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Discussion in 'Low Calorie Diets' started by AlcalaBob, Dec 12, 2017.
Metformin often increases weight loss.
Week 5 Day 32 Thursday 11th January. FBG 9.8 Weight 99.8kg
Another high FBG so I took 25 units of insulin this morning. After five days, I needed to take some action about it. There's an argument that says carrying on with no insulin and being patient will bring the numbers down but that rests on the idea of the pancreas recovering relatively quickly. Given that there's clearly some pancreatic response, that at least sounds plausible. But at the same time, the response so far is too weak even with the help of some vildagliptin. The other side of the argument is that as a long-standing diabetic, that recovery might be slow, weak, and in the end inadequate. Only sticking with the ND over a longer period will provide the data to decide.
In the meantime, it's clear that metformin and vildagliptin were not enough to bring the levels down so I still need some meds to control the BG. I was too quick to reduce the meds and certainly in eliminating all the insulin so I need to get the levels back under control, get the BG stabilised again and then assess what's happening. It's a minor set-back but only psychologically because I was too optimistic over too short a period of time. In a word, impatient. The liver is still recovering, there's some pancreatic function, and the weight has come down reasonably so, at the middle of week 5, it's showing some good progress. Now I just hang in there and once the BG level comes down, think about the meds again. So no change to the diet. Sticking to the plan. Still very positive.
SGLT2 inhibitors may be an along term option for you as they are the only class of drug that removes the excess sugar from the body. But they do have risks that you need to understand how to control. Maybe talk to your doctor about them at some point if you are still needing insulin in a few weeks time.
(Remember it can take over a week for the metformin to build up in your body and have its full effect.)
In fact metformin takes effect very quickly, typically within a few hours. It's actually eliminated from the body fairly quickly too, within six hours or so. It's not metabolised into anything, just straight excreted and it doesn't accumulate in the body at all. Any that you take last thing at night has completely gone by the morning. That's why I figured it wasn't enough to do what I need. I completely agree about the SGLT2. It would be a very good idea and I once mentioned it to my GP who simply repeated the mantra of eat lots of fruit... oh, and have some more insulin... I have a very difficult job getting my GP to address the evidence or break away from his routine script. Hopefully I'll have something convincing to give him in due course. Thanks for the suggestion about SGLT2 meds.
Metformin is a very odd drug, it is removed from the blood fairly quickly, but its effect on the liver/BG can take a long time to build up. For most people, the timing of the daily dose has no effect, yet the half-life in the blood says it should....
@AlcalaBob You aren't by any chance taking medication for other issues are you? I ask because certain meds can block Adrenalin and other hormones that trigger the liver to stop dumping once BG levels are in a normal range. This results in higher fasting levels.
No, nothing else at all. I think it was just a case of being too optimistic about the recovery of the pancreas. It's going to take a bit longer to see the sort of improvements that Taylor and Fung talk about. And that's fair enough. Both of them said this was possible, even likely.
Yes, I've seen reports from people who say metformin affects them differently but as with all anecdotal evidence, it depends on circumstances, lots of other factors. I think all drugs are very odd in some respect or other - pharmacokinetics is a complicated business. Half-life doesn't mean that the effect declines linearly. When people say there is an effect, or no effect, it's often hard to see what is meant by that. There could well be significant metabolic effects that are not visible which is why we have to rely on clinical data, etc. I was on metformin for years and the only peculiarity I noticed was that a tablet last thing at night reduced liver dumping in the morning - but that's explained by the pharmacokinetics. I can't yet see any evidence to suggest that it would take a long time for metformin to build up the effect on the liver. It doesn't react metabolically and is regularly eliminated intact. Maybe it's just anecdotal accounts - I certainly haven't seen any clinical explanations or evidence.
GPs often expect it to take weeks for Metformin to bring down very high BG, and hence often give another drug for 14 days, then wait for at least 8 weeks before deciding if anything else is needed. Metformin works on lots of different cells in ways that are not well understood. As no one makes a lot of money from selling Metformin, there has been very limited modern research on how it works.
Yes, I agree, the effect on the body overall, and the condition of diabetes will change over time given a constant presence of metformin. The balances will be different. The impact on the liver is pretty quick but the overall changes in the liver and the consequence for diabetes management develop over a period of time. We know metformin is one of those drugs that acts by loosely binding (physically not chemically) to various proteins and that distorts their shape so they are either prevented or enabled to take part in various reactions. So we know, for example, that it activates an enzyme AMPK which inhibits liver dumping. It used to be thought that metformin only did that. Now it's clear that AMPK metabolism is a whole lot more complex and metformin may be involved in lipid metabolism more directly (which wouldn't surprise Roy Taylor and Fung at all) and I think you're dead right. Since it's possible to produce generic metformin, drug companies have zero interest in the research.
Week 5 Day 33 Friday 12th January, FBG 9.3 Weight 99.7kg
The insulin is bringing the glucose down but not by enough yet so I've increased the dose to 35 units. It seems to be something of a juggling act at present. I can tolerate the BG raised a little if there's weight loss but insulin is going to make that more difficult. This level is the dose the last time I saw any weight loss. I have assiduously followed the diet with a stict limit of 800 and after the first week or so, I have seen almost no weight loss. Coming off the meds too early has destabilised my BG which now needs attention. I guess my metabolic level has simply dropped to compensate. Whereas sitting tight and waiting might well be a good strategy if there's a fairly strong recovery of the pancreas (especially for those with more recent diagnosis), there's much less of a case for me to do that. I think this shows that we can't simply apply the optimistic case to long-standing diabetics and eight weeks is probably just the start of a much longer-term recovery. If I'd been more objective I might have realised that at the outset. I'm cool with that though - I don't go in for miracles. I'm sticking to the plan as usual and I'll try to keep the blood numbers under 9. It looks like the changes in the biochemistry take longer for long-standing diabetics, which in itself is good to know. Still very positive.
I wonder if there are any other long-standing diabetics who hit this patch in their ND experience. I haven't seen any accounts of it but it's sure to have happened. Hopefully it didn't lead to people abandoning the diet. This is not evidence that it fails, merely that it's not quite as simple and rapid as we, or rather I, might have thought.
Week 5 Day 34 Saturday 13th January. FBG 9.1 Weight 98.8kg
Getting back under control now. The numbers are coming down again so it's all good. As they continue to fall, I'll very gradually reduce the meds again but this time I'll be a bit more cautious. For now, I'm taking 35 units of slow-release insulin and I'll wait for any further reduction until I see some numbers under 7. Curious little hiatus but relatively easily fixed and back on track now. All good.
Congratulations on your staying power! It's good to see things heading in the right direction.
I haven't read through all this thread yet, so this may be redundant. I'm pretty sure I'll get roasted alive for saying it anyway!
My own view of scientific experiments in general is that the empirical results are usually far more informative than the theories that lead up to the experiments, or are formed after the experiments.
As far as I've looked into this Newcastle stuff, in all 3 main studies / experiments, participants are taken off meds. I don't think people using insulin even get onto the studies in the first place.
My feeling always about things like this is that "we don't know what we don't know". Just because we think that people will get the same results while taking medication, doesn't guarantee that they will. The possibility for unknowns is huge, especially in biology.
I'm certainly not going to suggest you stop medication. I personally would, and feel reasonably safe doing so if I had a glucose meter, but it is of course a risk, hence there's no way I'd recommend anyone else would.
It does seem this process becomes much harder after around ten years of Type 2 based on the second study. Not impossible by any means. If anyone is going to do it, it will be someone with your staying power and level-headed reaction to things moving slowly!
I should probably add that, while I don't have enough personal data to back up the idea of stopping medication, these were my own findings:
* On 4xMetformin and eating according to standard diabetic guidelines, I couldn't get my morning fbg below 9.5 (very similar to yours at the moment). This included modest calorie reduction and a lot of exercise.
* I never tried 800 cals a day restriction while on Metformin, so there's a critical gap in my data there.
* I did try 800 cals a day restriction a few days after stopping Metformin, and my morning fbgs plummeted over a few days.
Thanks @AdamJames for your thoughtful comments. I think I've commented before that the reason given by the researchers for taking people off all meds at the start of the trial is that if they hadn't, there would have been no way of knowing they could trust their trial results since any or all of them might have been affected by the medication. It was simply part of the 'control' aspect of the trial. Fung, in his treatment regime, quite often keeps people on their meds and gradually reduces it but then, often he's managing their recovery over a longer time period.
In my case, I quickly reduced the meds, particular because my weight loss had stalled and the most likely reason was the continued presence of insulin. Cutting my insulin down to 35 units seemed to have restarted the weight loss. The effects of the energy deficit outweighed the effect of the remaining insulin. But then I think I was over-optimistic and chopped the insulin again and as the BG level didn't rise too much, I eliminated it altogether. That was my mistake, I think. That's where having some plausible theory and explanation helped me figure out what was going on. The Twin Cycles theory explains how the pancreas recovers and it was clear that although I'd seen increased liver sensitivity in the first week, the elimination of all of the insulin left the pancreas unable to cope. So the BG rose. That helped me figure out what to do. Put back some, but not all, of the insulin. I chose the last level at which there was reasonable BG control and some weight loss. What's happened in my case is completely consistent with Taylor and Fung's work. I was just too impatient.
I have a lot of confidence in the science because I've looked at the papers and the evidence and tried to do the devil's advocate bit, questioning as much as possible. For me, it's convincing and my experience bears out the conclusions. It seems true that for long-standing diabetics, it takes longer to get the pancreas recovering but I've already seen signs of some recovery, just not enough to get off the insulin - yet.
Unfortunately, I don't have a supportive GP and diabetic team on hand to support me in this or I would have sought their advice, and a few blood tests to be sure about what is going on. So I'm relying largely on the published research, the accounts of the many people who have followed the ND successfully, and my own figuring out what's going on. And of course, the very useful contributions from others here. I'm totally committed to it because I was diagnosed almost fourteen years ago and I've been through the mill with treatments, regimens and helpful suggestions, only to see my condition gradually worsening. I would recommend the ND wholeheartedly to anyone because there is absolutely nothing to lose and a great deal to gain, even for old lags like me...
Hopefully my account will give hope and encouragement to other long-standing diabetics and help them stick to the ND.
Sounds like you're in good hands. Namely, your own
With respect @AdamJames , jettisoning the fairly gentle action of Metformin, versus the much more "aggressive" support of insulin to a long-standing diabetic who may have reduced natural insulin production is quite a different proposition.
I appreciate you are not instructing @AlcalaBob to ditch his meds, but nevertheless I'd ask you (and everyone else) to review your understanding of the Community Ethos and Forum Rules, here, with particular regard to medical advice and statements relating to medications: https://www.diabetes.co.uk/forum/threads/community-ethos-forum-rules.50
I stumbled across this thread today and I am riveted! It like waiting to find out who dunnit.
My knowledge of physiology isn’t as great as yours but enough to find your changes fascinating and inspiring and I just wanted to say thank you. I will watch this tread for updates like a soap addicted pensioner.
The link doesn't work. I'll have a look if I can find it.
I'm prepared to bet I'm well within the guidelines. I wouldn't dream of suggesting anyone do something I would do, nor suggest that they would get the same results.
I've posted my experience, as we all do.
@DCUKMod that link to the rules isn't working for me. It brings up "error"