Why do I need to increase Metformin?

[tealeaves]

The nurse put me on 1 x 500mg of Metformin a day last week, and told me to start taking 2 a day as from this Thursday.

Aside from the fact that even just one is making me ill (throwing up, no trots but unbelievable stomach cramps that make it hard to stand up straight - I am going to ask for the SR version), my levels over the past week have been pretty much ok I think?

I'm averaging five-point-something first thing in the morning. I've found three cereals which don't make my blood spike too much - averaging between 6.x and 7.x two hours later.

I'm going for a walk on my lunch break after eating every day - the highest my bg has been two hours after lunch is 7.5, and by 4pm it's down to an average of about 5.5.

Two hours after tea and readings are generally between 6- 7 ...with the exception of last night, which was 8.3 - I went out for an Indian and genuinely forgot I was diabetic - cue poppadoms, naan, rice and bombay potatoes! But still, 8.3 is the highest test I've had since before I was on the metformin, and as the nurse said I was aiming for less than 10 and preferably less than 9 two hours after eating, I still don't think it's that bad?!

The nurse just basically said I have to go onto 2 x 500mg like she was pointing out the sky was blue - "just because". But I'd like to take as little medication as I need to and try to keep my bg low by diet.

So to summarise:
Is a reading of around 8 two hours after eating too high?
Is it essential to up metformin levels at this point?

 

[borofergie]

8.3 is the highest test I've had since before I was on the metformin, and as the nurse said I was aiming for less than 10 and preferably less than 9 two hours after eating, I still don't think it's that bad?!

"Less than 10" is basically bad NHS advice for those on a "eat carbs with every meal" default NHS diet. I'd be annoyed at myself if I scored a 9 one hour after eating, let alone two hours.

Is a reading of around 8 two hours after eating too high?
Is it essential to up metformin levels at this point?

It depends on the diabetic. I, like you, try and aim for less than 7 after 2 hours, but the odd 8.x after a special treat is fine I think. It sounds to me like you are doing really well. If you can keep that kind of control up I reckon you'll be getting a HbA1c beginning with a 5.

I think that you should try and stick with the Metformin for a while. I found it pretty difficult to stomach for the first couple of weeks, but I soon got used to it. The effect on your blood is pretty subtle, but even if it helps you drop your BG by 0.5 mmol/l it will still change those 8.x into 7.x readings.

I took myself off Metformin after getting a 5.2% HbA1c (mainly because my Doc threatened to do it anyway if I got another 5.x%). The difference is only small, but it doesn't make my diet any easier, so I'm going to ask him to give me some more when I pick up my HbA1c on Friday (which I expect to be 5.6%ish).

Well done and keep it up.

 

[chocoholicnomore]

I am on 2 x 500 metformin and my doctor wants to increase " because of your age". ( I am 44yrs) He said he wants to keep strict control because of this but I have convinced him to wait for my hb1ac result.

Don't know if you are much same age and maybe that is why your GP also wants to increase metformin.

My average readings have been around 5-6ish for a while now.

 

[tealeaves]

borofergie - thanks for the encouragement, I am trying my best but it's hard. I would never be happy with anything over a 9 (I am taking the NHS advice with a pinch of salt and the diet sheet she gave me is in the footwell of the car) and I am definitely aiming for 7-8 at the most - which for someone still on carbs seems fairly expected I think? I don't want to give up the Metformin, I'm just questionning why I need to up the dose from 500 to 1000 daily when the results aren't that bad.

chocoholic - I'm only 27! So do I need 2 tablets a day, really?

 

[borofergie]

This is what annoys me about the supposedly "evidence based" NHS. There is no consistency between the advice given.

chocoholicnomore seems to have better control than me but her GP wants to increase her metformin, while I have to fight my GP to let me stay on mine (I'm 40 in a few weeks as opposed to choc's much younger looking 44).

I don't think that GPs understand how hard won low HbA1cs are for T2 diabetics. I can understand the desire to be medication free (and I've just tried it for 3 months), but to be honest I could do with all the help I can get to control my diabetes.

 

[tealeaves]

It does seem to be a bit of a contradictory minefield.

Perhaps I will try 1000mg of metformin daily and see how much of an improvement it makes after another week. If the result is marginal, I might stick to 500mg and just work harder at the diet until I really need to go up a dose.

 

[borofergie]

I don't want to give up the Metformin, I'm just questionning why I need to up the dose from 500 to 1000 daily when the results aren't that bad.

Tsssk. Your results aren't "not that bad", they're "pretty **** great".

I think you should talk to your GP, and tell her that you are reluctant to increase your dose. Try bargaining with her to wait until your next HbA1c. If it's less that 6% then you have a good case for not increasing the dose.

I want more Metformin, you want less, we both have similar BG control. Fancy swapping GPs?

 

[chocoholicnomore]

chocoholic - I'm only 27! So do I need 2 tablets a day, really?

I think what my GP meant was that, as I have longer to live with it, then I need tighter control to prevent complications. You have even longer to live with it than I do.

I'm 40 in a few weeks as opposed to choc's much younger looking 44

Thanks Borofergie but you haven't seen me :lol:

Another plus is that metformin helps with weight loss so I might agree to up the dose.

 

[Sid Bonkers]

Hya tealeaves, the full dosage of Metformin is (currently*) 2 X 500mg tablets taken twice a day so 2000mg in total and that will typically lower bg levels by a maximum of 2 mmol/L. So one 500mg tablet a day will only bring your bg down by around .5 mmol/L which is negligible.


Regarding the side effects can I ask when it is you are taking your Met? Many people find that if taken literally with food ie between mouthfulls of breakfast, dinner etc it helps alleviate the cramps/sickness/diarrhoea, so if you are taking it before or after eating perhaps a re timing will help with your side effects


* I say currently as some people do take a larger dose as the maximum dose was reduced some years ago from 2500mg I believe.

 

[tealeaves]

Regarding the side effects can I ask when it is you are taking your Met? Many people find that if taken literally with food ie between mouthfulls of breakfast, dinner etc it helps alleviate the cramps/sickness/diarrhoea, so if you are taking it before or after eating perhaps a re timing will help with your side effects

Hi Sid, I take the tablet immediately after my evening meal, so perhaps I will take it mid-meal instead. The nurse has told me to take the second metformin from tomorrow after breakfast - dreading the morning at work after taking it!

I'm going to see how taking 2 a day affects my levels for a week and go from there.

 

[mcwhiteyoh]

Hi,

Im pretty impressed with your results tealeaves.
Im take 2x metformin and they make me feel really grotty. Its really strange but i get a metallic sensation around my head for about 2 hours after taking them. I also take 3x glicazide which are fine.

i struggle to keep my bs below 10. my average for december is 11.5 and my hba1c is 8.3%.

Its funny you mention the nhs standard diet of carbs with every meal, thats exactly what i was told, but now im limiting my carbs to about 50 grams a day to try and get rid of the weight i piled on becuase of the glicazide.

 

[tealeaves]

Been taking two a day since Thursday and my levels are creeping up. Had a few 10/11/12s after eating. Not impressed with myself.

 

[mcwhiteyoh]

its really annoying. ive found they work for a little bit then it starts on the up again!

 

[enzina]

Tealeaves, my GP and the diabetic nurse would be so happy if i had your levels. :clap: For a while i could control the diabetes with diet only, my hba1c was around 7.5.

When i was diagnosed two years ago, they wouldn't give me any Metformin for three month. My levels were high in the 20ies and i'm nearly 50!

Now i'm on 4x 500mg but i don't have any problems with Metformin.

Hope you get used to it or can convince the the doc to stay on 500mg. All the best!

 

[hanadr]

They usually start people on 500mg Metformin per day, because it does affect the guts in so many people. then put it up to 1000.That's called titration. If your BG is good on 500, you DON'T need to go up. If your guts don't settle down ask for the slow release Metformin. Most people adapt to Met in time. some , like me, never hae trouble with it in the first place. It's worth persisting, because it's one of the safest medicines. and its side effects, although unpleasant, are rarely dangerous.
Hana

 

[SweetHeart]

We have an argument going on between the diabetes nurse and our GP. The Nurse wants MH to take two 500mg Metformin per day, perhaps leading to an increased dose if two 'don't do it' we aren't sure what 'it' is...

....the GP has prescribed only one 500mg Metformin at breakfast time and, based on the low BG levels that MH is achieving, wants to cut out the Metformin altogether when MH has lost another stone or so (he's 6ft2, 18st) And we are more than happy to agree with the GP, but the nurse is really miffed.

I think the low levels speak for themselves,

Julia

 

[carty]

I have been on 2g sr metformin for the past 3 years or so and now have a Hba1c of 6.4 I am under weight so the GP suggested cutting my met down by half and I cant believe how much more energy I have in just 2 weeks. My BGs have risen very slightly but I think that by upping the exercise and keeping an eye on the carbs I can maintain the Hba1c.I will have another Hba1c in 3 months so I will know then how things are going
CAROL

 

[Unbeliever]

I have been on 2g sr metformin for the past 3 years or so and now have a Hba1c of 6.4 I am under weight so the GP suggested cutting my met down by half and I cant believe how much more energy I have in just 2 weeks. My BGs have risen very slightly but I think that by upping the exercise and keeping an eye on the carbs I can maintain the Hba1c.I will have another Hba1c in 3 months so I will know then how things are going
CAROL

How do you hink the metformin affected your energy levels Carty? Metformin did nothing for me bg wise but I was always told I was prescribed it for the cardiovascular protection. I take "g daily but feel sure I could reduce his but noone seems to know whether this would be OK or not.
I was prescribed them upon diagnosis nearly 5 years ago and have no felt well since.

 

[carty]

Hi Unbeliever
I really dont know how the met affected my energy I felt pretty awful before I was diagnosed with DB so it is only after halving my Met that I have my energy levels have risen so much I cant think of any other reason why I feel better I havnt changed my diet or anything else. I am not recommending lowering meds without contacting their HCP just reporting my experience
CAROL

 

[Unbeliever]

Hi Unbeliever
I really dont know how the met affected my energy I felt pretty awful before I was diagnosed with DB so it is only after halving my Met that I have my energy levels have risen so much I cant think of any other reason why I feel better I havnt changed my diet or anything else. I am not recommending lowering meds without contacting their HCP just reporting my experience
CAROL

Of coyurse you are not recommending just lowering them. IInmy case I have to do my own research and then go to a GP and get them to precscribe it behind the practice diabetes nurswee's back as she know nothing abiut any kind of oral meds but doesn't like the drs to know this.My annual review is the only ime i am allowed to spek to a GP about diabetes.
last year i asked if , as it was geberally agrred that I was only prescribed metformin or the cardiovascular effect I could decrease the dose without prejudice to my health. YThe Gp didn't know and obviously had no intention of finding out.
She made some noises about considering it if my HBA1cs continued to improve.

Normally I only see the DSN and she will not allow me to have the HBA1C before I see her but says she will cll me if necessary afterwards.
Then she is unavailable or weeks . besides I don;t trus her .
That is why I was wondering if lack of ebnergy was a known side effect of metforminn.
Its DIY time in my Practice!