Metformin didn't make a dent

After 16 years of managing with diet and exercise only I experienced BG creep as in my hba1c had gone above the 7.0 cut off. So my doctor prescribed metformin 500 mg a day. After the things I had heard about potential side effects I was somewhat wary. However, no gastric distress, nausea or bathroom trips at night. That was the good news. The bad was that BG levels continued to rise, reaching an hba1c of 9.4 at which point my doctor doubled the metformin dose. Still the same good news bad news, no negative side effects but no dent in my hba1c levels. At that point, three months ago, my doctor prescribed a second medication called Glyberide. Within two months my hba1c was down to 7.2 and random BG tests continue to fall. now averaging around 6.0. Not that I am complaining about that but I am still somewhat curious about why metformin had absolutely no effect, positive or negative, on my condition.

Glyberide is a sulfonylureas. What it is basically doing is over working your beta cells to produce more insulin. Metformin reduces the amount of sugar your liver releases when you are not eating. The problem ALL diabetics have is they are not producing enough insulin for their body’s needs. Neither address the root problem.

Dr. Ralph DeFronzo had high hopes for Metformin 30 years ago when he helped get FDA approval. The general feeling is it did not live up to the hopes. Here is what he said last July

“The most waste in type 2 diabetes is to continuously put people on metformin and sulfonylureas (glyburide, glimepiride, etc.). These drugs have no protective effect on the beta cell, and by the time you figure out what you’re doing, there are no beta cells left to save.” – Dr. Ralph DeFronzo (University of Texas Health Science Center)

One of the great minds in diabetes was Al Mann who invented such things as the CGM and insulin pump. Here is a quote from an interview Al did. He passed away several years ago.

Al said -"In early Type 2, a variety of alternative antiglycemic drugs are used today and these products are viable largely because of the deficiencies of current insulin products. But it is insulin that the body needs for glucose metabolism. Even with the limitations of current insulin products, there is increasing pressure to move patients much sooner to exogenous insulin. The alternative antiglycemic products are intended simply to supplement endogenous pancreatic insulin more effectively. Some of them are directed to increasing pancreatic output, likely contributing to early-year beta cell burnout. Other products have tested lower resistance to insulin to inhibit hepatic glucose release or to slow digestion, but all of these drugs have limited efficacy and side effects that can be significant in some patients and the long-term safety for many of them may still be in doubt. Moreover, none of these antiglycemics, I believe, does slow progression of the disease so that, after 8 to 12 years, patients using those drugs typically move on to insulins.

Another issue is that many of the newer, more advanced antiglycemic agents are very expensive. If only there were a physiologic ultra-fast-acting insulin that would reduce postprandial hyperglycemia to within normal guidelines without the risk of hypoglycemia or weight gain and without the complexity of titration or the need for multiple daily measurements of glucose. Such a prandial insulin would far better deal with postprandial excursions throughout the entire spectrum of diabetes. Moreover, key opinion leaders assert that, by reducing pancreatic and hepatic stress, such an insulin would slow and perhaps even stop progression of Type 2 diabetes and prediabetes. Surely, that would seem to offer a far better solution than those alternative drugs. Moreover, a therapy that does not require the inconvenience and discomfort of multiple daily injections, would certainly be more patient-friendly."

You didn’t indicate what type of diet you’ve been on.

My doctor upped the metformin to 2000 before adding anything else. So far it is working.

It appear that you are experiencing an unfortunate fact about T2, it progresses, The fact your T2 is progressing is not an indictment of you.

You have fought hard and long with diet and exercise, you should be applauded. There is still much you can do. Even 1000 mg metformin is a small dose, it can be increased to as high as 2500 mg a day, even themn there is many more options

Whatever you must do, as far as you must progress your treatment, is not important. The important thing is to tame the monster that lurks within.

The mainstay of my diet since my diagnosis in 1998 has been the glycemic index. I eat lots of fish, no beef, some poultry and pork.