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Nausea - due to HF / Metformin

Alexandra100

Well-Known Member
Messages
3,794
Location
West Yorkshire
Type of diabetes
Prediabetes
Treatment type
Tablets (oral)
I am currently trying to control my bg by LCHF and recently started 500mg Metformin daily. I have been aware for a while of feeling a little nauseous from time to time, but this morning it is bad enough to be disabling. I'm worried my body isn't tolerating HF, but as I am eating under 20g carbs daily and am underweight I don't see any alternative if I am to continue LC. First thing this morning my fasting bg was 4.8. I immediately consumed some cheese, 10g brazil nuts and a large mug of tea with cream (my usual breakfast) as when my bg is low it tends to rise if I fast. Now I feel as if I would never want to eat again. Going back to the balanced Mediterranean style diet I was eating before is not an option, as my bg levels were rising year on year and I had various symptoms which have abated since I started LCHF.
 
Is this due to the fats or to the Metformin? If it is the fats then try losing the cheese first thing in the morning. If it is the Metformin this nausea may pass in a few days or it may not. Some people cannot tolerate how they react to the drug and have to discontinue use.
 
Heya @Alexandra100 - sounds miserable: I'm sending you much love.

How long have you been LCHF? And how long have you been under 20g carbs? Are you eating enough protein alongside your fat (too much could drop you out of Keto). It could be a simple case of having dropped too much too fast and your body isn't tolerating a drastic and sudden shift in diet.

If you've been on it a while, try increasing your salt intake and drinking lots of water before you go to sleep in the evening (as opposed to in the morning as soon as you wake up). Also, maybe, you (delicious sounding) breakfast is just a little too much for your empty stomach to cope with, so have a little pre-breakfast, just to get it rolling before you fill it up with an entire meal. A few nuts and a bit more water or something else that's simple could help to wake your stomach up gently and, thus, avoid your nausea.

But, as @Guzzler has noted, too, it could well be the Metformin - it's fairly common for people to find it intolerable and most of the complaints (that I've read) are gastric symptoms. If you were eating the way you are now, with 20g / carbs and the timings and amounts you've described without issue before you started the Metformin, it might be worth having a chat with your prescribing GP / DN: Metformin has lots of different guises and types, dosages and whatnot, and it could be that you are able to identify a new version of the drug that allows you to reap the same benefits without the horrendous nausea: perhaps a slow-release, or splitting your dose so you take it twice a day... I don't know what your regime is, but there's certainly room to try other ways.

All in all, it's miserable and I fully sympathise. It's difficult to identify what could be causing it, but we can all relate to the misery your symptoms cause (and how they make sticking to your guns and keeping going increasingly challenging).

Keep posting, keep complaining, keep asking questions and looking to this lovely community for support: it's what it's here for.

Sock xx
 
SockFiddler & Guzzler, thanks very much for your replies & encouragement. As regards breakfast, I have to eat something first thing, especially when my fasting bg is low, as fasting tends to spike me. Most people here advise against eating many carbs for breakfast. Cheese & 10g brazil nuts are my solution to that problem. I am calling this breakfast, because it literally breaks my fast, but it is not really a meal, more the pre-breakfast SockFiddler suggests. But yes, maybe I could experiment with eating just the nuts. I don't yet know if that would be enough to avoid spiking.

My first proper meal of the two I eat later in the day usually happens about midday. When, as I have, one eliminates almost an entire food group (carbs) from one's diet, and one needs to gain rather than lose weight, that food group has to be replaced by protein and / or fat. I have slightly raised the protein in my diet and greatly raised the fat. I'm wondering if my body will tolerate this. I can't say exactly without going back over my records, but I have been eating under 20g carbs for some weeks. I arrived at this level gradually, reducing and reducing until I arrived at what I consider my irreducible minimum, which allows me to eat 100g low carb vegetables at each of 2 meals, cream in cups of tea and coffee and a few nuts. Cheese is my goto snack and I can't think of anything equally portable, almost no carb and ready without cooking.

I have only been taking the Metformin abut 2 weeks. (500mg which at present I am taking with lunch, as my "breakfast" is so low carb it doesn't need it as much as my other meals.) It was my wish to take it, as even <20g carbs does not give me the bg levels I'd like. My GP took some persuading, as in her eyes my bg levels are fine, so at this stage I don't want to discourage her from continuing to prescribe it. I'll wait and see.

Thanks again to you lovely members of a lovely community! As of now (after 11am) I'm feeling a lot better and am about to embark on lunch.
 
Can I ask a few questions.. you say that you get a FBG of 4.8 which is great but then you say you spike if you don't eat? Spike to what?
Have you tried just the tea with cream for b/fast with no food then eating more at lunch and dinner?
Why do you want metformin? It can cause the symptoms you describe so I would stop it for a couple of weeks and see if the nausea goes away. If it does then you know what the cause was, if not then resume taking it.
 
And excellent alternative to cheese as a snack could be a Peperami (they don't need to live in the fridge, either, so I keep some in my bag), especially as protein will bring your BG up, though at a much slower and steadier rate than something carby. Nuts are great, eggs, too - a boiled egg or an omelette with some ham could be a good alternative, perhaps?
 
Apart from the usual bowel problems metformin gave me nausea and headaches. I persevered as I was told it would wear off but after 11 weeks I still felt awful. I literally gagged as I was taking my morning pill.. I just spit it out and threw the lot in the bin.
I'm not suggesting you do this but it might be worth a chat with your GP, the slow release might work better for you.
 
I persevered with Metformin for about five weeks, but felt so ill I just stopped taking it - what a relief that was.
I suspect that Metformin is regarded as benign because most of the ill effects are never recorded - no mention of all the aches and pains, incontinence and internal distress was put into my notes and I had to explain three times before a record was made and the urging to resume stopped.
 
I am not saying it is Metformin, but nausea is certainly a common side effect, and after 2 weeks it will have built up in your system. On the other hand, it could be anything at all. I know that isn't very helpful, but it's all I can offer.
 
I get nauseous if I go above around 90-100g fat for more than a day or two. I eat 30-50g carbs daily.
Im not on metformin
 
SockFiddler said:
Yep! But I'm LCHF and you're trying to gain weight - fat's the macronutrient du jour!

https://www.peperami.tv
Click to expand...
I fear we are going round in circles here. I thought the suggestion was that I should eat less fat especially for breakfast, as too much fat may be causing my nausea, and that peperami might therefore be a good swap for my current cheese intake. But if peperami is fattier than cheese, I'd rather stay with the cheese. I do understand the theory of LCHF and I have been practising it, but if it is going to make me feel sick I'll have to modify it in some way. I'm thinking that if Metformin is improving my capacity to cope with carbs, maybe I can eat just a few more, and a few more grams of fat.
 

If you want to knock your fat intake down a bit but not lose weight, then why not increase your protein? Lean meat for example. I doubt very much that the Metformin is helping a great deal at your low dose and with your already lowish levels. It may help with reducing liver dumps a little bit, and a tiny bit with insulin resistance if you have that, but it doesn't help very much at all with post meal levels, so is unlikely to help with your capacity to cope with carbs. It seems counter intuitive to me for someone trying to gain weight because it can be an appetite suppressant.
 
Thanks very much for your interest. I want Metformin because I have reduced my carbs to <20 daily, which IMO makes a balanced diet very difficult / impossible. And my bg is still not stellar. My FBG is by no means always 4.8. Jenny Ruhl suggests that in this situation, Metformin is the next step to take.

I want to have more than just tea and cream first thing partly because I need to gain some weight and reducing my meals effectively to just two will not help with that. I don't think it is a good idea to make my meals bigger, as I think that will lead to higher post prandial bgs, and also I don't want to force down food when I feel pogged. I am just hoping the symptoms are not due to Metformin, though I realise they may be. As I understand it, it takes abut a week for Metformin to start working and I have only been taking it for two, I'd like to give it a chance to settle down. So I think I'll start on the assumption that I have been over doing the fat, reduce that a little, and relax just a bit on the carb restriction in an attempt to replace the lost calories from fat. Then I'll see if (a) I start losing weight and (b) I start to feel less sickly. I can always abandon Metformin at a later stage.

My main problem with my bg is that pretty much regardless of the pre-prandial reading it tends to go up to over 6, sometimes as high as 6.8 after a low carb meal and then stay there . Since taking Metformin I think this has improved, but it's early days. The picture is confused by the fact that I suffer from delayed stomach emptying, so that sometimes the maximum rise comes at 2, 3 or even 4 hours.
 
Peperami for breakfast?

Does anyone keep that down?

Scrambled egg maybe?
 
jcbman said:
Peperami for breakfast?

Does anyone keep that down?

Scrambled egg maybe?
Click to expand...
What I am calling "breakfast" has to be suitable to be left in the bathroom overnight, so I can eat something instantly after my meter reading if that should come out low. Actually, cold scrambled eggs can be rather nice - I'll think about that!
 
Alexandra100 said:
What I am calling "breakfast" has to be suitable to be left in the bathroom overnight, so I can eat something instantly after my meter reading if that should come out low. Actually, cold scrambled eggs can be rather nice - I'll think about that!
Click to expand...

Why?

What's a number on a machine mean?

I eat when I'm hungry
 
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