I'm being put on Metformin :(

Type 1 and LADA
1

Hi everyone,I just came back from my pump follow up appointment.My starting A1c was 8.5.a week after it came down to 8.2 ,a month later no change,which was kinda disappointing.But I’m positively
that it’s gonna go down.One reason might be because I almost had no lows to miss with the A1C.
My endo decided to put me on 500 milligrams.

My weight came down 1 kilo,which I’m happy about.But I’m normal weight to begin with,My mean BMI is about 20.My postprandials were ranging from 140 to 220s on rare occasions.My fastings are always perfect.Before meals sometimes run a bit high,once up to 200.

I know that Metformin is licensed as First-line drug for Type 2 diabetics.I’ve read quite a lot about it but I can’t find information on using it on Type 1s or with insulin at all.I know they use them with Type1s sometimes but I’m not satisfied with what I found yet.

I’m quite upset about this.For many reasons.I don’t want to add another drug to my list-Vitamin D3-Calcium-Thyroxin-Roaccutane in addition to insulin ),Which will increase the chance of me forgetting to take my pills.For another.It sounded like I wasn’t working hard enough.And lastly.Because of the side effects -gastrointestinal irritation-,although I’m open to losing some pounds :smiley: .

so please,any feedback,stories,…etc.I’d be glad to hear any.

2

An A1C a month after the last one includes 2 months of data cooties floating around in your blood that were measure last time, since the test measures 3 months. I’d be inclined to agree with the doc that 8.2 could be improved but any measurable improvement should be approached more positively. In only a month on the pump, I would think you’d still be getting the hang of playing wi…oops, I mean using it to manage your serious disease! I have never had a doc rx A1C on a month basis b/c most insurance companies in the US won’t cover it b/c there’s no medical need. I suppose it’s nice to measure a test like that but it’s basically measuring the same thing twice. I’m not sure why the Saudi “insurance” or health care system would think that monthy A1C tests are that viable that they’d shell out the $$ for them. It might be more cost effective to buy you 100 more test strips/ month and just use the A1C every 3 months?

Perhaps the doc may have seen something in the logs/ data to recommend the Metformin, I remember being intrigued by the stuff a few years ago,but I don’t remember exactly what it does. GI side effects would scare me off anyway. I would question the doctor’s science about adding a powerful and potentially unpleasant med. Be wary of appearing negative though, since you are 17 and I presume your parents are also involved in the decision making process here? I have a 12 year old and sometimes it seems like everything is a huge fight w/ her and that she doesn’t believe anything we say. The best way to approach a scientific question like improving your control is with data.

Review the reports and find “bulges” in your BG curve and figure out how to attack them. If you are still studying TKD, you have probably studied enough to perceive the sort of “reactionary” tendencies in sparring, where you wait for your opponent to attack and then use their mistakes against them. An off number is a good place to look for improvement, if you do a good job fixing it and can adjust your plan, or if your parents will go ballistic about you making a lot of changes, talk to them and explain “I want to make this change because I found this data and it will improve”.

3

Thanks for your feedback,I was happy to see a reply from you.

I think I’m gonna read Pumping Insulin again.To get the hang of playing :wink: .Regarding the Health System,I go to a Teaching Hospital that is funded by the government.This diabetes clinic doesn’t spare any money in treating patients.It also does research.Usually they do it every 3 months.every 6 months for type 2s.But I’m not sure what’s wrong with me exactly that makes the doctors so intrigued to order extra tests.I think it has something to do with their new A1C test procedure in which they use a machine that looks like a meter.That might be it.Or maybe because of the Researches they’re doing.I did sign for one.As for the test strips,They never spare any expense prescribing test strips,they’re always encouraging me to test more.
It doesn’t affect the healthcare I get at all.They’re quite observant.We do have Insurance Companies that give you trouble.But we have a VIP class so they only deny beauty stuff and teeth whitening and such.My friend
has first class and they deny her test strips.

I just wanted to make sure that there’s somebody out there on metformin.I fully trust my endo.She’s a great physician and her years of experience exceeds my age :slight_smile: .I had to go by myself today since my parents were busy.But they’re always against huge changes in my regimen.I remember them both being anti-pump at first.

I wouldn’t make any changes in my medication on my own.That scares me a bit.But I think I’ll benefit from a thorough study of my own.I think the problem is I sometimes grab a bite 1 hour after my meal.nothing to bolus for.But it’s worth looking into that anyway.

Thanks again,really appreciate it. :slight_smile:

4

No problem! I have been at this for a while (since 1984…) and spent a long time with very little medical supervision but these days, if my BG is higher or lower than I want it to be in a spot for more than a couple of days in a row, with no other ‘culprits’, I will adjust my ratios a bit. Mostly I adjust basals when I see pre-meal #s creeping up and bolus when I see them creeping down. I am more comfortable doing that than taking another drug like Metformin. I’m not sure why they wouldn’t just keep adjusting numbers on your pump before they’d try that? By rxing a systemic type of drug, it’s like changing the game you are playing to an entirely new one, like Mario Galaxy vs. Mario Galaxy 2. They are both interesting games but they are different enough that you have to figure a different game out. To me, it seems like the slight A1C improvement in a month is a step in the right direction? If you still have two bad months figured in the A1C, and showed that improvement, it may not be out of the question to expect a more signficant improvement down the road, unless there’s something I’m missing numberwise or something? At the same time, as you get used to the responsiveness of the pump, you should be able to improve at observing the data and using the data to see which spots you might focus your efforts to improve upon?

5

They are putting more and more T1 on metformin. I just started and it has made a HUGE difference in my numbers.

My biggest suggestions about the GI side effects. 1) Take it with food, even in the middle of a meal. 2) Try scaling up to a dosage rather than starting all at once.

There is a group here of people on metformin as well.

6

The weird thing is,why did they put me on it in the first place,My ISF is 35.My daily totals range from 20s-30s,on rare occasions up to 40 but no more basal rate is .55 U/H .So no Insulin resistance vibe or anything.

Though it might be because of the Roaccutane which causes high BS sometimes.



Well,here’s an update:



1)My numbers are getting much better,the same as the first week on pump.My defense strategy here is to mention the first week and I did that without the help of any drug.I think it came down because I started to be on tighter control.And losing apetite.

2)My Daily totals are the same.no more than 35.but I think it’s due to the fact that I’m not eating as much either because I had no appetite or I’m afraid of the nausea after the meal.

3)since I started pumping I had about a hypo or two a week.now they’re daily.but in the 60s.


and I am taking the pill during lunch,lowest dose there is.

7

Metformin is sometimes prescribed for PCOS (Polycystic Ovarian Syndrome) which will often have acne associated with it. But with no signs of insulin resistance it is weird that they added metformin.

8

I have a family history of PCOS.my sister has it.But they did an Ultra scan of the ovaries and everything was normal so…

9

Asma, what the doctor is figuring is that metformin decreases the liver output of glucose and increases insulin sensitivity.
If you get to diarrhea, notify her.
The doc is simply trying to hit whatever is keeping the A1c up. It will do the same thing in you as it does with all Type 2s. Keep us all informed on how it works! - after a month or two of it! - if you’re able to tolerate it! :slight_smile:

10

But my sensitivity id fine to begin with!.
I can tolerate having it for 2 months but never forever :frowning: .
It’s more than that,it’s the nausea,it did subside but not stop.Can I use it to take my A1C down then stop using it and try keeping that A1C with increasing my insulin-or keeping it the way it is since it never decreased anyway-.?

11

My ultrasound wad fine. but my cycles were completely irregular. They put me on metformin and they are getting back to normal. But like I said I have clear insulin resistance.

12

well,I used to have irregular cycles but I told them that they were getting better.

13

Asma, You can’t stay on metformin with nausea. It’s a no-go. Tell the endo. She’ll take a next step in the trial and error business known as recommended management.
Are you euthyroid?
Have you added some protein to each meal so you’re not hungry 1 hour later (grabbing the bite is enough to send you high). Ask for some shaved ham slices, white cheese. White cheese slices can stretch out the digestion of carbs making the highs lower. Ham slices at a meal where your protein is low can ensure you’re not so hungry right away after a meal.
Take a look at your basal when your food isn’t part of the landscape. Is it staying steady?
Do read, read, read.

14

A lot of patients cannot tolerate Metformin. Often doctors will recommend titration or to take Metformin with food, but it is a tough med for many. My PCP tried to get me to take it, and I never could tolerate it. I believe that you need to weigh benefit against the side effects to determine if you can handle adding Metformin. I’m a type 2 controlling my blood sugar only with insulin (basal and bolus), and I am so happy to be off all drugs such as Januvia, Actos, Glipizide, Metformin, and all the other glucose-controlling pills. They all had unpleasant side effects for me, but Metformin was the worst by far. I could tell you a funny story about an experience I had with Metformin, but it probably wouldn’t be appropriate. :slight_smile:

15

Now that I look back,It might be the problem,snacking less than two hours after the meal.

16

I specifically posted this discussion for stories and experiences.Also to know how to persuade my doctor into putting me off Metformin.
My numbers did get better,but that’s because I had better control of diabetes since I was scared they would take my pump if I didn’t lower my A1C .Another important fact is that I had my BS under control-no highs OR lows-the first week after the pump,and it was achieved with no more than 30 units a day.so it’s possible.

17

That’s great that things fell into line more! Have you talked w/ them about the 3 month range and my suggestion to wait a couple of more months to get a more significant A1C? If you found control easier to achieve, it seems like they should be working to build on your success rather than trying new drugs. I don’t get it.

18

My next appointment-pump related one-is in two months,she said that would give me time to work things out,The only problem is the Metformin.
But I did send them an e-mail.Expressing my concerns about the drug accompanied with my readings.The one I usually contact them with and send my readings,they usually correspond with no change in dose.Hopefully I’ll see something else.

19

I was on Metformin when misdiagnosed as a T2. That stuff is really hard on the stomach. It’s not really indicated for T1 and has some scary warnings on it. If you can’t tolerate it you need to tell the MD now. Don’t wait! And look at your diet, especially those carbs, as a way to lower your A1c. Good luck!

20

I started Metformin 500 mg AM and 500 mg PM back in March 2010.

Pre-Metformin, I was having severe insulin resistance and digestion issues. I have some CGM charts that show that no matter what I ate (a salad or a piece of cake) my post prandials would be perfect for 1 hour and then would SHOOT straight up to 300-400 for 4 hours after, no matter how many corrections I did. I asked to be tested for gastroparesis (negative) and other digestive issues. I researched the fat content in everything I ate and cut out almost ALL carbs from my entire diet. Nothing worked and I was completely exhausted all the time.

Metformin was around since the 1920s (before most analog insulins). The side effects are severe diahrea (I always spell that wrong). I’ve only experienced this side effect ONCE because I took 500mg with breakfast, 500 mg with dinner… then FORGOT I took it already and took another 500mg for dinner. It was bad. I thought I was going to die. Other than that, I’ve experienced nothing. Just WATCH YOUR BG READINGS VERY CLOSELY. Your insulin needs will go down pretty dramatically and you want to be on the look out for sudden lows.

Last year, I was on Metformin for only 3 months before my body seemed to reboot and return to normal. I took myself off the pill and was still able to eat carbs and lower my A1c to 6.9%… which is AMAZING for me. I’m a first generation Type 1 with insulin resistance. I’ve NEVER been below 8.5% EVER since diagnosis. It was a 11 year struggle to break that plateau and Metformin helped me do it. Even though I only used it for 3 months last year.

I am now almost 8 months pregnant with my first child and as of month 6, I started taking Metformin again, to help combat the insulin resistance from the placenta. It has helped me a lot. I plan on using Metformin for the remainder of my pregnancy- a few more weeks!- and then for a few months after birth to help me lower my insulin dosages back down to pre-pregnancy.

I’d say to give it a try. Watch your BG very closely. I was on CGM in 2010… but now I’m off CGM and testing 10-12 times per day to keep a close watch on my BG. Depending on your personal situation, 500mg might not be enough for you. Maybe you’ll do 1000mg at breakfast, and 500mg at dinner. It depends.

Good luck! Don’t be afraid.

~Type 1 for 13 years, no pump, no CGM, 1:2 carb ratio with Apidra, Levemir, 20 shots per day, 10 tests per day, 6.2% A1c, Metformin, anti-medication / anti-vaccine