Experiment: dropping Metformin

[Eddy Edson]

Day 4 ...

Experiment interrupted when batteries ran out & I couldn't find the spares I thought I had. (For clarity, batteries for my meter, not for me 🙂

Before dinner, after so far a relatively low-ish carb day for me & ~7km walking: 6.4.

That looks high versus pre-experiment expectation. But one thing I've noticed is that BG elevations are pretty closely associated with the stomach bloat-y issues I'm having at the moment - BG goes up when the bloat starts. And these issues aren't very closely associated with carbs. In fact, it's looking like almonds might be the culprit, which would be really annoying if it persists.

I assume this is a coincidence - can't see any reason why stopping Met would cause almond intolerance?

Bah!

Anyway, had my first appointment with the exercise physiologist today. She didn't have a pill to increase upper-body strength without tedious strength training, unfortunately, and didn't really have any exercise suggestions beyond the obvious kind of thing. Didn't have anything to say about Met interfering with exercise. Did have a few interesting things to say about fatigue and general expectations for how much exercise to do etc, which generally confirmed that my current walking strategy is OK.

I finally took the plunge and ordered a couple of Libre sensors. Some might call it indulgence but I call it Science, which continues its forward march. (I had to tell a fib & say I'm on insulin for the order to go thru.)

Update: Before bed reading = 6.4 after late dinner of berries+lemon juice+peanuts+chia/soy flat white. A point or so "too high", but stomach probs persist, so who knows? Tomorrow starts the no-more-almonds leg of the experiment; will have to scrounge those calories from somewhere else.

10km+ walking today, pretty easy.

 

[Eddy Edson]

Good luck!

I also decided to drop Metformin and try something new I heard about. It's called CuraLin- have any of you heard of it and can give advice?

On a quick look, it's a supplement manufactured in India whose ingredients include bitter lemon (Monmordica charantia) and a bunch of other stuff I don't recognise. This has some info on bitter lemon: https://www.medicalnewstoday.com/articles/317724.php

My summary: At most a small improvement in BG, maybe nothing.

I wouldn't take it without my doc's approval and as with any other unregulated supplement, you can't be sure of exactly what's going to be in any batch of it.

 

[Sharron1]

Oh no. Bad luck if the almonds aren't playing ball. I eat loads of them. I didn't realise they fill me up so much

 

[Drummer]

For me the meter always showed carbs make a whoosh, low carbs go ambling along no concerns or worries. Some carb types did a super whoosh - so they got the boot - but the key for me is diet - not pills supplements or concoctions but simply not eating myself into a condition requiring them.

 

[Eddy Edson]

Day 5 ...

No almonds & stomach much better. I guess almonds were the issue, damn it.

Waking 5.2, high 8.9 after carby b'fast, time-weighted average over the day ~6.5. Walked 11km+.

Compared to pre-experiment, waking is at the top end of the range, peaks are about 1 higher, elevations last longer, troughs are not quite as low and the time-weighted avg is also about 1 higher. That's pretty consistent I think with a picture in which my liver is doing its gluconeogenesis thing in a fairly "normal" way, hence fairly normal waking levels not much affected by dropping Metformin. Peripheral insulin sensitivity is not terrible but could do better and Met does seem to have an impact there.

Anyway, it's a hypothesis. It would seem to be consistent with the Roy Taylor et al view on things - by losing weight I've cleared my liver of fat, so reducing hepatic insulin resistance and allowing normal gluconeogenesis, but in the absence of muscle-building the peripheral IR benefits have not been as great.

Subjectively, the walking-fatigue situation is noticeably better. I also see some signs that dropping the Met improves peripheral IS after walking in the absence of food.

If this kind of picture holds up it would be consistent with an HbA1c of around 5.7% / 39, the top-end of what I consider "normal".

Taking it all together, suggests a possible strategy of dropping the Met permanently and adding strength training to build muscle and improve peripheral IS with or without food. The main advantage of dropping the Met in this strategy would be fatigue reduction, but also maybe longer term better peripheral IS as muscle builds.

I think I should get my Libre sensors tomorrow - exciting! The plan is to keep doing this for a week hopefully with added BG insight from the Libre, then go back on the Met for say 3 weeks and compare as closely as I can (to allow 1 week for it to build up + 2 weeks real experiment).

 

[Eddy Edson]

Day 6 ...

Waking 5.5, high of 7.2 after lunch, time-weighted avg ~6.3. Walked 9km+.

That waking read is the highest for months, at the very top end of what I think is "normal". If it continues to rise, my "normal gluconeogenesis" hypothesis gets torpedoed; we'll see.

Through lunch-time I had a pretty low carb-y time & also walked for an hour +, so I'm not sure why BG went up - not that it's a big deal. The more interesting thing is that my base pre-prandial level now seems to hover around in the low 6's, versus high 4's and low 5's pre-experiment. I guess this might also be a sign that the gluconeogenesis engine is running a bit fast.

Apart from that, not much difference vs yesterday.

The delivery company was supposed to leave my Libre sensors at the door but this didn't happen for some reason; have to pick them up from somewhere tomorrow, if I have time. Interesting that there's no availability issue here in Oz - maybe we've been dumped with last-gen surplus or something.

I see you're enjoying some normal summer weather there in the UK for a change 🙂

 

[Eddy Edson]

Day 7 ...

Waking 4.9, high of 8.4 after carb-y b'fast (fruit, melon, chia+soy flat white), time-weighted avg ~6.5. Walked ~4km.

So waking level back in the pre-experiment range, but the rest of the day in-line with the last few days. Fairly stressful - intense meeting, pressure to get a project finished.

No real time for walking, which means no fatigue data, the main point of this little experiment. It's so easy to get sucked into focusing too much on BG - I wish I had a fatigue-o-meter to give some numbers of that.

Didn't have time to pick up the Libre sensors - do it on Monday.

 

[Eddy Edson]

Day 8 ...

Waking 5.2 after not enough sleep, high of 8.3 after relatively low-carb-ish b'fast, in the 5's after ditto lunch, 4.9 after evening walk. Time-weighted avg ~6.0. Walked 10.5km.

Apart from walking, still buried in a project for a robotics start-up all day. General impression is that walking really doesn't zap me as much for fairly intense thinking, compared to pre-experiment.

Better BG numbers today probably linked to fewer carbs - no melon, no pumpernickel, less soy flat white - about 120g. Not a huge deal. Does seem to remain the case that BG takes longer to fall from post-prandial highs.

Niece's birthday - preparing birthday lecture covering deportment, nutrition, ethics and political history, lucky girl.

 

[Leonora]

Fascinating...as Spock would say. Are you eating the same foods every day on this experiment and will you be getting your a1c checked after it?

 

[Eddy Edson]

Fascinating...as Spock would say. Are you eating the same foods every day on this experiment and will you be getting your a1c checked after it?

The idea was to eat generally the same way I ate pre-experiment. But it's interesting the way frequent measuring tends to move you unconsciously towards lower carb, a Pavlovian slave to the meter. Reminds me of when I was first measuring and wrangling levels down.

I really don't want to change my pre-experiment eating habits very much. It'd be a reason for resuming the Met, if I couldn't eg fit good quantities of fruit & melon into the picture.

I'm supposed to be getting my next HbA1c in September.

 

[Sharron1]

Day 8 ...

Waking 5.2 after not enough sleep, high of 8.3 after relatively low-carb-ish b'fast, in the 5's after ditto lunch, 4.9 after evening walk. Time-weighted avg ~6.0. Walked 10.5km.

Apart from walking, still buried in a project for a robotics start-up all day. General impression is that walking really doesn't zap me as much for fairly intense thinking, compared to pre-experiment.

Better BG numbers today probably linked to fewer carbs - no melon, no pumpernickel, less soy flat white - about 120g. Not a huge deal. Does seem to remain the case that BG takes longer to fall from post-prandial highs.

Niece's birthday - preparing birthday lecture covering deportment, nutrition, ethics and political history, lucky girl.

You missed out chastity.

 

[Eddy Edson]

You missed out chastity.

I don't feel that I'm qualified to lecture on that topic 🙂

 

[Eddy Edson]

Day 9 ...

Waking 5.0 after once again not enough sleep, peak of 6.4 after lunch, 5's and 6's all day, time weighted avg of ~5.8. Walked ~8km.

That puts me dead on the mean of what the data I benchmark against says is a "normal" avg daily BG level and generally the profile over today looked like a typical day pre-experiment. Fairly typical eating day, ~185g gross carbs.

Maybe my poor old bod has adjusted to doing without the Metformin crutch? We'll see ...

Still buried in this project & limited time for walking but generally the fatigue thing does seem to be better. I'm pretty toasted right now but that's from a few 12+ hour working days in a row and not enough sleep - it's a different kind of fatigue.

Bed calls - early meetings tomorrow.

 

[Eddy Edson]

Day 10 ...

Waking early to 4.7, peak of 7.4 after fairly carby b'fast, time weighted avg 5.8 once again. Walked 10km.

Again a "normal" profile, on a 200g+ carb day. Neat!

For reference , the "normal" daily values I use as a benchmark, from a couple of CGM studies (+/- one standard deviation):

Low: 4.6 +/- 0.3
High: 8.0 +/- 1.3
Time-weighted average: 5.8 +/ 0.6
HbA1c: 5.3% +/- 0.3% or 34 +/- 4

Not one of my very "good" days for walking - a bit of a struggle; maybe put that down to still not having caught up on sleep.

Fetched my Libre sensors but then discovered my iPhone 6 can't run the app. Doh! I guess that means it's time to upgrade, which means I have to go a phone shop tomorrow & deal with a phone shop youth. For some reason dealing with tech-shop youth always spikes my misanthropy index (first world problems, never mind ...).

Snooze time ...

 

[Eddy Edson]

Just to triangulate on those "normal" benchmarks ... This is one of my favourite pics:



From https://www.ncbi.nlm.nih.gov/pubmed/30735238 published recently, assessing a new model for predicting how normal people's BG will react to different food based on a bunch of factors including their gut microbes. I think probably a really important piece of research, mentioned as such in the recent update to the ADA's dietary guidelines.

Anyway, the pic shows how six different non-diabetics' BG reacted to a standardised bagel+cream cheese meal. Each colour shows how a particular individual reacted on two different occasions. Pretty consistent over the two occasions for each individual; wide variations between individuals.

Eyeballing the peaks and 2 hour post-prandial values and dividing by 18 to convert from US-style mg/DL to mmol/L, I get:

Peak: Average 8.1, standard deviation 1.4.
2 hour: Average 7.0, standard deviation 1.7. [EDIT: fixed a typo.]

The peak calculation agrees very well with the 8.0 +/ 1.3 benchmark (which comes from other data), increasing my confidence in it. Message: Don't stress if you peak above 9. Lots of non-diabetics do too.

The 2 hour calculation is interesting to compare with the various numbers for 2-hr post-prandial you see floating around: no more than 7.8, no more than 8, no more than 8.5, no more than 10. Overall, I think it's a pretty weak metric to look at - much better to look at time-weighted average and peak, to the extent you can - but if you do track it and you're a T2 trying to be one-standard-deviation "normal", this data seems to support the 8.5 target more than the others.

 

[Eddy Edson]

Day 11 ...

Waking 5.3, peak 7.4 after carb-y b'fast, time-weight avg 5.9. Walked 12.5km.

Don't see much interesting data from today, except to note that everything continues to be "normal" on a 200g+ carb day, although a tiny smidgen higher BG-wise than pre-experiment expectation. Walking a bit of a struggle early on, much easier by the end of the day and little residual fatigue - continuing the general pattern with this experiment. Peripheral IS signal post-walking maybe a bit improved also.

I've ordered a Libre reader. Apparently I'm locked into a phone plan which means it would cost $gadzillion to replace my iPhone 6. I can't really blame the phone-shop youth for this, so I've decided to blame the one I bought my current phone and plan from, for not ignoring me when I said I didn't want to upgrade. Plus he had a goatee.

 

[Eddy Edson]

Day 12 ...

Waking 5.1, peak 7.9 after non-carby lunch, time weighted avg 5.8. Walked 13.7km. ~200g carbs.

Another pretty boring, "normal" BG day, still maybe a little bit higher than pre-experiment.

The big thing was being able to walk 13.7km at avg of ~5.4km/h with no probs, as if I didn't have a blocked artery at all. And no particular fatigue. Fab!

I am now Libre'd! Really very cool, how easy and plug'n'play the whole thing is. On a few tests, the readings seem within +/- 0.3 of my meter so far, better than I expected. Well done, Abbott.

As part of the experiment, what I'm looking forward to is getting more insight into what happens during and after exercise & what that might mean for my peripheral IS, comparing with what things look like when I do the back-on-Metformin leg.

And for curiosity, what happens to my BG over night. I'm guessing nothing very interesting, but I really have no idea.

 

[Ya Sham]

On a quick look, it's a supplement manufactured in India whose ingredients include bitter lemon (Monmordica charantia) and a bunch of other stuff I don't recognise. This has some info on bitter lemon: https://www.medicalnewstoday.com/articles/317724.php

My summary: At most a small improvement in BG, maybe nothing.

I wouldn't take it without my doc's approval and as with any other unregulated supplement, you can't be sure of exactly what's going to be in any batch of it.

You are correct I did consult with my doctor and she said it looks good and since it is 100% natural it can't be harmful... Look I joined the Facebook group Winning Type 2 Diabetes Together where most people there use CuraLin and are reporting amazing results not only in glucose levels but also changes with eyesight.. more energy and such. I recommend you to check it out for ourself- https://www.facebook.com/groups/261568611056436/

They also have a clnical review on their website where each ingredient is explained. For me, it works amazing so far...

 

[grovesy]

You are correct I did consult with my doctor and she said it looks good and since it is 100% natural it can't be harmful... Look I joined the Facebook group Winning Type 2 Diabetes Together where most people there use CuraLin and are reporting amazing results not only in glucose levels but also changes with eyesight.. more energy and such. I recommend you to check it out for ourself- https://www.facebook.com/groups/261568611056436/

They also have a clnical review on their website where each ingredient is explained. For me, it works amazing so far...

Just because something is natural it does not mean it can't be harmful

 

[Ya Sham]

Just because something is natural it does not mean it can't be harmful

That is true grovesy but from personal experience, the natural way is a lot less harmful than all the chemicals that are given to us in prescribed medications.. especially when I see in the group that people have been taking CuraLin for more than 2 years and are still doing great with amazing results