Coming off Metformin advice?

[JohnEds]

Diagnosed 18 months ago; HBA1c was 107. I was put onto Metformin - 2x 500mg tabs twice a day. I was 15 and a half stone at the time but I'm 6' 2" and fit. To look at I don't have an ounce of fat on me.

I thought I had a reasonably good diet but it was a lot of pasta, rice and potatoes and probably quite a lot of bread and quite a bit of milk in coffee. The good bits were meat and veg - which I really enjoy - and fish. I've never added sugar to anything but I do enjoy fruit.

I eliminated the milk completely, now having Almond milk on muesli and porridge and coffee is now black, which I've come to prefer. I cut out bread more or less completely, apart from the occasional slice of sourdough. I've also cut out pasta, rice and potato. Meals now are mostly meat, fish and veg although I do still have a Friday night curry. I still have a bit of fruit but I select from the better end of the carb table.

I've lost a stone and HBA1c went from 107 to 44 to 37 and last week to 34, which I'm happy with. When I test I am usually around 5.5.

I want to try and get rid of the meds but there are so many questions. What happens if I come off? I would assume my figures will worsen, but is there any way of knowing by how much? What normally determines when somebody comes off the meds. Is it results based or is there an optimum time between starting and coming off? Is it actually recommended to come off at all? Do the meds make your system lazy of do they wake the system up?

I know, sorry about that but I've gone from being normally very positive and decisive to a being slightly overwhelmed trying to work it all out.

 

[Antje77]

I eliminated the milk completely, now having Almond milk on muesli and porridge and coffee is now black, which I've come to prefer. I cut out bread more or less completely, apart from the occasional slice of sourdough. I've also cut out pasta, rice and potato. Meals now are mostly meat, fish and veg although I do still have a Friday night curry. I still have a bit of fruit but I select from the better end of the carb table.

Not an answer to your question, but I'm a bit puzzled by this.
Muesli and porridge have much more carbs than the few carbs which come from the milk that goes with it.
However, your hba1c is truly non diabetic, so it looks like you can deal with those foods without problem!

I want to try and get rid of the meds but there are so many questions. What happens if I come off? I would assume my figures will worsen, but is there any way of knowing by how much?

Do you use a meter? It will show you what happens on a meal to meal basis rather than waiting for an hba1c, very informative!

With your hba1c down to 34, I wouldn't expect diabetic numbers if you keep up your new way of eating. Your doctor would likely agree to you reducing the metformin and see what happens at those numbers.

 

[EllieM]

Do the meds make your system lazy of do they wake the system up?

My understanding is that metformin is a relatively mild drug, and mainly acts by reducing insulin resistance and making your liver a bit less likely to pump out sugar. I agree with @Antje77 that you can use your meter to detect whether skipping it makes a difference, though talking to your doctor first is always good.

And congratulations on an awesome set of diabetic results, very impressive.

 

[Riva_Roxaban]

What normally determines when somebody comes off the meds. Is it results based or is there an optimum time between starting and coming off?

Is it actually recommended to come off at all?

I took 2 x 500 gm Metformin daily, after I had several hba1c blood test in the middle 30 mmol/mol, I asked my GP about coming off them. He told me to cut back to one Metformin a day and see how we go for six.

After another six months of good blood tests I stopped taking Metformin completely after a chat with my GP. I could now call myself in remission, but I prefer recovering which I have been doing for the last couple of years.

In answer to your second question you will have to ask your GP that one.

Owing to other ill health and various new medications non diabetic related, my haba1c has now got a bit of a uphill trend. My new GP has tod me not to worry about as long as I am eating to my moderate lchf eating plan.

 

[Deleted member 543160]

I was diagnosed with T2 over 8 yeas ago with a couple of HbA1cs of just over 60. When my GP decided that I no longer needed Metformin after 3 years, he didn't renew my prescription and I simply stopped taking it, and as I've mentioned in previous posts, this had no adverse effect on my glucose levels. He's always been pleased with my HbA1c results and I think he'd decided that he could trust me to maintain them... I've been eating low carb since diagnosis and my glucose levels came down to pre-diabetic figures during the first 2-3 months and have remained at normal/low pre-diabetic since then.

I believe it's been my diet (mainly under 50g carbs a day) that has kept my glucose levels where they are. I lost a fair bit of weight but still weigh more than I should, and am now mostly inactive and gettin to be rather ancient, so I'd imagine that you, with your great non-diabetic results and a decent low carb diet, should be able to keep your levels down without the help of medication.

 

[JohnEds]

Muesli and porridge have much more carbs than the few carbs which come from the milk that goes with it.
However, your hba1c is truly non diabetic, so it looks like you can deal with those foods without problem!

Thanks for that. I realised I can't eliminate carbs completely so I've always worked on the basis of reduce where I can. The muesli is a low carb version - more nuts than cereal - and the milk is 33% of the porridge carbs. I found it easy to switch to Almond so thought why not? And now I've really come to prefer it so it's an easy win.

Re; your comment about the HBA1c being 'truly non diabetic'. I have presumed this is because of the meds. What generally happens when somebody comes off? Logic says blood sugar would bounce back and start to rise again. I thought I would find plenty of information on coming off, but I've found it quite difficult to find anything really solid.

I suppose what concerns me is the affect the meds are having on insulin resistance and if they are in some way allowing insulin production to recover or repair itself (is that even a thing?) and whether there a danger that coming off might somehow set back the good work so far? This could all be in my mind but I have to settle it.

 

[Riva_Roxaban]

What generally happens when somebody comes off? Logic says blood sugar would bounce back and start to rise again. I thought I would find plenty of information on coming off,

I kept to the LCHF way of eating, I did not stop and go back to the diabetic days with high bgl / hba1c. from eating the wrong food.

 

[Antje77]

Re; your comment about the HBA1c being 'truly non diabetic'. I have presumed this is because of the meds.

I wouldn't be so quick to assume that. Metformin alone, without a change in diet, has never brought anyones hba1c of 107 to 34.
I think your changed diet has done very much the greater part of your results!

 

[finzi1966]

John, your metformin dose is really low. I honestly doubt it’s going to make much difference at all! Your diet is going to be what’s done it, so congratulations! If you want to come off met, I’d probably drop one tablet first and after 3-6 months drop the other one. Just bear in mind that from that point on you will no longer be entitled to free prescriptions as you are now.

 

[Jaylee]

John, your metformin dose is really low. I honestly doubt it’s going to make much difference at all! Your diet is going to be what’s done it, so congratulations! If you want to come off met, I’d probably drop one tablet first and after 3-6 months drop the other one. Just bear in mind that from that point on you will no longer be entitled to free prescriptions as you are now.

Hi,

@JohnEds , apears from his profile at the "Goldilocks zone" age of 62.. https://www.nhs.uk/nhs-services/prescriptions-and-pharmacies/who-can-get-free-prescriptions/

 

[Antje77]

John, your metformin dose is really low. I honestly doubt it’s going to make much difference at all! Your diet is going to be what’s done it, so congratulations! If you want to come off met, I’d probably drop one tablet first and after 3-6 months drop the other one. Just bear in mind that from that point on you will no longer be entitled to free prescriptions as you are now.

2000 mg is the standard dose, not a very low dose.
Please keep in mind we cannot advise on dosing.
@JohnEds , should you think this would be a suitable approach for you, please talk about it with your HCP.

 

[JohnEds]

Thanks Robbity2, interesting.

 

[FSnow]

We are all different but here is a summary of my experience with stopping Metformin

Diagnosed 2002. 177 kilos hba1c 39
Metformin 500mg eat to the meter. Testing about 6 times a day which I still do.
2011 < 95 kilos > 41 hba1c
2018 > 86 kilos > 37 hba1c
2018 - 2019 low carb. No bread,no pasta,no porridge no potato etc. Almost Keto.16:8 - lunch dinner only
> 82.5 kilos > hba1c > 35
2020 No Metformin same diet. Almost Keto 16:8
> 82.5 kilos > hba1c 37
Conclusion:
Metformin even at a low dose does seem to help but only a little, diet is dominant. Alternatively it seems to me that the 16:8 diet means my stubborn elevated morning sugars 5.9 - 6.5 (and 7 occasionally) take a while to lower and may be increasing hba1c a bit. Prior to low carb my morning sugars were regularly in high 6 to low 7 but came down quickly if I ate.
Hope this helps

 

[bulkbiker]

2000 mg is the standard dose, not a very low dose.
Please keep in mind we cannot advise on dosing.
@JohnEds , should you think this would be a suitable approach for you, please talk about it with your HCP.

To be a little more precise in the UK 2000 mg is the maximum dose.
From here
https://cks.nice.org.uk/topics/diabetes-type-2/prescribing-information/metformin/



@JohnEds
I only took it for 3 weeks but just stopped.. as I had changed what I ate blood sugars continued to fall and 6 years later I'm still drug free and in remission.

 

[Antje77]

To be a little more precise in the UK 2000 mg is the maximum dose.
From here

That's what I thought, but I wasn't sure after seeing that in the Netherlands the max dose is 3000 mg. Very strange, such a large difference in recommendations.

 

[JohnEds]

Hope this helps

It does. Thanks. I took the decision to reduce and then out of the blue had a call from the local diabetes nurse. The first time in 18 months, despite contacting them numerous times. Anyway, she agreed, I should reduce one a day and then review when I am next tested.