DIY Metformin control

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palas

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Type 2
Hi everyone

Been diabetic type 2 for about 10 years now and on insulin for 8 years. I have recently radically changed my diet 1) to lose weight and 2) to cut down carbs and have brought down my average readings over the last 3 weeks. I take 1mg SR metformin 2x/day. I think that the metformin may be the cause of persistent diarrhoea and have found an abstract on the www which says " Patients with type 2 diabetes who are taking metformin and experience diarrhea deserve a drug-free interval before undergoing expensive and uncomfortable diagnostic tests, even when the dosage has been stable over a long period."

I wanted a telephone call back from the diabetes nurse in an associated doctors practice to discuss. Called today, the earliest she can call me back is a week on Wednesday!!!

My question is have any of you yourselves taken the decision to cut down / cut out the metformin, and if so how did you do it. I'm considering cutting my 1mg tablet in half to start with and then instead of taking 2 x day, take just once and see how I get on. I'm eager to do this before 9th September as I have a telephone consult with the hospital. If it really is the metformin which is causing this, then by then I'd know I think. I'm currently using very little insulin so think I could up that a smidge to offset the lack of metformin.

Any advice welcomed. Thank you.

Carolynn
 
palas said:
My question is have any of you yourselves taken the decision to cut down / cut out the metformin, and if so how did you do it. I'm considering cutting my 1mg tablet in half to start with and then instead of taking 2 x day, take just once and see how I get on. I'm eager to do this before 9th September as I have a telephone consult with the hospital. If it really is the metformin which is causing this, then by then I'd know I think. I'm currently using very little insulin so think I could up that a smidge to offset the lack of metformin.
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If you cut a slow release tablet in half then it's not slow release anymore as you have removed the protective coating around the Metformin.
 
Often when people first start on metformin or increase the dose they get stomach issues but it settles down but if this has only just started after some time it is a bit unusual.
As said cutting them in half they will no longer be slow release so better to just take 1 but keep it intact. Could you e-mail your diabetic nurse and get their opinion.
 
Ha ha, sorry, not trying to be flippant but I had to wait almost 30 minutes in a queue just to speak to the receptionist this morning, and she wouldn't pass me onwards. I have no email for the diabetic nurse unfortunately. I did ask her when I saw her last, but she said go through reception. The diabetic service where I live is diabolical.

However, that's a good bit of advice about cutting then in half. No it hasn't just started unfortunately, since starting metformin I've always had moments when I've had to run, as it were, but it has got worse over the last 2 years. I couldnt even take the normal metformin when I started it had such a bad effect.

Have decided to cut out my evening one for a few days and see what happens. Will ensure I go as low carb as poss with my evening meal. Thanks for your response
 
You need to be careful about going 'low carb' if you are taking insulin unless you are matching your insulin to carbs by adjusting your dose.
 
I have 500mg tablets, and take one a day (Breakfast.) Maybe they can give you these instead?
 
palas said:
Hi everyone

Been diabetic type 2 for about 10 years now and on insulin for 8 years. I have recently radically changed my diet 1) to lose weight and 2) to cut down carbs and have brought down my average readings over the last 3 weeks. I take 1mg SR metformin 2x/day. I think that the metformin may be the cause of persistent diarrhoea and have found an abstract on the www which says " Patients with type 2 diabetes who are taking metformin and experience diarrhea deserve a drug-free interval before undergoing expensive and uncomfortable diagnostic tests, even when the dosage has been stable over a long period."

I wanted a telephone call back from the diabetes nurse in an associated doctors practice to discuss. Called today, the earliest she can call me back is a week on Wednesday!!!

My question is have any of you yourselves taken the decision to cut down / cut out the metformin, and if so how did you do it. I'm considering cutting my 1mg tablet in half to start with and then instead of taking 2 x day, take just once and see how I get on. I'm eager to do this before 9th September as I have a telephone consult with the hospital. If it really is the metformin which is causing this, then by then I'd know I think. I'm currently using very little insulin so think I could up that a smidge to offset the lack of metformin.

Any advice welcomed. Thank you.

Carolynn
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I think you must be on 1g twice a day, usually 2 x 500mg tablets morning and evening. there is no 1mg tablet.
 
palas said:
Hi everyone

Been diabetic type 2 for about 10 years now and on insulin for 8 years. I have recently radically changed my diet 1) to lose weight and 2) to cut down carbs and have brought down my average readings over the last 3 weeks. I take 1mg SR metformin 2x/day. I think that the metformin may be the cause of persistent diarrhoea and have found an abstract on the www which says " Patients with type 2 diabetes who are taking metformin and experience diarrhea deserve a drug-free interval before undergoing expensive and uncomfortable diagnostic tests, even when the dosage has been stable over a long period."

I wanted a telephone call back from the diabetes nurse in an associated doctors practice to discuss. Called today, the earliest she can call me back is a week on Wednesday!!!

My question is have any of you yourselves taken the decision to cut down / cut out the metformin, and if so how did you do it. I'm considering cutting my 1mg tablet in half to start with and then instead of taking 2 x day, take just once and see how I get on. I'm eager to do this before 9th September as I have a telephone consult with the hospital. If it really is the metformin which is causing this, then by then I'd know I think. I'm currently using very little insulin so think I could up that a smidge to offset the lack of metformin.

Any advice welcomed. Thank you.

Carolynn
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hi just to let you know that i am of the opinion that metformin slow release has had a detrimental effect on my pancreas
resulting in a stay in hospital for a few days I am now on insulin been on this for 18 months now no reaction or after effects at all. the fda has said that slow release metformin has a high concentration of ndma . My brother in law has what you say you have along with pains in stomach .I have bought this to his attention. my meds are nova mix 30 70 twice a day and so far all ok . I should bring this to the attention of your diabetes nurse . I went from metformin to insulin right away on the instruction of the hospital my dose of nova mix 30. 70 is 8 units in morning 12 units evening adjusting up 2 down4 according to my level and excercise.
 
What makes the you think Metformin has a detrimental effect on your pancreas? It's not a known side effect.

The NDMA thing was a recall a few years back.
 
Some people have an adverse reaction to the coating on some of the slow release Metformin causing stomach cramps and diarrhoea. I think it may be Lactulose which is used. It can be a question of trying different brands until you find one which suits you or it may be that you don't get any significant benefit from Metformin anyway and it isn't worth the side effects.

The thing to be aware of with Metformin is that the dose doesn't have a direct impact on your BG levels. It builds up slowly in your system over a couple of weeks or so, and helps your cells to be more responsive to insulin. If you miss a dose here and there is it no big deal because that one dose doesn't have an immediate short term impact. Therefore, if you decide to stop it altogether, it might be a fortnight before it is fully clear of your system although I would expect any gastric side effects to reduce quite quickly.
Following a low carb way of eating is usually significantly more powerful and effective at reducing BG than any oral medication but you do need to be careful with reducing carb intake to radically when you are using insulin and be ready to reduce insulin doses as levels drop.
 
rebrascora said:
Some people have an adverse reaction to the coating on some of the slow release Metformin causing stomach cramps and diarrhoea. I think it may be Lactulose which is used. It can be a question of trying different brands until you find one which suits you or it may be that you don't get any significant benefit from Metformin anyway and it isn't worth the side effects.

The thing to be aware of with Metformin is that the dose doesn't have a direct impact on your BG levels. It builds up slowly in your system over a couple of weeks or so, and helps your cells to be more responsive to insulin. If you miss a dose here and there is it no big deal because that one dose doesn't have an immediate short term impact. Therefore, if you decide to stop it altogether, it might be a fortnight before it is fully clear of your system although I would expect any gastric side effects to reduce quite quickly.
Following a low carb way of eating is usually significantly more powerful and effective at reducing BG than any oral medication but you do need to be careful with reducing carb intake to radically when you are using insulin and be ready to reduce insulin doses as levels drop.
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spot on with your comments again. it is the slow release part of metformin that is suspect nothing to do with where there come from
 
harbottle said:
What makes the you think Metformin has a detrimental effect on your pancreas? It's not a known side effect.

The NDMA thing was a recall a few years back.
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the effect of thalidomide in the 60s was not considered to have any effect . we now know better.
 
s.e london said:
the effect of thalidomide in the 60s was not considered to have any effect . we now know better.
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That's a dubious comparison. Metformin has been in use since the 1950s, and prior to that the plant it came from was in use for centuries as an anti diabetic drug. Thalidomide's side effects were noticed barely 5 years after it came to market. Metformin's one of the most widely used drugs in the worlds and its side effects are well known.I suggest something else is responsible for your pancreatic problems.
 
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harbottle said:
That's a dubious comparison. Metformin has been in use since the 1950s, and prior to that the plant it came from was in use for centuries as an anti diabetic drug. Thalidomide's side effects were noticed barely 5 years after it came to market. Metformin's one of the most widely used drugs in the worlds and its side effects are well known.I suggest something else is responsible for your pancreatic problems.
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do you have any suggestion on the ingredient in novamix 30 70 called aspart and if it could be the cause of pains in the calves. if not what does it deplete on entering the body
 
rebrascora said:
Some people have an adverse reaction to the coating on some of the slow release Metformin causing stomach cramps and diarrhoea. I think it may be Lactulose which is used. It can be a question of trying different brands until you find one which suits you or it may be that you don't get any significant benefit from Metformin anyway and it isn't worth the side effects.

The thing to be aware of with Metformin is that the dose doesn't have a direct impact on your BG levels. It builds up slowly in your system over a couple of weeks or so, and helps your cells to be more responsive to insulin. If you miss a dose here and there is it no big deal because that one dose doesn't have an immediate short term impact. Therefore, if you decide to stop it altogether, it might be a fortnight before it is fully clear of your system although I would expect any gastric side effects to reduce quite quickly.
Following a low carb way of eating is usually significantly more powerful and effective at reducing BG than any oral medication but you do need to be careful with reducing carb intake to radically when you are using insulin and be ready to reduce insulin doses as levels drop.
Click to expand...

I believe this is down to the 'therapeutic concentration' - a few hours after taking the tablet the concentration peaks and then starts to drops, so another one is need to keep the concentration up at a level where it works. (Metformin peaks at around 3 hours, and then halves every 7 hours). There seems to be a lack of agreement on what this concentration is... although there will still be some effect at lower concentrations, just not as much.
 
s.e london said:
do you have any suggestion on the ingredient in novamix 30 70 called aspart and if it could be the cause of pains in the calves. if not what does it deplete on entering the body
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oh what happened to zantac been on the market for years where has it gone will omprazole go the same way . thank god ror the americans
 
s.e london said:
do you have any suggestion on the ingredient in novamix 30 70 called apart and if it could be the cause of pains in the calves. if not what does it deplete on entering the body
Click to expand...

Sorry, haven't got a clue.

Do you mean this:

en.wikipedia.org

Insulin aspart - Wikipedia

en.wikipedia.org en.wikipedia.org

It has some of the ingredients listed.
 
s.e london said:
do you have any suggestion on the ingredient in novamix 30 70 called aspart and if it could be the cause of pains in the calves. if not what does it deplete on entering the body
Click to expand...
I wonder if the pains in your calves is nerve pain (neuropathy) due to your BG levels coming down as a result of the insulin. Do you know what your HbA1c was before you were started on insulin? If it was pretty high and the insulin has now brought you down into range, then the blood vessels and nerves are affected by the improved levels but having been used to the higher levels, they complain if levels drop too quickly. This can often just be a temporary problem but it depends how long your levels have been running high as to whether it might be permanent.
What is the pain like? I believe walking if you are able is helpful to stimulate blood flow which will help the blood vessels and nerves repair. Have you had your feet tested... ankle pulses checked and toe tickle test?
Have you had retinal screening? The eyes are also very vulnerable to changes in BG levels, so it is important to have these checked regularly too.
What sort of BG readings are you getting with your mixed insulin and when do you test?
 
Update

Well I've cut out one of my 1mg metformin SR tablets in the evening, but have kept the morning one. Guess what.... yes my diarrhoea has completely stopped. I've had more than two complete weeks without any incident at all, which is unheard of. So much so, that I've had to add prunes back into my diet!!!

Finally managed to speak to the diabetic nurse last Wednesday, who seemed a bit peeved that I'd cut it out myself and told me I'd need to have another hba1c test now just to see where we were. When I spoke to her I asked if it was worth changing doctor to her practice, as surely anything was better than the practice I was with. Unfortunately this was not possible as they weren't taking on people with my postcode!! However, I've managed to change to another local practice with an "outstanding" from the quality care commission. When we went last week to drop the paperwork in, it was done straight away and the lady we saw said once she processed it we were welcome to make any appointments we needed.

After our forthcoming holiday I'll get my hba1c done and make an appointment with the new practice diabetic nurse. Strangely I'm still managing to stick to a radically reduced, low carb diet, so much so that I've also lost 11 lb in the last 5 weeks. It's slow going, at about 1lb a week (lost a lot in week 1) but I'm not too hungry and not too tempted by "stuff" so that's the main thing. As I count carbs for my insulin, I've dropped that by a ton as well. Managing quite well so far.

I can't stress enough that it's wonderful to go out without worrying about an attack of the "metformin trots"!!
Thank you all for your advice on here.

Carolynn
 
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