Still High Despite Metformin

1

So I got samples of Metformin from my endo when I saw him last week. He told me to take one on Sunday to "test" it and then he said that we'd talk about whether or not I should take it when he sees my blood test results.

I know he's putting me on it--I'm desperate at this point and he knows that I can't live through being pre-med if I have migraines every day from being high and go to sleep early every night because I don't feel well and am too tired to study. (And I also know that he really intends for me to take it because he gave me 2 sample bottles of the Metformin--that's 42 pills.) My last two c-peptides were high, and even though I sound like LADA much, much more than insulin resistant, that c-peptide is a deal-breaker.

So I started taking the Metformin, anyway. After the first pill I took on Sunday and experiencing the side effects, I knew that I didn't want to go through a second "transition period". That clinched the deal and I started taking it every day.

There are many, many other reasons why I did this (not being able to handle no carbs, being sick of feeling sick, etc). Suffice to say that it's not something I would've done under normal circumstances, but I was desperate enough that I had to.

The 500mg of Metformin worked wonderfully on Sunday and Monday, but I hit 150 on Tuesday night from about 35g of carbs (a bit much, but not out of reason). I hit 160 on Wednesday, too, also from a not-unreasonable number of carbs.

I do have a very, very mild cold, but I shouldn't think that it would affect my numbers so much if it's so mild, especially because my numbers aren't usually that much higher when I'm sick--even when I'm really sick. (In fact, last year I had serial lows from being sick.) My endo was hesitant to give me anything at all, but he did because I told him I couldn't function. He said I don't have much IR. If the IR isn't that bad, then shouldn't I be doing better on Metformin? (I AM doing better, just not as "better" as I would like to be.)

The good news is that I FEEL better, even if my numbers aren't stellar. But I'm still confused. I don't think I should be on a higher dose because I overlapped the Met dose on Tuesday morning by a couple of hours and I had a low from that.

This probably isn't something I can tell my endo about when he calls me with the blood test results on Sunday night or Monday (that's usually when he calls) because he'll be mad that I was taking the Met without his permission. He really doesn't like meds at all and I don't want to antagonize him because he's actually willing to put me on something.

Any opinions, thoughts, or ideas?

2

Ok, some stark reality. As Helen points out 500 mg is not a physiological dose (a minimum dose required to see an effect) of Metformin so it is probably not enough to see an effect. And since a non-diabetic blood sugar swing after a meal may reach 150-160 mg/dl your readings are hard to interpret as out of line. And while metformin will improve things, it is not going to just fix all your insulin resistance and return you to non-diabetic status.

And remember, metformin has three actions

  1. Improves insulin sensitivity
  2. Reduces glucose production in the liver
  3. Reduces carb absorption

You may see some of (3) right away, but the other effects will likely build up over time.

And if you have IR, whether it be because of diabetes or PCOS, you will have to battle blood sugar surges from meals containing carbs. As a T2, if I "only" hit 160 mg/dl 2 hrs after eating 35g of carbs and trying to do a perfect insulin injection to account for those carbs, I would consider that an accomplishment.

3

Low carbs as in extreme low carbs, or low carbs like 30g per meal?

I think that "not many" was probably about 40g, which is more than I'll usually eat in a meal, but that's a long story.

4

I wonder, then, if my endo's going to put me on a higher dose when he calls. I can't see him putting me on more than 1000mg, though.

A "normal person"'s blood sugar wouldn't be 160 an hour and forty five minutes after eating, no matter what they ate, especially if they walked a mile and a half during the time between they ate and had that reading. I also have read some pretty convincing studies that say that people with zero insulin resistance rarely venture over 140 or even 120, no matter how many carbs they consume.

According to my A1c (and all my A1c's over a long period of time), I don't have diabetes. After three years of complaining about highs, my endo has finally said the magic words "insulin resistance". He still wouldn't have put me on anything, but I complained so much about not being able to function that he knew he had to do something.

5

This is a most interesting discussion. Overlapping doses means that during the zone when the two drugs when up to strength in blood ( 2.5 hours up on each pill separately) can result in a strong enough dose in blood to haul back liver.

A key issue is whether the single 500mg dose was strong enough by itself to haul liver back. It may not be as I usually need 500 to 700 mg to enusre liver hauled back.
Overlapping them will give you either a higher blood load on the overlap zone guaranteeing liver hauled back or if each dose hauls back liver then a total of 2 to 6 hours of action based on the duration of a single pill up to strength numbers of 1 to 3 hours. ( this is all based on standard met and not XL.

I am not a Doctor but as I understand it they recommend you not overlap them like that. You did not indicate or I missed the ingestion times in your discussion of the two pills overlapped. Each pill will have a 2.5 hour up to strength ingestion time so calculatting actual overlap time of doses is tricky.

6

Maybe they didn't overlap, then. This was the XR version, and I only took the pill two and a half hours early. Since it caught the tail end of the last dose and the beginning of the first (and I was low only about two hours after I took the second pill), I guess I have to assume that the low was a fluke.