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Metformin - Benefits of low dose compared to stopping

Discussion in 'Greetings and Introductions' started by FSnow, Feb 12, 2019.

  1. FSnow

    FSnow · Newbie

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    This is my first post so please bear with me if I am not posting the right place.
    T2 diabetic since 2002 - now 17 years - When Diagnosed I aimed for 8.00 2 hours after meals, min one hour walk per day and reduce my weight then 117 Kilos. My doctor prescribed 500 mg metformin slow release with breakfast to assist control. Over the years my Hba1c have ranged 5.7 - 5.9. and so I reduced by blood sugar monitoring. My doctor recommended staying on metformin because of the benefits. I changed to high fat med moderate carbs diet several years ago and my weights goes up and down around 83 Kilos..

    In 2016 I began to eat sourdough bread because it was low GI and seemed OK within 2 hours. However, at the start of 2018 I accidentally discovered a massive spike 4-5 hours after eating sourdough - if you eat low GI monitor your blood sugars very carefully - Although I knew Low GI could a trap and risky (Rice seems to be a no go for me) I did not expect so large a spike and importantly it was not showing in the Hba1c results.

    So after reading Jenny Ruhl ( Blood sugar 101) I went low carb hi fat and resumed testing with a goal of 7.8 1 hour after meals and asked my doctor to increased metformin to 1000 xr to try and help achive tighter control.

    After 7 months Hba1c now around 5.4.

    I have checked Vitamin b12 levels and they are OK.

    I have had a cardiologist check me out and had a scan etc for calcium build up in my arteries etc and I am very low risk - so I don't have to take statins. I wonder if this is a benefit of taking 500 gm metformin all these years or just me. I plan to review of my increased level of metformin in the next week or so.

    My question is what are the benefits going medication free eg:- of coming off metformin and and or the down side to the increased level of Metformin versus the very low dose of 500mg. I have had some long term tummy issues starting in 2014 but these seem to be related to a picking us some form of infection in 2014 while travelling and not the low dose of 500gm metformin and now settled down to some mild symptoms even with the 1000-XR
     
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  2. Brunneria

    Brunneria Other · Moderator
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    Hi and welcome. :)

    And congratulations on your long term blood glucose control. Very interesting about the delayed sourdough spike.

    Regarding your metformin question, I think each person’s gut reacts differently, so it would be a case of discussing a trial of not taking it with your doc.

    I will ask whether, if you have had long term gut problems (whether from metformin or not), have you had Vit b12 levels checked? Long term metformin use can, in some patients, reduce the amount of b12 absorbed from food.
     
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  3. FSnow

    FSnow · Newbie

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    Hi Brunneria

    Had Vitamin B12 Checked all ok

    Gut issues related to weight loss of around 10 kilos 95 to 83 , iso bruffin for a tendon injury followed a bug in Italy in 2014. Resulted in very upset tummy. Fixed only with Fodmaps elimination of problem foods and slow reintroduction of diet.
    Would not wish it on anyone. Still not quite there 5 years later, but don't think it is related to Metformin.

    My understanding and personal experience is that low GI foods are dangerous as you can think that if you are say 6.5 after 2 hours you can have a desert or a snack. If you test you may find yourself having a nasty spike of 9 or so four to five hours after the meal.

    I'm early days 2003 - 2005 I found that rice in small portions would be under 8 after 2 hours but stay up for hours after - which meant you could not eat anything else or you would have nasty spike.

    Sour dough seems to have the same behavoir. I can eat a slice or 2 and look good after 2 hours but no good after 4 or 5, depending on the particular bread. I did get some slightly elevated hba1c before I realsed that paradise was indeed lost and I should not touch it.

    My metformin question is related to the studies showing the benefits of metformin versus going medication free.

    The doctor has consistently advised continuing with the low dose of 500mg.

    It seems many on the forum see going of medication completely is of benefit.
     
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  4. JoKalsbeek

    JoKalsbeek Type 2 (in remission!) · Well-Known Member

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    You're doing really well, congratulations!
    As for going without meds, well, i just really wanted to be off them because I'm really one walking side effect when I take them. Metformin was hell, statins aggrivated the reumatism, it wasn't good. So while I did alright on gliclazide, I just didn't need it anymore when I changed my diet. Some go low carb without meds, some do the diet with meds, others don't change their diet at all and just let medication solve everything... But when that happens, diabetes is a progressive disease and will require ever more medication and probably, eventually, insulin. So if you're comfortable like this, stick with it.

    That said.... I'm not too sure your tummy troubles aren't due to the metformin. I'm seconding Brunneria here; discuss a trialperiod with your doc of going without for a while. Check your bloods to see whether there's a huge effect or no (I'm thinking your diet has made a bigger difference than the met anyway), and see how your gut responds. Could well be you'll feel better in a week or two, with little difference in bloodglucose. But again, discuss it with your GP first.
     
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  5. JoKalsbeek

    JoKalsbeek Type 2 (in remission!) · Well-Known Member

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    (It takes a long time for a gut to heal when something's off.... But five years is a bit excessive. Met could be keeping those initial problems going for you.)
     
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  6. bulkbiker

    bulkbiker Type 2 · Master

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    I think for many of us., diagnosed for a lot less time than you, it seems better to keep medication for future use "in case we need it" rather than take it now when dietary control is working well. That at least is one of my motivations.
    The other would be that of course every medication has some side effects whether noticed or not which, while I can, I'd rather not run the risk of.
     
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  7. britishpub

    britishpub Type 2 · Well-Known Member

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    I was prescribed a dose of 500mg of Metformin daily last year by my GP on the advice of a consultant endocrinologist who she had asked for advice concerning my condition.

    I have had repeated HbA1c results in the mid 20's over the previous few years, and passed an OGTT, plus a fructosamine test came back negative.

    The advice was to prescribe a small dose of Metformin "just in case"
     
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  8. Grazer

    Grazer · Well-Known Member

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    I remain on low dose metformin out of choice. There are a great many trials, particularly in the States, that show that metformin provides good protection against cardiovascular disease if taken regularly. One USA endocrinologist went as far as to say that everyone over the age of 50 should take it, diabetic or not. Even when we have excellent BG control, we are still normally higher than non-diabetics who average HbA1c of 4.8% in old money (28mmols new) so are at extra risk of heart problems.
    I have no discernible side effects, so have decided to continue with metformin. Others may not - down to informed choice I believe.
     
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  9. FSnow

    FSnow · Newbie

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    My delemia is that I have had a calcium scan and my result for plaque build up is almost zero. So my cardioligst said he did not want to ever see me again and that I had no need to take statins to reduce risk of cardio issues.

    As I understand it the purpose of hba1c is to monitor heart issues. From my perspective then lowering the blood glucose is my main issue and avoiding spikes.

    Spikes are very hard to measure as the body does not always behave and you can have a very high spike and still be ok at 1 to 2 hour.

    I also usually have the dawn spike up to 7 in the mornings.

    I Think that these two issues mean that I am definitely a T2 despite hba1c of 5.4 which says I am in remission.

    So maybe I should stay on the low dose
     
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  10. Daibell

    Daibell Type 1.5 · Master

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    Hi. I would stay on the Metformin as I believe it enables you to continue to have free prescriptions. Met is supposed to have various benefits even including reducing cancer risk. I'm not sure how many of these things are scientifically proven but probably worth continuing with it.
     
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  11. BrianTheElder

    BrianTheElder Type 2 · Well-Known Member

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    I have been thinking about going back on metformin for some time. I was very keen to come off metformin, and I did that as soon as my HbA1c had dropped well below diabetic range. I agree with @bulkbiker that taking unnecessary medications is not prudent.
    However, it turns out I am very responsive to proteins and put on weight very fast if I eat too much (I allow about 80g per day). My gluconeogenesis obviously works really well and metformin slows that down, as seen by the very good response when I first took metformin before I started on keto. Getting off medication was one of my main drivers.
    It is all a very fine balance, and keeping my carbs and proteins very low can be rather restrictive.
     
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  12. Brunneria

    Brunneria Other · Moderator
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    Hi,

    The HbA1c is to measure blood glucose, not heart issues.
    BUT people with high insulin (aka insulinaemia) often also develop type 2 diabetes and metabolic syndrome, and heart issues are an increased risk too.

    The problem with linking HbA1c directly to heart risk is that people can have beautifully low HbA1cs yet have high insulin levels, with all the attendent knock on health effects except for high blood glucose. Sad but true.

    I can give you specific references on this if you like (i will have to dig them out), but they will basically be about Kraft’s study on insulin resistance and links to heart disease, and Ivor Cummins lectures on hyperinsulinaemia ‘the elephant in the room’.

    I completely agree with you that keeping insulin levels low by controlling blood glucose and minimising spikes, is a priority.

    Well done on that CAC score! No small achievement.
     
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  13. Rachox

    Rachox Type 2 (in remission!) · Moderator
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    Hi FSnow, I’m currently taking Metformin and plan to carry on with it. I did reduce the dose by one tablet last autumn but my weight loss stalled and I still have more to lose, so I went back up to my original dose. Whilst on the lower dose my blood sugars went up by only around 0.5mmol/l. I am lucky that I don’t suffer side effects. It sounds like you have done your homework about Metformin but here’s an article extolling it’s benefits which you might find interesting.
    https://www.lifeextension.com/magazine/2001/9/report_metformin/Page-01
     
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  14. AloeSvea

    AloeSvea Type 2 · Well-Known Member

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    @FSnow, I think your question is a really good question. I still ask myself the same question four and a half years after my own diagnosis, and I still don't have a definitive answer!

    The pros and the cons come out to look pretty even to me in the 'to take metformin or not to take metformin' question. (In the context of going low-carb of course! For me low-carbing is the default position... ie is "of course".) Because in my life previously I have leaned on the side of not going the trad medical route I have gone to the side of not medicating. A deep suspicion of pharmacology I have not been able to shake. (Thalidomide, HRT, statins... these are what I think of when having this discussion with myself.)

    But metformin has a great safety record, and it gets a pretty good result. Not as good as going low-carb, is my understanding, but still - it can lower your HBA1c by enough digits (or percentage points if going USA) to make it worthwhile. And definitely if you are reading Jenny Ruhl, and want to be part of the 5.0-club for better health with diabetes. (Hers is the most compelling argument that I have read, and the one I really consider when pondering on your question.) I think she has this great image of our cells bathing in a toxic glucose bath, or was that someone else? But an image that can spur one to the metformin bottle for sure! (IUnless digestive side effects and possible nutritional deficiencies drive you to close the bottle again?)

    And, But, again, the ACCORD study et al seems to be saying, if I have understood correctly, that getting your BG down as low as it can go with pharmaceuticals, at a certain level at least - I think the American figure is below 7.0%? Or maybe 6.5%? (Please anyone jump in and correct me if I am wrong, as I am operating on memory here) does not actually save you from a too early death from cardiovascular disease and so on - a big issue for us with blood glucose dysregulation and high insulin levels etc etc.

    Pros and cons, pros and cons.

    I have probably not helped you at all, and I am sorry for this. But I thought that by sharing with you my own ponderings on this issue might help you on your own path to better health. Make the decision making clearer at least? To know what is on the pros side, and what on the con. And you can look at your own balance sheet to help you make the decision.
     
  15. FSnow

    FSnow · Newbie

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  16. Rachox

    Rachox Type 2 (in remission!) · Moderator
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    I am on 1500mg per day, my ultimate goal is to drop down to 1000mg (that’s what I trialled last autumn), and yes it’s in line with Jenny Ruhl’s suggestion.
     
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