How is Metformin Dosage Determined?

[Daibell]

Hi. It's total guesswork. GPs just increase the dose in the sometimes vain hope it will finally do something. Metformin never does much but does help and I still take it. If you have any problems with it insist the GP changes the script to Metformin SR (Slow Release) or possibly refuse it if the GP won't change the script. Diet as ever is the number one action for T2 and other tablets/insulin for T1.

 

[bulkbiker]

Oh :/ I worry that you may be right! Have you had a bad experience with the drug?

Yes and with the healthcare profession generally...

 

[Guzzler]

Hi, yes this is very helpful thank you! Wow, yes i think that may be the highest dose. From what I've read it would seem that approx 2500mg is the daily maximum. This is really helpful thank you. Had your sugar levels reduced then for the metformin to be reduced? Sorry for all the questions, I'm trying to better get my head around the dosage so that I can better support a family member on metformin.

My dosage was lowered due to a fall in my HbA1c that my diet was responsible for. Metformin doesn't have a huge affect on blood glucose and is prescribed for different reasons. It is a mild appetite suppressant, it curbs the amount of liver dump and it affords some protection to the organs. Hope this helps.

 

[carty]

I have often wondered about medication and weight ,children can't take some medication unless they are over 12 years old ,cats have to be weighed to determine the dose .I am well over 12x6 but I probably weigh less than some 12 year olds
Oh woe is me !!
CAROL

 

[ringi]

The ACCORD study showed that people with Type2 who take metformin tend to live longer regardless of their A1C level. Metformin also seems to over the long term lower A1C by between 10 to 20 for many people.

Firstly let's remember from "low carb 101" that high insulin levels stop us burning fat including liver fat.

Metformin works by reducing the insulin resistance of our body a little, this results in both a small reduct in BG, as well as a reduction in blood insulin levels. This reduction in insulin level often results in people losing a bit more fat then they would have otherwise. This loss of fat results in yet more reduction in insulin resistance.

Metformin also reduces the "liver dumps", hence it still gives me benefits, as my A1C is now normal, but my fasting BG is a little high. Metformin has also been shown in recent research to reduce the risk of cancer, but how much of a reduction is not yet know.

I am happy to take Metformin for life, as I don't get the side effects, if I start to get the side effects, I will clearly change my mind! However, I am also committed to remaining low carb for life, as low carb clearly gives me more benefit then Metformin.

There has been no research in how well Metformin works when combined with low carb diets, but some of the leading low carb experts are positive on Metformin, and at least one of them takes Metformin for his Type2. (Its a bit confusing, as in the USA Metformin is seen as a drug to prevent Type2, not just for people with Type2.)

 

[Bluetit1802]

Metformin also seems to over the long term lower A1C by between 10 to 20 for many people.

10 to 20 of which units?

 

[ringi]

10 to 20 of which units?

Clearly, the UK units, as there would be no one with complications of Type2 if it was the USA units......

 

[Bluetit1802]

Clearly, the UK units, as there would be no one with complications of Type2 if it was the USA units......

But which ones? The HbA1c, mmol/l, DCCT?

 

[ringi]

HbA1c in UK units.

 

[Bluetit1802]

HbA1c in UK units.

Link? MMol/mol or DCCT? That seems an over estimation to me unless the people were very high to begin with with huge liver dumps. Have these studies mentioned diet? If not, they should, and any other reasons for such a reduction excluded. Bear in mind the date of the study - mmol/mol only arrived in 2011.

 

[ringi]

Link? MMol/mol or DCCT? That seems an over estimation to me unless the people were very high to begin with with huge liver dumps. Have these studies mentioned diet? If not, they should, and any other reasons for such a reduction excluded. Bear in mind the date of the study - mmol/mol only arrived in 2011.

Firstly I converted it to mmol/mol when I read the steady. It was a double-blind study done in the USA, of metformin with diet advice compared to diet advice only. Clearly, the diet advice was "low fat and low sugar", hence I said at the end no study has been done with low carb diets and metformin. Being the USA it is likely that most of the people where more overweight than in the UK.

I expect the drop was larger than you expect, as the long-term loss of liver fat from people losing a little more weight in the metformin group also helped. (And maybe the people who lost the weight with the help of metformin were then more motivated to avoid sugar etc.)

Sorry, I did not save a link to the study, but remember that most people get a much larger drop in A1C when they start low carb.

 

[Bluetit1802]

Firstly I converted it to mmol/mol when I read the steady. It was a double-blind study done in the USA, of metformin with diet advice compared to diet advice only. Clearly, the diet advice was "low fat and low sugar", hence I said at the end no study has been done with low carb diets and metformin. Being the USA it is likely that most of the people where more overweight than in the UK.

I expect the drop was larger than you expect, as the long-term loss of liver fat from people losing a little more weight in the metformin group also helped. (And maybe the people who lost the weight with the help of metformin were then more motivated to avoid sugar etc.)

Sorry, I did not save a link to the study, but remember that most people get a much larger drop in A1C when they start low carb.

Thank you.

 

[ringi]

I recall some time ago reading a NHS costing document that looked at the cost of Type2 and how money could be saved. The biggest return on investment was stopping people with Type2 gaining weight, and hence getting a worse A1c. (Once again it did not cover low carb!)

The effect in the Metformin study, if I recall correctly was partly due to the people not taking Metformin getting a worse A1c as the study went on – clearly, this is of less concern to us, as we know the power of low carb.

 

[Deleted member 308541]

As far as I know doctors just up the dose 'as tolerated' by the patient - they believe absolutely that it is good for diabetics, so they work on that even if the tablets make your life a misery and prevent any form of exercise, cause disturbed sleep etc.

My GP never did this when he put me on Metformin XR. I have been on 2 x 500 mg a day one in the morning and one in the evening ever since.

I was on the quick release Metformin when the XR was unavailable here for a while, and I had no gut problems with that either.

 

[ringi]

Great video, but shame it has not been updated with the results of the ACCORD study. Clearly, it is hard to justify anyone being put on more than 1000mg of Metformin without a very good reason. I expect that if GPs limited metformin to the 1000mg, a lot more people would take it due to fewer side effects, and above 1000mg there seem to be few additional benefits for most people. (Other the people find this website due to them not liking the side effects.....)

I am now flowering one more person on twitter.....

 

[ElloBee]

Hi. It's total guesswork. GPs just increase the dose in the sometimes vain hope it will finally do something. Metformin never does much but does help and I still take it. If you have any problems with it insist the GP changes the script to Metformin SR (Slow Release) or possibly refuse it if the GP won't change the script. Diet as ever is the number one action for T2 and other tablets/insulin for T1.

Thanks for the info! It is an difficult drug, so many experience negative side effects. Is the slow release more gentle on such side effects?

 

[ElloBee]

Great video, but shame it has not been updated with the results of the ACCORD study. Clearly, it is hard to justify anyone being put on more than 1000mg of Metformin without a very good reason. I expect that if GPs limited metformin to the 1000mg, a lot more people would take it due to fewer side effects, and above 1000mg there seem to be few additional benefits for most people. (Other the people find this website due to them not liking the side effects.....)

I am now flowering one more person on twitter.....

Hi Ringi, excuse my ignorance here (I am still learning!!), but why would it be hard to justify anyone being put on more than 1000mg of Metformin? Would it not help in bringing glucose levels down quicker? Sorry, I am not meaning to be ignorant, I am just trying to do my research to support my family member has experienced the drug to better understand the condition. Is there a glucose level that would warrant the max metformin dosage? I think it's best to ask people like yourself, with actual experience of the drug, rather than just asking those who prescribe it and who may not actually take it!

Also what is the ACCORD study?

 

[ElloBee]

My GP never did this when he put me on Metformin XR. I have been on 2 x 500 mg a day one in the morning and one in the evening ever since.

I was on the quick release Metformin when the XR was unavailable here for a while, and I had no gut problems with that either.

Hi Tipetoo, I am pleased that the Metformin has been effective for you! Did your GP determine the dosage based on glucose levels or were there additional factors involved? (If you don't mind me asking!!)

 

[ElloBee]

Yes and with the healthcare profession generally...

I'm really sorry to hear this. I genuinely hope things get better for you and that you can have better experiences.

 

[ElloBee]

My dosage was lowered due to a fall in my HbA1c that my diet was responsible for. Metformin doesn't have a huge affect on blood glucose and is prescribed for different reasons. It is a mild appetite suppressant, it curbs the amount of liver dump and it affords some protection to the organs. Hope this helps.

Yes, really helpful. Thank you so much!