Is it possible that Extended Release Metformin tablets could prevent Insulin Injection from working properly

[BCM3000]

Hi, I'm new here. So I'm type 1 Diabetic or type 1.5 so I've been told... But not sure of the difference.
I've been injecting fast release novorapid insulin and slow release levemir insulin since 2012. My blood glucose levels are generally kept under control pretty well... My average daily levels range from 5.5mmol to 10.0mmol... if they spike it's normally upto about 15.0ml at highest these days, and I get them back down in due time when the do spike...
Recently, my diabetic consultant prescribed me Metformin as she seems to think it will control those spikes in my blood glucose even though I really don't find it nessesary! but I thought id give it a go. I started on normal Metformin tablets, 2 a day, and they worked well with my insulin but I found it upset my stomach quite badly so o changed to extended release Metformin. I've been on the extended release tablets for about 2 weeks and I've found that since switching my glucose levels have been higher than usual and I'm having to inject more insulin throughout the day... For example today and yesterday I've had trouble keeping them below 12mmol, which shouldn't be the case with the units of insulin I'm injecting... So I'm wondering is it possible that the Metformin for some reason could be preventing the insulin from doing its job efficiently? Either way, I think I'm going to stop the Metformin all together....

 

[Inka]

Hi @BCM3000 and welcome 🙂 I haven’t heard of Metformin affecting insulin but I’ve never taken it. Presumably your consultant thinks you have some insulin resistance and that was why it was prescribed?

What’s your BMI? Are you getting the spikes after meals or at any time? Have you done a basal check? How much insulin are you taking?

Could the upset stomach be causing your higher levels, perhaps?

 

[Docb]

Hi @BCM3000 and welcome to the forum. We have a number of LADA's (sounds like a Russian motor car) on the forum so you will be able to swap notes.

Must admit, my first port of call would be to go back to whoever prescribed the Metformin and ask them whether increasing blood glucose levels needing more insulin is what they expected to happen.

 

[BCM3000]

Thanks for your replies. My blood glucose levels were absolutely fine before adding Metformin. I've actually spent years learning through trial and error and carb counting etc and for the last few years and my levels have been better than ever, my 90 day average sits at 7.9mmol as well as monthly/weekly averages of roughly the same level.
My consultant put me on Metformin because she saw from my readings that they tend to spike in the early morning... But other than that I've been told my readings are actually very good. I was told Metformin MAY help with the early morning spikes... I found that normal Metformin helped but gave me pretty annoying stomach problems... I'm now on the extended release Metformin as I was told it is easier on the stomach... But since taking the extended release Metformin with my fast release injections and slow release nightly injection I've noticed my levels have been slightly higher than usual and I seem to be injecting more units than usual to get my levels down.
I stick to a low carb diet and depending on what I eat I normally I inject (before starting Metformin) between 10 - 19 units of fast release novo rapid insulin 3-4 times a day (breakfast, lunch, dinner & sometimes before sleep if I've had a snack). I inject 90 units of slow release levemir insulin each evening at 6pm... I do not feel that Metformin is necessary but I'm giving it a go. I think I'm going to stop taking it as I've been taking the extended release Metformin for almost 3 weeks and it doesn't seem to be doing anything positive.

 

[Inka]

@BCM3000 If you don’t mind answering, what’s your BMI?

And have you tried splitting your Levemir dose - ie having some of that 90 units in the morning?

 

[BCM3000]

@BCM3000 If you don’t mind answering, what’s your BMI?

And have you tried splitting your Levemir dose - ie having some of that 90 units in the morning?

What exactly do you mean by BMI? (Sorry for my ignorance) and no I haven't tried spitting my slow release injection...

 

[Inka]

What exactly do you mean by BMI? (Sorry for my ignorance) and no I haven't tried spitting my slow release injection...

Your weight and height (BMI is a kind of measure of that). 🙂

 

[everydayupsanddowns]

Welcome to the forum @BCM3000

Sorry to hear you have been having trouble with your BG levels

Metformin is supposed to increase insulin sensitivity, and suppress output from the liver (both of which could have helped your morning BG spikes).

I think having a chat with your Dr is probably very worthwhile. Of course, there is always the possibility that your BG levels may have risen in any case, and the timing of the changes you’ve made to your type of metformin may simply be coincidental.

If it does end up being related to your metformin / glucophage though, it does seem like you may want to chat to your Dr about whether it is causing more trouble than it was intended to fix?

Have you considered experimenting with dose timings to reduce the BG spike from breakfast. Many members (including me) find it helpful to give their insulin a bit of a head start at breakfast, and leave a pause between dose and eating.

 

[rebrascora]

When you say you stick to a low carb diet, can you give us an idea of how many carbs per meal.... or the sort of things you eat as those NR doses seem to be quite high for a low carb diet and would probably indicate insulin resistance in which case Metformin might be helpful for that rather than your high morning readings which may just be down to Dawn Phenomenon of "Foot on the Floor" Syndrome. I inject 1.5-2 units of fast acting insulin as soon as I wake up to deal with my Foot on the Floor rise in levels.

When do you inject your quick acting insulin in respect of when you eat? Ie before you eat and if so, how long before, when you eat or after? At breakfast time, I need to inject almost an hour before i eat in order to prevent my levels spiking very high, so that may also be a reason for your morning spikes. For lunch, if I have any, and evening meal, it is about 15-20 mins before I eat.

Levemir is usually most effective if split into 2 doses supposedly 12 hours apart, but the split depends on the individual and is by no means always 50/50. I tend to inject much more on a morning and very little at night, particularly if I have been active during the day..... but finding the right balance is definitely a dark art.... as is adjusting basal insulin according to your needs and mine can vary on an almost day to day basis. It depends on your lifestyle, routine and activity levels. Taking a single dose might be best for you but it would be unusual. Most people find they need less at night and more through the day.

 

[AndBreathe]

Hi there @BCM3000 - As I understand things, Metformin is usually given to T1s help improve insulin sensitivity, perhaps lose a little weight, or both.

As you have been taking the Metformin slow release for only a short time, I wonder if you might have a low grade infection or a virus hanging around you?

I'm not a huge subscriber to coincidences, but it can happen.

It would likely make sense to have a chat with whomever prescribed the metformin to take their view.

I'm not an insulin, or Metformin user, but in your shoes, if this was carrying on for a while, I might be inclined to go a bit native and pause the Metformin for a week or so and see what happened to my blood glucose numbers.

As I say, that's what I might do. You would have to use your own judgements.

 

[AndBreathe]

@BCM3000 - I should also have asked if you have tried a fresh vial/pen, ideally from a different batch, for your fast acting, in case that's gone a bit "tired", for whatever reason?

 

[DaveB]

I'm confused. 90 units of Levemir is very high and implies insulin resistance and T2 not T1/LADA? Metformin doesn't aid weight loss by any noticeable amount but can help BS reduction a bit. It also doesn't help with spikes (where did the consultant get that from?); the Gliptins are one of the drugs of choice for that. I have taken Metformin SR for 20 years and Basal/Bolus for 5 years and have found that the Metformin reduces my BS by a tad. I continue to take it as my DN suggested it has some other benefits which I've also read. Can you let us know whether you have some excess weight? BTW the difference between T1 and LADA is that LADA refers to late onset T1. LADA is essentially the same as T1 but the cause may vary.

 

[Inka]

My consultant differentiates between LADA and Type 1.5 interestingly. She says 1.5 is Type 1 with a ‘Type 2 like’ insulin resistance (hence the 1.5 as it’s kind of between the two).

 

[DaveB]

My consultant differentiates between LADA and Type 1.5 interestingly. She says 1.5 is Type 1 with a ‘Type 2 like’ insulin resistance (hence the 1.5 as it’s kind of between the two).

I would say that is wrong. My understanding from many articles over the years is that LADA has nothing to do with insulin resistance. In fact in many/most cases the patient will have lost weight suddenly due to ketosis (fat burning) so where would the insulin resistance be?

 

[Inka]

I would say that is wrong. My understanding from many articles over the years is that LADA has nothing to do with insulin resistance. In fact in many/most cases the patient will have lost weight suddenly due to ketosis (fat burning) so where would the insulin resistance be?

Which is what I said...She differentiates between LADA and 1.5 - 1.5 being the one with the insulin resistance.

Edited for clarity - she considers them two different conditions not different names for the same thing.