LADA and Metformin

[runner]

Hi, was anyone else with LADA using insulin, recommended to continue taking Metformin? I continued taking it, as recommended, although I take a lower dose, and recently came across this, from ActionLada:
Management of LADA:

There is no established management strategy for people diagnosed with LADA. The potential value of identifying this group at high risk of progression to insulin dependence includes:

• Avoidance of using metformin treatment given the theoretical associated risks of metformin in patients becoming insulin dependent.
• Early introduction of insulin therapy.
• Application of intervention trials to arrest or reverse the destructive disease process.

For those people diagnosed with diabetes in whom the primary defect is loss of insulin secretion, treatment should aim to restore islet insulin secretion. Therapy to prevent progression towards insulin dependency could include immunotherapy, insulin or oral hypoglycaemic drugs. The efficacy of sulphonylureas has not been formally tested but it is evident that they do not arrest progression to insulin dependency in subjects with LADA. Whether metformin is of benefit is unclear and the drug may be contraindicted in those with LADA as there is a theoretical risk of severe metabolic disturbance in individuals who progress to insulin dependency whilst on it.

the link to the info is here: http://www.actionlada.org/why/why.html

 

[Inka]

Bumping this for you @runner 🙂 Do you have insulin resistance?

 

[runner]

Bumping this for you @runner 🙂 Do you have insulin resistance?

Yes. Sorry I meant NO (senior moment)

 

[Inka]

Yes

Then perhaps that’s why you’ve been given the Metformin. I’m sure I’ve read of others with Type 1/LADA being given it. There was talk of giving it to those without insulin resistance too because of its benefits, but I don’t remember the details sadly.

 

[runner]

Okay, thank you.

 

[everydayupsanddowns]

I think @Pattidevans took Metformin for a while as a T1 to reduce insulin resistance.

I wonder what ‘theoretical risks’ they are referring to?

Met isn’t a medication that urges the islet cells to push out extra insulin (thereby perhaps risking ‘burning them out’). Is it just the risk of hypos (because of increased insulin sensitivity) do you think?

If so, the solution would surely be just to reduce insulin doses as required?

 

[runner]

I think @Pattidevans took Metformin for a while as a T1 to reduce insulin resistance.

I wonder what ‘theoretical risks’ they are referring to?

Met isn’t a medication that urges the islet cells to push out extra insulin (thereby perhaps risking ‘burning them out’). Is it just the risk of hypos (because of increased insulin sensitivity) do you think?

If so, the solution would surely be just to reduce insulin doses as required?

I was originally diagnosed as T2 in 2007, put on Metformin, then Glicoside, started running etc. but still high HbA1c. Was re-diagnosed after a few months as T1.5 LADA and went on to insulin and DAFNE. It was recommended I keep taking the Metformin, and so I did, but took a lower dose As my tolerance of it was not good. Now on slow-release and waiting for consultation re pump. Will ask about the Metformin then.

 

[rebrascora]

@runner What makes you believe you are insulin resistant?
Do you need particularly large doses of insulin to manage your levels?
I think asking if someone is insulin resistant is a bit of a loaded question because it is subjective.... We all have an element of insulin resistance. Sometimes it is just in the morning or when our levels stray above 10 etc.

I recently asked my consultant about trying Metformin again (I was initially diagnosed Type 2 and put on Metformin for the first 6 months along side the insulin which was introduced 6 weeks after diagnosis. The Metformin was then stopped by the consultant. I was told by the practice nurse there were health (heart I believe) benefits to taking the Metformin at the time. I did not see any benefit from the Metformin to my diabetes management or improvement when I stopped. The reason I asked to try it again was because I take so long to respond to my bolus insulin even with Fiasp but my consultant was not in favour of it for someone of a normal BMI which I am. He says it is an absorption issue with the Fiasp delay rather than resistance, as I don't need large doses.

 

[runner]

@runner What makes you believe you are insulin resistant?
Do you need particularly large doses of insulin to manage your levels?
I think asking if someone is insulin resistant is a bit of a loaded question because it is subjective.... We all have an element of insulin resistance. Sometimes it is just in the morning or when our levels stray above 10 etc.

I recently asked my consultant about trying Metformin again (I was initially diagnosed Type 2 and put on Metformin for the first 6 months along side the insulin which was introduced 6 weeks after diagnosis. The Metformin was then stopped by the consultant. I was told by the practice nurse there were health (heart I believe) benefits to taking the Metformin at the time. I did not see any benefit from the Metformin to my diabetes management or improvement when I stopped. The reason I asked to try it again was because I take so long to respond to my bolus insulin even with Fiasp but my consultant was not in favour of it for someone of a normal BMI which I am. He says it is an absorption issue with the Fiasp delay rather than resistance, as I don't need large doses.

Ah, that's interesting. Sorry, I meant not insulin resistant - the fact I was sensitive to it was one of the indicators it was T1, or T1.5 rather than 2. Yes, I was also told that Metformin has other benefits, which is why I persisted.

 

[rebrascora]

The only draw backs that I know about with Metformin are the obvious particularly digestive disruption side effects and that it can inhibit the absorption of vitamin B12 causing deficiency.

Avoidance of using metformin treatment given the theoretical associated risks of metformin in patients becoming insulin dependent.

It would have been interesting to know what exactly they meant by that excerpt above.