Effects of metformin long term

[winter2342343]

Hello, I’ve been researching a lot about diabetes reversal (I’m type 2) and watching Dr Jasmine j Fung videos on YouTube. Im interested in intermittent fasting and a low calorie diet to aim to lose weight. I am worried though about metformin or diabetes meds in general. If you take metformin it lowers you blood glucose level which should take you out of the danger zone for complications? This is what I’ve thought was true since I’ve been diagnosed, but what happens to the insulin you are resistant to, will that not be stored as fat and hence create complications anyway, so is taking medication just treating the symptoms of the problem and not the cause? I’m primary worried about nerve damage as I feel I’ve got the early stages of it.

Any thoughts would be much appreciated.

 

[KennyA]

Hi. Officially the way metformin works isn't fully understood. It interferes with the liver adding glucose to the bloodstream, but the exact mechanism is unclear. It doesn't lower BG, but it does prevent the liver raising it. I have zero personal experience with metformin but on its own it does not appear to be a solution. It might of course be part of a solution.

Insulin is not stored as fat. Carbohydrate (including sugar) when eaten is digested to glucose which is stored as bodyfat (this does not happen if you eat protein or fat).

Insulin is the thing that allows muscle cells to take in glucose for use as fuel. If you're insulin resistant (and T2s are by definition insulin resistant) you have plenty of insulin but the cells are resistant. The result of resistance is that the glucose hangs around in the blood stream and is converted to bodyfat.

You're right that high blood glucose is a symptom. However high blood glucose over time is the thing that causes physical damage to cells and nerves. This is one of those times when it's important to treat the symptoms. I had a number of unpleasant effects when my BG was only just out of normal range, which are 99% corrected by keeping my BG at a low level. It seems that some people can tolerate raised glucose levels better than others.

My advice would be to forget about calories - which are units of energy - (my personal opinion is that calories are irrelevant when dealing with T2) and concentrate on reducing your carbohydrate intake. It worked (and works) very well for me - never being hungry is a bonus.

Best of luck

 

[winter2342343]

Hi. Officially the way metformin works isn't fully understood. It interferes with the liver adding glucose to the bloodstream, but the exact mechanism is unclear. It doesn't lower BG, but it does prevent the liver raising it. I have zero personal experience with metformin but on its own it does not appear to be a solution. It might of course be part of a solution.

Insulin is not stored as fat. Carbohydrate (including sugar) when eaten is digested to glucose which is stored as bodyfat (this does not happen if you eat protein or fat).

Insulin is the thing that allows muscle cells to take in glucose for use as fuel. If you're insulin resistant (and T2s are by definition insulin resistant) you have plenty of insulin but the cells are resistant. The result of resistance is that the glucose hangs around in the blood stream and is converted to bodyfat.

You're right that high blood glucose is a symptom. However high blood glucose over time is the thing that causes physical damage to cells and nerves. This is one of those times when it's important to treat the symptoms. I had a number of unpleasant effects when my BG was only just out of normal range, which are 99% corrected by keeping my BG at a low level. It seems that some people can tolerate raised glucose levels better than others.

My advice would be to forget about calories - which are units of energy - (my personal opinion is that calories are irrelevant when dealing with T2) and concentrate on reducing your carbohydrate intake. It worked (and works) very well for me - never being hungry is a bonus.

Best of luck

Thanks for the info. So what I don't understand is when metformin stops working, i.e diabetic blood glucose is on the rise they start putting you on different medication to compensate, getting to the stage where you are injecting insulin (my friend does that) - if the cells are insulin resistant anyway how will putting more insulin in the body work to reduce blood glucose levels?

Also I have read some of your posts about neuropathy and they have given me hope so thankyou for that!

 

[KennyA]

Yes, there are other medications that will help to lower blood glucose. I'm not sure that the metformin "stops working" - it might be that the carb intake has increased, glucose levels have gone up, and any gain from the metformin is now negligible. Unfortunately a lot of the treatment offered by the health service is simply more and more glucose-lowering medication, without really attempting to do something about diet and lifestyle. I think there's certainly a place for medication, but it shouldn't be the first and only thing on offer.



My preference has always been to do without medication wherever possible, and I didn't appreciate being offered metformin at the point of diagnosis.



The body's response to cells becoming insulin resistant is to produce more insulin. Taking an injectable insulin follows the same principle. It's not that the insulin simply doesn't work - it's that it works slowly and erratically, for example. If insulin didn't work at all there would be no energy available to your body from glucose, and in general you'd be in a very bad way.



This is why the blood test before and after eating is so informative. If you're not back somewhere close (within 2 mmol/l and not above 7.8mmol/l) to where you started after two hours, it shows that your system is having trouble shifting glucose into muscle cells for fuel, so there are still high levels of glucose in your blood, which over time can do damage - for instance, neuropathy. Adding more insulin can help reduce glucose levels in the short term, but at the same time can tend to increase insulin resistance even further.



The low carb approach (by reducing carb intakes and therefore glucose) reduces the need for the body to produce insulin, so firstly levels of blood glucose are reduced, avoiding physical damage, and secondly, the muscle cells have a break and a chance to recover some insulin sensitivity. They may start to deal a bit better with whatever glucose there is around.



Overstressing the cells by having too much glucose in the blood leading to higher insulin production is likely to increase insulin resistance all over again, so low-carb is not a "cure" - it is (for me and others) a way of managing the condition long-term.

 

[winter2342343]

Brilliant thanks!