Shall I ask my GP to reduce my Metformin?

My first post here, though I've been reading for a while.

I was diagnosed type2 last summer, fasting readings from 7.5 to 8.0 (routine pre-retirement medical, but I was OK a year ago)

Instead of just diet/exercise, my doc started me on Metformin immediately as well, saying some people respond better in the longer term like this.

I'm only(!) on 2 x 500mg per day, but even after 7 months, the side-effects of gas and general stomach troubles are still pretty bad.

i rang the practice nurse, to see if I could try an alternative drug, but she asked me to keep on with the stuff for a while to see if things settled down, as the GP says that Metformin has the least serious side-effects of any of the oral drugs.

I've got an appointment next weekand was wondering if I should ask to reduce the dose or even stop altogether, since my numbers are pretty good now.

Here are my morning fasting numbers for the last two weeks:

4.4, 4.8, 4.6, 3.9, 4.3, 5.2, 3.6, 4.9, 4.2, 4.0, 5.0, 4.4, 4.8, 4.4 (newest numbers first)

I really don't know why I had the two readings at 3.6 and 3.9 - only thing I can think of out of the ordinary is I had an extra glass or two of port (about my only indulgence) after supper the previous night.

And here are the numbers (three times per week, as recommended by the practice nurse) for two hours after a meal, some lunchtime, some evening.

5.1, 5.4, 5.5, 4.5, 4.7, 4.7 (oldest numbers first, don't know why I jotted them down like that, but I did).

Oh yes, I'm 59 and now only about 5Kg over weiight, having lost about 15. I've been leaving the car at home and cycling about 8 miles each way for work.

All advice gratefully received!

mark

Thanks, I'll remember to ask about that.

Is there a downside to SR version, is it less effective in any way, or just more expensive?

thanks.

I took readings at one, two and three hours after a meal (both lunch and dinner) and got 4.5 then 5.2 and then 4.5 again. (ist and second tries only varied by 0.1 at the peak and final)

Don't have any lipid values, GP said I was only marginally diabetic, so would only do those later if I failed to improve.

(probably trying to save on the budget?? ;-) )

Appointment is on Friday, so will see what response to Metformin SR request is (it looks to be a *lot* more expensive). Would it be likely to help if I broke the existing 500mg pills in half and spread them out over the day a bit more?

Have to say that the problem has been a bit less over the last week, but I've reduced my carbohydrates a bit, don't know if Metformin probs are particularly made worse by carb intake?

Well, my appointment with the GP was this morning.

Being a bit apprehensive generally about visiting doctors, when I woke up at 4am with a dry mouth (which occasionally happens) I did a test - 4.4 and it was 4.6 when I tested four hours later.

MY GP is generally happy with things as they are, has taken a sample for an HbA1c test, results in a few days I guess, BP is down a bit, still needs to fall a bit more - but then so does my weight.

He still wants me to stay on Metformin, but I can drop to only one 500mg tab with whichever is the bigger meal of the day (I generally eat only twice per day, an early brunch and relatively early dinner)

He says that Metformin SR is too expensive and only really prescribed to those that have intolerable side-effects, mine are not bad enough, apparently!

He said I'm not yet a success story, plans that I stay on Met for another 6 months, when he'll aim to suggest that I stop, then see him monthly for three months to evaluate how I get on.

Presumably the results of the blood he's just taken will effect this. He's pointed me at the US diabetes prevention study to read and told me to 'Go away and sin no more'....

Anyway, nowhere near as terrible as I'd feared when first diagnosed last year - then I was pretty **** depressed!

A point I forget to ask him - red peppers, tomatoes, melons and grapes (not all together...) good or bad for BG management?

hanadr said:

Try taking the Metformin in the middle of a meal. that's supposed to help. I wouldn't know from experience, it never upset me.

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Ah, good idea, I always take it immediately before the meal, will try that and see if it helps.

mark

Trinkwasser said:

So far soo good!

I'd avoid the grapes unless they are matured (in a bottle <G>) and personally I can't do melons but some can.

Red peppers are extra good, so are the other colours (bioflavinoids) and tomatoes (lycopene) see the Eat The Rainbow thread in the Food forum

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Thanks, I'll read up on thet thread - I do eat quite a lot of all three colors of peppers.

As to melon and grape, I often (as in 4 or 5 times a week) have one of my favorite M&S melon and grape 400g fruit salads after a meal.

I was wondering if I should ensure that I only have them with the single daily meal that I'll be taking Metformin with, if they are a bit naughty, BG-wise.

They don't seem to have done any damage to my BG readings so far, but once I've halved the Met, I want to make sure I'm not sabotaging my progress.

I've just ordered some test strips from a discount online vendor, since more did not seem to be forthcoming from the NHS - I still want to keep closer watch on things than the practice nurse seems to think is necessary.

mark

Buachaille said:

I take the same dose of Metformin and have no problems unless I eat grapes, nectarines, peaches, mangos, strawberries, pineapples etc. Apples, pears, bananas and most other fruits do not cause any problems. I was told to eat no more than 5 grapes in a portion. My solution was to avoid grapes and the other fruits that cause the 'Metformin bulge' problems. Such is life.

The other thing that seems to upset Metformin and me is star anise which increasingly appears in a lot of Indian and Chinese dishes. It gets worse if I add a bottle of beer to the mix.

That said with BG at 4.7 and last Hba1c at 5.2 I am happy to avoid things that cause upset.

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Ah, so my habit of frequently consuming half or even a whole 500gram pack fo grapes may be my undoing then.

I also tend to keep a string bag of nectarines/satsumas on my desk as well. It looks as if I may well have been the cause of a lot of my own problems!

Dennis said:

Hi Mark,
Yes, fruit is good because of the vitamins, minerals and fibre content, but only in moderation because of the sugar content.

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I obviously need to look a bit closer at what I eat!

I've been testing after meals a bit more frequently now I'm down to one 500g Metformin per day.

Lunch Is generally the bigger meal of the day so I had my Metformin during lunch (tuna salad)and I had an entire 500g pack of Marks and Spencer mixed white and red grapes on the end of my meal and one nectarine 5 minutes later.

I tested at 1hr and 2hr and got 4.5 and 4.4

I've just looked here: http://caloriecount.about.com/calories-grapes-i9131

and discover to my horror that 500g of grapes contains 81g of sugar! Am I correct in thinking that this is more or less the equivalent of the 75g sugar drink for an OGTT, since I wolfed the lot down in only a few minutes as I had to get back to work?

If so, then I'm pretty happy with 4.5 and 4.4 after that meal.

Problem is, I guess, that doing this sort of binge on grapes hammers my pancreas pretty heavily, so I'll certainly cut that out in future!

I've only been on a single daily Met since Friday and I have noticed the stomach probs have abated a bit - how long does the stuff stay in your system, ie is there much of the (now missing) evening dose left to reinforce the dose the following lunchtime?

Fasting has stayed about the same so far.

I get a bit tongue-tied and forget things at the doc's - always think of a stack of questions *after* I've left...maybe I should write them down before going.

thanks,

Mark