Eddy Edson
Well-Known Member
- Relationship to Diabetes
- In remission from Type 2
I think it's great if you find it helpful but to me it looks like just another dismal snake-oil supplement scam. That FB group belongs to the company that makes it, BTW.
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Experiment: dropping Metformin
- Thread starter Eddy Edson
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I think it's great if you find it helpful but to me it looks like just another dismal snake-oil supplement scam. That FB group belongs to the company that makes it, BTW.
grovesy
Well-Known Member
- Relationship to Diabetes
- Type 2
I am suspicious of sites like that one,
Eddy Edson
Well-Known Member
- Relationship to Diabetes
- In remission from Type 2
With good reason, I think. How could you know if it's real people posting there, rather than just company sock-puppets?
Eddy Edson
Well-Known Member
- Relationship to Diabetes
- In remission from Type 2
Experiment update ...
First, some more on "normal". The most comprehensive study I've seen looking at "normal" is this: https://care.diabetesjournals.org/content/32/7/1188 Dates back to 2009 and the population is Chinese, but I don't think either of those things is very important.
A good thing is that it looks at data grouped by age and sex:
BG values in US mg/dL - divide by 18 to get mmol/L. "PT140" is percentage of time during the day with BG > 140 mg/dL = 7.8 mmol/L. "PT70" is percentage of time with BG < 70 mg/dL = 3.9 mmol/L. "P5" etc means the 5th percentile etc, so "P50" is the median.
Dead-centre "normal" is the median, so the P50 mark. For me, a 58 year-old male, the numbers look like this:
Median is around 5.9 mmol/L, corresponding to a 5.3% / 34 HbA1c on the conventional translation, with < 2% of time above 7.8 mmol/L. But anything up to 6.5 mmol/L, 5.7% / 39, 13% would still be within a solidly "normal" range.
According to the Libre, over the last week my avg BG is 5.8 mmol/L and I'm spending 5% of time above 7.8 mmol/L. It's still reading a bit high versus finger-pricks:
... but getting better. Anyway, the data is enough to confirm that I don't currently "need" Metformin for any BG-related reason.
I think it's definitely the case that I have fewer fatigue issues since the start of the experiment. There's fatigue (and pain) from walking, which is subjectively better to a moderate extent; and "brain fatigue", which seems much better. I have had zero days where I was complete toast, and the other night I had to pull a frantic all-nighter getting a complex project finished, which I was able to do without getting completely destroyed.
Comparing BG levels is difficult - I wasn't testing a lot pre-experiment - but waking levels over the last few days have been in the lower 4's, versus higher 4's, and moderate walking has a big (1.5 - 2.5 mmol/L) impact on BG levels without a big bounce-back afterwards.
A complicating factor for the comparison is that my last lab tests in May gave an HbA1 of 4.6% / 27. That would correspond on the conventional translation to an avg daily BG of 4.8 mmol/L, which is actually below the 4.9 mmol/L 5th percentile value from the study. I'm certainly not that low now, but I'm pretty sure I also wasn't that low back in May; I suspect the low result had a lot do with changes in my red blood cell count.
Next: I do want to do the back-on-Metformin leg, starting now with a good set of comparison data in a day or two. But probably with just 500mg rather than the pre-experiment 1000mg. Will it deliver a net improvement in peripheral insulin resistance, reducing that 5% time above 7.8 mmol/L? Will it do the opposite, plus maybe bring fatigue issues back?
First, some more on "normal". The most comprehensive study I've seen looking at "normal" is this: https://care.diabetesjournals.org/content/32/7/1188 Dates back to 2009 and the population is Chinese, but I don't think either of those things is very important.
A good thing is that it looks at data grouped by age and sex:
BG values in US mg/dL - divide by 18 to get mmol/L. "PT140" is percentage of time during the day with BG > 140 mg/dL = 7.8 mmol/L. "PT70" is percentage of time with BG < 70 mg/dL = 3.9 mmol/L. "P5" etc means the 5th percentile etc, so "P50" is the median.
Dead-centre "normal" is the median, so the P50 mark. For me, a 58 year-old male, the numbers look like this:
Median is around 5.9 mmol/L, corresponding to a 5.3% / 34 HbA1c on the conventional translation, with < 2% of time above 7.8 mmol/L. But anything up to 6.5 mmol/L, 5.7% / 39, 13% would still be within a solidly "normal" range.
According to the Libre, over the last week my avg BG is 5.8 mmol/L and I'm spending 5% of time above 7.8 mmol/L. It's still reading a bit high versus finger-pricks:
... but getting better. Anyway, the data is enough to confirm that I don't currently "need" Metformin for any BG-related reason.
I think it's definitely the case that I have fewer fatigue issues since the start of the experiment. There's fatigue (and pain) from walking, which is subjectively better to a moderate extent; and "brain fatigue", which seems much better. I have had zero days where I was complete toast, and the other night I had to pull a frantic all-nighter getting a complex project finished, which I was able to do without getting completely destroyed.
Comparing BG levels is difficult - I wasn't testing a lot pre-experiment - but waking levels over the last few days have been in the lower 4's, versus higher 4's, and moderate walking has a big (1.5 - 2.5 mmol/L) impact on BG levels without a big bounce-back afterwards.
A complicating factor for the comparison is that my last lab tests in May gave an HbA1 of 4.6% / 27. That would correspond on the conventional translation to an avg daily BG of 4.8 mmol/L, which is actually below the 4.9 mmol/L 5th percentile value from the study. I'm certainly not that low now, but I'm pretty sure I also wasn't that low back in May; I suspect the low result had a lot do with changes in my red blood cell count.
Next: I do want to do the back-on-Metformin leg, starting now with a good set of comparison data in a day or two. But probably with just 500mg rather than the pre-experiment 1000mg. Will it deliver a net improvement in peripheral insulin resistance, reducing that 5% time above 7.8 mmol/L? Will it do the opposite, plus maybe bring fatigue issues back?
Last edited:
Eddy Edson
Well-Known Member
- Relationship to Diabetes
- In remission from Type 2
But actually, maybe ... Yesterday I averaged 5.0 by both Libre and finger prick, which are now agreeing excellently - avg variance less than 1% - on a day when I did hardly any walking (miserable weather). Back in May I was walking on avg 12 km+ per day.
Then today this happened (up until 10.30pm, the time here now):
According to the Libre my avg BG has been 4.8 today so far, with 10km+ walking.
Over night, I woke at about 4am and went back to sleep for a few hours at 6am. While asleep, the Libre reckons I spent maybe 4 hours below 3.9, dropping as low as 3.4. Do I believe that? Who knows? Finger prick said 4.1 soon after first waking, at a point where the Libre said it was on the rise from 3.8 to 4.1. Before going back to sleep, another finger prick said 4.4 vs Libre's 4.6 and falling. And so on - excellent agreement between Libre and a few finger pricks for the rest of the day.
(It definitely wasn't squashies and I didn't notice any hypo effects, apart from feeling like I'd just been disinterred upon waking, but that's normal 🙂 )
In the early evening I set myself to test whether I could make BG go below 3.9 by walking a few kilometres - in the last few days walking has certainly been enough to get me down to ~4.0. According to the Libre, I was down at 3.7 after walking 5km. But I didn't get the chance to compare with finger pricks; maybe better luck next time.
It might be that getting down to very low fasting and post prandial levels with a bit of exercise is now a regular kind of thing for me & my bod has just taken a a couple of weeks to get over whatever aftershocks of dropping the Metformin.
Or perhaps my liver's decided this whole gluconeogenesis business is bogus - hard to pronounce; nobody talks about it on Internet message boards, only experts with actual qualifications in professional papers; doesn't have anything to do with low carb so not sexy - and it's not going to make much of an effort anymore.
Or maybe I've got a touch of some kind of hepatitis.
Or maybe it's just random squidginess ...
Eddy Edson
Well-Known Member
- Relationship to Diabetes
- In remission from Type 2
So the last day of the no-Metformin leg - how exciting!
I certainly had the squashies last night - Libre reading in the 2's - but we'll skate over that.
I've set up my spreadsheet so I can compare some metrics over different periods.
"Mean" is just the average Libre BG reading. "Avg Low" is the average low over the period.
"Avg Day Low" is the average low between midday and 11pm. I pull out this metric because it might sorta-kinda reflect peripheral IR. Hepatic IR would also be a factor here, especially for pre-prandial and bed-time levels, but I'm pretty much assuming that hepatic IR and gluconeogenesis aren't issues for me now, in which case this is a fairly interesting rough metric.
Similar the daily "Avg High" and "Avg P7.8" = percentage of time > 7.8 mmol/L are interesting peripheral IR indications.
"Avg FP-L" is a check against finger pricks, the average difference between the Libre and FP values.
In this table you can see that levels in the last week have been lower compared to the whole period including the first few days of wearing a Libre. But in the last week the Libre has on average been spot-on versus finger pricks, whereas for the whole period the Libre was reading ~0.2 high. If you apply a rough adjustment and reduce the whole period levels by that 0.2, you get kinds-sorta similar numbers to the last week. So everything seems to hang together.
Briefly:
- Everything looks well within the bounds of "normal", without Metformin.
- It'd be nice but not essential to get that P7.8 lower and maybe Metformin will have an effect there.
- Unfortunately I don't have a "fatigue metric" so will just have to be subjective with that comparison.
In pics: First, hourly means for the whole period for Libre versus finger pricks.
Very close. I don't include the few overnight finger prick readings in the data base, because obviously I was awake when I took them and it's not apples-vs-apples to compare with sleeping Libre values.
The Libre line looks smoother than any individual day, because I am not a creature of very regular habits so peaks and troughs happen at different times, to some extent cancelling each other out when you munge everything together. But there is still a noticeable breakfast bump, reflecting my most carby meal, usually.
Second, a chart showing the hourly means for the last week versus the whole period:
In the last week, as reflected also in the table, levels have generally been coming down and the afternoon "shape" has been different, maybe reflecting a bit of peripheral IR improvement, maybe just to do with time eating/exercise timing. I'll be looking at this comparison as the back-on-Metformin leg progresses for a quick overview of any major changes.
I certainly had the squashies last night - Libre reading in the 2's - but we'll skate over that.
I've set up my spreadsheet so I can compare some metrics over different periods.
"Mean" is just the average Libre BG reading. "Avg Low" is the average low over the period.
"Avg Day Low" is the average low between midday and 11pm. I pull out this metric because it might sorta-kinda reflect peripheral IR. Hepatic IR would also be a factor here, especially for pre-prandial and bed-time levels, but I'm pretty much assuming that hepatic IR and gluconeogenesis aren't issues for me now, in which case this is a fairly interesting rough metric.
Similar the daily "Avg High" and "Avg P7.8" = percentage of time > 7.8 mmol/L are interesting peripheral IR indications.
"Avg FP-L" is a check against finger pricks, the average difference between the Libre and FP values.
In this table you can see that levels in the last week have been lower compared to the whole period including the first few days of wearing a Libre. But in the last week the Libre has on average been spot-on versus finger pricks, whereas for the whole period the Libre was reading ~0.2 high. If you apply a rough adjustment and reduce the whole period levels by that 0.2, you get kinds-sorta similar numbers to the last week. So everything seems to hang together.
Briefly:
- Everything looks well within the bounds of "normal", without Metformin.
- It'd be nice but not essential to get that P7.8 lower and maybe Metformin will have an effect there.
- Unfortunately I don't have a "fatigue metric" so will just have to be subjective with that comparison.
In pics: First, hourly means for the whole period for Libre versus finger pricks.
Very close. I don't include the few overnight finger prick readings in the data base, because obviously I was awake when I took them and it's not apples-vs-apples to compare with sleeping Libre values.
The Libre line looks smoother than any individual day, because I am not a creature of very regular habits so peaks and troughs happen at different times, to some extent cancelling each other out when you munge everything together. But there is still a noticeable breakfast bump, reflecting my most carby meal, usually.
Second, a chart showing the hourly means for the last week versus the whole period:
In the last week, as reflected also in the table, levels have generally been coming down and the afternoon "shape" has been different, maybe reflecting a bit of peripheral IR improvement, maybe just to do with time eating/exercise timing. I'll be looking at this comparison as the back-on-Metformin leg progresses for a quick overview of any major changes.
Eddy Edson
Well-Known Member
- Relationship to Diabetes
- In remission from Type 2
Day 3 of back-on-Metformin ...
Too soon to really say anything, of course, but I have to say I'm not sure about this Metformin caper. Plus, this is the Internet, where confirmation bias is *just fine* 🙂
First, the fatigue. Both forms are back: today I felt like I had the mental acuity and focus of an old cigarette butt & had to nap; and walking 10km was a painful chore and left me feeling for much of the day like I had over-exercised.
My BG profile looked like this:
(Blue = Libre, orange = finger pricks.) A new Libre sensor is performing excellently, so far.
The general pattern for the day:
- Post breakfast, it's smooth!
- No noticeable Met impact on overnight levels.
- Noticeably lower post-prandial levels.
- Generally higher daytime pre-prandial levels and BG reduction from walking is quite muted and transient. An afternoon nap had a bigger and more lasting impact.
Comparing the day with the no-Metformin leg:
(where I've applied crude adjustments based on finger pricks).
No significant diff in daily average BG or overnight lows. But daytime lows are fairly significantly higher, and this combines with much lower post-prandial peaks.
If this pattern continues it's very much in line with my initial hypothesis, ie:
- I've dealt with hepatic insulin resistance via weight loss, so gluconeogenesis under control, so overnight levels completely normal and Metformin won't do anything for that.
- Metformin might still have an impact on peripheral ie muscle IR, particularly post-prandial, so it might shave peaks.
- The Metformin and exercise mechanisms for peripheral IR improvement might interfere with each other so maybe pre-prandial, post-exercise levels will be higher.
I need to run this for at least a few more days, but if I continue to feel toasted I'll probably blame it all on the Met and ditch it ...
The strategy will then be to up my strength work from current daily average of around 78 seconds to something real, in order to build muscle and improve natural peripheral IR, finding some way to deal with the tedium. Maybe carry weights while walking? My exercise physiologist is supposed to be looking into that.
Too soon to really say anything, of course, but I have to say I'm not sure about this Metformin caper. Plus, this is the Internet, where confirmation bias is *just fine* 🙂
First, the fatigue. Both forms are back: today I felt like I had the mental acuity and focus of an old cigarette butt & had to nap; and walking 10km was a painful chore and left me feeling for much of the day like I had over-exercised.
My BG profile looked like this:
(Blue = Libre, orange = finger pricks.) A new Libre sensor is performing excellently, so far.
The general pattern for the day:
- Post breakfast, it's smooth!
- No noticeable Met impact on overnight levels.
- Noticeably lower post-prandial levels.
- Generally higher daytime pre-prandial levels and BG reduction from walking is quite muted and transient. An afternoon nap had a bigger and more lasting impact.
Comparing the day with the no-Metformin leg:
(where I've applied crude adjustments based on finger pricks).
No significant diff in daily average BG or overnight lows. But daytime lows are fairly significantly higher, and this combines with much lower post-prandial peaks.
If this pattern continues it's very much in line with my initial hypothesis, ie:
- I've dealt with hepatic insulin resistance via weight loss, so gluconeogenesis under control, so overnight levels completely normal and Metformin won't do anything for that.
- Metformin might still have an impact on peripheral ie muscle IR, particularly post-prandial, so it might shave peaks.
- The Metformin and exercise mechanisms for peripheral IR improvement might interfere with each other so maybe pre-prandial, post-exercise levels will be higher.
I need to run this for at least a few more days, but if I continue to feel toasted I'll probably blame it all on the Met and ditch it ...
The strategy will then be to up my strength work from current daily average of around 78 seconds to something real, in order to build muscle and improve natural peripheral IR, finding some way to deal with the tedium. Maybe carry weights while walking? My exercise physiologist is supposed to be looking into that.
Last edited:
Eddy Edson
Well-Known Member
- Relationship to Diabetes
- In remission from Type 2
Experiment terminated!
Two days of brain fog and walking pain//fatigue is enough. Obviously I can't be certain that these are to do with Metformin, but it sure feels that way, and I simply have too much on my plate to spend time in zombie-mode, so anything which might cause it needs to go.
Based on the no-Metformin leg, dropping it shouldn't take my BG outside of a "normal" range, and this includes post-prandial peaks which it seems Metformin might shave - the peaks are within normal bounds, even without shaving.
The potential non-BG benefits of Met are too nebulous to justify the fatigue, and it seems to me that there's a better chance of being able to improve peripheral IR without it, along with putting some muscle on my scrawny frame.
I'm interested now in whether lactic acid build up has anything to do with the fatigue and brain-fog. It doesn't seem stupid to my (admittedly pretty clueless) thinking. Met does promote lactic acid; my blocked leg artery means I start building up the stuff with not very much walking; there seem to be some well-recognised brain-foggy effects from it. But really only of academic interest for now ...
Two days of brain fog and walking pain//fatigue is enough. Obviously I can't be certain that these are to do with Metformin, but it sure feels that way, and I simply have too much on my plate to spend time in zombie-mode, so anything which might cause it needs to go.
Based on the no-Metformin leg, dropping it shouldn't take my BG outside of a "normal" range, and this includes post-prandial peaks which it seems Metformin might shave - the peaks are within normal bounds, even without shaving.
The potential non-BG benefits of Met are too nebulous to justify the fatigue, and it seems to me that there's a better chance of being able to improve peripheral IR without it, along with putting some muscle on my scrawny frame.
I'm interested now in whether lactic acid build up has anything to do with the fatigue and brain-fog. It doesn't seem stupid to my (admittedly pretty clueless) thinking. Met does promote lactic acid; my blocked leg artery means I start building up the stuff with not very much walking; there seem to be some well-recognised brain-foggy effects from it. But really only of academic interest for now ...
Eddy Edson
Well-Known Member
- Relationship to Diabetes
- In remission from Type 2
FWIW, to wrap up, comparing the no-Metformin leg with the few days back on Met, after a couple days build-up:
No significant difference in avg BG. Pre-prandial lows lower and post-prandial peaks higher without Met.
No significant difference in avg BG. Pre-prandial lows lower and post-prandial peaks higher without Met.
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