Life (more) miserable since diagnosis and Metformin

[garabe]

Hi,

apologies there are already similar threads but I was hoping for specific advice/suggestions without jumping on someone else's specific question.

I was diagnosed beginning of June. Type 2 diabetes, happened somewhere over the last few years only to be diagnosed. 57 and 61 blood sugars so without much information beyond 'deal with it' by the GP I was started on Metformin. Worked my way up to 1500mg a day with diarrhoea all through out.

Got my metformin changed to the slow release and there were some OK days but now it's just as bad - no sooner do I finish eating do I need to go. I think I had to go number 2 14 times yesterday.

This is miserable. Loperamide just doesn't work. I've had to work from home today on a day I'd otherwise be in the office as I'm now getting worried to leave the house.

I've lost a stone in weight (on purpose) since my diagnosis on 2nd June (1 stone, 1 pound 6 ounces). Not eligible for wegovy or whatever. I'm 24.3.8 stone trying to get back down to 19/20. I'm 38 male, white British, and lactose intolerant.

I've tried to quit as many things as possible - alcohol (didn't drink much anymore anyway), fruit juice, chocolate, potato as much as possible, red meat maybe once a week. Just feels like a long long list of what I can't eat. I'm apparently not supposed to eat carbs, but there's not many options for a quick lunch.

I've just had 2 bagels plain with no condiments and 4 slices of prosciutto and have drank over a litre of water today and immediately after finishing I had to go to the toilet again (twice since eating an hour ago) and another 2 loperamides on top of 4 yesterday.

I feel like I can't eat anything. Can metformin have given me IBS? Things that used to not cause me any issues now are. I have ADHD and feel like I've just been abandoned with a medication that makes me phyiscally unwell and even more shuttered in than I was beforehand.

 

[KennyA]

Hi and welcome. Unfortunately many newly diagnosed people have this sort of experience - just given metformin and told to get on with it. You'll find the forum is a good source of advise and support - and one thing - try to forget everything you think you know about what "healthy eating" is.

I have no experience with metforim myself (was offered it and didn't take it). However the side effects on the gut are well known and affect around a third of all users, so it's not uncommon.

The thing is that the big impact on your blood glucose is caused by the sugars in the food that you eat, either directly or when digested from carbohydrate. That means things like cereals, bread, rice, pasta, fruit, pastry, anything sugary, including root vegetables like potatoes etc are all sources of glucose - and they're also usually eaten in quantity. You can establish and evaluate the impact of these foods on your blood glucose by using a glucometer, which measures your blood glucose via a fingerprick.

I found my glucometer absolutely invaluable when I was diagnosed. It showed really clearly which foods did what to my BG levels, and therefore what I could and couldn't eat. The pattern is to test immediately before eating, to give you a baseline, and then again two hours later, by which time your insulin response should have dealt with the incoming glucose and got you back close to where you were two hours before. You are not testing to "see how high you go". The peak point is probably around 40-50 minutes after eating, but the test at the two hour mark shows how well your system worked to manage the excess glucose.

So - if the second test is within 2 mmol/l of the first, that shows you can cope with that level of carb. If not, it means yiur system currently cannot handle that amount. The result would be that the excess glucose hangs around in the bloodstream. High levels of glucose over time can cause damage to capillaries and nerves, and trigger high levels of insulin, and therefore risk making insulin resistance worse.

I cut out almost all carb (bar ~20g/day) from my diet in December 2019 and my BG was normal inside four months. I've lost around six stone since then. I eat all kinds of meat, fish, dairy and green veg. I can handle legumes and pulses, so they're on the list again every so often. These days there are "bread" substitutes that allow for bacon (and other) sandwiches, and zero-carb beer.

best of luck. Ask as many questions as you like. The key thing is to find what works for you, there's no single answer - and beware anyone who tells you what you "must do".

 

[Mark Rawlinson]

I too had very bad experiences with Metformin, phone your Nurse or Dr surgery for a call back see what they say it is also a good idea to see if a Pharmacist can help, another tip re Loperamide get shops own not branded far far cheaper

 

[ianf0ster]

Hi @garabe and welcome to the forum.
I'm like @KennyA in that I have never taken (any) diabetes medication. I too used a low carbohydrate high protein (highish fat) way of eating to control my blood glucose and hence remission of just over 5 yrs. The main difference being that I was always slim to normal weight and only became 'overweight' a few months before T2D diagnosis.
Metformin is a drug which acts by 'persuading your liver' to put less glucose into your bloodstream. It takes time for the effect to build up and by it not tackling the primary source of high blood glucose it doesn't have a big effect. Thus, many forum members who have problems, even with the extended release version, find little difference if they decide to give up on taking it.

An LCHF way of eating (to satiety) together with cutting out snacking has a huge difference because, except for Type 1 diabetics, fat and even protein have hardly any effect on raising blood glucose (or on 'making you fat'. Indeed, LCHF has been shown in Dr David Unwin's over 150 low carb patients to be exceptionally good at 'curing' fatty liver, weight loss and normalising blood pressure, as well as producing T2D remission.

 

[Rosie9876]

Here are some thoughts based on my experience: I also reacted badly to Metformin. Switch to SR became better with time. Why are you on 1500mg a day though? I was put on 1000mg a day to start with. I can't recall what my A1c was, but yours at 61 doesn't seem terrible to me. But that's a question to raise with your GP.

I didn't understand about low carb diet for years, but when I switched to it, my A1c began improving. In my case, it wasn't a question of losing weight, just reducing carbs and finding out which and how much affected me adversely. I still eat some carb, and it's working for me, albeit a work in progress.

Abbott offer a free trial of their continuous glucose monitor (CGM) which should last 15 days. It will give you a 24 full-time reading of your BG, figures may not be exact but seeing what raises it and for how long is very instructive, even if you can't afford to self-fund after that - although you can then apply for a free trial of Dexcom, giving you an extra 10 days.

To start with, maybe instead of 2 bagels plain with no condiments and 4 slices of prosciutto, you can try a thin seeded protein bagel (Warburton's) with smoked salmon and lactose-free soft cheese and/or avocado maybe with cold chicken instead of salmon - or to start with, even 2 thins if appetite demands and you tolerate one well. Or even their plain thin bagels if those suit you better. The idea is to reduce the carbs in your diet to a level that lowers your glucose spikes. And to fill up further, raw carrot and cucumber sticks.

Also, if bread is a very important component of your diet and even the thin bagels raise your BG too high, there are specialty low carb breads, but they are expensive. As you are newly diagnosed, I bet you can beat it. Good luck.

 

[MrsA2]

but there's not many options for a quick lunch.

I often just cook extra for the evening meal before and have the planned leftovers cold. Quick and easy to grab
Eg unlimited amounts of:
Cold chicken legs or thighs
Cold sausages (look for high meat contents ones at least 90% meat)
Eggs made into a frittata (with all sorts of additions) or simply hard boiled

Add bagged salad and a few nuts if still hungry

Shop bought options include Cold meats,olives, nuts

 

[Sammydoos]

So - if the second test is within 2 mmol/l of the first, that shows you can cope with that level of carb. If not, it means yiur system currently cannot handle that amount. The result would be that the excess glucose hangs around in the bloodstream. High levels of glucose over time can cause damage to capillaries and nerves, and trigger high levels of insulin, and therefore risk making insulin resistance worse.

This is massively useful information as I had always been told that the aim was not to go over a 2mmol/l increase at all as if you did that was considered a 'spike' - if I have understood this correctly if my BS is at 4.5 mmol/l before i eat and at a the 50 min mark is sitting at 7.5 mmol/l that's not an issue as long as at the 2 hour mark i am back to 6.5 mmol/l or ( ideally) less?

 

[KennyA]

That's my take on it. There is sometimes a misconception as people think that the two hour mark is the high BG point, and that your BG has been rising steadily up to that point, when neither is actually the case. There seems also to have been a belief (current about five years ago when I was diagnosed) that you shouldn't see any BG rises/changes at all - this led to some issues among non-diabetics trying out CGMs who didn't understand that BGs fluctuate all the time.

Here's a personal example which I only found out through using a CGM. I had a small latte while waiting for a train. Normally I wouldn't fingerprick for something like this. The CGM showed that about 15 mins after drinking the latte (no sugar, this was just lactose) my BG started to rise from 5.3. After about 40 minutes it topped at 9.6. By 60 minutes I was back at 5.3. It would have been undetectable via normal pattern fingerpricking.

In addition, I don't like calling perfectly normal BG rises "spikes" - it makes them sound dangerous and unusual, and they are certainly not unusual. Given that non-diabetics experience them, normal rises are unlikely to be "dangerous" in the way they are sometimes described. The attached short study shows the impact of various meals on non-diabetic CGM wearers - they all show rises after eating, bigger rises the more carbs in the meal.

Continuous Glucose Profiles in Healthy Subjects under Everyday Life Conditions and after Different Meals - PMC

This study investigated continuous glucose profiles in nondiabetic subjects. Continuous interstitial glucose measurement was performed under everyday life conditions (2 days) and after ingestion of four meals with standardized carbohydrate content ...

pmc.ncbi.nlm.nih.gov

The graph is from the study and clearly shows the rises and falls in BG after eating (values in mg/dl). Remember these people are not diabetic.

So - yes, if someone was at 4.5 pre-meal, and at 6.5 or less at +2hrs, that would be OK. As you say, personally I would want to see a fair bit less than 6.5, but as it would have been a carby meal, it would do.

 

[garabe]

Here are some thoughts based on my experience: I also reacted badly to Metformin. Switch to SR became better with time. Why are you on 1500mg a day though? I was put on 1000mg a day to start with. I can't recall what my A1c was, but yours at 61 doesn't seem terrible to me. But that's a question to raise with your GP.

I didn't understand about low carb diet for years, but when I switched to it, my A1c began improving. In my case, it wasn't a question of losing weight, just reducing carbs and finding out which and how much affected me adversely. I still eat some carb, and it's working for me, albeit a work in progress.

Abbott offer a free trial of their continuous glucose monitor (CGM) which should last 15 days. It will give you a 24 full-time reading of your BG, figures may not be exact but seeing what raises it and for how long is very instructive, even if you can't afford to self-fund after that - although you can then apply for a free trial of Dexcom, giving you an extra 10 days.

To start with, maybe instead of 2 bagels plain with no condiments and 4 slices of prosciutto, you can try a thin seeded protein bagel (Warburton's) with smoked salmon and lactose-free soft cheese and/or avocado maybe with cold chicken instead of salmon - or to start with, even 2 thins if appetite demands and you tolerate one well. Or even their plain thin bagels if those suit you better. The idea is to reduce the carbs in your diet to a level that lowers your glucose spikes. And to fill up further, raw carrot and cucumber sticks.

Also, if bread is a very important component of your diet and even the thin bagels raise your BG too high, there are specialty low carb breads, but they are expensive. As you are newly diagnosed, I bet you can beat it. Good luck.

Hi, thank you - I'm not sure on the doses, just told that I should take 1 500mg SR 3 times a day then when moving over to the extended release 1 500mg with breakfast and 2x 500mg for dinner in the evening.

Today has been better.

I love chicken but having it so often I'm getting bored. I do like smoked salmon and avocado but a bit more expensive than Sainsbury's £1.89 prosciutto so was cheaping out really.

I'm a bit of a baby in that I can't stand most vegetables (carrot and cucumber right up there, typically!)

With regards to meat, like the darker cuts of chicken (wings and legs) I see the red contents warnings which puts me off - looking at these in the supermarket is a big downer on the amount of things I shouldn't eat due to the sat fat contents so the things I am eating are yellow at worst whilst keeping an eye on sugars and generally I would say I'm staying in the <30% daily recommendation (giving it an extra wide berth, it's probably lower) but obviously not taking into account the carb > sugar problem.

Big things I ate (and overate in putting 5/6 stone back on last 2 years) were chocolate, pastry, white breads/pasta/rice/noodles, red meats, cheeses (that I could tolerate), pizzas, sweets, crisps (last two not as much) and chocolate. Too much chocolate. So have cut back significantly or eliminated from diet.

just finding sticking to the rules where I can but still being ill from the metformin getting me down

appreciate the support and advice

 

[lovinglife]

Don’t be afraid of fats, I never take any notice of the traffic light system on the front - it’s not fit for purpose. I only use leg & thigh meat from chicken, breast is pretty tasteless. I don’t consume loads of fat but I don’t avoid it either, I don’t add much but I don’t take it away, so I eat fattier cuts of meat like chicken legs, pork chops, lamb, steaks, salmon, eggs, a bit of cheese, butter avocados, good oils like extra virgin olive oil, avocado oil, nut oils like walnut, sesame, coconut oil, mayo, seeds sprinkled on my veggies & salads. Not loads of everything just normal portions.

These are all natural healthy foods that will keep you fuller for longer, the only macro I look at is carbs,
So for example today I’ve eaten
breakfast 2 eggs scrambled in a nob of butter with some grated cheese & everything but the bagel seasoning sprinkled on top (I’m addicted to that stuff)
Lunch a cooked chicken thigh diced, couple of cherry tomato bit of gherkin, a pickled onion all diced up and mixed with a tablespoon of mayo on a low carb roll
Dinner, a couple of Sainsburys Toulouse sausages 1.4g carb for 2, some cauliflower mash & green beans

 

[Antje77]

Big things I ate (and overate in putting 5/6 stone back on last 2 years) were chocolate, pastry, white breads/pasta/rice/noodles, red meats, cheeses (that I could tolerate), pizzas, sweets, crisps (last two not as much) and chocolate. Too much chocolate. So have cut back significantly or eliminated from diet.

Things on those list that are perfectly fine for diabetes are: (chocolate, provided you like high % cocoa dark chocolate), red meats, all of them including fatty cuts, all cheeses.

Alcohol doesn't hurt diabetics more than non diabetics either, as long as you choose lower carb alcohol like dry wines, neat whisky/rum/gin etc, or mixed with a diet drink.

Do you like bacon and eggs? Those make for a very good breakfast or lunch, as does a full English, skipping the toast and beans but having all other options.

You might like this thread where we share what we eat in the low carb forum. Some of us eat very low carb, others moderately low carb, and I love the thread for food ideas: https://www.diabetes.co.uk/forum/threads/what-have-you-eaten-today-low-carb-forum.75781/page-3280

I think you'll also like to read this informative piece written by one of our members: https://josekalsbeek.blogspot.com/2019/11/the-nutritional-thingy.html