Metformin and hypos?

I was diagnosed with Type 2 about 4 and a half years ago and did the usual for three months of trying to control it with food which dropped it down a bit but not enough and was put on 2 metformin 500mg one with breakfast and one with my main meal. I continued to try to drop weight as I was very overweight at the beginning and in fact was 21 and a half stone. I managed to lose 2 stone but still my levels had not come down quite enough so was put on 3 in total instead. I have always had a very low cholesterol level and it is very normal for my levels to be around 2.2 or 2.4 whenever tested and had been for many years. I have now lost another 4 and a half stone and have after a battle with a nurse who did not want to try lowering my meds been allowed to drop my metformin back to 2 per day and for the last 3 years my HAB1C has been approx 5.2 or 5.3.. I had an interim non fasting check this time and saw the senior nurse practitioner who deals with diabetes and told her I had recently had a hypo where I felt extremely sick and shaking and sweating and when I tested with my machine that they no longer provide my test strips for like most of the surgeries now, I was only 3.2 which I considered to be a hypo. This happened after having a very healthy well balanced meal. They will keep telling me it is not possible to have a hypo on Metformin and yet again she said the same. I ate a mars bar and an hour later followed it up with a small sandwich and then I was back to normal and my reading then was 6.4. On this visit she has now dropped my Metformin down to 1 in the morning but I keep feeling sick and shakey although my level was still at 4.2 and this again was after eating my breakfast. I have a small portion of porridge for breakfast every day and until now it has never affected me. I just don't understand what is happening to me and who to believe what from. Does anybody have any advice that still helps me to stay on a healthy well balanced normal food regime. I am still 5 stone overweight so it is not that I am underweight or anything like that and we measure and weigh all my food as that is how I have managed to lose the last 4 and a half stone since August 2010. I cannot take any real exercise as I am in a wheelchair with two collapsed hips and fibromyalgia and I am also on a lot of mega strong pain meds etc.

Thanks for the advice. The 3 months of trying to get it under control was when I was first diagnosed and I really did make a lot of changes with my gp who specialises in Diabetes then (have moved areas since) agreed that he could see that I had made all the right changes but it was not having the desired effect and despite continuing to do so had to give me the 3rd pill to help control it at that time. I know my HAB1c looks excellent and has done all through since being on the 3 x 500g metformin and it is only recently that things seem to be going haywire. I have been losing weight steadily by sensible eating and smaller portions, smaller plates etc but I do not really understand this low carb thing. I don't eat a lot of carbs anyway but find if I don't have any I do not feel satisfied and am continually looking for something to eat. I eat lots of vegetables and some fruit and use things like the Weight watchers small loaf bread if I do eat a sandwich and have a small jacket potato or boiled potato with my meal or a portion of basmati rice or wholemeal pasta and apart from having a small serving of porridge oats for breakfast with half milk and half water I don't really eat a lot more in the way of carbs apart from 1 or 2 apples in a day. Do you think that would be classed as high carb usage? I could do with some advice really about it as nobody as ever told me about lowering carb usage and I have not been to one of the training courses that are run despite being offered as I find it hard to sit in anywhere for any length of time and keep concentrating because of my pain levels and problems with keeping concentrating on one subject for long because unfortunately it is my fibromyalgia that affects me that way. Thank you ever so much for answering me.

Thanks for the advice about the foods. I am trying to balance a low calorie diet at the same time which I can live with for the rest of my life as I have been working hard at losing weight to have my hips replaced and that is the only reason I have changed to the Weightwatchers wholemeal. I have eaten the Burgen bread for many a year and do love the Soya and Linseed and will go back to it. I had just been looking at keeping my calories down and the WW was only 48 a slice and I think the Burgen Soya and Linseed is about 83 or so which when you are trying to keep within a reasonably low calorie allowance to counteract the fact I cannot exercise as I cannot walk and the fibro stops me exercising in a way that would burn it off. I always buy the bags of new potatoes and it is only occassionally we have a jacket one and I often have sweet potatoe instead. I am familiar with the Glycaemic Index and have tried to do as much Low GI as possible. Life is a ***** at times as I have to be able to feel full and satisfied, yet try to balance the diabetes and lose weight as quickly as I can and it is quite hard at times. You have to have treats of things and I do eat soft fruits in the summer and I have cut down my consumption of apples as I became quite addicted to them at one time. None of the diabetic proffesionals I have seen have ever told me to stay within a certain amount of carbs or even discussed carb counting with me that is why I am a bit vague about how many carbs a day I should be having. Do you know if there is somewhere that will tell me that amounts so that I can measure that too. I am luckly that I am not having a problem with keeping my Glucose levels from rising. I only wish I could eat nuts but they are a bit of a problem because sometimes they start my asthma off and I had no idea that cashews were not nuts either lol. SO much to take in me thinks lol. I thought I was doing so well too. I eat loads of salad and don't eat a lot of parsnips but do eat swede. I really wish I found that shredded wheat kept me feeling satisfied but sadly they don't and within 2 hours I am looking for something else to eat and that is my danger time. Thanks Carol. I saw it in Tescos yesterday and actually did pick it up and consider it and yet put it down again because I would only be able to have one slice of that for a sandwich and physcologically that does not look enough lol. Things will be easier when I can move around by walking again as I will at least be burning some more off. At the moment I am sticking to 1000 cals a day to give a final push before I see the surgeon again as he has a lot of worries about working on me because of other health conditions.

Once again Grazer thanks for your help with this. I have no idea how many carbs I have been eating but will start to take notice now and see what my normal total within the regime I have adopted and is very successful for me in weight reduction and compare it with the range you suggest may be appropriate. I think that they should have told me to count the carbs from the beginning instead I have always been advised to eat a healthy mediterranean style diet which on the whole is what I have been doing and had done for the majority of my adult life anyway. When I first tried to control my glucose levels in the beginning without meds what I did is basically what I do now but not quite as severe. I reduced my portion sizes and avoided any cakes and biscuits and chocolate. I have always eaten a low fat diet anyway and never have lived out of the chip pan. My problem with weight was not so much what I ate it was more the size of the portions. I have never had a stereotypical fat persons diet as I have been trying to control weight since I was a child and only got way out of control after I stopped working as I had been doing a physical and long hours job. It does make me cross when on the telly they always portray the sort of overweight person that eats mega amounts of the wrong food when I would say a high proportion don't do that they just over indulge in what is on the plate because as we know even healthy food will put weight on if you are eating too much of it. I may have eaten a bar of chocolate at the weekend but not all through the week as well and barely ever drank fizzy drinks at all. I will report back on here as to how I am getting on with it. I can't wait to find out what my carb totals are now. Thanks again.

Hi Starlight. I am glad that someone understands what it is like to be in our position. We only want to do the best thing for our health but it is hard with conflicting advice too. I thought that my dietician that I go to for my weight loss would have mentioned the carb counting but she has always said she is very happy with the way I am living my life with relation to food and drink. I mean tea and coffee not alcohol as I rarely ever drink as I am on 260mgs of morphine a day plus many other drugs like diazepam etc. I have found that getting smaller plates one of the best changes that we made and it is very much a visionary thing as if your plate looks full on a small plate your brain tells you that you have had a good meal. I eat a lot of salad type foods and also eat fresh fish and tinned fish for oily fish at least 2 or 3 times a week, I also have chicken breast often but my husband and I always have a half a breast each as we find that it is plenty enough with a good variety of vegetables like broccolli, dark green leaves and cabbage, curly kale, I eat carrots and need to look at the carb levels of that, sweet peppers and courgettes and leeks. I also make with my husbands help big pots of vegetable soup with things like lentils or pearl barley in or kidney beans instead of meat. We use a lot of tomatoes and grow our own and our own lettuce, cucumber, courgettes, runner beans, french beans, carrots beetroot. I do eat olives and garlic these days and we are now getting more into chillis but only in a small way and not hot ones if we can help it, I do hope you can find a way to get your weight down that is as easy to cope with as mine has been. Will let you all know when I have had the hips replaced and I pray that when all is sorted I will cope with walking around again and maybe even drive my car once more. xx

Thanks for that Viv. I am familiar with the Collins Gem books as currently use the calorie one and that is how I have lost 4 and a half stone since last August without any exercise at all due to my disabilities. If one more person who needs to lose weight tells me they can't because they can't exercise I shall explode as they are talking to someone who has just done it. I am not keen to follow any form of Atkins Diet though but will look at your diet though to see if I am getting the wrong end of the stick with regards it. . Everybody has been very helpful and I thank each and everyone for taking the time to reply. I think that my glucose control is very good and will continue on the 1 tablet now for a while and see how things go and then when I have an idea of how that has settled or not I will discuss it with my gp again about leaving off the last one and that will be such an achievement to have gone from 3 a day to none. Take care yourself. I have just noticed that we were on exactly the same dose until about 6 months ago when we dropped off the first metformin and now this last week the second one. You may find the same that you will gradually be able to reduce your meds too. Have you got weight to lose?

We are like two peas in a pod with regards to weight as I would like to lose another 5 stone too. I am only 5'2 and they really recommend you to be between 7 and a half and 9 stone approx but I am aiming at 10 stone as cannot imagine getting down any lower as wasn't any lower than that at school. I now it will be a few years as slow and steady is my chosen way to do it and that way so far I have not been left with any overly loose skin and in fact everyone is really surprised at how good it has gone back including my gp but nobody as much as me lol. You are right about everybody being different as I feel ill if I have not had a reasonable amount of carbs but I don't eat a lot of meat or stuff and actually quite enjoy the wholefoods side of things. I have my bp at a really good level now and like I said earlier my cholesterol has always been really low at 2.2 approx so I can only think that is because I have eaten low fat for so many years now because when I was in my late 20's and had it taken it was 5.5 but has dropped lower and lower ever since and I am not taking any statins or anything either. I think I have the right food balances now really as I lose steadily at a 1lb a time apart from having the odd blip in the middle where I have had too many meals out and been a bit naughty but like we discussed with the dietician - if you don't have some down time then you will not stick to being sensible the rest of the time and revert to just eating it all wrong again what has always happened to me in the past when I have tried with other ways like WW and Slimming world and my whole life gets taken up with what I am allowed to have and when etc. I would love to improve muscle tone because although muscle weighs heavier than fat it also burns up more energy and therefore carbs. Hopefully if I can get back on my feet and out of the wheelchair I will be able to move around more and get some more muscletone back in my legs slowly. Still have to watch what I do because of the fibromyalgia. I have an awful back too but not really sure if it is referred pain from the hips as I always complained of back problems in the first place. I am praying the OA has not gone into the lower spine as well. I am 53 now and still very fashion conscious so I just wanna be a girl having fun again lol. We will both crack this thing one way or another Viv!!!

Wow Viv they took there time arriving at your diagnosis didn't they. I have always found that with back problems before they even now how serious it may be they want to put you through physio when you could already have condition that needed more careful handling. I always think that after someone had complained of repeated back problems especially like you with numbness that the first thing they should do is to give you a full scan and get a real picture of what is going on in there. I would not have had my OA in my hips diagnosed if it hadn't have been that I went into a severe flare after having a cortisone in my hip for bursitis which is what they said it was. For years I kept telling my gp that I was having trouble in my hip and every time he would lay me on the couch wiggle my leg around and about and say no nothing wrong there probably just a pulled muscle. I had dreadful back ache too and if it hadnot have been for a decent female doc I would not have managed to got back to work like I did as she gave me a cortisone either side of my spine and that was the best relief I had had in years. Anyway whilst in hospital being checked over because of the fact that my hip was burning up and in agony I was put through a nuclear scan and it was that which showed up the OA in both hips and the earlier start of it in my knees.

I really hope you can be operated on and like me slow and steady is best and before you know it you will be there and in a fit enough state. Your surgeon may even accept you as you are. Mine is willing to do my hips now. Like they said though if they had their way as surgeons everyone would have a BMI of about 18 or 20 to make it easier but it will be a month of sundays before I ever get there and neither do I want to. lol.

I know what you mean about the money per pound lost as like you I would be worth a fortune as I have been dieting since I was a child as that is how long back my weight problems go. I have just been and had lunch in the pub with my youngest sister and her husband and grandson and she is a Slimming World Consultant and would dearly love me to be on her diet but is so proud of what I have achieved anyway. I was pleasantly surprised to find sweet potato,goats cheese and spinach pie with sweet potato chips and veg on the menu and it was delicious. I could not eat it all which was a shame as the veg was broccoli, carrot and the most beautiful cooked red cabbage that I think must have been cooked with orange as it had a sweet tang. I normally eat all my veg but the portions were enormous so I shan't be wanting anything much for my tea tonight and probably not until about 9 tonight which I know isn't the best way of doing things but like I said we have to live our lives too and not treat ourselves like we are aliens who can't have fun. I shall have a couple of ryvita and a bit of celery and tomato with hummous then and that will be ample. Reversing the ages means I am older than you lol. I like your style though lol ;-) I was good at the pub and avoided the pudding so feeling pleased with myself. Just remembered that I have a GI book on the shelf so will get it off later when hubby is back up from his rest to remind myself of some different things to have for a change. Grandchildren coming for the weekend in a couple of hours so about to get some shut eye before I can't lol. Take care and start looking through your wardrobe for your dancing shoes and bling lol. <3

It is such a shame that medical profession are not a bit more explanatory about the hypo and metformin situation as then people like us that do get them would not worry so much. They will state without hesitation that you cannot get a hypo on them so when you do you are left worried and confused. I never thought for a moment that it was Metformin that caused my hypo and was never ever told in the beginning of taking them that you can't get a hypo on them. In fact I was advised by my diabetic doctor what to do should it happen but that it was fairly unlikely which is the way that I think that all the nurses should advise on it rather than the never route I have been informed of since moving to another area and therefore another surgery.

As for your situation with the hypo today:- maybe you could have had a snack mid morning to have just given yourself a small boost especially if you had a fairly early breakfast and a lunch a little later. You may have done exactly the same time wise as you normally do but I am only trying to think why it may have happened. I have never eaten Granola as I was under the impression it was quite sweet but perhaps I am wrong. I always find I am better with little and often so normally have a small snack mid morning and mid afternoon and the same before I go to sleep. It is always planned into my day so I don't tend to trip up and have things I shouldn't unless I have planned for it to happen. After all we have to live and nobody said we have to be perfect all the time. lol. I always have porridge for breakfast but I only use the real oats porridge not the instant packet stuff and am really glad as I was reading a book on GI foods over the weekend and in there it actually stated that the real porridge oats are low GI whereas the instant porridge is not and that is a mistake that could easily be made. Someone on here did advise me to have Shredded Wheat instead of porridge because he thought that it was better and I wonder now if he thought that I was using the instant stuff and that was his thinking behind the suggestion. Is Shredded Wheat low gi or is it med/high because it seems to me that other wheat things are high gi and even bran cereal is only low gi if you have the original noodle shape (All Bran) rather than the flakes which are med gi. It is a minefield if you don't check every now and again. I never was somebody that ate loads of chocolate or a lot of sweet foods really at all. I may have had a chocolate bar once a month or so and it is so hard to rationalise why one of us has a hypo when someone else doesn't but like Viv said at least you are aware of the feeling that it gave you and you can be prepared with something like the glucose tabs or the other thing my doc suggested to me was a can of coke but not the diet type obviously and then I was told to follow it up with a sandwich about half an hour later. I think that we all get told different things and it is only time and trying things to see what works best for you as an individual. ;-)