Do I need to change meds?

Brunneria · Jun 27, 2020

xfieldok said:
Metformin won't bring your numbers down diet will. Are you eating low carb?

I find this myth that Metformin ‘doesn’t bring your numbers down’ very misleading.

Metformin is one of the best studied medications (2,800+ trials!) that is used on people with diabetes, and there is plenty of evidence that yes, metformin DOES result in lowered blood glucose (lowered HbA1c) depending on dose, tolerance and individual circumstances.one example in obese and non obese patients:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2991324/
In this study Metformin was shown to lower to lower the participants’ HbA1cs by an average of 1.1% (approx 12 mmol/mol).
and here is how it performs in comparison with other meds:
https://care.diabetesjournals.org/content/diacare/35/2/446.full.pdf
That is significant.
It is very significant for someone with an HbA1c of 53mmol/mol which then lowers to 41mmol/mol.
Less significant for someone whose HbA1c is at 90mmol/mol which then lowers to 78mmol/mol, but it is still a reduction.

as @JoKalsbeek has pointed out, it has other benefits too.

changes in diet and lifestyle may have a bigger impact, of course. So will injected insulin, or a combo of other or additional medications. However, claiming that Metformin doesn’t have an impact is misleading.

@Josie66
You may well need other interventions on top of the Metformin, and as others have said, you may not be T2, so proper investigations are called for.
But please don’t throw the Metformin baby out with the bathwater. It doesn’t suit everybody, and not everyone can tolerate it, but it may well be helping your blood glucose not to rise even higher.

Oldvatr · Jun 27, 2020

Brunneria said:
I find this myth that Metformin ‘doesn’t bring your numbers down’ very misleading.

Metformin is one of the best studied medications (2,800+ trials!) that is used on people with diabetes, and there is plenty of evidence that yes, metformin DOES result in lowered blood glucose (lowered HbA1c) depending on dose, tolerance and individual circumstances.one example in obese and non obese patients:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2991324/
In this study Metformin was shown to lower to lower the participants’ HbA1cs by an average of 1.1% (approx 12 mmol/mol).
and here is how it performs in comparison with other meds:
https://care.diabetesjournals.org/content/diacare/35/2/446.full.pdf
That is significant.
It is very significant for someone with an HbA1c of 53mmol/mol which then lowers to 41mmol/mol.
Less significant for someone whose HbA1c is at 90mmol/mol which then lowers to 78mmol/mol, but it is still a reduction.

as @JoKalsbeek has pointed out, it has other benefits too.

changes in diet and lifestyle may have a bigger impact, of course. So will injected insulin, or a combo of other or additional medications. However, claiming that Metformin doesn’t have an impact is misleading.

@Josie66
You may well need other interventions on top of the Metformin, and as others have said, you may not be T2, so proper investigations are called for.
But please don’t throw the Metformin baby out with the bathwater. It doesn’t suit everybody, and not everyone can tolerate it, but it may well be helping your blood glucose not to rise even higher.

https://pubmed.ncbi.nlm.nih.gov/9428832/
84 mg/dl equates to about 4.66 mmol/l at max dose

Brunneria · Jun 27, 2020

Oldvatr said:
https://pubmed.ncbi.nlm.nih.gov/9428832/
84 mg/dl equates to about 4.66 mmol/l at max dose

And 1.1% roughly equates to 12mmol/mol on an HbA1c

we can probably bounce individual studies backwards and forwards all day, but the second link I gave in my post above looks at 42 studies on Metformin (incl diff therapies, diff d types), and comes up with an average reduction fig of 1.1% (approx 12 mmol/mol) For Metformin as a monotherapy.

do I care whether the exact fig is 0.9% or 1.3% ? Nope.

but what I would really like is for for people to stop perpetrating the myth that Metformin won’t affect blood glucose, because it does.

edited for clarity.

Andydragon · Jun 27, 2020

Brunneria said:
And 1.1% roughly equates to 12mmol/mol on an HbA1c

View attachment 42369

we can probably bounce individual studies backwards and forwards all day, but the second link I gave in my post above looks at 42 studies on Metformin (incl diff therapies, diff d types), and comes up with an average reduction fig of 1.1% (approx 12 mmol/mol) For Metformin as a monotherapy.

do I care whether the exact fig is 0.9% or 1.3% ? Nope.

but what I would really like is for for people to stop perpetrating the myth that Metformin won’t affect blood glucose, because it does.

edited for clarity.

Thank you for this. I know this thread has derailed and I hope the original poster gets the support from the doctor that they need but whilst not every medication works for everyone, stating that it doesn’t work at all is wrong

Brunneria · Jun 27, 2020

Yes, I am sorry I derailed @Josie66
My part in the derailment is over

Oldvatr · Jun 27, 2020

Brunneria said:
And 1.1% roughly equates to 12mmol/mol on an HbA1c

View attachment 42369

we can probably bounce individual studies backwards and forwards all day, but the second link I gave in my post above looks at 42 studies on Metformin (incl diff therapies, diff d types), and comes up with an average reduction fig of 1.1% (approx 12 mmol/mol) For Metformin as a monotherapy.

do I care whether the exact fig is 0.9% or 1.3% ? Nope.

but what I would really like is for for people to stop claiming that Metformin won’t affect blood glucose, because it does.

We are talking different units for a start. The 1% change in the figures you display converts to mmol/mol whereas I was converting from mg/dl (US) to mmol/l which is the units that a home test meter will display in the UK. The report I linked was discussing changes to fasting glucose levels, not HbA1c. In simplistic terms if the daily average meter reading is 10 mmol/l then a 1% reduction is 0.1 mmol/l. Looking at HbA1c chart then a 1% reduction ia approx 1.6 mmol/l blood glucose so it is not a large effect as was stated by others. You are correct to point out that we should not say it has no effect since it clearly does, but for newly diagnosed forum members, it is important that they are aware that Metformin alone is not going to make much of a difference to their DX values, and that other measures are normally required.

What is also missing from this info is that Metformin only reduces glucose where there are still active islet cells but is prescribed for its other benefits.

JohnEGreen · Jun 27, 2020

As far as I am aware Metformin is not classed as a blood sugar reducing medication I for one have never said it does not work at all but on many occasions have said it's affect is minimal and what upsets me is when people like a friend of mine who thought that relying on metformin to reduce her levels meant she could carry on eating carbs ended up in hospital.

Josie66 · Jun 27, 2020

Daibell said:
Hi. I would ignore both SW and WW as they don't really understand diet. You need low carbs and as much fat and protein as you need to keep you feeling full. When was you last HBA1C? At your levels you should have one every 3 months. Insist the surgery do that. Metformin will do very little and there are further meds that can be added but the right diet is essential

Last test was 3 months ago just before lockdown

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