Metformin

[witsum]

Hi
I am a newbie to this forum and would like some advice. I was diagnosed with Pre-Diabetes (IGT) last October and my GP advised that I should just continue with my already healthy eating and active lifestyle and my blood sugar levels would be monitored regularly with a further GTT in October-he stated that I did not need any medical intervention until such time as I was diagnosed with full blown diabetes, which hopefully I will be able to resisit for a good while yet.
However, I saw an endocrinologist the other day about unexplained weight gain/query Under Active Thyroid and the first thing he said is that he will be writing to my GP to tell him to put me on Metformin but I don't yet have diabetes so don't understand why he wants me on Metformin.
Hope you can clarify this for me.
Many thanks

 

[sugarless sue]

Hi Witsum and welcome to the forum.Did the endocrinologist do any blood tests? Did he say anything about blood sugars?

 

[witsum]

Hi Sue
Thanks for your prompt response
I have got to have a batch of blood tests for the problems I saw the endo for, but he hasn't included blood sugar levels, and to be honest, he never even asked what my levels were after the GTT!
I do test my levels intermittently with a home kit and the readings 2 hours after food are averaging 6.1-6.5 so don't think they are excessive.
I am reluctant to start taking tablets for a condition which I don't actually have yet!

 

[sugarless sue]

You don't have PCOS do you?( Poly cystic ovary disease)Sometimes metformin is used to help with this.

 

[witsum]

Sue
No, my age precludes PCOS-I'm 56!
The endo is considering the possibility of Cushings Syndrome-a disorder of the adrenal/pituitary glands.
When I told him about pre-diabetes and that I wasn't on medication he said that a study in the US where IGT patients were given Metaformin or a placebo, the patients taking Metaformin showed much reduced incidence of going on to develop full diabetes than those on the placebo so he obviously thinks that all IGT patients should go on to Metaformin!!

 

[sugarless sue]

Metformin will bring your Hba1c down by about 1.5 % so in that respect,if you are pre diabetic it may save you from developing 'full blown' diabetes.I would go back and discuss this with him again and say that you did not quite understand what he was saying.

 

[Trinkwasser]

Metformin is useful in reducing insulin resistance especially alongside exercise and this is certainly a way of slowing the "diabetic progression"

Another way is not to bombard your body with excessive carbs and thus not needing to force your pancreas to generate excessive amounts of insulin to deal with them.

If your "healthy" diet is the standard high carb low fat offering, then this would be a useful thing to modify.

Good to hear you are being worked up for other endocrine malfunctions, they often seem to travel in gangs and can each make the other worse.

 

[markd]

When diagnosed, I was just over the edge from pre-diabetes into diabetes territory.

My doc started me on Metformin straight away telling me that this was the best route (plus exercise and weightloss - achieved by low-carb) to preserve whatever beta-cell function I have left in my pancreas, since gluco-toxicity may have suppressed their action, but not killed them all off yet.

This would imply that insulin resistance, rather than insulin production was the bigger factor in my elevated BG readings. Now Metformin treats (among other things) insulin resistance, so...

A year on and he seems to have been proved right, I'm down to only one Met per day and my fasting readings for the last 7 days are:

4.4, 4.4, 4.1, 4.4, 4.6, 4.2, 4.4

Post-prandial readings are pretty good too, being always in the desired 'non-diabetic' normal range.

I probably *could* go off the Met now, but I find the idea of retaining as much beta-cell function as possible in the long term very appealing.

I did have quite a bit of gutrot with the Met initially, but now tolerate it extremely well - there seems no real reason *not* to take it.

 

[hanadr]

Hi Witsum
Reducing your intake of carbs is a perfectly safe, benign way to reduce the stress on your pancreas.
there is nometabolic requirement for carbohydrate in the diet, so you could cutt to zero without doing yourself any harm, however you could probably get away with a less stringent cchange in diet.
At the same time, you may be interested to learn that the Food Standard Agency's Healthy Eating plate model, is VERY likely to tip you into diabetes.

 

[Dennis]

Because nearly all of us on the forum are already diabetic we tend to think of metformin as only a diabetes treatment, but it is also often used in pre-diabetes to prevent insulin resistance and reduce the risk of pre-diabetes developing into full-blown diabetes.

 

[Trinkwasser]

I did have quite a bit of gutrot with the Met initially, but now tolerate it extremely well - there seems no real reason *not* to take it.

I was technically just *under* the threshold so it was never offered. Really it's a judgement call, it seems to offer some cardioprotective benefits which may make it worth continuing. OTOH some people who have discontinued it found symptoms they didn't realise were related went away.

 

[witsum]

Hi
Have not logged on for a few days so apologies for not responding to last few replies which gave such useful info.
I went to have the blood tests for the query underactive thyroid and told the practice nurse about the endo's recommendations to start on Metformin and she said the GP would be very reluctant to put me on the tablets until I am actually diagnosed with full blown diabetes. She stated that the Metformin would regulate my blood sugar levels to such an extent that it would mask diabetes when I eventually develop it!
I am going to wait till the endo sends the letter and then discuss it with the GP but I am not due to see the endo again for 3 months unless blood tests throw up some positives so to be honest I feel as if I am stuck in the middle if the GP and endo have conflicting views.
I'll keep you posted!
Hanadra-I agree with you about the 'FSA healthy plate' and my GP practice diet sheet given to me is also strongly biased towards carbohydrates! Iv'e also found that many low fat options are loaded with sugar!

 

[Katharine]

Witsum,

I'm a doctor and I prescribe metformin to my pre-diabetics. If they can't tolerate it, the nick name is "Metfartin" then I don't push it. The reasons I prescribe it are:

1. Proven improvement in cardiovascular mortality.
2. Reduces insulin resistance and blood pressure.
3. Improves hbaic.
4. Pre-diabetics can get diabetes complications too. 10% of them have diabetic complications at diagnosis.

I have one pre-diabetic patient who has:
diabetic retinopathy
carpal tunnel syndrome
cataracts
has had a heart attack
stiff tendons around the neck and shoulders
high blood pressure

I think your endocrinologist is ahead of the game here. Give him a cuddle from me.

 

[witsum]

Katharine
Thanks for that-it certainly puts things into perspective for me and highlights the advantages of taking Metformin!

 

[Katharine]

It does. Your brain is persuaded, but what about your gut?

(If regular metformin is no good, do ask for the long acting formulation.)

 

[Trinkwasser]

Listen to Katharine!

Also listen to your endo!

Ignore the nurse and GP since they are determined to leave you *until* you have become diabetic before doing anything. This Is Not A Good Plan!

(It doesn't even save that much money, metformin is relatively cheap)

 

[markd]

I'm a doctor and I prescribe metformin to my pre-diabetics. If they can't tolerate it, the nick name is "Metfartin" then I don't push it. The reasons I prescribe it are:

2. Reduces insulin resistance and blood pressure.
3. Improves hbaic.

My GP is also an early-Metformin prescriber as I mentioned in an earlier comment.

As of today, my BP has come down from approaching 160/90 18 months ago to 138/78 at last test, and fasting BG is now in the middle 4s (with HBA1C well down too, just under 5 and good post-prandials as well) - but I've also lost 90 pounds in weight, bringing my BMI down from 36 to a fraction under 25.

I read, however, that Metformin has its greatest effect on more obese diabetic patients and is much lower on those of 'normal' weight. One paper reported that those with a BMI of less than 25 only see a 0.5mmol/L drop in their fasting BG, compared to around 1.5 or more for obese patients.

I'm not due to see my GP for almost 6 months now; initially, I had set myself a goal of getting off the Metformin completely, but the more papers I read (and comments like yours) I feel that a maintenance dose that no longer causes side-effects may be the best way to stay.

Especially true if Met helps prevent weight gain, as some other papers claim.

Mark

 

[hairlessone]

How long does it take for Metofmin to start to work? I have been on it for 2 1/2 weeks and have not seen any reduction in my levels

 

[Trinkwasser]

How long does it take for Metofmin to start to work? I have been on it for 2 1/2 weeks and have not seen any reduction in my levels

What dose are you on? Typically metformin is started at a minimal dose and the increased slowly to avoid "gastric distress", for many people it doesn't do a lot until they have racked it up into the 1500 - 2500 mg range.

I'd return to my doctor and see if they will increase the dose.

 

[hairlessone]

I am on 850mg twice a day. Possible side effects so far; nausea (almost sickness!) stomach cramps/upset stomach - although the side effects are not as bad as they were the first week. I am due to see the doctor at the end of next week after being on them a month. Tonight I have a really bad headache