Can’t tolerate Metformin

[Kathleen68]

My diagnosis of type 2 came approx 2yrs ago, Hba1c - 53. GP told me to cut out sugar (no mention of carbs) and that was that. I am not overweight, am within the BMI range for my height. I took control of my diet by cutting down carbs and sugar etc and my subsequent bloods showed up as 48, then 45. However, I suffer with severe asthma and have been on maintenance steroids for the past 15months, with many high dose courses needed for asthma flare ups. My Hba1c in February was 63 , in May 66. I have been told by a clinician that even if I followed a strict Keto diet my glucose levels would not decrease because of the prednisolone steroids I am forced to take. I have tried Metformin regular and Metformin slow release and both cause intolerable stomach issues. I suspect because I have several health issues and take a lot of meds that adding Metformin into the mix just causes GI chaos. My Dr tried me with Gliclazide but I couldn’t tolerate that either . Any help or suggestions would be great please x

 

[Leadinglights]

Unfortunately steroids are renowned for causing havoc with blood glucose management so dietary measures are going to be one of the most important measure you can do to help.
What sort of meals do you have as it could be that your carbohydrate intake is just too much for your body to cope with.
Things change over time and diet can slip so it would be worth revisiting your carb intake, making a food diary and noting the carbs of everything you eat and drink as that might reveal your carb intake is too high. Low carb is less than 130g per day and is an approach many find successful though many do need to go lower than that.
Do you test your blood glucose at home as that may reveal some problem meals. Testing before you eat and after 2 hours will indicate the meal is OK if the increase is less that 2-3mmol/l.
The GlucoNavii is an inexpensive monitor with the cheapest test strips which can be bought on line.
This link may help with some meal ideas https://lowcarbfreshwell.co.uk/

 

[gll]

Just dropping you this link
https://forum.diabetes.org.uk/boards/threads/nice-sign-flowchart-for-t2-medication.99813/
Its a link of links for the T2 meds available and the progression path the GPs tend to take.

There are more options than just metformin and gliclazide available in addition to dietary measures.
Might be worth a look and doing some of your own research on the ones you haven't tried so during the next conversation with your team, you know what they are talking about 🙂

Keep on at them to find the right fit for you. If you care about excess drug piles because of not tolerating meds, ask for short prescriptions until you find the right one....*casually looks over at the mini mountain i have accumulated*

Truly hope you can find something that works for you, completely understand how miserable and frustrating it can be x

 

[Kathleen68]

Unfortunately steroids are renowned for causing havoc with blood glucose management so dietary measures are going to be one of the most important measure you can do to help.
What sort of meals do you have as it could be that your carbohydrate intake is just too much for your body to cope with.
Things change over time and diet can slip so it would be worth revisiting your carb intake, making a food diary and noting the carbs of everything you eat and drink as that might reveal your carb intake is too high. Low carb is less than 130g per day and is an approach many find successful though many do need to go lower than that.
Do you test your blood glucose at home as that may reveal some problem meals. Testing before you eat and after 2 hours will indicate the meal is OK if the increase is less that 2-3mmol/l.
The GlucoNavii is an inexpensive monitor with the cheapest test strips which can be bought on line.
This link may help with some meal ideas https://lowcarbfreshwell.co.uk/

Leadinglights - Thanks so much , I’ve downloaded the Freshwell approach which seems good and straightforward. I don’t test my blood glucose as the diabetes nurse at my surgery said it wasn’t necessary whilst on Metformin. I‘m still surprised at a clinician telling me that whilst I’m on prednisolone there’s no point in being on a strict low carb diet as it won’t make any difference, surely it will help??

 

[Kathleen68]

Just dropping you this link
https://forum.diabetes.org.uk/boards/threads/nice-sign-flowchart-for-t2-medication.99813/
Its a link of links for the T2 meds available and the progression path the GPs tend to take.

There are more options than just metformin and gliclazide available in addition to dietary measures.
Might be worth a look and doing some of your own research on the ones you haven't tried so during the next conversation with your team, you know what they are talking about 🙂

Keep on at them to find the right fit for you. If you care about excess drug piles because of not tolerating meds, ask for short prescriptions until you find the right one....*casually looks over at the mini mountain i have accumulated*

Truly hope you can find something that works for you, completely understand how miserable and frustrating it can be x

gll:
Thanks so much for your help , that link is very informative. My problem is that I have to take so many meds daily, a couple of which do affect my GI system and cause me to be very careful what I eat already .......I found that both the slow release and standard Metformin left me in a state of being reluctant to leave the house, I‘m sure you get my drift !! Gliclazide was no better. I’m sure if T2 was my only issue I would probably be able to cope with the side effects of the Metformin ( which I guess would be less brutal ), unfortunately I have a shed load of issues all requiring medication so it’s a bit tricky .
Thank you xx

 

[gll]

I had issues with metformin (both) and when they doubled gliclazide I was sick.
I tried empagliflozin (sglt2 inhibitor) and it was okay on 10mg but moved up to 2 x 10mg with the intention to switch to the 25mg tablet if tolerated but it pushed my bp up so it reduced back to 10mg and within days it was normal again.
Because I was on 2 meds and my a1c was over 75 (and rapidly rising), I was referred to the DSN clinic and put on insulin (which we are still working on adjusting and tweaking) but I don't have side effects which stop me from doing life.
I'm not saying don't try what's offered, oral meds are much easier if you can get on with them, I'm trying to say you aren't alone in struggling to tolerate medications. I would apologise for my body being so stupid

The low carb approach for you would be to minimise the bg rises from food. Not much can be done about the steroid induced rise but if you can take one thing out of the equation (too many carbs), it might mean less meds needed to keep your bg under control reducing the side effect risk.

HCP tend to discourage testing in T2s (unless on gliclazide type drugs or insulin) but most on here will be able to tell you the benefit of testing to see the effects of meals on your bloods and tweaking and tailoring your meals to suit.

Whatever you do, it has to be compatible with your life and other conditions 🙂

 

[BlueSmarty]

I was on metformin with awful side effects. Nurse moved me to the prolonged release 1000mg taken at night. It’s much better but do have the squitts the next day until the afternoon. They are now going up to 2000mg. But seem conflicted about when to take them! Does anyone take 2000mg in to be go at night or split the dose morning and night. Also will I end up with squitts all day

 

[chocolatefudgebrownie]

I would agree there with gll, there are quite a lot of alternative medications, if you can tolerate Empagliflozin or other SGLT-2 inhibitors they are some of the best for long term renal and cardiovascular outcomes. Sadly i couldn't tolerate Metformin or Empagliflozin, both of which have good long term outcomes, as they turn me into an emotional mess. Wish i knew why but anyway. Diet is really the most important factor to bring those bg levels down. I wish you all the best with that and finding a med for back up and help.