I am a type one and have been experiencing insulin resistance. My liver has clearly been converting fat and protein to sugar, and as I exercise my blood sugar has been rising to the point of needing between 6 and 10 units with no food, if I exercise in the morning. At other times of day the exercise would cause me to require more like 2-5 units, depending.
I eat low carb. Fifteen years ago I needed 20-25 units per day while eating low carb. In the past year I have required 35-45 units per day.
So I convinced a clinic doc to prescribe Metformin (my regular doc has resigned-but that is another story.) He prescribed me 250 mg twice per day. I raised up my dose up to 1000 mg twice per day, and by jove it worked! NO more high morning sugar, no more exercise induces raises, and no more liver dumps. All this as a renegade patient with no permission.
I will not be able to continue on this dosage without a prescription. I would like to try 500mg twice per day for a bit, but I really think I need more than 250 mg twice per day. (I still do not know why I have resistance: fatty liver? PCOS? or just “leaky liver?”) I would like to know what is working for you other low carbers taking metformin. How severe was your insulin resistance?
Robyn - I’m also T1D and use low carb. I tried Metformin a while back, I think it was 1000 mg 2x per day. I remember starting at a lower dose and titrating up. I had a lot of gastro distress and stopped after about a week. I was not insulin resistant at the time, however. I was curious if this drug could benefit me,
I developed insulin resistance several years ago and it was accompanied by a slow weight gain over many years. Have you gained any weight as this IR developed? I was able to defeat my IR when I changed to lower carb eating. At the time I reduced my carbs down to less than 100 grams per day.
Over time I reduced to less than 50 grams per day. I lost about 25 pounds with my initial dietary change but gained about 10 back, even at the 50 grams per day target. Looking back I think my body was converting some of the protein to glucose and reclaiming some of the lost weight.
Is the above what makes you think you’re insulin resistant? Many people with diabetes have a hard time with rising BGs and morning exercise. It may not be insulin resistance per se. I know that one of the definitions of insulin resistance for insulin users are people who need to take more than 0.5 units of insulin per day for each kilogram (2.2 pounds) of body weight. Is this true for you?
So, you’ve discovered that Metformin helps you but in a dosage higher than what the doctor ordered. (I see nothing wrong with your unilateral action. It’s your body!) In my experience with my doctor and reading about others here, doctors are inclined to ramp up the Met dosage until it’s effective. Why not just call the doctor and request a dosage increase? You could even tell him/her that you tried 1000 mg 2x/day and had great results.
Good luck. I’ve heard that many T1Ds can benefit from Metformin and that’s why I asked my doctor to try it.
Thank you for your response.
I am having raising sugar (out of control) after large meals; general double doses of insulin for meals compared to past; needing insulin for protein; rising sugar during exercise (worse during morning). So possibly IR and pretty certain the liver overdoing the gluconeogenesis. As these problems are inconsistent, I am not sure whether there are food absorption issues combined, insulin uptake issues, or solely liver production of sugar.
I eat low carb, mostly 30-40 grams per day and have gained about 25 pounds over four years with no success losing it by bringing the carbs lower and exercise. Anyone who eats like I do should be pretty thin by now! I tend to eat less if my sugar runs high, as I do not have a large appetite or cravings as long as my carbs are low. I have decreased my eating for family events and special occasions due to control problems. Previous to this IR or Leaky liver effect…I was able to keep my weight under control.
The formula you use…is this for eating 30 grams of carb per day? If so, I am on that dosage. However, from 1991-2010 I would have been on 18-24 units per day with low carb eating.
With carbs above 50 g per day, I am easily on 40-60units per day. I am sure that would go up and up if I let loose and ate high-carb all the time, because on the occasional long weekend I see that happening.
The physician I dealt with will likely not be very open to me choosing to up the metformin, based on my one time experience with him. He was a little threatened by my approach (low carb, tighter standard for control, etc.)
However, I am trying to find a family doc who will be open as my previous one. I was able to chat with her (she is out on disability) and she instructed me to go back to 250 mg twice per day and follow the other guy’s instructions. I will try 500 mg twice per day, if that is ineffective I have to find someone who is open to a higher dosage prescription before I run out!
On the other hand, if 500 mg twice a day is effective, then I will drop down to 250 as it would be preferable to do the lowest effective dosage.
No, this is a medical textbook formula to help detect insulin resistance. I’ve seen it referenced in several medical studies. I view it as a standard, not an absolute truth.
Do you bolus for protein? With your 30-40 grams of carbs per day, it’s likely that your liver is converting some of your protein to glucose. If it is, it’s likely that your blood glucose is rising 3-5 hours after you eat.
Having to increase your total daily insulin dose from the 1990s is consistent with the slow loss of endogenous (home-made) insulin. If you’re like many T1Ds, your pancreas did not quit completely at diagnosis, hence the honeymoon period many experience.
Is your current doctor an endocrinologist? If so, he must have plenty of experience increasing Met doses for his T2Ds. Maybe he’s being extra conservative since he is rx’ing Met “off label” for you, a T1D.
If you want to stay with him for convenience sake, I would withhold your self-prescribed dose increases, revert to his current orders and report quickly your unfavorable symptoms. If he’s not willing to adjust before letting damaging time periods elapse, like 3-6 month, I would definitely look for another doctor.
You’ve already done the hard work and discovered an effective Met dose! Good luck getting a doctor to help you. This kind of authoratarian arrogance drives me nuts. Somtimes we must be diplomats, caring for tender egos!
I have insulin resistance due to PCOS (and possibly other reasons, but who knows). I started on Metformin (1k 2x per day) and also birth control pill to help treat the PCOS. I have been on a low carb diet for several months and exercising, but was still gaining weight and unable to bring my BG down without tons of insulin.
I was taking 35 units of Lantus and 30+ units of Humolog per day just to keep my BG on the high side of normal!
Once we figured out I have PCOS and I started on the Metformin and birth control my insulin resistance improved quite a bit, but I still have unexplained times where my BG rises and refuses to come down…then suddenly after a day or more of this frustrating issue, my BG will even out again and I’ll be fine for awhile. Still working on figuring out what that’s all about. My only guess at the moment is erratic changes in my hormones.
I am still having to take 35 units of Lantus, but I take much less Humolog, 10-20 units per day. This, I think is because I am unable to exercise as much as I should due to neuropathy and other issues. But I try my best to push myself and the more exercise I get the less insulin I need.
I still have yet to begin losing weight, but at least I’ve stopped gaining. I’m told it takes time for the meds to really start helping on the weight loss part.
But I have a lot of complications of diabetes so sometimes it is a real battle to try to figure out what’s causing what, etc.
Just me, but these Metformin side effects give me pause. I would be more inclined to make dietary changes and use supplements to optimize efficacy of receptor sites for insulin resistance.
I was needing to bolus 6 units with a scoop of low carb protein powder (almost no carb) and indeed there was a delayed rise in bs after breakfast. This is not happening on the Metformin.
Also needing to correct after eating a large meal (just one plate…not massive amounts of food. I can no longer eat big meals due to erratic sugar.) BTW I am using supplements to assist in breaking down food and that helps to some measure. Digestion does not seem to be the sole source of my troubles.
For example, a Thai meal with no rice that fills me would shoot my sugar way up and require a couple corrections before bed, then probably leave me with a morning high, way out of range.
Ahnalira, I am pretty sure the problem is in liver gluconeogenesis (overactive) and not receptor sites. I do agree about lifestyle and diet changes being the first line of treatment. They simply are not working for me. Thank you! smile
As far as lifestyle goes, I have been very methodical with exercise, supplements and diet, trying to get things under control…and to no avail. So the time for medications is here, because erratic blood sugar needs to be gone! smile
I have no diagnosis of PCOS,fatty liver or leaky liver, and doubt I will be tested as doctors are scarce here and they do not even understand how low carb is the very best treatment to control diabetes. They just think I am lucky to be on a low dose, even with an a1c that is 7.5 and higher on a strict low-carb diet. The truth is, I would not be on a low dose if I ate a full breakfast, stopped exercise and ate carbs freely, and indulged in restaurant foods other than stir-fry and salads.
Ten to fifteen years ago, I was having extreme lows. It was to the point I thought maybe I was producing my own insulin. Could this be a clue that there is something else involved like adrenals or thyroid, etc.?
Another question I have for other type 1 people…I was extremely fatigued this year (losing my evenings to deep long sleep, needing a day per week to sleep.) The fatigue went away after a week on Metformin and I went from about 11 hours per night (plus needing to sit) to a normal 7-8 hours without needing to sit down.) Anyone else experience this? Knowing what works is good (that being Metformin) but understanding why is better!
I may never get to the bottom of all this. If I think I know what is going on, I will have to go to the US for testing to prove it, as I am Canadian. I just feel so defeated because I do all the lifestyle things one should do, and my body acts like I am eating fast food every day!
One last note is the things I have tried and tests that are pending: bioidentical progesterone treatment, domperidone for gastroparesis (past), enzymes and probiotics currently, magnesium and vitamin D.
Endo has tested me for celiac, liver enzymes, b12 deficiency, ferritin, TSH, T3 and some other stuff. He has not seen me and will not, unless tests show a problem (due to physician shortage.)
I think knowing what works is more valuable than knowing why, if you can’t have both!
It appears the Metformin has made a big difference in how you feel. You’re asking good questions and your curiosity is your ally. I would keep doing Google and other searches of the medical literature. Metformin is used by a lot of people, but not so many T1Ds. I think you will find your answer, it just may take some time. In the meantime you have a med that works.
Many of us are more insulin resistant in the morning. I know that for myself having a protein shake alone can cause a blood sugar rise, a typical scoop is 25 g of protein which I count as equivalent to 12.5g of carbs. I could never stand to mix the stuff with water so I always a used cup of milk which added another 12g of carbs. So before you know you it you have 25 g of carbs. As to why metformin is helping I cannot say.
And as to large meals, when you eat a large meal you can trigger a glucagon response. Bernstein calls this the “Chinese Restaurant Effect.” It is the so called incretin hormones, so if you eat an entire head of iceberg lettuce you will have an blood sugar rise that is unrelated to the few carbs in the lettuce.
And finally you mention sleep. If you are having disturbed sleep this can itself cause insulin resistance and problems with morning blood sugars. I have sleep apnea and if I don’t sleep well it makes a huge difference. If you snore or have ever been observed stopping breathing while sleeping you might consider being tested for sleep apnea. They can actually do an in-home test these days for that.
Underactive thyroid might have correlate. Very low cortisol does cause low bgs, and very high cortisol does cause high bgs. There is a proven correlation there.
A Candida overgrowth can also cause insulin resistance.
