Metformin vs. Metformin ER

Wondering if anybody has experimented with both Metformin and Metformin ER. I know ER causes less stomach issues....but as far as weight loss and BG control, is there an advantage to taking the regular Met?

I am on ER, but have heard better results with regular.


why are you taking metformin? you posted that a small dose of 8u lantus was causing you to go TOO low, which clearly indicates insulin sensitivity. did your endo put you on metformin and is that why you're going low on lantus, the combination of the two? are you taking metformin to try and lose weight? all your posts seem to be focused on weight. not too many type 1's take metformin, as it often has little results?

I am back on my pump. I have been taking metformin ER for a long time. I know of a lot of type 1's that do take it for weight control and BG control. And yes my posts say a lot about weight loss because as a woman in my 20's who eats healthy and exercises but cannot achieve weight loss to easily it is very frustrating.

Yeah I don't think metformin is the answer, but I have horrible experiences with it from my misdiagnosis as it made me lose like 4 lbs in a week (when I'm already skinny and do not need to lose weight it makes me look sickly as hell) and gave me the worst gas known to man where I call it metfartmin. There was only one positive, it fixed my period like entirely and my period was awesome then but has not been ok since I went off it. Have you talked to your endocrinologist about this and what options are possible like besides metformin?

insulin in itself doesn't cause weight gain, unless newly diagnosed and going through recovery of DKA. many type 1's take insulin and don't gain weight, i mean look at Mary Tyler Moore, she's bone thin and many others. what i've been told is high blood sugars or maybe taking too much (basal especially) causes weight gain, high blood sugars result in insulin resistance (insulin resistance typically associated with type 2 causes weight gain) and needing more insulin. I too would suggest discussing with Endo. You couldn't pay me enough to take metformin...i'm not sure it would do anything really and I certainly wouldn't entertain the idea of taking it to lose weight.

Yeah I don't know if I'm lucky or what but even with slowly adding more and more insulin into my life I haven't gained any weight at all. But I struggle to gain weight and always have (though in childhood I was like skin and bones until I got older now I'm more on the average thin side) .

Metfartmin isn't worth it though the gas pains haunt me forever if I fart now at all and the gas was horrible and I haven't fully recovered from that either where I feel like if you're not a type 2 that it works for. I mean I've heard of type 1's (besides people misdiagnosed like me) being on metformin or even victoza (WHICH IS EVEN SCARIER SOUNDING TO ME) for weight loss and I have to wonder how safe that is/why they let people do that?

If you can reduce your insulin levels that should promote fat and weight loss. Weight loss when you use insulin is harder. I understand your desire to lose weight and metformin is reasonably well accepted as a way of increasing insulin sensitivity and achieving weight loss for T1s. Actually other medications such as Actos also have been used with T1 as well.

In my view, if you don't have stomach issues then you should choose between Met and Met ER based on other considerations. First, Met reaches peak levels 1-2 hours after you take it while Met ER takes about 7 hours. This means that Met is best for timing to address meals and Met ER is best to address fasting levels. So a key questions is which do you think is causing you to use more insulin to drive your blood sugars into normal range, after meal or fasting?

The second consideration is max dosing. The max dose recommended for Met is 2500 mg, but for Met ER max dose is 2000mg. You can actually take more Met which may give you better results.

If you don't have gastric issues it certainly would be worth trying Met. You should take it 1-2 hours before your meal to achieve the greatest benefit.

Brian, ACTOS is not at all recommended for type 1 diabetes and can often do damage as it requires naturally-secreted insulin to be effective, ACTOS is not recommended in type 1 diabetes where the amount of insulin is very low or absent. Metformin is sometimes used for type 1's but typically for a type 1 who has had the disease for a very long time and who has become extremely insulin resistant; someone who needed a total of 8 units of lantus and still going low does not equal someone with extreme insulin resistance. Also, the dosages you recommended for metformin are for a type 2 diabetic with insulin resistance and probably not used for a small dose supplement for a type 1 diabetic. Again, type 2 and type 1 are two different things, one an autoimmune disease the other a metabolic syndrome.

I'm not sure where you got some of this information, but it is not accurate. Neither metformin nor Actos are approved by the FDA as a treatment For T1. But they both can be (and are) prescribed off-label as insulin sensitizers for T1s. This helps both with reducing insulin usage and weight loss. Bernstein specifically uses both metformin and Actos for his T1 patients specifically for weight loss. Our T1 member Richard157 who suffers from insulin resistance has used Avandia, Actos and metformin with various success in improving his insulin sensitivity.

Metformin might cause B12 deficiencies (google it). I was very low on B12 after taking it a while. For me side effects were headache issues and stomach problems, but I was a misdiagnosed T2 at the time (I am T1). I found that I had more stomach distress with Metformin ER. I couldn't tolerate the ER. It has some added chemicals to enable the slow release and they might have unexpected consequences.

Both seem to have long term and shorter term impacts on BG. Metformin ER is supposed to have a slow and steady release. Regular metformin actually has a peak followed by a valley. For a T1 diabetic, regular metformin can be a huge PIA. I was taking it before the T1 diagnosis while I was taking insulin. The metformin kicked in pretty hard for me at 5-6 hours, and then mostly gets out of my system after about 9. So if I took it in the morning, the Levemir I was taking would be very effective around 2 (I would need to eat) and then completely ineffective around dinner time (BG would shoot up).

I have heard of people using small doses of regular metformin at night to counter a dawn phenomenon, but it's a PIA for T1s. I suppose 3-4 half pills a day might be doable.

google Actos with type 1 diabetes. Dr. Bernstein does most of his stuff 'off label' that doesn't make it right, typically it's off label and not approved by FDA for a reason, IMO. Read what Actos does and how it could possibly harm a type 1...ask an Endo if he/she would put a type 1 on Actos, someone other then Dr. Bernstein. Insulin Sensitivity, type 1's don't have any or much to be sensitive to and I'm not sure that includes analog insulins. If you're going to just use 'Richard' as an example, his post suggests he has double diabetes or EXTREME insulin resistance, he's been a T1 for YEARS. A typical type 1 should not use Actos, Avandia is not Actos. Every medical report, journal, posting says do NOT use for type 1 diabetes.

even joslin diabetes center, in conjunction with Harvard Medical School states type 1's do not need orals like avandia, actos, etc...additionally, as Richard stated when diagnosed, there was no testing available in terms of type 1 or type 2.

If type 1's had all these oral medications as options and choices available to us, like type 2's, don't you think we'd all be taking them? I would imagine most type 1's would like to use as little as insulin as possible and would take 'anything' to help aid us with our management and lessen complications. Insulin is what is needed. I was wrongly diagnosed too, by an uneducated NP, who Rx'd orals...but she knew something wasn't right, I had NO characteristics of type 2 and really was on my way to DKA, referred to an endo the next day and put in the hospital. I begged to be put on oral medications...she wouldn't do it nor would any other Endo who I saw..insulin, that's all they would give me because I was and am a type
1 diabetic. I think they would probably laugh at me if I asked for an oral of avandia or actos.

here's a link from Dr. Bernstein's book, where he clearly states these orals would be ineffective for type 1's.

We seem to be talking total cross purposes. There is no suggestion that Andrea take metformin as a treatment for T1. She is taking metformin to treat insulin resistance and to aid weight loss. Bernstein is very clear that he uses both Metformin and Actos for weightloss in T1 patients. And Richard also has used Metformin, Avandia and Actos successfully to address his insulin resistance. The use of metformin in patients other than T2 who have insulin resistance is quite common, for instance it is a standard line of treatment in PCOS to address problems with insulin resistance.

Yeah, that's what I got. Good weight loss drug, good against insulin resistance (which T1s can have), and then it might have some use to help manage dawn phenomenon (especially for those of us who can't afford a pump).

Still, I'm not fond of the side effects.

When I was "T2" I was on regular metformin while taking Levemir once a day, and I had these wild roller coast BG levels. Around 2 I could eat anything, and then around 8 my BG would shoot up to 200 for virtually no reason. I was crediting the Levemir (I was not in a good place at the time) and it took me a couple of weeks of very aggressive testing to figure out that metformin was the culpret. Fortunately I wasn't listening to the doctor telling me to test only 3 times a day.

These aren't 'weight loss' medications, they're to be used for the treatment of type 2 diabetes. Andrea stated she went off pump, back on MDI and she was taking 8 units of lantus total and was having lows, that hardly suggests insulin resistance. PCOS is not type 1 diabetes and is also associated with type 2 diabetes, obesity, high cholesterol, etc.. Bernstein does a lot of questionable things. Actos, avandia are diabetes drugs for type 2's. I'm talking about type 1's, Andrea has stated she's a type 1. Richard also said he has double diabetes and there was never a clear test when Dx'd for type 1 vs. type 2. To suggest a type 1 take actos for weight loss, well...don't know what to say to that. I'm not talking about metformin. Being a few pounds 10 or so maybe overweight vs. someone who is indeed obese and type 2 are very different issues, IMO.

most t1's don't have insulin resistance especially just a few years after diagnosis. Most type 1's don't have weight issues either when diagnosed, often times the opposite, where we need to GAIN weight due to high blood sugars, ketones, etc...

and..what qualifies - quantifies as insulin resistance; a type 1 needing to go from 15 to 20 units basal insulin on MDI vs. a type 2 who takes a total of 600 units of basal and still can't get BG's down without the help of orals too, there's big difference between the two. OK, i'm out on this subject now. Ha! :)

Sarah, you are right and Bsc is simply wrong about this. He just feels the need to defend crazy bernie no matter what. As you pointed out Andrea is anything but insulin resistant - she takes a total of 8 units of basal insulin per day. Insulin resistant? I don't think so.