Type 1 Metformin/ Glucophage Usage

[cyrryan]

Hi all,
I am type 1 diabetic on Novorapid/Levimir 3 & 2 daily. I also take Metformin. I had been on 500 mg x2 daily for several years. Recently my hospital doctor increased Metformin to 2000 mg daily. I got a very upset stomach, cramping and pain with nausea. I reported to clinic at hospital and the nurse reduced it to 850 mg twice daily. I still felt very ill. The nurse has further reduced it to original 500mg twice daily I don't understand why the doctor made such a significant change to my treatment. On the 500mg I don't have the sickness or nausea but I feel very tired mostly if I take a cycle or long walk. I have suggested to doctor that maybe I should come off it totally but this was frowned upon as the diabetes clinic recommends it to all diabetics. It is used by 90% of patients at the clinic. Hope someone can advice me here. Why can't insulin be increased only plus some exercise? I have had diabetes for over 20 years and have a lot of experiences with it. I know my BM's are not perfect and my HBA1 C is not great either maybe these are the reasons..
Hope someone can advice??
C

 

[GrantGam]

I've read articles over the past few months regarding the possible positive effects of Metformin on type 1 diabetes. Although I thought these were only speculative as I was under the impression Metformin for type 1 diabetics was not regular practice.

I've never heard from a type 1 diabetic who has been prescribed Metformin though... Correctly administered quantities of insulin should be enough by itself.

Is there something different about your diabetes such as high insulin resistance?

Grant

 

[cyrryan]

Hi Grant,
Thanks for response. There could be a reason in that I don't exercise a lot. It could be high insulin resistance. My hospital recommends Metformin as it helps insulin work better. Correctly administered quantities of insulin is fine, but my bm's are up and down. The pattern is not stable as I have highs and lows. Alternating dose gives a rebound and then it becomes an unpleasant circle. Getting the balance between insulin, diet and exercise is a concern for me! I am unable to crack it...

 

[GrantGam]

You don't need to rub marathons or the like though. A half hour walk a night would be a good place to start.

I'd go for some basal testing to adjust your background insulin so it's working as it should. Most T1D's will tell you that although successful diabetes management is tough, it's achievable. And the majority of us don't use Metformin for this.

What's your HbA1c if you don't mind?

Also, what is your insulin to carbohydrate ratio and is it working?

Grant

 

[cyrryan]

You don't need to rub marathons or the like though. A half hour walk a night would be a good place to start.

I'd go for some basal testing to adjust your background insulin so it's working as it should. Most T1D's will tell you that although successful diabetes management is tough, it's achievable. And the majority of us don't use Metformin for this.

What's your HbA1c if you don't mind?

Also, what is your insulin to carbohydrate ratio and is it working?



Grant

Hi Grant,
Thanks for response. There could be a reason in that I don't exercise a lot. It could be high insulin resistance. My hospital recommends Metformin as it helps insulin work better. Correctly administered quantities of insulin is fine, but my bm's are up and down. The pattern is not stable as I have highs and lows. Alternating dose gives a rebound and then it becomes an unpleasant circle. Getting the balance between insulin, diet and exercise is a concern for me! I am unable to crack it...

You don't need to rub marathons or the like though. A half hour walk a night would be a good place to start.

I'd go for some basal testing to adjust your background insulin so it's working as it should. Most T1D's will tell you that although successful diabetes management is tough, it's achievable. And the majority of us don't use Metformin for this.

What's your HbA1c if you don't mind?

Also, what is your insulin to carbohydrate ratio and is it working?

Grant

Hi Grant,
Can you explain what you mean adjusting background insulin? I am on Levimer twice daily along with Novorapid 3 times daily! Yes I agree walking is good, I like cycling better. My HBA1 C was 9.0 on last occasion. I have not been offered the DAFNE program so I can't comment on carbs or ratio. I am on waiting list for 2 years but still waiting. Is the DAFNE worth completing?

 

[catapillar]

Background insulin is your levemir. That's your long acting basal insulin. The job of the basal insulin is to keep your blood sugar flat when you don't have any fast acting insulin in play, you aren't taking in any carbohydrates and you aren't doing any unusual exercise.

Here's some info on basal testing - https://mysugr.com/basal-rate-testing/

It does strike me as unusual to hear 90% of patients at your diabetic clinic are on metformin, unless that includes all the type 2 patients too.

It's not that unusual for a type 1 to be on metformin, but it's certainly not the default position. Reasons a type 1 might be on metformin include: insulin resistance; dawn phenomenon; type 1 ladies with PCOS wanting to get pregnant.

It does sound like DAFNE would be worth completing for you - it could help you understand how the basal bolus regime works and then, hopefully, how to make it work for you.

As a starting point, there is a free carb counting course available online - http://www.bdec-e-learning.com

 

[cyrryan]

Background insulin is your levemir. That's your long acting basal insulin. The job of the basal insulin is to keep your blood sugar flat when you don't have any fast acting insulin in play, you aren't taking in any carbohydrates and you aren't doing any unusual exercise.

Here's some info on basal testing - https://mysugr.com/basal-rate-testing/

It does strike me as unusual to hear 90% of patients at your diabetic clinic are on metformin, unless that includes all the type 2 patients too.

It's not that unusual for a type 1 to be on metformin, but it's certainly not the default position. Reasons a type 1 might be on metformin include: insulin resistance; dawn phenomenon; type 1 ladies with PCOS wanting to get pregnant.

It does sound like DAFNE would be worth completing for you - it could help you understand how the basal bolus regime works and then, hopefully, how to make it work for you.

As a starting point, there is a free carb counting course available online - http://www.bdec-e-learning.com

Many thanks Catapillar for info..