Go from High to Low

[Stuart60]

about 8 years ago I was told I had type 2 diabetes this based on mainly high blood sugar readings this from a HB1AC, I was subsequently put on Metformin. At this time I weighed over 21 stone.
Subsequent HB1AC's suggested it was well controlled.
About 5 years ago I lost a lot of weight very quickly and at my lowest went down to under 14 stone, something my GP was worried about as it happened so quickly. Nothing was found other than the stress going through a highly acrimonious divorce.
And so life went on and the HB1AC's said I was still well controlled. However last June I had a serious road crash which has been put down to a medical event and it was believed I had a Hypo, after 6 weeks in hospital my GP issued me with a Libre Freestyle and this shown rather odd results in that about every 3 weeks or so I would have several days of serious lows going down sometimes down to 2.3 this confirmed with finger prick testing.
I should point out following this my GP doubled my Metformin and put me on Ephagolozin and Linagliptin. Also my Girlfriend of 4 years also noted me having a number of absences, prior to the accident she and my daughter noted I had a couple of absences but just thought I was a bit daydreaming as my daughter who is a teacher described it.
Speaking to my GP I was told I would be referred to a Endocrinologist, and whilst I was getting lots of appointments for other issues nothing forthcoming. 2 weeks ago I found and got access using the NHS wales App only to find a letter from Endocrinology asking my GP to stop my medication for a month and see what happened, I called my surgery and spoke to the GP pointing out that this letter existed from last November but nobody had told me to stop my drugs, this despite me having 2 appointments with the Diabetes nurse and asking my GP about the Endocrinology appointment and being told I was on the waiting list.
So on the 1st of this month the GP told me to stop the medication and as I am mobility restricted I started closely monitoring what was going on with my sugars, Since I have never had a low I tend to be a little on the high side most of the time this all confirmed with regular finger prick tests.
On further research on the net I found this article https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1783540/ which seems to suggest that the amount of metformin can be weight related and I wonder if any one else has experience of this as I wonder with my significant weight loss but still on the same 3 times daily 500mg metformin was too much and as such causing the lows and associated Hypos?

 

[harbottle]

None of those drugs you were taking tend to cause low blood sugar, but in combination the flozon and linagliptin might.

Metformin doesn't affect insulin secretion in any way and is very unlikely to cause it.

 

[Stuart60]

None of those drugs you were taking tend to cause low blood sugar, but in combination the flozon and linagliptin might.

Metformin doesn't affect insulin secretion in any way and is very unlikely to cause it.

So is the article I referenced not correct when it talks about the links about Metformin with a BMI of Obese which I was before I lost all the weight whereas at my lowest I had a BMI of underweight?
it is odd that the stopping of the Metformin has led to only high readings and doing more research on Metformin 1500mg a day is a lot and I wonder with a lower weight being maintained for 4 years, a bit higher than my lowest but I wonder if maybe taking a lower dose would keep the blood sugars better controlled without the risk of going low and having blackouts?

 

[rebrascora]

As said above, the Metformin will not drop your BG fast or too low because it doesn't stimulate insulin production (it just discourages your liver from releasing so much glucose and helps the cells of your body to be less resistant to using the insulin you do produce) and the normal full dose is 2000mg (ie 2g) or 4x 500mg tablets a day, regardless of body weight. I was taking this max dose at 10stone and many other people too with a weight and BMI less than yours, with no hypo issue, so I am pretty confident that Metformin was/is not the cause of your issue.
Did you ever have pancreatic scans. I wonder if you have some anomaly with your pancreas which caused it to release too much insulin. Problems with the pancreas can also cause weight loss because it produces digestive enzymes, so if you were short on those you would lose weight quite dramatically even when eating the same/normally as your body simply can't access the nutrients in your food.

 

[harbottle]

Not sure what the relevance of that paper is. It's just comparing Metformin and another medication.

Have you stopped all medications?

 

[Stuart60]

I guess this article is misinformed then and needs reporting as such
I have not had a pancreatic scan as endocrinology wanted me to stop medication for a month first.
I guess my hypos and blackouts are a mystery as since stopping I have not had a single hypo or blackout since stopping where as following the accident my blackouts were associated with low blood glucose readings both on the Libre and subsequent finger prick tests.
Odd my GP did not look at pancreas issues as a cause for my dramatic weight loss at the time.

Not sure what the relevance of that paper is. It's just comparing Metformin and another medication.

Have you stopped all medications?

Yes all diabetes medication stopped
I am just trying to understand the link between why I should go from being treated for high blood sugar readings with Metformin and being obese then suddenly I start having Hypo's and the only link I can make is a sudden drop in weight which my GP didn't link to my pancreas but religiously I kept taking the same levels of Metformin.
Suddenly I start having Hypos and some of my finger prick readings were lower than the used to be and on occasion below 5 but HB1AC's saying I have good control for years which of course having a mix of high and low readings on average would show.
However after using the Libre I seem to have quite a number of lows going down as low as 2.3 and these seeming to on occasion relate to my girlfriend observing my blackouts and thus makes me wonder why this change hence the looking for answers on the web and finding this article.

 

[harbottle]

The article is fine and isn't misinformed. It's just looking at the lowering effects of Metformin on obese patients compared to another drug. I'm not sure why you think it's relevant to your case.

You've gone from 3 anti-diabetic medications to zero?

 

[Stuart60]

The article is fine and isn't misinformed. It's just looking at the lowering effects of Metformin on obese patients compared to another drug. I'm not sure why you think it's relevant to your case.

You've gone from 3 anti-diabetic medications to zero?I

I am trying to understand why it is I went for years from controlled diabetes to having hypos and low blood sugars? The only link I can make is the fact that prior to the accident I dropped a lot of weight and maintained this much lower weight beyond that no medications changed until after my accident when my metformin was doubled from 500mg 3 times a day to 1000mg 3 times a day, I also had the Empaglozin and Linagliptin added and now using a Libre now I seeing low sugars and these seem to occur in line with Blackouts, obviously we could not make that association beforehand.
The Lingliptin was stopped after a month as I contacted the GP about my concerning irregular lows and the Empaglozin a month after so both gone by end of November but I was still remaining and having lows and Hypos and these continued through December and January so through those 2 months I was still having lows and even went on to have a blackout in front of my Physiotherapist.
After finding the letter on the NHS Wales app and on 1st this month told to stop the Metformin, yes my bloods have for the last 8 days been on the higher side but thus far no lows and no blackouts so is why I started to investigate this and came across this article and others talking about use of Metformin in low doses to control Hyperglycemia, my first thought is the 3000mg of Metformin especially is a lot but even 1500mg seems a lot when I see some only take metformin at 500mg per day remembering that my dose of Metformin had never changed for some 8 years prior to the accident and given the mention is made of obesity and Metformin my query is to understand if this loss of weight had any play in my change of symptoms and going from high side readings to having low readings if anybody else had noted this interaction?
I guess I am going to have to go the month then await an appointment with the Endocrinology which given the length of wait having first been requested in August but my GP only getting the letter in November and then the delay actually starting the removal of medication I guess I am likely not to be seeing an Endocrinologist before April or May at the best.
Has as been suggested this could be an issue with my pancreas and as my Dad died of Panceatic Cancer it is somewhat worrying to me.
Yes maybe I shouldn't go digging around the net for answers, then again if I hadn't use the NHS app I don't doubt this missed letter would not have been picked up.
Sorry if my confusion and search for answers is seen as a crass use of the forum and users time, I merely search for answers as to why this life changing accident occurred in the first place and did my Diabetes as has been proferred by the the Police as a reason for the accident be the cause.

 

[harbottle]

Losing weight may have kick-started the beta cells so you no longer need any medication?
What sort of readings are you seeing now?

 

[Stuart60]

Losing weight may have kick-started the beta cells so you no longer need any medication?
What sort of readings are you seeing now?

Between 8 and 15 a lot checked with Finger pricks which are only usually 0.2 - 0.4 different

 

[rebrascora]

I am very surprised that you were on 3g Metformin a day. That is very unusual and I would check in your notes that that is correct because I believe that is more than the maximum dose which I think is 2500mg or 2.5g. That said, Metformin really doesn't make a big difference to BG levels. It works away in the background gradually lowering your base level but it doesn't suddenly drop your levels and generally people on the maximum dose still have to modify their diet in order to see good results long term. If I remember correctly you were still more or less following a normal diet with breakfast cereal and bread and potatoes etc., so the Metformin would struggle to make much headway with that diet in my (non medical) opinion.

 

[Stuart60]

I am very surprised that you were on 3g Metformin a day. That is very unusual and I would check in your notes that that is correct because I believe that is more than the maximum dose which I think is 2500mg or 2.5g. That said, Metformin really doesn't make a big difference to BG levels. It works away in the background gradually lowering your base level but it doesn't suddenly drop your levels and generally people on the maximum dose still have to modify their diet in order to see good results long term. If I remember correctly you were still more or less following a normal diet with breakfast cereal and bread and potatoes etc., so the Metformin would struggle to make much headway with that diet in my (non medical) opinion.

I was originally on 1500mg however following my accident that was doubled in August and I remained on this till I came off the meds on 1st this month.
You are right I made little change to my diet both before and after I lost all the weight, I have found that stopping the metformin my BG levels have stayed higher but even after the other 2 drugs were removed by November in December and January I was still have readings as low as 2.9 and the blackouts were still being seen, I know it is only 8 days into February but have not gone below 6.7 since and am usually in the 9 to 13 range with an occasional spike up to 16ish after big meals.

 

[John Gray]

No, the maximum dose of metformin is 3g per day.
I was on this for several years until it was determined that metformin was problematical if one had renal dysfunction or congestive cardiac failure.
Now waiting for Mounjaro = tirzepatide...

 

[Leadinglights]

I was originally on 1500mg however following my accident that was doubled in August and I remained on this till I came off the meds on 1st this month.
You are right I made little change to my diet both before and after I lost all the weight, I have found that stopping the metformin my BG levels have stayed higher but even after the other 2 drugs were removed by November in December and January I was still have readings as low as 2.9 and the blackouts were still being seen, I know it is only 8 days into February but have not gone below 6.7 since and am usually in the 9 to 13 range with an occasional spike up to 16ish after big meals.

Those are quite high blood glucose levels and if you are still eating high carb meals then that can induce the pancreas to over produce insulin which will drop blood glucose quickly.
Have you tried eating lower carb meals to try to get your high levels down.9

 

[Stuart60]

Those are quite high blood glucose levels and if you are still eating high carb meals then that can induce the pancreas to over produce insulin which will drop blood glucose quickly.
Have you tried eating lower carb meals to try to get your high levels down.9

I have since my accident been eating better can't say all low carb but following my accident my Girlfriend has moved in to look after me and feed me, I know she follows a number of cookbooks and following the accident being put down to me blacking out due to a Hypo looking for diabetes friendly recipes but exactly if they are Low Carb I couldn't say as I have to rely on her cooking as my injuries prevent me being able to cook, this is something she has done since I came out of hospital in August, so was cooking very similar meals since both my early lows and now when higher
Whilst I accept I may need some level of metformin which originally seemed from the HB1AC's to be controlling my well, as I was only getting these tests every 6 to 12 months and as it aims to give an overall average based on a period of I am told 3 months if following my weight drop if I was having a mix of highs and lows this would just give an average where I would be told I am well controlled I am wondering if following the weight drop I was pre disposed to more hypo's being on this high level of metformin and following my weight drop which was put down to the stress of an acrimonious divorce following this I was eating a lot more of take out food (Yes I am a terrible cook) but also sometimes not eating however after meeting my girlfriend she would then often cook meals for me to get on my way home as a field service engineer so some days I was eating better home cooked food during this year preceding my accident.
The GP arranged for a HB1AC which was done on the 1st and has said I am to stop the meds and see what a further HB1AC shows next month and then hopefully he can get the Endocrinologist to see me for as has been raised already I may have issues with my pancreas and given my Dad died of Pancreatic Cancer it is a worry to me.