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What Will Increasing Metformin Dosage Accomplish?

M

maxell

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What will increasing Metformin dosage accomplish at this point? I've been on 1000mg of Metformin (500mg twice daily) for about 5 months now. I started with an internist and my endo, whom I started seeing for about a month, wants to increase the Metformin to 2000mg (4x daily).

I seem to be normalizing my BG after starting a low carb diet. My fasting BG is now around 95-105 (5.2-5.8) and my postprandial (2h after) is 105-125 (5.8-7). Before the diet, my fasting BG was 140ish (7.7'ish) and my postprandial was 220+ (12.2+). In fact, I'm planning on limiting carbs even further (to about 50g per day) so I can more tightly control my BG. I wanna do this incrementally, however, since the low carb diet is causing me some consipation and weakness later in the day.

My concern about increasing Metformin dosage is possible gastric distress (no diarrhea yet but it did happen once when I took the doses too close together) and deficiency in B-12 and B-6, which can worsen diabetic neuropathy. I do have neurpathy in my legs and I'm taking Alpha Lipoic Acid (600mg).
 
I have been taking metformin in the amount of 3 x850 per day for the last 10/12 years. I have now been given victoza as well as my sugar reading was between 10 and 25 with no real reason following 3 operations for breast cancer ( now clear, thank you). My understand of nutrition is that if you deplete your carbs too much, you deminish your energy levels to a high extent and then have no energy to keep going and can also lead to weight gain through immobility. Metformin can eventually be spiteful to body too lacking in carbohydrate, if it has no carbhydrate to work on it seems to work on you. This is only my personal observation as someone on metformin. Increased doses I think would be detrimental, both health and diabetes wise. I too suffer from diabetic neuropathy and hve asked to come off metformin but this has been vetoed, even on the victoza.
I have been on victoza since June, 2 days after it came on the market. Not authorised here at present and am on 1.2 per day. I still have readings of between 8. and 10. with the occasional spike but these are when I have celebrated or misbehaved, as I believe we all do at times. I believe that readings of 5 for you are optimum, lower would be unwise on the medication so to lower your carbs or increase your metformin the achieve this would make you somewhat unwell.
I would like you to let me know please what you take for the neuropathy as it is in the process of putting me in a wheelchair and also stopping me from having a good nights sleep. My husband who has been type 1 for the last 31 years has no problem with neuropathy but does have slight diabetic retinopathy, which I do not. I therefore am convinced that metformin is responsible for a lot of the neuropathy.

pymlar
 
Hi Pymlar welcome to the forum. Victoza is authorised in the UK but is mainly being trialed at the moment.

You say you had breast cancer, the medication that you may have taken for this would put up your blood sugar levels quite a lot. Continuously high blood sugar levels are what cause neuropathy.

Metformin will only take blood sugar down by about 1.5 mmol/l at best at the maximum dose.
Were you ever offered any other diabetic medication to help lower blood sugars ?
 
Sugarless Sue - The only thing I was taking with metformin was Gliclizide 80 x 4 daily. The plus side to victoza is that it suits me, very little in the way of side effects, except that I have lost 10 kilos, 22 lbs since starting with it without having to put in a great deal of effort. This I find very exciting.
 
pymlar said:
Sugarless Sue - The only thing I was taking with metformin was Gliclizide 80 x 4 daily. The plus side to victoza is that it suits me, very little in the way of side effects, except that I have lost 10 kilos, 22 lbs since starting with it without having to put in a great deal of effort. This I find very exciting.
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Are you still on the maximum dose of Gliclazide or has that been cut back now that you are taking Victoza ? There is a good thread here about Victoza, hopefully you can post your experiences with it there so we can add to our database. Well done on the weight loss BTW...... :D

Are you no longer taking any cytotoxic drugs then ?
 
I am sorry not to be more specific. The gliclizide stopped when I began the Victoza. This I take as one 1.2 injection per day. The largest dose is 1.8, so we still have some in reserve, but part of the fight is that it is approximately £78 per 0.6 does so costs £156 at present for me. However, the way I feel at present to the way I felt 6 months ago, there is no comparison. My treatment for the Cancer has been Examstane tablet to clear the hormones from my body, these I will have to take for the next four years. This is instead of and is often given if tomoxifen fails. As I am post menopausal examstane is the best for me. Other than that I have received two lots of radio-therapy. The powers that be decided that chemo would be detrimental to me because of the volume I would have to take because of my size. I have my yearly mamogram, and scan on Saturday, and am keeping my fingers crossed, well and everything else too! I think that if they really do decide that Victoza is too expensive, they should look at the positive side effect which I have heard through the grapevine is a positive for many of the people on it. Perhaps they should adjust this side effect for people whose bmi is way above the norm to assist in payment for the diabetic treatment. Surely it would be better than liposuction. However, I digress. Just as an aside I take 3 x 850 metformin per day 1.2 victoza injection. Up to 6 x 50 tramadol for the pain in my feet and legs. 1 x 200 Quinine sulphate for cramp. 1 x 300 allopurinol. 1 actonenel per week
and 1 ergocalciferin a day (these are for the osteporosis in the spine that is already well established). 1 x 10 lisinopril - blood pressure, which is extremely good being regularly 95/65
and 1 co-amilofruse for water retention. This may seem a lot but apart from the pains in my feet and legs I am really glad to be alive and kicking and still enjoying life.
 
I would suggest that you get your doctor to do a full review of your medications. The drug Exemestane can make your diabetes worse but you really need to see an Endocrinologist for expert advice on this.
 
I saw the Endocrinologist last week and they are very pleased with my bloods taken three weeks ago, and he has not adjusted my dosage at all. Unless I have need of seeing him in the next six months I will be seen on the 2nd June. I can see the nurses at any time I wish and am seeing the oncologist in January. They all seem to think that I am handling the conditions very well, eat plenty of veg, i.e. cauli, broccoli, brussels and lots of salad to help the situation. This seemed reasonable to me , but am happy to have input from others. Do not want to spoil how I feel at present.
 
pymlar said:
If anyone can see any problems with my overall medication, please give me a message.
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As none of us on here are professionals and you say you have access to your own HCP's when you need to, I don't see what advice we could give you other than what you have already had. As Sue stated if you have problems of any sort then it is best to discuss it with your own HCP's.
 
pymlar
This that you wrote puzzles me. Not that you've been taught it, but that you seem to believe it
>>My understand of nutrition is that if you deplete your carbs too much, you deminish your energy levels to a high extent and then have no energy to keep going and can also lead to weight gain through immobility.<<

I can tell you that I do in the region of 7 hours exercise a week in the swimming pool and the gym on almost zero carbs( most of the time) and far fromgaining weight as a result of immobility, I have lost about 2 1/2stones . I also walk a lot of miles each week and I've survived a stroke( 6 years ago)
Our bodies are perfectly capable of using fats and ketones as a primary energy source and tthere'ss evidence to sugges that's what the did before we became carb eaters.
Hana
 
The question was "What will increasing metformin dosage accomplish". I know that if your optimum reading is 5.- 6.5 increasing your metformin dosage will mean that you will need to increase the carbs taken in. As you say you are on low carbs, but you do have carbs. The questioner also stated that they felt confused etc by the end of the day and lethargic. It is my experience that this is probably because carbs are too low and will eventually lead to problems, therefore if you increase your metformin intake it is necessary to increase your carbs intake.
Whilst you can't go hypo on metformin, it can make you feel very ill and give similar by less dangerous symptons to a hypo. I can only say that this is my experience and I thought that this is what it is all about. Some of this experience is borne out of 14+ years on metformin and the wife of a man who has been Type 1 for the last 31 years. Various things can also lead to high "sugar" readings, as I have gleaned from information on this site the drugs I am taking to treat double breast cancer have also pushed my readings high and now on victoza they are once more manageable but not quite as low as I would like. I didn't intend to offend.
 
Hi, thanks for everyone's reply. They are very insightful. Looks like my afternoon fatigue has gone away. It was my body's attempt to adjust to my rapid weight loss (lost 35 lbs. in 8 weeks) and lower carbs. It was probably ketosis, which I wasn't used to, combined with hypoglycemia: when my FBG is something like 205 (11.38), then 100 (5.55) will seem like I'm doing something unnatural.

So that part of the problem is solved, while another part has reared its head. While on 1,000mg Metformin, my FBG could be as low as 85 (4.72). Only occasionally would I go over 140 (7.77), once I learned how to eat low-carb. Now, however, I'm taking 1,500mg Metformin. I'm probalby even more disciplined now: 60g net carbs, 1800 calories. My FBG has gone up to ~100 (5.55) . My postprandial is still very well controlled; I rarely even go over 120 (6.66).

In other words, my BG volatility has been stabilized, while my FBG is a lot higher than before (85 (4.72) vs. 100 (5.55). What do you make of this? Do you think I should cut the Metformin to 1,000mg?
 
Hi Maxwell
Congratulations on that amazing weight loss.... you have blown mine right out of the water!
My neuropathy was caused by excessive alcohol (I have since studied symptoms that I had that would indicate this like severe anemia, long term diahorrea etc) as I had it about 5 years before I was dx impaired which later became T2. Apparently I never had HbA1cs high enough to indicate damage from increased glucose.

I stopped drinking and was put on Metformin but when I noted one of it's side effects could be neuropathy I was totally commited to getting it out of my life to allow my feet a fighting chance of improving, not getting worse. Five months of low carbing (around 30g per day) and I slowly tailed off the Metformin as my BGLs went into the low 4s and then had my 6 month visit to the Endo. I don't advocate making those descisions oneself but I was confident of my understanding of the process and luckily the endo agreed to "OK" my choice!

I too take ALA as well as a neuropathy formula of Vit B's, EPO, biotin, Omega 3 fish oil and Vit D3 drops. Good luck with your journey to health, you certainly seem to be doing it right.
Alison
 
Alison, you can bypass the neuropathy side effect by taking B-12 and B complex vitamins. Metformin may (but not always) deplete your body's store of B-12, B-6 and other vitamins. Many people believe, however, that the deficit isn't that significant. When I get my blood work, I ask my endo to test my serum B-12 and B-6 levels, as well as other vitamins such as Vitamin D hydroxy.

But there could be other culprits of neuropathy, whichi may present itself as diabetic neuropathy. It could result from hypothyroidism, which many diabetics have. Strong statins such as Crestor and Lipitor, could also induce neuropathy. I personally experienced neuropathy while taking such drugs.

Aside from making me insulin sensitive, I think Metformin has also lowered my triglycedirdes. Since being on Metformin, my trigs have dropped tremendously. I was previously on statins and my trigs never budged an inch. I believe it was Metformin which caused this.

Also, if you're taking Alapha Lipoic Acid, you might wanna consider taking Biotin supplements, since ALA supposedly competes with Biotin for cellular absorption. To be safe, you could ask your doc to measure your biotin level and take 10% of your ALA dose: if you take 600mg ALA, then you Biotin dose should be about 6mg.

clearviews said:
I stopped drinking and was put on Metformin but when I noted one of it's side effects could be neuropathy I was totally commited to getting it out of my life to allow my feet a fighting chance of improving, not getting worse.
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