/8 hours now. I've taken 2 1000 this morning together and I'm at 4.5 now. I'll keep an eye on my readings throughout the day. Maybe over the weekend I'll try the 3 1000 together and see how things work out.

The outbreak of spots are what's troubling me but they may well have nothing to do with the Met. Thankfully they're on the way out.

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Four's and three's shouldn't make you feel bulletproof, they should make you feel worried. 3's are hypo's. Forget everything I said about going low carb, because you're hitting too many lows already. Fours are fine, but you shouldn't be hitting 3's. That's dangerous territory. I'm with @ringi on this one: See your doc!

Scriobh said:

Thanks @ringi and @JoKalsbeek. I used to have a 3 monthly check up with my GP to see how my HbA1c was doing. With the increased Glick dosage to 120g in September last my she said my readings were significantly better so put me on a 6 monthly check up (which is coming up soon). Looks like I need to change Doc as there were times on my journey I felt like she was making it up as she went along.

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If all a doc looks at are your HbA1c's, all they're seeing are averages. You can have an okay HbA1c, and be nice and even... Or you can have an okay HbA1c with a lot of spikes and dips. It's just one number, and a doc can't tell whether it's nice'n'even or spiking up and down. You and your meter can tell though. If you make a curve during a regular day (testing every hour on the hour, or every 2 hours, depending on how much you love your fingers), it'll show what your bloods are doing over the course of a day. Take those results in, and go over them. If there's 3's in there and no action is taken (like reviewing your medication etc), you might want to ask for a referral to an endo. Your GP may be in over her head a little, and diabetes isn't a one-size-fits-all kind of deal.

I tale 500mg 3 times daily of Metformin and I remember in the past I on my own initiative increased my dosage to850mg x 1 500mg x 2 ie from 1500 mg to 1850 mg per day and was Severely told of by my Thai Doctor who Stressed that I should not exceed 1500 a day under any circumstances. as it was dangerous. So if I was you I would get a second opinion

I would also be interested to hear of others who take a higher dose and if it is the only drug they take I take Metformin/Januvia/Lantus

JoKalsbeek said:

Fours are fine,

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Sorry I don't consider 4 being "normal" to be safe on Gliclazide as it will not take much to get a 2, and nearly everyone who reads this forum gets lower BG by doing so. A 4 that is an exception may be OK provided the reasons for it is understood.

But if Metformin was the only drug, then 4s would always be great. So a good aim would be over time to reduce the Gliclazide (under GP control), then get back down to 4 once the Gliclazide have been stopped.

Personally I am happy taking Metformin for life, but other people wish to stop it once BG is well controlled by diat and lifestyle.

Scriobh said:

Looks like I need to change Doc as there were times on my journey I felt like she was making it up as she went along.

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I expect if you show her your reading in the 3s and 4s, along with telling her you have found this website and am going to improve your diet, she will make the correct changes to the dose. Often GP just need "helping" to think in the correctly way by having your personal data presented clearly and the correct questions asked. Remember a GP gets about 7 minutes and we have a lot longer to process information and ask the correct questions. So give your GP a chance.

JoKalsbeek said:

If all a doc looks at are your HbA1c's, all they're seeing are averages

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I was thinking about this today, the real problem is that a HbA1c say what happened in the past, not what will happen in the next week. Hence it is not a good tool when BG is decreasing and a person is on Gliclazide or Inslin.

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I was in on 30 mg of Gliclazide a day with a BG of over 15, I discovered "low carb" (before I found the site) and had a hypo in a little over a week. But I had read all the information in the Gliclazide pack etc, and hence was always keeping carbs with me, so my hypo was mostly a none event.

Scriobh said:

I've been taking 3000g of Metformin SR 3 times a day

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I read somewhere here that the max dose of Metformin is 2000 mg daily, and Metformin SR is 2500 mg.

3000 mg is more than the recommended dose...

@Scriobh

If I were you I would be discussing with the doctor that you are over medicated. It happens. Doctors and nurses always seem to think it is the medication that is giving you good results, rather than the diet.

Tipetoo said:

I read somewhere here that the max dose of Metformin is 2000 mg daily, and Metformin SR is 2500 mg.

3000 mg is more than the recommended dose...

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There is no "hard" max dose of metformin, but kidney test results etc have to be great for the larger dose. However doubleing the dose does not double the benefits.

@Scriobh
Hello and welcome to the Forum Here is the Basic Information we give to new members and I hope you will find it interesting and helpful.

BASIC INFORMATION FOR NEW MEMBERS

Diabetes is the general term to describe people who have blood that is sweeter than normal. A number of different types of diabetes exist.

A diagnosis of diabetes tends to be a big shock for most of us. It’s far from the end of the world though and on this forum you'll find well over 235,000 people who are demonstrating this.

On the forum we have found that with the number of new people being diagnosed with diabetes each day, sometimes the NHS is not being able to give all the advice it would perhaps like to deliver - particularly with regards to people with type 2 diabetes.

The role of carbohydrate

Carbohydrates are a factor in diabetes because they ultimately break down into sugar (glucose) within our blood. We then need enough insulin to either convert the blood sugar into energy for our body, or to store the blood sugar as body fat.

If the amount of carbohydrate we take in is more than our body’s own (or injected) insulin can cope with, then our blood sugar will rise.

The bad news

Research indicates that raised blood sugar levels over a period of years can lead to organ damage, commonly referred to as diabetic complications.

The good news

People on the forum here have shown that there is plenty of opportunity to keep blood sugar levels from going too high. It’s a daily task but it’s within our reach and it’s well worth the effort.

Controlling your carbs

The info below is primarily aimed at people with type 2 diabetes, however, it may also be of benefit for other types of diabetes as well.

There are two approaches to controlling your carbs:

• Reduce your carbohydrate intake
• Choose ‘better’ carbohydrates

Reduce your carbohydrates

A large number of people on this forum have chosen to reduce the amount of carbohydrates they eat as they have found this to be an effective way of improving (lowering) their blood sugar levels.

The carbohydrates which tend to have the most pronounced effect on blood sugar levels tend to be starchy carbohydrates such as rice, pasta, bread, potatoes and similar root vegetables, flour based products (pastry, cakes, biscuits, battered food etc) and certain fruits.

Choosing better carbohydrates

The low glycaemic index diet is often favoured by healthcare professionals but some people with diabetes find that low GI does not help their blood sugar enough and may wish to cut out these foods altogether.

Read more on carbohydrates and diabetes.

Over 145,000 people have taken part in the Low Carb Program - a 10 week structured education course that is helping people lose weight and reduce medication dependency by explaining the science behind carbs, insulin and GI.

Eating what works for you

Different people respond differently to different types of food. What works for one person may not work so well for another. The best way to see which foods are working for you is to test your blood sugar with a glucose meter.

To be able to see what effect a particular type of food or meal has on your blood sugar is to do a test before the meal and then test after the meal. A test 2 hours after the meal gives a good idea of how your body has reacted to the meal.

The blood sugar ranges recommended by NICE are as follows:

Blood glucose ranges for type 2 diabetes

• Before meals: 4 to 7 mmol/l
• 2 hours after meals: under 8.5 mmol/l

Blood glucose ranges for type 1 diabetes (adults)

• Before meals: 4 to 7 mmol/l
• 2 hours after meals: under 9 mmol/l

Blood glucose ranges for type 1 diabetes (children)

• Before meals: 4 to 8 mmol/l
• 2 hours after meals: under 10 mmol/l

However, those that are able to, may wish to keep blood sugar levels below the NICE after meal targets.

Access to blood glucose test strips

The NICE guidelines suggest that people newly diagnosed with type 2 diabetes should be offered:

• structured education to every person and/or their carer at and around the time of diagnosis, with annual reinforcement and review
• self-monitoring of plasma glucose to a person newly diagnosed with type 2 diabetes only as an integral part of his or her self-management education

Therefore both structured education and self-monitoring of blood glucose should be offered to people with type 2 diabetes. Read more on getting access to blood glucose testing supplies.

You may also be interested to read questions to ask at a diabetic clinic.

Note: This post has been edited from Sue/Ken's post to include up to date information.
Take part in Diabetes.co.uk digital education programs and improve your understanding. Most of these are free.

• Low Carb Program - it's made front-page news of the New Scientist and The Times. Developed with 20,000 people with type 2 diabetes; 96% of people who take part recommend it... find out why
  
  
• Hypo Program - improve your understanding of hypos. There's a version for people with diabetes, parents/guardians of children with type 1, children with type 1 diabetes, teachers and HCPs.
  

oh, thats gave me pause for thought.
two tablets 500..twice daily..2000 a day..mmhhh.

for my tuppence worth, i also wouldn't try to shotgun ALL my doses into one hit.

ringi said:

Sorry I don't consider 4 being "normal" to be safe on Gliclazide as it will not take much to get a 2, and nearly everyone who reads this forum gets lower BG by doing so. A 4 that is an exception may be OK provided the reasons for it is understood.

But if Metformin was the only drug, then 4s would always be great. So a good aim would be over time to reduce the Gliclazide (under GP control), then get back down to 4 once the Gliclazide have been stopped.

Personally I am happy taking Metformin for life, but other people wish to stop it once BG is well controlled by diat and lifestyle.



I expect if you show her your reading in the 3s and 4s, along with telling her you have found this website and am going to improve your diet, she will make the correct changes to the dose. Often GP just need "helping" to think in the correctly way by having your personal data presented clearly and the correct questions asked. Remember a GP gets about 7 minutes and we have a lot longer to process information and ask the correct questions. So give your GP a chance.

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Thanks @ringi ,

I wasn't on glic for long, but hypo'd regularly on it while I was. I was terrified of 4's, as they would indeed dip, but I thought that was just me... My endo wasn't much help, she said a T2 couldn't hypo! (On glic, they bl***y well can!) Guess it wasn't just me then! I see 4's quite often now, and I really had to get used to that being "okay", with no meds and on keto.