Can Metformin make my BG go up??

[markd]

I was diagnosed as veryhigh normal/just-pre-diabetic early last year and my doc, because of my family history, decided that intensive early treatment with Met/diet/exercise was in order.

I was very obese (not far off morbidly obese) and did very little exercise, but since then I've lost well over one third of my weight and got my BMI down to 23.5, slowly reducing my Mewtformin to 2 x 250mg per day.

All my numbers got a lot better in step with my weightloss (last A1c was 4.9) and the doc said I could stop the Met if I wanted; I decided to stay on it as both my parents died of diabetes-related conditions.

The last couple of months, I've not done much exercise (other than being maniacally busy at work) but still kept to a sensible low-carb diet and my numbers remained pretty good.

But:

I tend to get lows once or twice per week - down in the low/middle 3s, 2 - 3 hours after a meal, followed by a spike as high as 6.5 a little while after - this sounds a little like reactive hypoglycemia (if I've got that right?)

Anyway, I ran out of Met and delayed getting a refill just to see what happened (remember my Dr had already OK'd me stopping Met if I wanted).

My fasting average has gone up by 0.1 but my pre- and post- prandial readings are now more stable:

Average (for the last 14 days) fasting (and pre-prandial), then 1, 2, 3 and 4 hour post-prandial readings being:

4.7, 5.8, 5.2, 4.9, 4.7 (this is almost exactly on the central thick blue line of the normal 'daily life' graph I linked to from the Blood Sugar 101 site)

Before, something funny (high) often happened around the 3 - 4 hour mark, for over an hour.

So now I'm rather puzzled as to what to do next - I know that even moderate, but frequent, high BGs can eventually cause long term damage but bearing in mind my family history, I'd intended to stay on Met forever.

OK, you may think I'm beng a bit paranoid about what is, in the grand scheme of things, a rather small spike, but I'm really sold on the concept of forcing my BGs to as normal a proflie as possible.

I'm not due to see my doc until almost year-end, so I'll go back on Met from this week and still keep en eye on my BGs. If the same pattern is repeated, I may ask about going on low dose Acarbose/Glucobay instead of Met.

It only offers a small reduction in BG, but then so does Met at my current dose - since it work in a completely different fashion (slowing down digestion/absorbtion of sugars in the gut) from Met, I wonder if it might keep me a little lower without those postprandial spikes?

AsI said, I'm pretty much sold on the idea of maintaining near-normal levels to take as much of the strain off the poor old beta cells in my pancreas, anyone else been in this position?

Mark

 

[wallycorker]

Hi Mark,

I'm not certain as to what is concerning you. All those numbers sound just fine and all fall into the normal range. In fact, they sound almost exactly like mine and I'm as happy as Larry!

I think that you are possibly a little bit over anxious about the whole thing.

Why not tell us all how you have achieved such good results?

Best wishes - John

 

[markd]

Achieved by losing well over a third of my starting body weight - got my BMI down from almost 37 to just over 23 and a lot of exercise, plus a moderately low-carb diet. Had peaked at 3 x 500mg Met per day, now down to 2 x 250mg per day.

Still drink a few pints of beer per week and similar number of glasses of wine.

Have tried Cinnamon and Chromium also - no more than weak evidence that they do much good in the longer term, though seemed to be effective for the first few weeks.

I've read on Blood sugar 101 that Met becomes increasingly less effective with a low BMI, also with a low-carb regime.

Acarbose seems to keep up its effect at low BMI, hence my interest in it.

Since neither of these are supposed to cause hypos, there seems little danger in pushing for the lowest BGs I can reasonably maintain - the research indicating that halting the progression at the earliest opportunity helps prevent beta cell burnout looks interesting. Bear in mind that I had never gone beyond pre-diabetes and my doc suggested that it was well worth being aggressive at such a reasonably early stage.

With my very bad family history (both parents and, so far, one elder sibling) I'm still keen on maintaining near-normal BG levels.

Mark

 

[wallycorker]

Thanks for that Mark - very interesting!

You've done remarkably well and I'm certain that you'll do everything you can to keep your blood glucose levels normal.

I'm impressed with your exercise regime - it makes me feel ashamed because I do very little.

Best wishes - John

 

[Dennis]

I've read on Blood sugar 101 that Met becomes increasingly less effective with a low BMI, also with a low-carb regime.

Hi Mark,

Metformin acts in 2 ways:
1) it reduces insulin resistance
2) it reduces overproduction of glucose by the liver.

As one of the primary causes of insulin resistance is overweight, it follows that as you reduce weight then you are also taking away one of the things metformin is supposed to handle, so it is valid to say that it's effectiveness is reduced. But if, like me, you find your BS levels are higher first thing in the morning, then it is likely that you have an overproductive liver and the metformin will be helping to keep that in check.

 

[markd]

But if, like me, you find your BS levels are higher first thing in the morning, then it is likely that you have an overproductive liver and the metformin will be helping to keep that in check.

Good points, especially about the apparent change in effectiveness. My fasting is pretty good now, always between 4.4 and 4.9 (for the last 90 days, for example), down from around 6.0 early last year.

I've lost so much abdominal fat that what I suspect was a rather fatty liver is probably less so now; I wonder if that might contribute to it being a bit less overproductive?

The only negative points about the weight loss is that it cost a fortune to buy new clothes and I do feel these cool Autumnal mornings a bit more keenly...

Mark

 

[wallycorker]

..........My fasting is pretty good now, always between 4.4 and 4.9 (for the last 90 days, for example), down from around 6.0 early last year.......

That's superb Mark! I'm generally in that range 'on rising' fasting level but I still do get readings higher than that in the 5s and occasionally in the 6s. Well done!

I'll stick at it and try to get even better control and match your results.

How did you achieve them - are you following a strict low-carb diet?

Best wishes - John

 

[markd]

Had a chat with my GP (had to see him on a non-diabetes-related matter) and switched to Glucobay.

The result? Spikes gone. Lows/semi-hypos gone.

So long as my weight doesn't go back up (I've lost well over 50Kg) and I keep up with the exercise, I hope that my IR will stay well controlled, so the Glucobay merely has to lop the top off the post-prandial spikes to reduce the stress on my remaining beta cells.

Jenny, on bloodsugar 101 has good things to say about Glucobay.

When I look at the graph from the OneTouch software over the last few weeks, I get a much flatter graph on Glucobay (50mg per meal), no spikes and no lows below 4.3, no peaks above 5.4 at 1, 2, 3 or 4hr.

Fasting this morning was 4.6, one hour after lunch 5.2 and two hours 4.3

I've been testing a bit more intensively to get a good idea of the changes; after the weekend, all being well, I'll reduce testing frequency again to a couple per week.

The graph looks quite interesting, can images be posted here?

I've followed a moderately low-carb / low GI diet with plenty of exercise for the last 18 months. Started off taking a higher dose of Met, gradually reduced to 2 x 250mg per day, before stopping entirely.

Glucobay apparently has similar side-effects to met, but I've not seen any at all.

Mark.

 

[markd]

So, I've been on lowdose 50mg Glucobay for a month, replacing the 2x250mg Met.

I'm on holiday in the US at the moment (and no, unfortunately, cannot find any A1C-Now test kits in shops, only online) so picked up a Relion mail-in A1c test kit last week - email results just arrived:

4.7 - whooppee!

Glucobay/Acarbose certainly seems to do the trick for me! Much flatter graph with no lows or spikes (apart from the occasional pre-sex spike mentioned in another post) and A1c down 5.2 - 5.1 - 5.0 - 4.9 - 4.7 over the last year.

Although there have been trials - showing some success - in using Glucobay for pre-diabetes, hardly anyone actually seems to prescribe it, I wonder why.

Do GPs earn more brownie points for prescribing Met for newly-diagnosed diabetics, instead of treating pre-diabetics and not earning said brownie points?

(That's come out a bit harsher than intended, but maybe funding from 'the system' does encourage funny things.)

All it does is delay/flatten glucose metabolisation, effectively converting whatever you eat into a lower glycemic impact version - and magically, does this without really getting into the bloodstream much.

Mark

 

[wallycorker]

Mark - I really must say you are a star!!! Well done!

Best wishes - John

 

[cugila]

Hi Mark.
Glucobay® (Bayer)
Tablets , acarbose 50 mg, net price 90-tab pack = £6.27; 100 mg (scored), 90-tab pack = £11.57.

Metformin (Non-proprietary)
Tablets , coated, metformin hydrochloride 500 mg, net price 28-tab pack = 93p, 84-tab pack = £1.37; 850 mg, 56-tab pack = £1.34.

I think it is self evident why Metformin is the first drug of choice........cost !

 

[markd]

To: wallycorker - thanks!

Once I'd got rid of all the excess weight, the rest has fallen into place reasonably painlessly...

I think it is self evident why Metformin is the first drug of choice........cost !

You old cynic you - but yes, you are probably correct!

As Jenny mentions on her site, the effect of these drugs in preventing progression from IFG/IGT/pre-diabetes has been the topic of some research - but only compared to a control of very modest (5%-10%) weightloss and not *in conjunction with* it.

I've heard it said that most GPs don't bother trying to counsel their obese newly-diagnosed patients to lose a lot of weight as they don't believe it is possible to achieve/maintain.

That potentially being the case, how many obese pre-Ds have lost all the excess weight in conjunction with either Met or Acarbose? - if more intensive early management was attempted, would we see better results?

OK, hands up - I freely admit to preaching with the zeal of the newly-converted, but even so...

Incidentally, as a question perhaps for the mods, is it worth there being a separate forum heading for pre-diabetes?

I realise there is a lot in common with T2, but a lot not too - no insulin, pumps or hypos.

Just a thought.

Mark