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My insulin is not working.

Discussion in 'Type 1 Diabetes' started by Catsymoo, Apr 28, 2018.

  1. EllieM

    EllieM Type 1 · Well-Known Member

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    I guess it depends if you're insulin resistant? No real reason why T1s can't become insulin resistant if they're genetically prone to T2 so I'm assuming we can take metformin for the same reason T2s do.... Do you reckon you're insulin resistant at all? (eg waist measurement more than half your height, T2s in family?)

    Mind you, I wouldn't have thought that one 500mg tablet of metformin would do much for anyone, T2/T1 or not....
     
  2. Juicyj

    Juicyj Type 1 · Moderator
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    Hi @Catsymoo Just another thought..

    You ate eggs yesterday - still went high, did you bolus for the eggs ? They are about 6g of protein each, but due to the fact you are eating low carb you body will need to get energy in the absence of carbs and convert this protein to glucose (Gluconeogenesis), which will of course raise your BG levels if you've haven't bolused for them.

    I would suggest following a daily chart such as the one @donnellysdogs uses, seeing a daily chart of bolus/carbs/BG results will help understand patterns and will enable your DSN to make more information decisions about what work needs to be done.
     
  3. Celsus

    Celsus Type 1 · Well-Known Member

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    Suggest you read The Lancet, Volume 5, No. 8, p567–569, August 2017...

    "Fun thing" to observe is that Metformin is not to be taken by Diabetes Type1 patients taking insulin.
    That is listed in its guidelines for market approval and counter indicator for its prescription/use across many countries.
    Yes, I might now receive yet again a truckload of pushbacks from all out there who think its the greatest thing on earth... But reality is that the docs prescribing this to a Type1 is not following the medical guidelines and counter-indicators for this drug and its usage (in some countries!). And there are good reasons for why they are as they are. (Anyone wanting to go hypo overnight with no glucose left in your liver???)

    I totally get why Metformin works well for type2s. Especially for those that then doesn't need to take insulin.

    Personally I would never want to take more drugs at the same time than absolute necessary due to undesirable side-effects by combination of two or more pharma components. As a type 1 on insulin then Metformin is highly questionable even for low-insulin sensitive patients due to the simple facts of its channels of efficacy: Metformin decreases your hepatic glucose production, decreases the intestinal absorption of carbs you eat and improves insulin sensitivity by increasing peripheral glucose uptake and utilization. Just that it inhibits the hepatic glucose production is directly dangerous for a type1 in case we go hypo, as the natural gluconeogenesis process (the formation of glucose primarily from lactate and amino acids) is severely limited. Result being your body's ability to counter a hypo is challenged.

    Next to this, depending on your metformin level in your system (which varies no matter how stable you take your drug) then depending on your intestines' ability to absorb the drug on any given day, your insulin will be more or less efficient to support the glucose metabolism. => ie. endless variation in how many units you need of fast acting insulin to counter eating 10 grams of carbs.

    As type1 life wasn't hard enough already.
    Anybody up for some Russian roulette?
    <going to make some tasty popcorns>
     
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  4. Celsus

    Celsus Type 1 · Well-Known Member

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    OK Catsymoo, though you have my sympathy, drinking a high-sugar coffee with 15g of fast acting carbs for breakfast is not really very serious...

    Neither for your Type1 diabetes (no simple sugars in large quantities please) or your trouble with GERD and acid in your stomach (no coffee please)... Sometimes I start to think if you are just trolling us on this forum??? ;)

    Anyway, back to your Metformin and its well known and frequent side-effects. As with any drug slowing down digestion then the most common side-effects are:
    1. Acid or sour stomach
    2. belching
    3. bloated
    4. excess air or gas in the stomach or intestines
    5. full feeling
    6. heartburn
    7. indigestion
    8. loss of appetite
    9. metallic taste in the mouth
    10. passing of gas
    11. stomachache
    12. stomach upset or pain
    13. vomiting
    14. weight loss
    So yeah, GERD is a top of the list especially for diabetics with some level of neuropathy.
     
  5. NicoleC1971

    NicoleC1971 Type 1 · Well-Known Member

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    Have been offered metformin as a type 1 (age 47 and not hugely large or taking large doses) but am naturally reluctant and do not believe I am insulin resistant (taking about 24 units of the stauff a day via a pump ). My glucagon response seems very random already as is to be expected for a type 1. I feel as if because it might prevent cancer the consultants clearly see no harm in offering it Thanks for the background on why it may not be a good idea and lead to further unpredictability.
     
  6. karen8967

    karen8967 Type 1 · Expert

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    hi catsymoo im on metformin of a morning and of an evening with my insulin and i find if i forget to take it my numbers rise considerably throughout the day and i find it hard to get bk in range dsn told me that the metformin helps the insulin as it acts like a key to let the insulin in as im very insulin sensitve hope this helps x
     
  7. Celsus

    Celsus Type 1 · Well-Known Member

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    I had come across some more descriptive and concluding research on Metformin usage by Diabetes Type1 patients in PubMed and MedScape, and here I found a source that is open to public forum:
    http://www.endocrinologynetwork.com/diabetes/adjuvant-metformin-type-1-diabetes

    And I quote:
    ---
    Adjunctive metformin may have small short-term benefits, but it provides no added benefit during 10-year follow-up, according to a study published online in Diabetes, Obesity and Metabolism.

    The study is the first retrospective, long-term analysis of metformin as adjuvant therapy to insulin in type 1 diabetes mellitus (T1DM).

    “We conclude that metformin is not associated with long-term beneficial effects on BMI, HbA1c or daily insulin dose when added as adjunct therapy to intensive insulin therapy in T1DM patients,”
    ---
    So the question remain: Then why take Metformin as a type1?
     
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  8. Catsymoo

    Catsymoo Type 1 · Well-Known Member

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    My stomach problems are not triggered by GERD trigger foods. I avoided all those foods for a while and it made no difference whatsoever. I've had days where I've eaten spicy stuff, coffee, cocoa, acidic fruits and nothing. When the reflux flares up I find even almond milk and fish and alkaline foods give me reflux. The only connections I can find out so far are alcohol and Metformin.

    Please let me explain the coffee. It was exactly 15g and I used it to test my bolus. Normally in the past I've had the same coffee and don't usually need to even bolus for it. My background insulin can usually cover up to 20g of carbs fast or slow without much rise and my nurse told me this when I was put on Lantus.

    Now, I think that's the problem. I've woken up at 9.2 today and I haven't eaten anything in 10 hours and I only had a boiled egg and was at 7 when I tested before bed, down from 13 most of the night. If basal is off everything else goes off too right? My sugars are much better but still running too high and the only reason they aren't going into the 20s is because I'm borderline starving myself and eating small portions and low carb. It's not healthy but it feels better than hitting high teens and 20s and feeling sick and angry for hours.

    One time this morning I even correction dosed 4 units at 13, tested blood sugar 3-5 hours later.. still at 13. I bolused 1 unit after that and I went down to 9 and then 7.2 but it took a good few hours and no food.

    I tried Metformin again yesterday and had loose movements a few hours later so I won't be doing that again.
     
  9. 8bitkitty

    8bitkitty Type 1 · Member

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    Hello this happened with me!
    It turned out that my PCOS was causing me to have become resistant to insulin!
    It was so frustrating because I was injecting huge amounts of novorapid and it rarely came down from the 20s
    Cut a long story short I ended up with DKA in November and they realised when they put me on the sliding scales that I wasn’t coming down much, so I suggested that I may need metformin (I did some research!)
    If metformin was causing you to have a bad stomach, you can ask to go on the modified metformin which doesn’t affect the stomach as much. That’s what I had to do!
    Anyway my current HBA1c from a couple of weeks ago is now 54! I’m so happy! You can thank the freestyle libre for that! Been on it for about two months and my HBA1C has come shooting down! So expensive but so worth it.
    The only thing getting me down is all the weight I’ve put on since they increased my insulin! Put on about a stone in 2 months! I’m on a set amount of 12-14 units of novorapid before each meal and 32 units of levermir in the morning, 28 at night! Taking two 500mg of modified metformin with breakfast and one 500mg with evening meal. I’m having quite a lot of hypos now (since they changed my metformin to the modified one a couple of weeks ago) and especially in my sleep...
    I’ve got my DAFNE course in a couple of weeks so I’m hoping that’ll sort me out! Also think I might have to start slimming world once I learn my ratio and how to carb count.
    Good luck @Catsymoo
     
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  10. EllieM

    EllieM Type 1 · Well-Known Member

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    The metformin not for T1s is interesting.
    I was recently on a double blind 3 year study to see whether metformin would help T1s (particularly eyes and arteries) and was never told that hypos might be an issue. I'm generally quite willing to do medical trials if they're of the low risk kind (eg extra eye tests during pregnancy), as I've got a lot to be grateful to the medical profession before (eg being alive). No idea whether I was on the drug or not but control and weight control seemed slightly easier then (probably because I had 8 months of libre use before I developed an allergy), but my GP was totally willing to prescribe metformin when I mentioned it, even enthusiastic. (I said I'd get back to her when I found out if I was on metformin rather than a placebo, but still don't know that.) Not so keen now.
     
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  11. 8bitkitty

    8bitkitty Type 1 · Member

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    I only think I’m getting hypos now with metformin because I’m on such a high dose of insulin and I’m finally getting less resistant to insulin now thanks to metformin making me more sensitive!
     
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  12. Catsymoo

    Catsymoo Type 1 · Well-Known Member

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    Can I start by saying I LOVE your makeup and you look so gorge! (fellow makeup junkie here)

    They said no to a libre with me, I only wanted to borrow one to get my confidence back and fear of hypos gone! I also gained so much weight since being on insulin but my nurse said it's rubbish and had that look in her eye like I'm just a fatty who eats badly when I don't at all. I'm one of those pretentious people that drinks kale smoothies with no fruit and eats avocado on rye bread with chia seeds and puts wheatgrass powder in everything. Our cupboards are full of health foods - all mine, my boyfriend eats rubbish. I really am neurotic about my health and what I eat. The only bad things I have are Pepsi Max to curb sugar cravings, and chocolate, but I try to stick to dark chocolate. I love to find ways to make healthy chocolate stuff, like fudge out of coconut oil and cocoa powder and sweeten with honey. :D

    I find that when I'm ill for a week with a cold and have to increase insulin, I can gain up to half a stone even if I'm eating veggie soup! With my stomach problems the last 6 months and probably only eating half as much as I used to, even on weeks of bad flare ups/constant nausea where I was STARVING, I only lost 5lbs. Most other people in my state would be wasting away.

    I am pleased to say that I think I've discovered my problem. My basal and/or injection sites. I woke up earlier with a fasting of 9.2, I took my basal around 7pm, I injected a little higher and one unit more than yesterday (36 units) and went back to bed (I am a night owl), I've just woken up at 3.8. I am actually HAPPY to be low because it meant I can finally eat my half leftover sandwich and some digestives LOL. I don't mind hypos between 3 and 4 because I only tend to get hungry and slightly weak rather than a full on panic episode of sweats and nausea. Probably need to lower my basal tomorrow. 28-31 (usually 30) units has been a consistent Lantus dose for me unless I am really ill or was on steroids once.

    I will see how I go today, might go out for a walk in the morning. For years I've always rotated injection sites around my hips, thighs and sometimes the front of my tummy near my belly button. I only use 4mm needles and don't think that's the issue as I've never needed to pinch my skin but I might start doing it now to see if it helps.
     
  13. Catsymoo

    Catsymoo Type 1 · Well-Known Member

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    Just another update, I went up to 11 after treating my hypo. I injected extra bolus for half a sweet potato which was 16g of carbs... went up to 14. I injected more 4 units of bolus to correct and did a few sit ups. 3 hours later I am sitting at 16.7 again. I don't understand this at all and I'm in tears, I am afraid to eat. I just don't get this at all. I'm calling my DSN again today because I can't live like this. I thought it was my basal, I took extra yesterday and it dropped my sugars from 9.2 to 3.8 in 4 hours. I've been drinking water and green tea. I really don't know if it's my basal or bolus.
     
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  14. Celsus

    Celsus Type 1 · Well-Known Member

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    OK, I am lost now.... :wideyed:
     
  15. EllieM

    EllieM Type 1 · Well-Known Member

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    Oh that's just awful for you. Lots of virtual hugs. I can't believe they won't give you a libre just to get some confidence back. (Could you self fund - apparently some people can get them for 35 pounds? Maybe they could lend you a reader?)

    So, am just wondering what basal you're on? (My apologies if you've already said and I missed it). Maybe it's time to change the basal or even go on a pump???? Lantus seems to have a mixed rep at the moment....

    And anyone who doesn't appreciate why T1s have hypo anxiety should be forced to experience one themselves so that they understand just how serious hypos can be. (Grr, makes my blood boil to hear how unsympathetic and unhelpful your DSN is).
     
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  16. Catsymoo

    Catsymoo Type 1 · Well-Known Member

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    I've been reading about a pump the last hour or so keeping an eye on my sugars as they dropped suddenly at roughly 7am. My hypo anxiety is extreme, even if I see a drop from 16 to 11 like today, I start freaking out because right now I do not have any understanding of how my insulin is working. My legs start shaking and I get cold and nauseous. I have to do breathing exercises to calm down.

    I'm going to ask about a pump because it just seems like it would improve my life given I work shift work at all different times of day. I've had time off because of my diabetes recently and my boss isn't pleased even though I am fighting tooth and nail to get this under control. I feel like I'm falling apart.
     
  17. 8bitkitty

    8bitkitty Type 1 · Member

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    @Catsymoo That’s sweet! Thank you! I love makeup! If you have an Instagram you should follow and I’ll follow back! It’s @8bitkitty :)
    Yeah the libre isn’t on the NHS where I live (in Leicester) so my partner buys them for me! He said he doesn’t mind paying around £100 a month for me as it’s making me a lot better!
    Anyway sweetie you could try having the modified metformin as it may help you when your insulin doesn’t work very well?
    Bless you, I know how frustrated you must feel, I was the same and on the verge of giving up!
    Also about insulin and weight gain, it’s very true that it causes it but a lot of diabetic specialists deny this whenever I bring this up! I think they say it so people don’t abuse their condition by not injecting to lose weight.
    Keep me updated sweet!
    Eliana xx
     
  18. Catsymoo

    Catsymoo Type 1 · Well-Known Member

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    It's a drink I have all the time and don't need insulin for. So a familiar food that doesn't require bolus was a good thing to do an experiment with. Normally i can drink it and my levels stay stable while I'm at work. I bolused for it this time and was expecting to go hypo if I'm honest, as in the past 3 units would've been too much for it.
     
  19. Celsus

    Celsus Type 1 · Well-Known Member

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    A drink with 20 grams of simple fast carbs. And you don't need to bolus for it?
    As your basal insulin will cover for it (as your nurse told you when starting you on Lantus)?

    I am not saying its impossible to realize a stable and predictable bg level when taking carbs like that and utilizing rather non-conventional way of countering fast acting carbs with a glargine long-acting insulin. But you are definitely not making it easy for yourself, as you set yourself up to be on a non-stable platform that will need non-stop corrections with bolus and carbs to bring you through the day without going hypo or hyper.

    From your previous postings I can calculate that you typically (in best case scenario) would need to take:
    - 1 unit of fast acting bolus to metabolize 7 grams of carb.
    - 1 unit of fast acting to drive down your bg with approx. 1.4 mmol/L.
    And yeah, you would actually normally need to bolus 3 units to counter that 20g carb rich coffee...

    So without bolus for that heavily sugar loaded coffee, then your bg would spike up with approx. 4 mmol/L. (best case scenario)
    Don't know the volume of your coffees, but with 20g of carbs in it, it might be more sugar rich than full fat Coca-Cola! :)

    If you are challenged by going high all the time, then full fat Coca-Cola is normally not your best friend. :hungover:
    Just saying...
     
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  20. Fairygodmother

    Fairygodmother Type 1 · Well-Known Member

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    I agree with @Celsus. Lantus is a basal insulin. A basal deals with the body’s needs for energy so that all organs can function throughout each 24 hour period. It’s the base that’s required for energy to be transferred to everything we need to keep functioning.
    Bolus insulin is required to deal with carb that we eat and either store it or use it.
    I used Lantus for approximately 25 years and if my basal dose was correct then I knew that it would provide a base and at no time did I think that it would cover carb injested.
    There were insulins once that peaked at pre-set times for food but they’ve not been available for a few decades. Maybe your DSN was still caught up in the thinking that applied then.
     
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