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Advice on Metformin

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Deleted member 391597

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Hi everyone!

So basically I have gone from being diagnosed with gestational diabetes in 2016 with a normal BMI and expected pregnancy weight gain, to being diagnosed as Type 1 in 2017 after going in to DKA (wasn't being treated with anything), to now being told I probably have MODY and will be treated as Type 2 following a negative GAD antibodies test!

So I have taken insulin for the last 13 months, but following my last appointment with my endocrinologist last week, due to having negative Type 1 antibodies and a Hba1c of 34, he wanted me to try and come off insulin and to see how I got on with 500mg of Metformin twice a day.

So I took my first tablet this morning and have already experienced stomach cramps and an upset stomach! Is this normal and does it get better? Do you need to limit your carb intake in any way? I used to carb count when on insulin.

Any advice would be much appreciated!

Thanks.
 
Wow! What a journey. The affect that Metformin is having on your system is common. It may settle down in a few days, it may not and if that is the case ask your GP for the slow release version which is said to be kinder on the system. Has to be said, though, some people can't tolerate Metformin in any guise.

Sorry, I have no advice about MODY and carb counting but there are members here who have MODY and I am sure they will be along soon to give their views. Good Luck.
 
Hello Hollie, I am a Metformin enthusiast. I struggled to be prescribed it but have only been taking it for a few weeks. I began on 500mg once a day and have now progressed to 500mg x 3 times a day. I do experience some bowel looseness, but as I used to have problems with constipation which I found much worse, I don't mind that too much. I also feel a bit sick after taking the pills, which wears off after about 30-60 minutes. Next time I see my GP I am hoping to switch to the extended release pills and go up to 1000mg x twice daily. I make sure always to take Metformin with food, not necessarily a full meal. That is supposed to help with digestive issues, but on the other hand means that it may not help lower post-meal bg as much as it might, since I read that Metformin takes about 2 hours to kick in. So for that reason too I'd like to try the extended release version and just take that with breakfast and dinner.

You might do better to cut back to only one 500mg tablet daily for a week or two and then gradually increase. Some even recommend cutting the 500mg tablet in half so as to take only 250mg at first, but the tablets I have are domed and I don't think they would cut easily. (Btw we discussed this on another forum and it was decided that it is OK to cut the ordinary Metformin tablets in half, but not the extended release ones as that would mess up the dose.)

Metformin doesn't either increase or reduce your carb intake needs, but if you read the enclosed instructions, you will see that drinking alcohol is not recommended. I suspect that many Metformin users here do indulge at any rate in one small glass! However as a T2, if you want to lower your A1c and post meal readings you will probably need to lower your carb intake. Metformin will not do it all for you!

You might find this article concerning Metformin encouraging: http://www.mendosa.com/blog/?p=1261
 

Metformin does not have great effects on blood glucose levels whether they are post prandial or not. They also act on a cumulative basis so do not really have a 'kick in' affect.

Metformin works in the background and is not prescribed as a blood glucose lowering drug.
 
Thanks for your replies! @Guzzler what is the purpose of Metformin if it doesn't lower blood sugar control? I am a little anxious about taking it as I had such good control using insulin. Thanks!
 
Hollieo4 said:
Thanks for your replies! @Guzzler what is the purpose of Metformin if it doesn't lower blood sugar control? I am a little anxious about taking it as I had such good control using insulin. Thanks!
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If you are normal weight and if you do not have much insulin resistance, I can't see any point in taking Metformin. It is an appetite suppressant. It also helps to a limited extent in reducing the amount of glucose your liver makes, and therefore may help a little with morning fasting levels. It does not help the pancreas to produce more insulin and will therefore not help with post meal spikes. It is of more benefit to overweight people and those with severe insulin resistance.
 
@Hollieo4 have you actually had genetic testing to confirm MODY? MODY isn't diagnosed by a negative antibody test, 25% of type 1s are antibody negative and remain type 1.

MODY is genetic diabetes caused by a mutation on a specific gene. Genetic testing will tell you which particular gene mutation has caused your diabetes. This is important because depending on the gene mutation that determines which treatment is most appropriate for your diabetes.

MODY isn't treated with metformin, it's treated with Gliclazide and sulphonyureas.

You really should be seeking a referral to Exeter for proper genetic testing and an appropriate treatment plan from the MODY specialists.
 
To make things even more complicated, there are multiple possible gene mutations underpinning monogenic diabetes, some respond very well for long periods of time to Gliclizide and other sulfonylureas, others dont. Some require only mild pharmacalogical interventions, others need more aggressice treatment - as mentioned in the previous post, you really need to know what gene mutation, if any, you have in order to know how best to treat it
https://www.health.harvard.edu/diabetes/maturity-onset-diabetes-of-the-young-mody
 
@catapillar, I've been referred to a genetic specialist (with a long waiting list apparently!) I am just following what my consultant has advised to do. Stop insulin and try Metformin, although I must admit I do feel anxious about it. Spoke to my DSN yesterday who said to continue with Lantus for the time being.

Thanks for your reply @Bluetit1802. When I was first diagnosed I had a normal BMI but gained weight when I started insulin therapy. I have since lost 10lbs and have another 7lbs to go until I am back in my healthy target weight range. Unsure if Metformin will benefit me after all?!
 
Also, does anyone know if it is considered bad for a Type 2 diabetic to take insulin? If my hba1c is 34, would there be a reason I would need to come off it? I take 8 units of Lantus once a day and between 2 and 4 units of Novorapid for most meals. I don't take any if I don't eat carbs, as protein doesn't raise my levels. But I take more if I'm having a treat too!
 

Insulin isn't bad for T2s that need it to keep control and prevent diabetic complications, or worse. For these people it is essential. It is bad if you take too much and go hypo. It is also not good if you have severe insulin resistance because you need more and more insulin to cope with the carbs, and too much circulating insulin can (and does) cause weight gain, and makes insulin resistance worse - a vicious circle. Too much insulin is also being blamed for being a risk factor in heart problems. However, if you carb count and make sure you are having enough but not too much or too little, it isn't bad. Without insulin, you would need to carb count in as much as you would need to keep carbs right down to avoid spikes, just as we non-insulin users have to..

I think you need to discuss all this with a professional, preferably a consultant.
 
Its a nasty drug that has messed around with my stomach,eyes,feet and now my liver.
I have an Hba of 33 now and I have lost 6 stone.
I've now stopped the metformin and now going through the come down stage.Vile drug.
 

Sorry -- just a few tiny corrections: genetic testing does not always reveal precisely which gene is involved with MODY -- they are still identifying new ones (though it's definitely worth having the test done); gliclazide IS a sulphonylurea; there's no reason why MODY wouldn't be treated with metformin in combination with other drugs (some forms of MODY are especially sensitive to sulphonylureas but not all). Metformin is generally a safe drug -- though a few people are allergic to it and it does reduce B12 in the longer term. I stopped taking it because the side-effects of even the slow-release form made my life intolerable and exacerbated other conditions. I get by with gliclazide and carb count the usual way. Sulphonylureas may ultimately squeeze your pancreas dry, so if you can tolerate metformin and it is helping you keep your levels under control then it's worth sticking with it, I'd say. I would still see a diagnosis of MODY rather than T1 as an enormous plus
 
I'm on borrowed time taking only Metformin ..after 12+ years on it.

My HbA1c keeps creeping into the amber zone despite my best efforts.

A ✻flow chart✻ I've seen suggests I might be put on another medication some time in the future ..which from what I've read ..is not trivial.

I'd like to hold onto Metformin as my sole medication as it doesn't give me aggro ..but that looks more like an aspiration than anything else.
 
Until recently, I had been on Metformin since it came out. One is typically given an initial dose of 500mg to develop tolerance. That dosage is not actually therapeutic. The problem with Metformin, and most diabetes drugs for Type 2s is that it does not address the disease, but only the primary symptom (high glucose levels). Metformin prevents your liver from releasing glucose into the bloodstream (one of the primary components of the Dawn Phenomenon). So it does not actually lower your blood sugar, it just prevents it from being as high as it might be. The good thing is that it does not raise your insulin. Type 2 diabetes is caused by insulin resistance. You have to demand less insulin to become more sensitive to it. We all know people who shake a large amount of salt on their food before they even taste it. Why? Because they are so used to eating salt that it takes that much for the food to taste salty to them. A Type 2 needs more and more insulin to control his blood sugar, whether he produces it himself or takes it, because his system has steadily increased the need. The reason a low carb diet and intermittent fasting are effective for diabetes is that they give your body less need of insulin, giving it a chance to recover some sensitivity. In my case, even a very low card diet provided a marked improvement of the disease, but not until I really gave my liver, pancreas and muscles a break by adding intermittent fasting, was I able to achieve normal blood sugars.
 
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