Help me decide whether or not to ask for metformin?

My last A1C was 6 and my fasting numbers are usually between 100 and 110, although this week I’ve had a couple of 117s that go down after breakfast. My 2-hour-after-meal numbers are 130 or below. I exercise daily for almost an hour, really vigorously, and my diet is where it’s going to be, I’m not one of those people who can cut down to 30 carbs a day and have success on an eating plan. My BMI is 27.5, but I haven’t noticed any improvement in insulin resistance with weight loss. I’ve heard metformin can actually help people lose weight.

When I went to the doctor last, her feeling was that metformin was not indicated until someone had numbers above like a 6.5 A1C, but I sense that there must be some disagreement about that because there are plenty of T2s on these boards with A1Cs below 6 who are on metformin. I have a doctor’s appointment coming up in a week. Should I lobby hard to get a prescription for metformin? My doctor is pretty respectful so I think she’d take my wishes seriously, but I’m not sure what to do.

As with any medication, its really a decision you need to take up with your doctor. that said, if you are not happy with your treatment, or your numbers and have exhausted other options, (diet is where its going to be, exercising etc), Met is one of the longer standing drugs out there for the treatment of D particularity for T2 (although i have known some insulin resistant T1’s on it as well). It can have the positive side effect of weight loss as well so that can be a bonus. Like duck, I was also Dx’d with A1c of 11 and was immediately put on Met (500 mg x2 daily). My latest A1c is 5.0 and I am staying on it with the lowered A1c. If it was me, i would also bve concerned with the 6.0 A1c. Not that is not respectable, but if you can lower it, and lower your risk of complications, then its an option I would consider. If you doc is hesitant to prescribe Met, just talk to him/her about insulin therapy and they will probably give in quickly to Met treatment :wink:

I have learned over the years to not ask for things until they are needed. i take met and it is a stomach killer if you are looking to lose weight try a dietician or a personal trainer they are less harsh on the stomach

I didn’t want Metformin when I was diagnosed. I hate the idea of having to take those pills everyday but my doctor wanted me on it because my A1C was 9.2 which is on the high end and a fasting BG of 205. I think he just wanted to make sure I had help to get it down. I don’t really know for certain if the Metformin is the main cause of my now lower numbers. My A1C is now 4.9 - and I really think it is because I changed my diet and I also think my weight loss in the beginning was because the diet change. I don’t think the Metformin makes you lose weight. Having low blood sugars per se doesn’t make you lose weight - you lose weight by diet and exercise. The Metformin helps keep your body deal with the excess blood sugar so you don’t have those higher numbers which cause damage. If Metformin helped one lose weight, they would be prescribing it as a weight lose drug. Weight and low A1C are not always related. Thin does not equal low A1C necessary.

I would happy if I were you not to have to take the Metformin. I am on the lowest dosage right now but I hoping my doctor will cut it in half in a year. Even though my A1C is low now, I am sure he wantes to make sure it stays that way. I think I could honestly do this with the Met. But I would have to try and see - right now, I am staying where I am at. Your number do not sound high at all. On Met, I can be in the Low 100 after breakfast some days.

I’ve been on met (and more) for 3 1/2 yrs. I started that way. Personally, if you can keep the decent numbers without the benefit of drugs - go for it. Your numbers will tell you when your control is either slipping or other parts are not working as well as they have been at which time, meds will most likely be the answer.

As Wil said one of the side effects of Metformin is upset stomach. Thankfully I didn’t have that problem for very long. Another side effect is weight loss. That happened to me as it killed my appetite. As with any medication the side effects vary from person to person.

The goal to me is to get normalized blood sugars and I will do what it takes. You have done a wonderful job getting your A1C down.

However a A1C of 6 is pretty darn high with an average blood sugar of 126 and in the diabetic range and I would be nervous about that. Then the question comes up what is a normal blood sugar? Ask you Dr what a normal blood sugar is and where you should be at? Dont settle for as long as its under 7 A1C stuff and the ADA recommendations. It is currious why your Dr thinks people only above 6.5 A1C should be on Metformin?

The other thing is that there has likely been damage done to your pancreas over the years and even with diet and exercise you may need a little more help to get those sugars down.

For me I want my posts to be in the lower 90’s if not mid 80’s two hours after a meal as a T-2 and not to spike above 130 1 hour after a meal. Yes I really have to watch my carbs to do that and sometimes it is monastic.

Strongly recommend you read “The Diabetic Solution” and “Blood Sugar 101”

I generally agree with your doctor – if you are keeping your A1c under 6.5, then I wouldn’t change a thing!

Perhaps some of the people with A1c’s under 6 needed the Metformin to get there…

Met can cause stomach problems for many people, I have not had that problem at all, but I think my stomach is so used to having meds in it, that it doesn’t know that Met is there. I take 2250mg a day (850mg 3 x a day) But my system has proven to need it to get the kind of numbers I want. I do exercise, I do eat well in the carb area, and follow instructions, but the metformin was indicated. My last A1C was 7.4…and I wanted to be closer to 6 so we upped it; and will change it as needed in three months. Are you wanting to use the Met for weight loss? In my opinion, which you can take or leave, it’s not a weight loss med, although that “can be” a side affect. You’d be better off finding another route to take though, because if you should have to use Met for your “D”…you don’t want to already be taking it, and have no place to go. Check with the dietician or trainer and see what you can do to lose the weight without the Met, when you see your doc indicate your concerns and see what they say…but I’d hold off on the Met for as long as you can.

Probably better sooner than later. The D is not fun when your pancreas dies completely. some people cannot stomach it pardon the pun. One diabetic I met had a near miraculous weight loss on met you never know until you try.

I think it is a personal choice on what your blood sugar targets should be and how much risk you wish to accept. There is evidence that your risk of heart problems with an HbA1c of 6% is about double that of a non-diabetic, and that is independent of cholesterol. The ADA goal of < 7% and AACE goal of < 6.5% both are high enough that over the long term, the majority of diabetics will still suffer from one or more complications. If you are young (relatively) you may find that unacceptable. I do. Even though I am 50 (and I know, you think I look younger), I don’t look kindly on the prospect of complications and marked decrease in life span. I also realize that having only been diagnosed 5 years, keeping my HbA1c < 6.5% and despite that still having emerging complication, I am not going to be one of the lucky ones. My blood sugar target is < 6% and I would be prefer it to be below 5.5%. I will do what is necessary to achieve those goals. And I have left numerous doctors over disagreements on this matter.

In my view, your health targets are your personal choice. Try to make an informed choice, listen to your doctor, but make your wishes known. You have a “right” to a normal blood sugar. A doctor does not have an ethical basis to deny you access to a safe and afforable medication that can help you avoid preventable consequences. If your doctor does not respect your personal decision on this matter, then you need to find a doctor that will.

Frances, you ultimately know better than anyone else what is good for you. But I think what you are asking for here is information and opinions so you can make an informed decision. So, my opinion is, I have to agree with Kristin. It appears that really tight control isyour goal, but Metformin is a medicaton that works on the liver as well in some other ways. Just consider how that functions with your body long term and weigh the pros and cons. I am sure you have probably read all about Metformin, but this was a little something on how it works.

I wish you well.

Metformin works well and sometimes may cause some gastrointestinal distress but mostly well-tolerated. It helped me lose the weight I needed and my BMI is now 18 (was 25). Metformin did help me with weight loss, it also protects you about 50% from getting breast cancer (new study from Joslin Center) and its a 30 year old drug with a very good track record. You are doing pretty well with your numbers and you may be able to keep or lower your A1C with diet. I eat under 100 carbs per day and the carbs I do eat are ‘good carbs’. (grains, almond/flax meal, veggies and good sources of protein, fish, eggs, chicken, etc).
I stay away from rice and potatoes, occasionally a tiny red potato and I use only Dreamfield’s Pasta, a low-carb variety, a bit pricey but very good. Diet and exercise are key even if you are on medication. Try walking after dinner, even if its for 10-20 minutes, just adding another form of exercise that is relaxing and good luck.

You sound exactly like me! I take the lowest dose of Metformin to be like that though. I had great hopes that I would lose weight from taking Metformin, but I didn’t. I also don’t work out as much as you. I can’t give you any advice really, I am too new to it all. I haven’t had problems with side effects. I haven’t lost weight. I take the Metformin at around 2 (when I remember, or at dinner if I forget.) which takes care of my dawn effect. Good luck with whatever you end up doing.