A little advice

[jimgooly]

Hi Everyone,

I am after a bit of advice as I really can't get on with Metformin, I am due to see the nurse at my GP practice to review everything but want to go in with a bit more of a plan than last time when everything was new and pretty daunting.

A little bit of background on my circumstances:

• I got diagnosed type 2 after experiencing lots of the common symptoms
• My HbA1c was 99
• Was about 5 or 6 weeks ago so still a little bit at the 'What the hell' stage
• I was put on 500mg Metformin twice a day (1000mg in total)
• Nurse did not put me on a repeat prescription as just wanted to get my glucose levels down to start and see if i can mange it

Metformin was making feel really ill so I spoke to the nurse about 3 weeks in and asked if I could go from 2 a day to 1 to see if that helped, she was fine with it. After dropping down the bad stomach did get better but I was still getting constant headaches and at night I was getting very dehydrated.

I also recently decided to get a Free Style Libre for a couple of weeks (8/9 days in) with the idea of seeing what foods and what routines helped keep my blood sugars lower but it has kind of raised more questions about my medication. As I was coming to the end of the prescription I decided to do 5 days without any medication and it made me feel much better but... my sugars seemed to spike 3 times a day (sometimes up to 15mml). The last 3/4 days I decided to go back on 1 Metformin and I now only spike in the morning and my levels are much better. I have attached a typical day where I was not on Metformin and a day where I was, you can see it helps my levels but I do feel really ill again.

What do you guys think? Should I just push through the problem I have with Metformin? Has anyone else had similar to me and tried another drug with some success? Should I sack off the drugs? Are my graphs without Metformin that bad? Should I stop freaking out and chat to the nurse?

Honestly any advice welcome

 

[Lucyr]

I’d either give it more time to get used to the metformin, or ask for slow release metformin which can have less side effects

 

[jimgooly]

The nurse gave me slow release, can't imagine what the normal ones would be like

 

[Windy]

I'd go back to the nurse and say you're still not getting on with the Metformin. It's not like you haven't tried. There's other medication for diabetes they can give you, which I'm sure have side effects of their own, but ask the nurse, as it's not worth feeling poorly if the medication isn't getting on with you if you can find a different one.
Sarah

 

[Drummer]

I was so ill with Metformin, and Atorvastatin thrown in for good measure - I was suicidal.....
So I binned the tablets and relied on eating low carb choices - no longer diabetic in 80 days from diagnosis.
If the spikes on the graph are the consequences of eating high carb foods, just swap to lower ones.
As I am reacting to exposure to Covid, I got up at the crack of noon today and ate a blob of mozzarella and a green salad. I'll have coffee with cream soon, then eat another low carb meal later on.
I usually eat just twice a day and no more than 40 gm of carbs - today I might have some sugar free jelly with berries and either yoghurt or cream - I often need to use up a pot of cream before the use by date.
I need to be quite strictly low carb to maintain normal numbers, others can eat more, but for me, under 7mmol/l after eating seems to be what I need, all that I need to be free of diabetes, and also in need of new clothes or adjustments to a smaller size as the years go by.
I am told my diet is so strict - I find it hard to feel hard done by when my first meal is often steak or a chop with mushrooms and a stir fry and dinner is often roast pork or chicken, though in hot weather a salad with fish or eggs and cheese is more cooling.
In the colder months, particularly if I am going out, I put a beef casserole in the slow cooker - so good to come home to the smell of it. I make enough so I can do mashed swede next day, beaten with eggs and fried, then grilled and served with the last of the casserole. Mmmm - roll on autumn...

 

[jimgooly]

I'd go back to the nurse and say you're still not getting on with the Metformin. It's not like you haven't tried. There's other medication for diabetes they can give you, which I'm sure have side effects of their own, but ask the nurse, as it's not worth feeling poorly if the medication isn't getting on with you if you can find a different one.
Sarah

Thanks Sarah, I will chat to her about it all. Metformin does seems to help but feeling ill all the time sucks

 

[jimgooly]

I was so ill with Metformin, and Atorvastatin thrown in for good measure - I was suicidal.....
So I binned the tablets and relied on eating low carb choices - no longer diabetic in 80 days from diagnosis.
If the spikes on the graph are the consequences of eating high carb foods, just swap to lower ones.
As I am reacting to exposure to Covid, I got up at the crack of noon today and ate a blob of mozzarella and a green salad. I'll have coffee with cream soon, then eat another low carb meal later on.
I usually eat just twice a day and no more than 40 gm of carbs - today I might have some sugar free jelly with berries and either yoghurt or cream - I often need to use up a pot of cream before the use by date.
I need to be quite strictly low carb to maintain normal numbers, others can eat more, but for me, under 7mmol/l after eating seems to be what I need, all that I need to be free of diabetes, and also in need of new clothes or adjustments to a smaller size as the years go by.
I am told my diet is so strict - I find it hard to feel hard done by when my first meal is often steak or a chop with mushrooms and a stir fry and dinner is often roast pork or chicken, though in hot weather a salad with fish or eggs and cheese is more cooling.
In the colder months, particularly if I am going out, I put a beef casserole in the slow cooker - so good to come home to the smell of it. I make enough so I can do mashed swede next day, beaten with eggs and fried, then grilled and served with the last of the casserole. Mmmm - roll on autumn...

Thanks Drummer, my diet is much better than before but can still definitely improve. Slowly discovering replacements for the bad foods I love. Binning the tablets and no longer being diabetic so quickly is quite inspirational!

 

[Drummer]

Thanks Drummer, my diet is much better than before but can still definitely improve. Slowly discovering replacements for the bad foods I love. Binning the tablets and no longer being diabetic so quickly is quite inspirational!

Not really - I have a scientific outlook - identify the problem and find a way around it - in my case it was the high carb 'healthy' diet my GPs have insisted was essential for me to follow, despite decades of it not working.
The foods you love most probably do not love you in return.

 

[Leadinglights]

As you have the benefit of having the Libre for a bit longer it would be worth your while making a detailed food diary to see if you can spot particular meals which are sending your blood glucose more than 2-3mmol/l increase from before you eat to 2 hours afterwards and tackle those with some lower carb substitutes or reduced portions or cutting out completely.
Many foods which are thought to be healthy are not so for Type 2 diabetics.
You might find this link useful for some ideas on a new way of eating. https://lowcarbfreshwell.co.uk/. Keeping a good watch on your carb intake will be needed even if the metformin is tolerable in the long run.

 

[everydayupsanddowns]

Welcome to the forum @jimgooly

Sorry to hear you are having a rough time with Metformin. We have some members who start off with unpleasant side effects but find it settles after a few weeks, whereas others never get on with it, and have to try to manage without, or explore other options.

Metformin doesn’t work directly on meals, but works by reducing glucose output from the liver, and improving insulin sensitivity.

Are those Libre patterns you posted typical of multiple days, or just one-offs? Did you eat the same meals each time? And if not can you remember what sort of meals they were and guesstimate how much total carbohydrate were in them?

It looks a little like perhaps the met is just providing sufficient background support to help your metabolism focus on the meals - and cope better?

 

[jimgooly]

Thanks both for your response.

@Leadinglights that's a good tip about the 2-3mmol/l increase, looking back I already think I need to swap my breakfast (always have homemade steel cut oats, with berries and nuts) but it seems to go up quite a bit.

@everydayupsanddowns, yes these were typical readings but both screengrabs were the more extreme days to highlight the difference but still a pattern with and without. My breakfast and lunch would have been the same but dinner would vary. I think you are right the Metformin is helping, will be good to hear what the nurse thinks about it all.

 

[harbottle]

1000mg of Metformin is a low dose won't make a huge difference, maybe < 1mmol/L to fasting glucose levels (Based on the research I've seen) and less than 10 to hba1c measurements. 500mg is an even smaller change. The rest has to be done by diet and change of lifestyle. (I'm lucky, as Metformin doesn't disagree with me at all.)

Some of the things are you are experiencing might be due to blood sugar lowering. The only side effect I had from Metformin was wind, although that seems to have stopped now. It was like an orchestra in my arse at one point.

Oats are high in carbs, so you will see a spike (As I did last year when I had some oats while using a Libre). I believe the Libre accuracy is lower the higher the reading as well.

I stick to low carb meals - effectively meat/fish and vegetables, plus a lot of nuts and berries. Apples and Oranges are OK in moderation, but they are quite high in carbs.

 

[jimgooly]

Thanks @harbottle what you said is very interesting.

I think the Libre may be higher than my actual levels as I have done random finger prick tests and it is always higher on the libre. It was 2.2mmol/L difference 20 minutes ago and that was a fasting level. I still think it useful for me though as I have ruled out another breakfast following advice from @Leadinglights about sticking to 2/3mmol/L increase.

 

[harbottle]

I've used 2 Libres, and one was pretty close to finger pricking, the other was way out and seemed to randomly jump when I moved my arm! I just used it to look for trends - but there weren't any, it just seemed to flatline during the day and then during night went low and stayed that way until breakfast.