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T2 on insulin and Metformin

Annb

Annb

Expert
Messages
9,393
Location
Western Isles, Scotland
Type of diabetes
Type 2
Treatment type
Insulin
I have, apparently, been T2 diabetic for something over 50 years but only diagnosed in the last 15 years. I was first put onto Metformin but when it caused a lot of digestive problems I was hospitalised and put onto insulin. Bowel cancer was discovered and treated successfully and I was advised to stop Metformin by the surgeon. However, my diabetes nurse persuaded me that it would be safer in diabetes terms to keep taking the Metformin. I was also told that, having been put onto insulin "just while in hospital", I could not come off of it.

As time has gone on, I have managed to reduce the amount of insulin I am taking (by low carbing) and lost some weight. However, I have a damaged liver and CKD. There seems to be some difference of opinion now about Metformin and damage to these organs and I am wondering if I really ought to be taking Metformin, or if I could just rely on insulin and diet.

Does anyone have any experience of stopping or reducing Metformin and could suggest what changes I might expect if I do decide to stop?
 
Hi @Annb
It would probably be best if you had a conversation with the GP, or other HCP. Perhaps even the surgeon who advised you to stop Metformin. The contradictory advice you have received is confusing, and no doubt frustrating for you. You have the further difficulties of CKD and liver damage, so do need specific advice, which is unlikely to be provided by our members. You need someone with full medical info, such as results of your blood tests etc. In your situation Iwould be a bit more assertive with the nurse who has given different info to your surgeon, and ask for an explanation of her rationale, and a new consultation for a second opinion.
 
Hi @Annb. I have started and stopped Metformin a few times, in order to see what impact Metformin was and wasn't having.

I personally seem to be one of the people who is not impacted by Met in terms of blood glucose levels being affected. They have identified a gene cluster for this apparently, not that my genes have been tested. My trusty GP and I are assuming now I am one of these people.

So the only thing I can truly contribute to you is the importance of good tracking when stopping and re-starting - the only way to test impact I imagine?.I see you are have expert status on the Forum, so you probably either track your blood glucose readings, or your HBA1c, or both? Or at least have good medical records. And I extend my commiserations for the kidney and liver damage. Your diabetes nurse hopefully is a trusted ally in this battle?

I did discover that Met did affect me in terms of being a mild appetite suppresant though, which was an interesting experience for me, as I usually have a hearty appetite. So for me, going off Met (plus life circumstance contributing) meant I regained that weight back, being back at the higher end of normal weighted, as opposed to slender. I miss the clothes horse aspect! But no dent in the diabetes....
 
I'm only a newbie compared to you @Annb , with just 8 years of diabetes under my belt.
I also most likely have a different type of diabetes than you have, although your T2 doesn't behave typical from what I've read throughout the years by you, and my T1 diagnosis isn't a 100% one, and insulin resistance seems to be a part of my diabetes, judging from its behaviour.

From what I've read, metformin is a medication that is very helpful for some, and doesn't do much for others.
I had an 8 month experiment with it two years ago to see what it did, and for me it was very little, definitely not enough to makeit worth it for me, according to my sensor and insulin doses.
Others (both T1 ad T2) have found a very clear effect on their insulin needs or BG.
Annb said:
Does anyone have any experience of stopping or reducing Metformin and could suggest what changes I might expect if I do decide to stop?
Click to expand...
As is often the case, the proof of the pudding is in the eating, and the only way to find out how it affects your diabetes is to try if you wish to.
 
I have an appointment to see my new diabetes nurse tomorrow. I have only seen her once before because I was transferred from the hospital clinic to the local health centre clinic. I will ask her about Metformin but I thought from our first meeting in July that her attitude was fairly "traditional". I really don't have enough information on the subject to have a sensible discussion, but I will try. I'm beginning to think that my kidneys are in a bit more trouble than I had realised, which is why I am wondering about the effects of the Metformin. I have though been put onto a much higher dose of Levothyroxine recently, so maybe that is the issue, not the Metformin. This diabetes and all the other issues make quite a juggling act.
 
I dare say that there haven't been extensive tests of metformin (or indeed any medication) with your individual set of conditions. There are just too many variables for any one to be able to be absolutely certain. You will (and already are!) the expert in yourself so ask and listen to the professionals, keep testing and monitoring, and do what is right for your body.
And keep an open mind and open options. Things may need change the future, nothing is set in stone.
 
This time I was told that my eGFR was better than previously but was shocked to hear what it actually was - much lower than a year ago when with a reading of 90 I was at stage 1 of CKD. Not that anyone seems to worry about me now being Stage 3b. At my age, apparently, it is to be expected. Still, since it is improving (no long Stage 4), we decided that I should keep going as I am with medications and hope it improves further. I'll keep going for the next 3 months with the Metformin and see what happens then.
 
Annb said:
This time I was told that my eGFR was better than previously but was shocked to hear what it actually was - much lower than a year ago when with a reading of 90 I was at stage 1 of CKD. Not that anyone seems to worry about me now being Stage 3b. At my age, apparently, it is to be expected. Still, since it is improving (no long Stage 4), we decided that I should keep going as I am with medications and hope it improves further. I'll keep going for the next 3 months with the Metformin and see what happens then.
Click to expand...
The results for my renal scores state that the normal gfr for a 30 year old woman is 78 to 158, this drops by 1 each year.... They also say that egfr should be greater than 60 to be normal. Have no idea what the difference between egfr and gfr is....
 
There is no difference really. It's just that there are 2 ways of obtaining the figure one is measured using complicated tests and is called mGFR the other is found with a blood test and is estimated - eGFR.

Aged 79, my GFR in November 2023 was 90 - it had been lower (into the 50's) and, it seems, there were other indicators of kidney disease, so it was called Stage 1 Chronic Kidney Disease. The alarm for me was the drop, within a year, by 64 to 26, which is CKD stage 4 and only one stage short of dialysis. That's why I wondered about the effect of meds on my kidneys - Metformin being one of them. However, the figure is a bit better now at 32 and may improve, so we're leaving well alone for now.
 
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