I’ve been a lurker for a while and love the content here. I wanted to run a recent scenario by the group to see where some hidden clues might be.
I’ve been diabetic for about 17 years with A1c’s generally ranging from 6.8 to 7.4. About two years ago I had some recalcitrant tendon issues in my feet that the podiatrist thought might be neuropathy. There wasn’t hard evidence of neuropathy as two different neurologists couldn’t find anything of note. About six months ago I got a copy of Bernstein’s book and started working on getting my A1c under 6.0.
My last two A1c’s came in at 6.1 (November) and 5.9 (March). At my November appointment my endocrinologist decided to add Metformin to the mix. I have been very slow ramping up the Metformin and got to 2000 mg per day shortly after the March appointment. Once at the 2000 mg level digestive issues came in which are expected. Lots of lows forcing basal and correction recalibration kicked in. Both of those are expected.
What was not expected is I feel like the pain and tingling in my feet is back double time. I know Metformin messes with B12 which is linked with neuropathy. My B12 test came back well above target range so the endocrinologist wasn’t concerned with lack of circulating B12 and suggested staying on 2000 mg of Metformin per day.
I’m wondering if any other type ones have made that transition with similar experiences. Any other bad reactions from Metformin? If it is neuropathy, I know Bernstein notes that better control can bring on neuropathy like symptoms. Any other evidence to tell if nerves are healing or continuing to degenerate?
I’m curious as to your daily testing results. Lots of lows and highs can balance out to a wonderful A1C but suppress the fact that you really aren’t in control. Depending upon your Cpeptides, and how much insulin you are or are not producing can let you know if the Met will be doing anything or if you need to be on straight insulin at this point…
the higher the spikes and quicker you come down can cause the sensations you speak of…some diabetics who present quite high and use insulin to get them in range find that they have more or new neuropathy as the nerves adjust the changes in sugars…
I can’t tolerate Metformin, but during the time that I was on it, I did have some tingling - even pain - in my feet from time to time. My doctor (like Bernstein) suggested that the pain was due to nerves that have some minor damage repairing themselves. For me the pain stopped after a while (5-6 weeks?) and had not returned. As a precaution, I was taking a B12 supplement while taking Metformin, in part because pernicious anemia tends to run in my family and I did not want to take any chances.
I’m T1 on 2000mg—no neuropathy-like symptoms, but also not much in the way of digestive symptoms. Any reason why you might not try a lower dose, like 1000 or 1500mg?
I also take B12, as well as D3, for what it’s worth.
However, I have experienced healing from nerve damage that occurred for non-neuropathy reasons (I had an injury to one of the sensory nerves in my hand due to an infiltrated potassium IV that caused internal burning of the tissue in my wrist—I initially had a large portion of my thumb/side of my hand without much sensation at all and it’s now close to normal). I experienced a lot of pain during the healing period, which lasted prob the better part of a year. Although I was experiencing pain, my sensation was increasing as well, which seemed like a good sign (just increasing in erratic and painful ways)—it may be harder for you to determine changes in that since your nerve damage was less severe than mine. I took gabapentin during that time, which helped manage the pain somewhat. Eventually my repaired nerves seemed to figure out how to sense things reasonably again, and I went off my meds and have been fine since. So yes, nerve pain definitely can be a good sign.
