Should I stop metformin?

[Thomas 2]

Dear all,
I was diagnosed with diabetes 3 months ago, with no symptoms, HbA1c 8.9%, blood glucose in early morning (hungry) measured 165 mg/dl, triglycerides were a little bit higher than recommended range. My doctor prescribed 1 metformin x 500mg a day. I started diet with very low carb and exercises 1-2 hours a day with table tennis.

I visited the doctor again yesterday, and my numbers are now: HbA1c 5.5%, glucose in the morning 5.92 mmol/L, all numbers such as total cholesterol, LDL, HDL, triglycerides are in good ranges. My doctor suggested to lower 1 metformin x 500mg daily to half (0.5 x 500mg a day). I would like to ask for your opinions if I keep such good numbers in next 3 months, I could stop metformin ?

Your answers appreciated.
Thomas

 

[kokhongw]

Do you think the daily tab of metformin is the reason for your excellent glucose results?

 

[kokhongw]

This info from Merck gives some baseline metformin dosage/HbA1c reduction figures...in 24 weeks trial of Janumet
https://www.merckconnect.com/janumet/clinical-trial-24-week-data.html?hcpUser=yes

 

[kokhongw]

And this is a comparison of Metformin and Farxiga (SGLT2 inhibitor)
https://www.farxiga-hcp.com/type-2-diabetes-clinical-studies/add-onto-metformin.html

 

[catinahat]

Good morning Thomas welcome to the forum
Apart from helping a little with insulin resistance Metformin has other benefits, have a look at this link
http://www.lifeextension.com/magazine/2001/9/report_metformin/Page-01
So I would say that if you can tolerate Metformin without suffering any of the unfortunate side effects. It's worth continuing for it's other protective quality's

 

[ringi]

I am not planning to stop metformin however low my A1c gets unless I start to get side effects, as it has been proven to has lots of benefits other then lowering A1c a little.

 

[MikeyU]

Hmmm, apparently, Metformin combined with a lot of exercise actually increases insulin resistance. The article below is more about Polycystic Ovary Syndrome (PCOS) which causes increased insulin levels but the drug often prescribed for this is Metformin http://www.thepcosnutritionist.com/resources/metformin-pcos/

In addition I read somewhere else (can't find that articale anymore) that Metformin taken by non-overweight/non-obese people (with BMI below 25) and BG levels close to normal may actually be counter-productive by, again, increasing insulin resistance. Go figure...

 

[Sam50]

Hi @Thomas 2 and congratulations on lowering your HbA1c- well done !

If you manage another HbA1c that is in the non-diabetic ranges then (and this is my personal opinion) I would ask the doctor whether you could discontinue with the drug. I imagine the reason that the doctor suggested reducing the dosage on this occasion (rather than stopping straightaway) is to wean your system off the medication. When people are first prescribed Metformin they have to titrate the dose up to the level the doctor wants them to take so you need to do the same process in reverse to come off it.

As you are eating healthily and exercising, I would question the necessity of taking a pharmaceutical drug that you don't 'need'. Many members on here have been able to achieve non-diabetic numbers through diet/lifestyle and not had to take any medication. At the end of the day it has to be your decision and you have to decide whether you believe that there are other benefits to taking the drug.

At our surgery diabetic patients are generally taken off Metformin once they are back in the non-diabetic ranges. Which I suppose saves the NHS a bit of money....

 

[Alexandra100]

At our surgery diabetic patients are generally taken off Metformin once they are back in the non-diabetic ranges. Which I suppose saves the NHS a bit of money....

However Metformin is out of patent, so cheap.

 

[Alexandra100]

I imagine the reason that the doctor suggested reducing the dosage on this occasion (rather than stopping straightaway) is to wean your system off the medication. When people are first prescribed Metformin they have to titrate the dose up to the level the doctor wants them to take so you need to do the same process in reverse to come off it.

IMO it is not necessary to take any particular precautions when stopping Metformin. However I have read that once stopped, to start again it is necessary to go through the whole long-drawn out process of beginning with a low dose and building up gradually, otherwise one risks the dreaded digestive problems.

 

[Alexandra100]

Hmmm, apparently, Metformin combined with a lot of exercise actually increases insulin resistance. The article below is more about Polycystic Ovary Syndrome (PCOS) which causes increased insulin levels but the drug often prescribed for this is Metformin http://www.thepcosnutritionist.com/resources/metformin-pcos/

In addition I read somewhere else (can't find that articale anymore) that Metformin taken by non-overweight/non-obese people (with BMI below 25) and BG levels close to normal may actually be counter-productive by, again, increasing insulin resistance. Go figure...

On the other hand, there are many many articles on the benefits of Metformin even for pre-diabetics and people with good A1c results:

http://www.mendosa.com/blog/?p=1261
http://www.mendosa.com/blog/?p=3790
http://www.phlaunt.com/diabetes/14045911.php

And here is Dr Bernstein writing abut the insulin sensitising drugs, which include Metformin:

"Some obese diabetic patients come to me who are injecting very large doses of insulin because their obesity makes them highly insulinresistant. These high doses of insulin facilitate fat storage, and weight loss becomes more difficult. Insulin sensitizers make these patients more sensitive to the insulin they’re injecting. In one case I had a patient taking 27 units of insulin at bedtime, even though he was on our low-carbohydrate diet. After he started on metformin, he was able to cut the dose to about 20 units. This is still a very high dose, but the metformin facilitated the reduction.

Insulin sensitizers have also been shown to improve a number of measurable cardiac risk factors, including blood clotting tendency, lipid profile, lipoprotein(a), serum fibrinogen, blood pressure, C-reactive protein, and even abnormal thickening of the heart muscle. In addition, metformin has been found to inhibit the destructive binding of glucose to proteins throughout the body—independent of its effect upon blood sugar. It has been shown to reduce absorption of dietary glucose, and also improves circulation, reduces oxidative stress, reduces blood vessel leakage—in the eyes and kidneys—and reduces the growth of fragile new blood vessels in the eyes.

These medications can also down-regulate the genes that cause fat storage."

Personally, I very much want my bg to be as near normal as I can get it. I am currently taking 1500mg Metformin daily and I have no plans to discontinue or lower that dose.

 

[Thomas 2]

Thank you all for your replies and useful links, after long hours of searching I decide to keep metformin (500mg per day) 3 more months to the next tests to see HbA1c, total cholesterol, HDL, LDL, triglycerides, ... I have concern about the side effect of metformin, the main reason why I want to discontinue medication. I don't have any complications yet, my body adapts well with metformin.

Another problem is that since I'd used new strips box with OneTouch Ultra2, it seems the readings are a bit higher than before, that's why I keep dose 500mg. Are you experienced with this inaccuracy?

Thomas

 

[gusbudone]

I stoped metformin after 1 month, afetr 2 month my blood glucose is not spike, when i stopped it i make sure that my fasting glucose is no in diabetic range

 

[BaliRob]

To answer the subject of this thread literally - YES IF YOU HAVE CONGESTIVE HEART FAILURE and probably other heart problems. I found this out for myself - many (if not most) doctors do not know this it would seem. Studies have concluded that Metformin/Glucophage IS CONTRA-INDICATED in such cases !! I have felt great since coming off Metformin which, in MY OPINION ONLY, did nothing to keep my bs under control and 10+ years of liquid stools and other unexplained side-effects have all disappeared - well fancy that !! Almost as good as the period after I stopped Statins of my own accord - I have more energy - no nocturnal skeletal aches and pains !!

 

[expostie1]

Dear all,
I was diagnosed with diabetes 3 months ago, with no symptoms, HbA1c 8.9%, blood glucose in early morning (hungry) measured 165 mg/dl, triglycerides were a little bit higher than recommended range. My doctor prescribed 1 metformin x 500mg a day. I started diet with very low carb and exercises 1-2 hours a day with table tennis.

I visited the doctor again yesterday, and my numbers are now: HbA1c 5.5%, glucose in the morning 5.92 mmol/L, all numbers such as total cholesterol, LDL, HDL, triglycerides are in good ranges. My doctor suggested to lower 1 metformin x 500mg daily to half (0.5 x 500mg a day). I would like to ask for your opinions if I keep such good numbers in next 3 months, I could stop metformin ?

Your answers appreciated.
Thomas

No don’t stop it, it will be the metformin that is keeping your levels down, also it is considered a good drug, it has other health benifits

 

[Phoenix55]

Welcome @Thomas 2 As you have read there is debate about whether to continue or not. Some prefer to keep medication to a minimum, others believe that there are other health benefits to the medication. You were taking a very low dose of Metformin and your doctor clearly wants to make sure that you maintain the change of lifestyle for a while longer before removing the 'prop' altogether. It is something for a conversation at your next appointment.

 

[Resurgam]

According to 'Lecture Notes on Endocrinology' by William Jeffcoate which has been sitting on my bookcase shelves for years - it is dated 1993 - fifth edition - Metformin should be offered to all obese newly diagnosed type twos with symptoms, but only for two to three weeks when an offer should be made for them to come off it.
Those without symptoms should be advised to reduce carbs.

 

[Alexandra100]

According to 'Lecture Notes on Endocrinology' by William Jeffcoate which has been sitting on my bookcase shelves for years - it is dated 1993 - fifth edition - Metformin should be offered to all obese newly diagnosed type twos with symptoms, but only for two to three weeks when an offer should be made for them to come off it.
Those without symptoms should be advised to reduce carbs.

This makes no sense at all to me, since we are advised to start Metformin at the lowest possible dose and only raise it very gradually in order to avoid the well-know digestive problems it can cause, AND it normally has no effect until the dose has risen to 1500 mg daily. So prescribing it for 2-3 weeks would be a complete waste of NHS money.

 

[Resurgam]

The book's advice is problematic in that, on diagnosis type two diabetics without symptoms are to be advised to avoid sweet foods, rather than carbs - but it also gives the information that blindness is to be expected in a significant number of cases, both type one and two.
I suspect that we are the first generation of diabetics who are questioning this sort of accepted treatment, but treatments have been altered due to them being found ineffective in practice.