Type 1 and metformin

Hi. I am new to this forum, trying to get used to the format.

I am type 1 diagnosed at 18. Been diabetic for 19 years. I've never really had good control except for when I was pregnant, since then (8 years) ago, my insulin needs have slowly crept up and I've gained a good amount of weight.

I've never been to an endo, long story, but started with no insurance, to county insurance, to finally group insurance went to gp, and none ever suggested an endo. I am now trying to get on a pump and I've been denied, my gp said, maybe an endo can help with this.

I go tomorrow. Question though. Before my son was born I was on 54 unites of Lantus. I am currently splitting 110 units of lantus, and am on Symlin, and its helped my bolus units. I eat mostly low carb 8 carbs in the AM, 20 lunch, 20 dinner. If my #'s are not high I bolus about 3 units for meals. My I/C ratio is different in the morning compared to the rest of the day. In the AM it's about 1/3 and the rest is 1/6. Two months ago I was 95 units of Lantus and much more bolusing. Is there anyone here who has experience with Type 1 and metformin?

I want to suggest it to the endo, my gp flat out told me no way. Because type 1's are not insulin resistant, but my history shows I've had to keep upping my dosage. Plus I've been eating healthier the past 3 mos, walking and I have yet to lose 1 pound!

Sorry if it all sounds like a ramble, but every time I try to make strides to better my health, it seems there are always more obstacles and hurdles to jump over. Thanks!

Oh and in March my A1C was 9.5 last week was down to 7.6. :D
And even with that much Lantus, my fasting #'s in the AM are HIGH. 140-170. During the day, still at about 120-130. :(

Of course you can get insulin resistant as a T1. And if you are eating < 50 g of carbs /day and require more than 100 units of insulin/day, you may well be insulin resistant. It is quite appropriate to consider metformin and at $4/month and being very safe, I think it is a no brainer. I would suggest it to your endo and see what he says.

Possible that you may have developed resistance to Lantus & worth discussing with your endo if changing to Levemir may help. Lantus has also been associated with weight gain.

Marps is a T1 member who used Metformin. Don't know if she still is. With your large basal doses, Metformin is certainly worth trying.

I thought I had a serious case of DP because of high fasting. Turned out gastroparesis was the culprit. Delayed stomach emptying was causing dinner to digest overnight.

Good suggestion from Sally to have thyroid checked. Not uncommon to have thyroid problems with T1, especially for women. Make sure you have a full panel done. Most doctors only test TSH. You need to have Free T3 & Free T4 tested to know what's going on.

My first question is why were you denied getting a pump? These days, I thought T1s were pretty much guaranteed approval of a pump. If your management can benefit from it, you should have access to it. End of story. Make sure to get to an endo and start the process. Make sure that you have at least 3 months worth of logs, a letter/report from a dietician stating that you know how to carb count (stupid, I know, but I was required to provide one), and the signed certificate of medical necessity from an endocrinologist. Also, work directly with the pump company. They want to sell you their product, so they will push things along for you and help you with any denials. I worked with Minimed and they were great at getting things approved very quickly.

Yes, you can definitely take Metformin. As a T1 who is demonstrating some insulin resistance, you will likely benefit from it. BUT, metformin is NOT a good idea if you have any signs of kidney damage, and your doctor will need to monitor your kidney function closely to make sure you're not experiencing any issues. But plenty of T1s on here have gone on metformin to address insulin resistance.

Keep in mind that on a pump you will require less insulin and your body will use the insulin more effectively.

And yeah, T1s can DEFINITELY develop insulin resistance. I am constantly amazed at how ignorant doctors are when it comes to diabetes.

At my last annual info meeting for T1 diabetics my endo expicitly mentioned the combination of T1 treatment with metformin. It makes sense and it can help to reduce your basal dosage. The drug has a good safety record and is used for a very long time now. One downside is that the drug can make you feel unwell stomach-wise. In my opinion metformin is not only advisable to overcome resistance but useful to moderate the liver in general. Some people have a very reactive liver. Just little amounts of stress hormones will trigger their liver to convert glucagon to glucose. With some metformin on board this behaviour can be downregulated to a more moderate response. As a result this subgroup of T1 diabetics should see less spikes in BG with metformin treatment.

You can certainly have insulin resistance *and* type 1.

And many doctors are prescribing metformin for type 1s in addition to insulin.
There are several scientific papers which have looked at the use of metformin in
type 1 diabetics.

For example:

My endo prescribed it for me as I was also seeing increasing insulin usage and very high basal rates at night. It resulted in about a 25% decrease in insulin usage.

One more thing...insulin needs are related to weight, so if your weight goes up, your insulin needs will go up. The average of type 1's is about 0.7-0.8 units/day per kilogram of weight (about .32 units/ lb).

So a 100lb person might use about 32 units TDD on average. A 200 lb person might use 64 units a day.

Some will naturally be much higher, some much lower. If it is way higher, there is perhaps some insulin resistance.

Thanks for the replies everyone. I appealed my denial and finally got the report back from the medical director. Basically said, I have not proven to be Type 1. They don't have c-peptide blood results. Also, I didn't submit my log books. No one told me to :(

I've been DKA twice, it's in my history, so hmmm. This is new insurance too. Gawd, I hate insurance bureaucracy.

I'm going to admit, yes, I am overweight too. I've gained 20 lbs in the past 8 years. But I was about 50 lbs overweight even then. I haven't always taken care of my diabetes. I'm doing it in spurts. But I feel so much better when I am in control, I don't know why I always slide away from it. I still think the amount of insulin I'm giving myself isn't really helping with weight loss, and resistance.

It's been a struggle these past 4 months to stay in control. It was scary when my last results showed my triglycerides over 1,000. I got scared straight. Last week my triglycerides were down to 226. Still on the high side, but I'd say it's getting better.

I will definitely bring up the thyroid issue. I'm always tested but everything seems normal. But again, I would have no clue as to what is abnormal! LOL!

Maybe it's time I switch insulin too. Even though I just got a 3 months supply of lantus, that is 9 vials sitting in my refrigerator. I will make that suggestion too. Thanks so much!!

It might be helpful to see an endocrinologist that specializes in treating diabetes...at least they would be familiar with what the insurance companies need and put the package together right.