Question about getting metformin

I know that metformin isn’t FDA approved for use in type 1 but I have read some people have been prescribed it anyway. I would like to try it and experiment with it but im worried that since it’s not FDA approved that my dr. will either not be able to prescribe it or the process to prescribe it would entail a lot of paperwork or something.

anyone have any info about this?

I used Metformin while on Tresiba because I was experiencing insulin resistance, especially in the evening. I used the Metformin XR, and I only used 500 mg in the evening with dinner. It helped substantially, but I found my need for it went away when I switched to back Lantus. Lantus is a better fit for my body type.

The conversation with my doctor was pretty simple. I talked through why I wanted to try it out, and he said that he would prescribe it. I showed him my cgm graphs with my problem point being in the evenings.

He thought it would cause lows. And initially, it did because I was taking it in the morning. This was less of an issue after I switched to the evening. I also had to decrease my daily basal dose by 1 unit. You may experience something similar

It’s increasingly common to take it for T1s, and things are commonly prescribed for “off label” (non-FDA approved) use all the time.

I take metformin ER, 1000mg 2x a day (worked up from 500 1x a day initially). In my case, it was actually my endo’s idea. It is awesome—I went from about 23u of basal a day to 16u with improved control and markedly less dawn phenomenon. I also lost about 13 lbs and have kept it off, returning to my usual weight that had crept up over about 4 years before I started it (suggesting I was developing some insulin resistance in addition to the T1).

Definitely ask for the ER formulation. Time of day absolutely does matter, and while I would ask start on 500mg 1/day to see how it does with your GI tract (some people have a lot of side effects; some like myself do not), I might suggest trying to go to 2x a day for more even coverage.

Yeah I definitely want to try ER, but I’m hoping to go for the max dose immediately which I believe is 2000mg? My c-peptide was .7 in February when I was on a standard high carb diet. Now I’m on beef only one meal a day and I want to try to inhibit the hepatic glucose production with metformin and hopefully stop lantus. I figure it’s worth a shot since metformin is very low risk and my dka risk is very low as well with a decent c peptide I have discontinued insulin use for weeks at a time (while on zero carb)

quick edit: if im consuming zero dietary carbohydrate, the only glucose in my body is coming from what my liver is making. so if metformin can inhibit my liver from making glucose i dont see how this wouldn’t work. unless of course the dose required to inhibit the hepatic glucose production is beyond a safe dose. i believe my c-peptide is more than enough to support a basal/fasting/no-carb rate

This could result in your BG going too low.
Do you feel symptoms when you are low or dropping?

Yes I do. But I would be using metformin alone for this experiment, not concomitantly with insulin. And as far as I know metformin typically cannot cause low blood sugar

I’m type 1 btw

That seems like a bad idea to me both because you run the risk of much more severe GI side effects but more importantly, a drastic effect on blood sugars and risk of severe lows. I would be surprised if your endo supported that plan for that reason. Better IMO to start slower even if you ramp up fairly quickly so you have time to adjust insulin as needed.

That’s pretty good advice, appreciate it. However is low blood sugar common on metformin alone? Even at max doses? I’m aware of the GI problems associated with metformin so I figured it would be best to take with the meal

I don’t know that it’s a good or reasonable plan to think you’d get off of insulin. If you’re T1 or LADA, you’ll need it and your need for it will continue to rise over time anyway. I think metformin can increase risk of lows regardless though, but as a T1, I have no experience using it alone; you’ll probably have to ask T2s that. Also it’s not like in my experience the max dose of metformin inhibits anywhere close to all glycogen release, it just lessens it somewhat.

Yeah I don’t want it to completely stop hepatic glucose production because I consume no carbs, eating only beef and eating only one meal a day. I just want it to inhibit the hepatic glucose production. If I fast for 24+ hours I don’t need any insulin, that is proof that my body produces enough basal insulin in the absence of food and hepatic gluconeogenesis

@anon7061735 How long have you been a type 1?

Just some more quick info.

I typically eat 4-8pm and by this time my blood sugar is typically around 80mg/dL. I also typically take lantus within an hour or so of finishing my beef only meal. If I WERE NOT to take lantus my blood sugar would likely be 90-130 at 12am and 160-220 by the morning, say 8am, due to gluconeogensis, the liver converting the protein to glucose.

My hypothesis is that metformin extended release will inhibit that and allow me to discontinue lantus

Almost 1 year. But after studying and research I believe I was slow onset that eventually went full-blown when I started letting my healthy diet and exercise habits go

@anon7061735. LADA can take 8 years plus to fully develop. Without changing my diet I wasn’t even on insulin for 5 years. Because you make some for a while. Eventually you don’t. ( maybe in erratic tries).

But the odds are you are still making some insulin and will for a while. Hence being able to skip insulin for days.

In the old days before insulin, they restricted what was eaten, had no insulin and died young.

People always tell me this when I tell them my diet and med regimen. To be quite honest I don’t know why I should be vilified for choosing to do this regimen. I never have to worry about hypoglycemia by doing this lifestyle. If someone wants to eat whatever and take lots of meds that’s fine with me, but if someone wants to be extremely restrictive that should be fine too. As long as both know all the options, which upset me when diagnosed because no one informed me about about zero carb. I was told I need massive insulin doses and massive carb meals and snacks all day

Sorry about the rant but yeah about LADA I definitely agree. A few months before my official diagnoses I had gone from a pretty decent diet largely consisting of high carb but Whole Foods like fruits, plain Greek yogurts, etc to eating McDonald’s, Burger King, Taco Bell, etc 3-6 times a day. I believe this along with a flu shot which I hadn’t received in many years all triggered the diabetes to manifest

@anon7061735. I did not say you have to change your diet. I have always been one to say whatever works.

I just think trying to shut off all glucose (liver) and trying to go without insulin could be a huge mistake. Some glucose and insulin probably is needed. Granted they couldn’t block glucose from the liver back then, but no insulin means death for a type 1. They actually could block some insulin from the liver as metformin came from an herb that was commonly used.

Oh absolutely. Glucose is required by cells that’s why the liver produces it. Insulin is also always required. In insulin deficient diabetics gluconeogenesis runs out of control because insulin inhibits it

Getting your Dr. to prescribe metformin is pretty easy in my experience and many type 1’s use it. Insurance also has no problem paying for it either. Do not take the full 2000mg dose right out of the gate. That’s just asking for digestive upset. Slowly titrate up to the full dose over the course of a couple of weeks.

I’m not suggesting that you change your diet although it is not personally something I would be willing to do but don’t be surprised if it doesn’t get you off of insulin completely. You really are still in the early stages of LADA and unfortunately your C-peptide will decrease to the point that basal insulin will always be required.

I am happy that the regimen you are on is working for you. I am curious though why you are determined to get off of insulin. Are you having lows?

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I have been on Metformin a long time. I take it with Novolog. for me it helps with insulin sensitivity. I tried the ER version and it was not helpful to me. I need to take the metformin with the insulin at meals. Metformin alone did not work for me. I would have to take lots more of insulin to get the same effect. Some have GI effects with the drugs. You probably will not get off insulin as the metformin will makes cell more sensitive to insulin but not replace it, (sorry) I take 850 3x a day. Each pill drops my bg about 50 pts in addition to what the insulin does. But that is me and you will not be the same. Combine that with the insulin and I may go low if carbs or exercises are off. Your doc will not give you the max dose. Will possibly start you
the starting dose. of 500mg. Metformin does have side effects. It may damage the liver.

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