Metformin ER or regular?

A couple of years ago I switched to the extended release from regular Metformin. I switched because a friend said it helped him, I wasn’t necessarily having any problems with it. During that time I can see that my A1c increased from 6.0% to my latest 7.9%. Coincidence? Maybe. Has any of you switched back?

I use metformin in conjunction with insulin therapy to help combat insulin resistance. I have tried both and I am not sure I noticed a difference other than the size of the pills.
This is an interesting question however and I hope others share their thoughts…

My guess would be yes, it is a coincidence. For many people, Type 2 progresses with time, and I suspect that this may possibly be the case with you and that what is needed is a dosage adjustment and/or consideration to adding insulin to your treatment regimen.

My advice to you would be to look into this issue soon, as I don’t consider an A1c of 7.9 a healthy one. I wish you the best of luck!

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Thanks for the response, i failed to mention that i am on insulin. I used NPH for over a year, then switched to Lantus for my Basal and a few wewka ago started Humalog for Bolus. I agree that this stupid diaease is progressive, i am just trying to find some loop holes that will fix me. I am due to reorder Metformin and not sure if i want to stay on ER. I assume many others find no difference between the two besides the gastro problems.

Since Met reg didn’t cause side effects for me didn’t switch. Started Glipizide after. I just noticed the glip says ER. Had always taken glip and met with food. That is what the bottles say to do but everything on internet says GLip 30 minutes before meal. So started doing that and seems to be right for me numbers wise. Anyhow the pharmacist in my class said take the met before a meal. Get it breaking down in stomach first.

Hey, Cynthia–I experienced a lot of exercise lows while on Metformin and couldn’t get my basal right, either. How is this combo working for you? CL

So you do fine with regular? I am thinking of switching back.

Hi Todd,

Many of us have tried regular in the past (at the beginning), and have found that the more modern insulins are superior in terms of profile and predictability. I certainly found that - and was very happy to wave regular goodbye. That said, some people who use low carb diet, or who have major dawn phenomenon have found that regular can help.

Anyway, before switching I would like to ask about your current management. Your Hba1c means that your blood sugars are averaging close to 200. Probably no more loop-holes and your best bet will be becoming expert on how to manage your blood sugars with diet, exercise, insulin, metformin etc.

What are your targets for fasting and post eating? If you have been told that 180 is a good number and your target, there would be many people who disagree and who target blood sugars closer to non-diabetic range. My personal operating targets are 70 - 120, and mostly I can achieve this with insulin, and low carb eating.

Have you done basal / bolus testing to check that your doses are correct and optimised?

How do you dose your insulin? A sliding scale? Or basal-bolus.

You can get lots of inputs from others on how they manage their blood sugars, which may be helpful for you.

Metformin ER was developed because something approaching 50% reported unpleasant gastrointestinal side effects with plain glucophage. If you don’t have any problems with the plain, then using it is fine. You should also discuss it with your physician and see if perhaps you need a larger dose of the ER.

Theae are the questions that I wish my dr would ask. She is a GP and just sort of prescribed the insulins and a bit if guidance and i have to experiment carefully to bring my numbers down.
My current management is 1. I am active. I do a lot of yardwork, walking (more than 10k steps per day). 2. I am medium carb. About 100 per day. 3. Metformin, Lantus basal, Humalog bolus. Though the latter i just started less than a month ago; 5u at dinner, occasionally 2u when i am over 200 after lunch.
I haven’t done any testing for optimalzation, looked into it, i may ask for guidance from dr.
Thanks for the info, i will look into it more.

There are some good books you can refer to in order to teach yourself how to use insulin, though ideally your Dr will be referring you to a diabetes educator.

Basal insulin is meant to keep your blood sugars stable when you don’t eat. Ideally they will stable at around 70 - 100 range with correct basal dosing. Typically the basal dose will be increased by 1 or 2 units every 3 or so days until your blood sugars are on target. There is also a test called basal testing where you don’t eat and monitoring blood sugars (and target that they will be stable within about 20 points or so).

Basal Testing Basics - Basal Insulin Testing - Insulin Program (this link tells how to do basal testing)

Bolus insulin is used for correction and also to cover carbs eaten. You need to work out how many grams of carbs 1 unit of insulin covers. For me that is about 10 - 15 g. For others it can be completely different. Bolus insulin is usually taken before eating (the timing based on what you eat and how quickly you digest). But start with taking it just before eating. The target is that your blood sugar before and 2 - 4 hours after eating is about the same. In any case, your sugars are so high there may not be a problem with careful experimentation.

When I started bolus insulin I was told to assume 1 unit of insulin for 15 g of carbs. So test before eating. Lets say your sugar is 160. Then, say you are having a meal with say 30 g of carbs inject 2 units (1 unit insulin for 15 g carbs). Eat and then test about 1 1/2 to 2 hours after eating. See what your blood sugar is. Let’s say it is now 200. Test at 4 hours, as some people have delayed response. Lets say it was 220. Ok. the 2 units of insulin was not enough to stop you going high. So the next time you have the same meal you try with 3 units of insulin (1 unit insulin for 10 g of carbs). See the results again. Continue experimenting.

Then you will also need to work out how much 1 unit of bolus brings down a high blood sugar when used for blood sugar corrections. For example, test when you haven’t eaten (or 5 - 6 hours after a meal - so there’s no food to affect sugar levels), if you are higher than you want then you do a correction. Start with a conservative approach. For example. Your blood sugar is 200 - inject 2 units of insulin. Test after about 2 hours to see how much your level has dropped. It may now be say 150. This means that 1 unit of insulin dropped your blood sugar by 25 points. The next time you try this again. Maybe you’ll inject 4 units and measure after 2 hours, and this time be at 100, confirming that 1 unit dropped you by 25 points. Of course this is not an exact science but there are definitely patterns and trends to learn from.

Good Books, and these explain it much better than I’ve tried to, are:-
Diabetes Solutions by Dr. Richard Bernstein (very good IMHO, but very techy) - Also on Utube @ Bernstein Diabetes University.
Think Like A Pancreas by Gary Scheiner
Using Insulin by John Walsh

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Thanks for the info. I will try yo work this out.

I’m not sensing a coordinated plan of action here. Do you log your meals, their carb/protein/fat content? Fingersticks? Dosing? Response to dosing? That should be done and presented either to your doc or, perhaps preferably, to a diabetes nurse in order to get you on an optimal regimen. I would note that if you are type 2, your doses of 2U and 5U are practically homeopathic. Generally, type 2s requiring prandial insulin require rather large doses.

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Todd, tell your GP to perscribe the NON genric form of Metformin XR. GLUCOPHAGE XR what ever the time released form is…studies have shown that the Generic Metformin is NOT as effective as actual Glucophage…