How long for Metformin to show the effects

[NoCrbs4Me]

Thanks for your imput Paulus 1

There seems to be a wide-spread bias in this Forum in favour a low carbs diet to control glycemia . You go as low as recommending 50-70 g /day!

I don’t know on which medical grounds people can make this recommendation, unless they are prompted by an unbounded faith in hear-say and popular wisdom and a corresponding wide-sweeping mistrust in the medical establishment , which indeed warns against an indiscriminate low CHO diet..

I am sure some will say “ Well , it works for me..”.

I’ll only say that even if glycemia were to improve with a low CHO diet in one or more individuals, it is difficult to establish a an uncontrovertible causality link, because there are too many complex variables of which the layman, as compared to health professional, may not be aware..

First, according to Diabetes Canada, formerly the Canadian Diabetes Association,(http://guidelines.diabetes.ca/fullguidelines/chapter11#sec1 , the current recommended minimum intake for CHO is not less than 130 g/day, to provide glucose to the brain, a far cry from 50-70 g/day !

This can be outright dangerous ,as according to D.C. , the long-term sustainability and safety of CHO-restricted diets (mean CHO from 4% to 45% of total energy per day) may not ensure sufficient vitamin, mineral and fibre intake. While these low CHO diets may improve A1C and triglycerides (TG), they do not improve total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) or body weight compared with higher-CHO diets over the short term.

D.C. recommend that the percentage of total daily energy from CHO should be no less than 45% to prevent high intakes of fat, which are associated with higher risk of chronic disease for adults and I see no reason to question their opinion.

Secondly, speaking of “low” CHO ( and 50-70 g /day at that!) without further qualification is problematic , without considering the glycemic index ( G.I.) of the carbs.

According to D.C, the key point is not an indiscriminate reduction of CHO, with the risk of going below the safe limit, or replacing them with other energy sources ( fats and proteins) which can be just as dangerous if taken in higher quantities, but to exchange high-GI CHO foods with low-GI CHO foods.

You can go to the D.C. website to read more extensively. I will only quote an excerpt from their recommendations:

QUOTE Meta-analyses of controlled feeding trials of interventions replacing high-GI CHOs with low-GI CHOs in mixed meals have shown clinically significant improvements in glycemic control over 2 weeks to 6 months in people with type 1 or type 2 diabetes .

This dietary strategy also leads to improvements in cardiovascular risk factors, such as TC, over 2 to 24 weeks improvements in postprandial glycemia and high-sensitivity C-reactive protein (hsCRP) over 1 year (40) in people with type 2 diabetes, and reduces the number of hypoglycemic events over 24 to 52 weeks in adults and children with type 1 diabetes.

Dietary advice to consume a low-GI diet was shown to sustain improvements in glycemic control and HDL-C compared with a high cereal fibre diet over 6 months , and to improve beta-cell function compared with a low-CHO, high monounsaturated fat diet over 1 year (42) in people with type 2 diabetes.UNQUOTE

So the key point is not to drastically decrease the daily quantity of CHO intake in absolute terms, but to exchange high-GI CHO foods with low–GI ones.


Ittiandro

I'm in Canada as well. After I was diagnosed I met with a nurse specializing in diabetes care. She told me to follow the Canada Food guide (i.e. high carb/low fat) and exercise at least 150 minutes a week. She looked me in the eye and informed that if I follow this advice, my glycemic control will slowly deteriorate over time, I'll be be prescribed increasingly powerful diabetic meds until eventually I'll be put on insulin, then I'll likely die from diabetic complications. They know this will happen because that's what happens to every type 2 diabetic patient who follows their advice. Great advice!!

I decided to ignore her advice and now, 4 years later, I am on no meds and my blood glucose levels are normal. I no longer require expenditure of tax money on my diabetes. They can use the money on other people. And I'm as healthy as I've ever been in my life.

Although I consume much less than 130 g of carbs per day (probably around 10g from eggs and milk), I can assure you that my brain function is quite excellent. I have a highly technical career and have not been fired yet. I even got a raise last year. Why does Diabetes Canada believe we need to consume 130 g of carbs a day for proper brain function? I really don't know but they are patently incorrect.

Your blood glucose levels are worryingly high. Mine are normal. With all due respect I will not be following your advice.

I urge you to reconsider your approach. Do not be afraid to reduce your carb intake. Perhaps it will work for you as well.

You should ask yourself: "why do so many people on this forum favour a low carb diet?" Also do a little research on clinical studies of low carb diets with respect to type 2 diabetes. There is plenty of scientific evidence supporting what to me is quite obvious: type 2 is a disease where the principal manifestation is an inability to process carbohydrates properly and reducing carb intake is the principal way to treat it.

 

[ickihun]

I balloon without metformin.. long term.
It doesn't fully control bgs even on insulin for me but a fantastic med if you can cope with side effects. I can now with help.

Looking like weeks before op now. Losing weight again to. Ha ha imI delighted, Metformin is the key for me.

 

[SockFiddler]

The other approach, of course, is to try LCHF for 12 weeks (no cheating, give it an honest try) and see how you feel and what your BG, body weight etc is doing after those 3 months.

I'm curious, you have no diagnosis of diabetes or metabolic disease (that you've mentioned), but your doctor has prescribed Metformin and you have been testing your BG regularly for years? Have you just not had two successive HbA1c tests to confirm?

 

[Bluetit1802]

Oh, also, Dr David Unwin, our very own in-house guru, who started DCUK

Started DCUK?

 

[ickihun]

I'm in Canada as well. After I was diagnosed I met with a nurse specializing in diabetes care. She told me to follow the Canada Food guide (i.e. high carb/low fat) and exercise at least 150 minutes a week. She looked me in the eye and informed that if I follow this advice, my glycemic control will slowly deteriorate over time, I'll be be prescribed increasingly powerful diabetic meds until eventually I'll be put on insulin, then I'll likely die from diabetic complications. They know this will happen because that's what happens to every type 2 diabetic patient who follows their advice. Great advice!!

I decided to ignore her advice and now, 4 years later, I am on no meds and my blood glucose levels are normal. I no longer require expenditure of tax money on my diabetes. They can use the money on other people. And I'm as healthy as I've ever been in my life.

Although I consume much less than 130 g of carbs per day (probably around 10g from eggs and milk), I can assure you that my brain function is quite excellent. I have a highly technical career and have not been fired yet. I even got a raise last year. Why does Diabetes Canada believe we need to consume 130 g of carbs a day for proper brain function? I really don't know but they are patently incorrect.

Your blood glucose levels are worryingly high. Mine are normal. With all due respect I will not be following your advice.

I urge you to reconsider your approach. Do not be afraid to reduce your carb intake. Perhaps it will work for you as well.

You should ask yourself: "why do so many people on this forum favour a low carb diet?" Also do a little research on clinical studies of low carb diets with respect to type 2 diabetes. There is plenty of scientific evidence supporting what to me is quite obvious: type 2 is a disease where the principal manifestation is an inability to process carbohydrates properly and reducing carb intake is the principal way to treat it.

Totally agree. @ittiandro low carb has stopped me edging on 30st due to bad so called healthy diet.
I'm 18-19st and still losing. I'm hoping to get my 40+yrs of diabetes as close to remission by extreme low calorie - low carb egg size meals via bariatric surgery this year.
We all have different needs but low carb is universal, in as it works for all types of type2s even slim ones.

 

[SockFiddler]

My memory could be patchy but it's my understanding that he was involved in starting PCHUK because he wanted to gather evidence and promote LCHF to other doctors, which led to the LCP, which also needed a website and this forum?

https://phcuk.org

I will happily correct myself if I am - as if often the case - getting my facts confused!

 

[NoCrbs4Me]

The other approach, of course, is to try LCHF for 12 weeks (no cheating, give it an honest try) and see how you feel and what your BG, body weight etc is doing after those 3 months.

I'm curious, you have no diagnosis of diabetes or metabolic disease (that you've mentioned), but your doctor has prescribed Metformin and you have been testing your BG regularly for years? Have you just not had two successive HbA1c tests to confirm?

According to Diabetes Canada, a fasting (no caloric intake for at least 8 hours) blood glucose level of at least 7.0 mmol/L is diagnostic of diabetes .

 

[ickihun]

Oh, also, Dr David Unwin, our very own in-house guru, who started DCUK after this happened:

http://www.norwoodsurgerysouthport....s_release_low_Carb_GP_wins_National_Award.pdf because he realised that patients who actively manage their sugar intake (again, carbs turn to sugar) will require less meds and complex / life-changing medical procedures and, therefore, save his GP surgery cash. In a single year, he saved his surgery more than 45k in prescriptions alone.

It's not made-up. It's actual. Our bodies don't need carbs, and once we've hit a state of insulin resistance, it's time to leave the carbs alone.

Sock x

I agree. Didn't know Dr started DCUK thou.?

 

[SockFiddler]

I'm pulling out info from 6 or so months ago. I kept some of my original reference links bookmarked, others have been lost entirely. Honestly, if someone's got better info than me, I'll be cheerfully corrected!

 

[ickihun]

My memory could be patchy but it's my understanding that he was involved in starting PCHUK because he wanted to gather evidence and promote LCHF to other doctors, which led to the LCP, which also needed a website and this forum?

https://phcuk.org

I will happily correct myself if I am - as if often the case - getting my facts confused!

Thanks @SockFiddler . I thought I'd miss something somewhere. Well you know me I often get kn*ckers in a twist over something.
Thanks for clarification.

 

[Rachox]

ittiandro
Low carb diet has worked for me! There I’ve said it! Why? Because it’s true!
Not only has it controlled my blood sugars and reduced my HbA1c from 70 at diagnosis to mid 30s (non diabetic level), I have lost over 5 stone (over 32kgs or around 70lbs) in weight, I have way more energy and feel very much healthier than before diagnosis.
To add to this my GP supports my decision to control my diabetes this way.

 

[Guzzler]

Thanks for your imput Paulus 1

There seems to be a wide-spread bias in this Forum in favour a low carbs diet to control glycemia . You go as low as recommending 50-70 g /day!

I don’t know on which medical grounds people can make this recommendation, unless they are prompted by an unbounded faith in hear-say and popular wisdom and a corresponding wide-sweeping mistrust in the medical establishment , which indeed warns against an indiscriminate low CHO diet..

I am sure some will say “ Well , it works for me..”.

I’ll only say that even if glycemia were to improve with a low CHO diet in one or more individuals, it is difficult to establish a an uncontrovertible causality link, because there are too many complex variables of which the layman, as compared to health professional, may not be aware..

First, according to Diabetes Canada, formerly the Canadian Diabetes Association,(http://guidelines.diabetes.ca/fullguidelines/chapter11#sec1 , the current recommended minimum intake for CHO is not less than 130 g/day, to provide glucose to the brain, a far cry from 50-70 g/day !

This can be outright dangerous ,as according to D.C. , the long-term sustainability and safety of CHO-restricted diets (mean CHO from 4% to 45% of total energy per day) may not ensure sufficient vitamin, mineral and fibre intake. While these low CHO diets may improve A1C and triglycerides (TG), they do not improve total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) or body weight compared with higher-CHO diets over the short term.

D.C. recommend that the percentage of total daily energy from CHO should be no less than 45% to prevent high intakes of fat, which are associated with higher risk of chronic disease for adults and I see no reason to question their opinion.

Secondly, speaking of “low” CHO ( and 50-70 g /day at that!) without further qualification is problematic , without considering the glycemic index ( G.I.) of the carbs.

According to D.C, the key point is not an indiscriminate reduction of CHO, with the risk of going below the safe limit, or replacing them with other energy sources ( fats and proteins) which can be just as dangerous if taken in higher quantities, but to exchange high-GI CHO foods with low-GI CHO foods.

You can go to the D.C. website to read more extensively. I will only quote an excerpt from their recommendations:

QUOTE Meta-analyses of controlled feeding trials of interventions replacing high-GI CHOs with low-GI CHOs in mixed meals have shown clinically significant improvements in glycemic control over 2 weeks to 6 months in people with type 1 or type 2 diabetes .

This dietary strategy also leads to improvements in cardiovascular risk factors, such as TC, over 2 to 24 weeks improvements in postprandial glycemia and high-sensitivity C-reactive protein (hsCRP) over 1 year (40) in people with type 2 diabetes, and reduces the number of hypoglycemic events over 24 to 52 weeks in adults and children with type 1 diabetes.

Dietary advice to consume a low-GI diet was shown to sustain improvements in glycemic control and HDL-C compared with a high cereal fibre diet over 6 months , and to improve beta-cell function compared with a low-CHO, high monounsaturated fat diet over 1 year (42) in people with type 2 diabetes.UNQUOTE

So the key point is not to drastically decrease the daily quantity of CHO intake in absolute terms, but to exchange high-GI CHO foods with low–GI ones.


Ittiandro

We are individuals. Glycemic index v glycemic load are two very different things. Lastly Insulin Resistance makes all the difference, two people (with the same Type of Diabetes) of the same weight, height, age and diet may have vast differences in their insulin response times and their insulin resistance. I have roughly 30g of carbs per day, I have lowered my A1c and my bg levels have improved greatly.
There is no such thing as an essential carbohydrate.

 

[bulkbiker]

There seems to be a wide-spread bias in this Forum in favour a low carbs diet to control glycemia . You go as low as recommending 50-70 g /day!

I don’t know on which medical grounds people can make this recommendation, unless they are prompted by an unbounded faith in hear-say and popular wisdom and a corresponding wide-sweeping mistrust in the medical establishment , which indeed warns against an indiscriminate low CHO diet..

The main reason is because it works.

It worked for me and thousands of others on this forum and on many others.
You can choose to believe us or think we are deluded but if you want to get decent control of your blood sugar I would suggest you try it for 3 months.
Personally I have spent many many hours over the past 2 years reading the science behind what I am doing and am comfortable that not only am I not harming myself but that I am getting healthier.
It looks as if your HCP's have misled you over the past few years with your blood glucose readings as your levels are far higher than I would be comfortable with.
Ask for an HbA1c test and get the results in writing and don't accept a vague "oh they are fine".

Oh yeah I aim to eat fewer than 20g of carbs per day (usually succeeding) nothing wrong with my brain.

 

[Guzzler]

I have come to think of the notion of an essential carb is the same as a unicorn, both are surrounded by myth but neither has truly been discovered.

 

[Bluetit1802]

My memory could be patchy but it's my understanding that he was involved in starting PCHUK because he wanted to gather evidence and promote LCHF to other doctors, which led to the LCP, which also needed a website and this forum?

https://phcuk.org

I will happily correct myself if I am - as if often the case - getting my facts confused!

He was certainly a founder member of PHCUK but had nothing to do with starting DCUK website or forum. DCUK has been going for donkeys' years, long before Dr. Unwin discovered the benefits of low carb. However, he is a forum member.

 

[Alexandra100]

Oh yeah I aim to eat fewer than 20g of carbs per day (usually succeeding) nothing wrong with my brain.

Me too, not because of any theory, but because that is the only way to get my blood glucose down to a level I believe to be not too harmful. (Sadly, getting it down to "normal" doesn't seem to be an option for me at present.) I'd gladly eat more carbs if I could get away with it. Such a thing as an essential carb may or may not exist, I don't know, but unfortunately lots of nutritional elements that I consider highly desirable, not to mention enjoyable, come indissolubly packaged with carbs. (Not complaining, just saying!)

I don't want to succumb to heart disease sooner than necessary, the way my maternal family all did, and if I manage to make it to my 85th birthday in 10 years time I don't want to be celebrating as a blind person in a wheelchair who has to go to hospital for dialysis three times a week. For me, eating under 20g carbs daily appears to be the least worst option. For others more fortunate maybe eating under 100g carbs, or even just being a bit more mindful about not hoovering up the enormous amount of unnecessary carbs that our society pushes at us unceasingly will be enough.

 

[Alexandra100]

I balloon without metformin.. long term.
It doesn't fully control bgs even on insulin for me but a fantastic med if you can cope with side effects. I can now with help.

Looking like weeks before op now. Losing weight again to. Ha ha imI delighted, Metformin is the key for me.

I'm encouraged by your praise of Metformin. With great difficulty I persuaded my nice GP to prescribe this for me (500mg) and I began taking it with lunch 10 days ago. I think it is helping, but of course this is a very small dose. I'm happy with this for the present as I understand that starting low and very slowly increasing gives me a much better chance of avoiding side effects. So far I have had none. I may have trouble persuading my GP to bump the dose up eventually, but I'll cross that bridge when I come to it. Anyway, 500mg is a lot better than none!

 

[Alexandra100]

We all have different needs but low carb is universal, in as it works for all types of type2s even slim ones.

And is helpful to T1s too, vide Dr Bernstein's book "Diabetes Solution" which as far as I know single-handedly started the whole low-carb revolution.

 

[ittiandro]

Heya!

Here's the basic logic for low carbing:

All carbs turn to sugar. All sugar is dangerous to a diabetic. If you want to control your diabetes, find a different macronutrient (fat, protein, carbs) to feed yourself for energy.

Carbs - all carbs (except dietary fibre which we class differently in Europe to how North Americans see it) are dangerous to a diabetic. If someone has a nut allergy, we don't tell them to eat nut products. Diabetes is a kind of sugar allergy: we overload our pancreas and liver and we are unable to process the sugar effectively until it makes us ill. The logic of someone with a sugar allergy eating more sugar is flawed. (Incidentally, high-GI and low-GI is irrelevant: they're still sugar, they just release it slower. You still have all the sugar that metabolises from those carbs to deal with).

Further, the companies that sell predominantly foods based on carbs and sugar are also the companies that invest most heavily in dietary councils and nutritional boards around the world. There is money to be made, and they intend to keep making it. And if you don't believe me, check out your own CFDR board:

http://www.cfdr.ca/about/board.aspx

That's right, 2 directors from Nestle and another from PepsiCo, and that's just one branch of Canada's fairly tricky dietician organisation: with more than 2 minutes, I'm sure I could find more.

Saying that CHO’s turn into sugar and therefore diabetics should drastically reduce ( or eliminate them?) is a bit of a simplistic rationale: if CHO’s turn into sugar, as they do, so do fats, albeit perhaps with a different bio-chemical process. .

In fact, a clinical study done by a number of Australian universities in collaboration with reputed American Universities, including Harvard University (http://care.diabetesjournals.org/content/diacare/38/6/1008.full.pdf ) reported that dietary fat modified postprandial glycemia.

Quote

Evidence suggests that meals containing carbohydrates and that are high in dietary fat cause sustained late postprandial hyperglycemia. One study showed the addition of 35 g dietary fat significantly increased postprandial glucose concentrations by 2.3 mmol/L at 5 h (15). Wolpert et al. (19) demonstrated that the addition of 50 g fat caused significant hyperglycemia over 5 h, even when additional insulin was administered using a closed-loop glucose control system.

Free fatty acids (FFAs) directly induce insulin resistance, and one study postulated that the mechanism for the delayed hyperglycemic effect of dietary fat is FFA-induced insulin resistance with increased hepatic glucose output (20). Consistent with the observed time course of hyperglycemia following higher-fat meals in type 1

Unquote

One can always argue that there are perhaps other clinical studies indicating the opposite.I searched the Internet , though, and I couldn’t find any .

Be it as it may, I don't know how much more credible are the no-carbs sources you mentioned, than the Australian clinical study warning against the dangers of fats as well as the D.C. recommendation of a minimum daily CHO intake of 130 g, with the all-important distinction between low-GI and high- GI. CHO's .

Again, the premiss that CHO’s are to be reduced or avoided by diabetics as much as possible because they turn into sugar is faulty : it is based on the wrong assumption that fats do not turn into sugar. They do! They may do it with a different biochemical process than CHO’s, but if fats affect post-prandial glycemia, as the above-mentioned clinical study indicates, this is the best evidence that fats, in the end, do turn into sugar, hence.bottom line , they are just as bad as the CHO’s are, in the eyes of some. ..

At best, even if low CHO’s may improve glycemia, at the receiving end replacing them with fats presens other serious risks ( high “ bad” cholesterol, etc) .

As to questioning the guidelines of organizations like Diabetes Canada or other similar governmental organizations, like Health Canada or similar ones in other countries, on the ground that their pro-CHO's recommendations are dictated by commercial interests, with all due respect, I think this is an all too easy excuse to vindicate one's own pre-conceptions . William James spoke of a " will to believe" , a " no-matter-what" will that goes counter facts and scientific evidence.
I don’t know if the no-CHO's argument is more solid than saying that fats do not turn into sugar……
I am sure that real experts, like medical doctors or medical trained health professionals, don't read these Forums. If they did, I am also sure they would not agree with contentions like this..

A Forum like this is wonderful, in that it allows people to exchange their experiences, give comfort to some in their illness and perhaps clarify some issues, but when it comes to medical advice or prescribing diets, I still think one should exert some caution and rely, rather, on doctors and other qualified health personnel.

One final note: the analogy of diabetes with an allergy (sugar allergy?!) is questionable.

Medically, an allergy is the reaction of the immune system to substances in the environment that are harmless for most people. In the case of diabetes it is either insulin resistance or failure of the pancreas to produce insulin, in both cases we are faced with pathologies that have nothing to do with an allergy..

Ittiandro

 

[SockFiddler]

So you don't have diabetes, but you do test your blood and take Metformin. You don't want to adopt a LCHF approach, but you will come to a forum that openly promotes such a thing to try to debunk us. You do want an evidence-based discussion, but you won't accept anyone's research except your own. You imply we're somehow all looking to vindicate our own pre-conceptions while determinedly defending your own. You will quote a dietary body's guidance as "pure science" while cheerfully ignoring who funded, interpreted and then publicised said science.

This is the point where I wish you the very best of luck and bow out of the conversation. May your path, whichever you choose, bring you health and happiness.

Sock x