Metformin

[Cokecan]

Hi Guys,
I just wanted to say, after giving myself a good talking to, i decided to try and take control of my diabetes again. I was taking Metformin 500mg x2 twice a day allbeit ramdomly due to horrendous side effects, they've changed me to modified release and lowered my dose to 2x500mg after tea without checking my bloods and told me to be careful at first incase i have a hypo in the mornings. I'm slightly confused didnt think this happened with type 2's, is there anything i should be mindful of?

 

[LeeLee]

Metformin works primarily by reducing insulin resistance, thereby allowing the insulin that you produce to do its job and lower your blood glucose. I've never heard of a hypo caused by M alone - are you taking anything else as well? Did they tell you why you're having it all in one dose rather than half morning and half evening?

 

[Cokecan]

Im Taking metfomin alone - they said book in for bloods in about a weeks time but just take 2 in the evening for now - think it could be i tolerated the evening dose of normal metformin better

 

[Caroline]

It is rare for a type 2 to hypo but it can happen, even people who are non diabetic can hypo. Keep an eye on things. If taking the metformin this way works for you so much the better.

 

[Copepod]

To quote BNF (British National Formulary) about metformin:

Dose (regular metformin, not slow release): "?Diabetes mellitus, adult and child over 10 years initially 500mg with breakfast for at least 1 week then 500mg with breakfast and evening meal for at least 1 week then 500mg with breakfast, lunch and evening meal; usual max. 2g daily in divided doses"

Dose (modified release metformin): "Dose initially 500 mg once daily, increased every 10?15 days, max. 2g once daily with evening meal; if control not achieved, use 1g twice daily with meals, and if control still not achieved change to standard-release tablets
Note Patients taking up to 2g daily of the standard-release metformin may start with the same daily dose of metformin modified release; not suitable if dose of standard-release tablets more than 2g daily"

Perhaps part of Cokecan's problems with side effects were due to
"ramdonly" taking - usually wind problems etc are slightly lessened by taking with food. Admittedly, even taking carefully, regular metforming still doesn't suit everyone, so slow / modified release may be better. Hope this type works for you 🙂

 

[MargB]

Copecod, that is interesting. When I was put on Metformin it was 3 x 500g each day from the start. Side effects were dreadful and could not tolerate the 3rd tab so now just take one in morning, one at lunch. Perhaps if it had been introduced properly as advised in your post it would have been better.

Mind you, I am puzzled as to why I am still on it but when I discuss with Dr she says my levels are so well controlled because I am on Metformin.

 

[Copepod]

BNF is written for prescribers (mainly doctors and nurses for medicines taken internally, plus others for topical medications applied to skin, eyes etc) and pharmacists, so that patients get the best value from those medications. It's frustrating to hear when patients don't get the most appropriate things prescribed, along with the information about how and when to take. Lots of the information is in Patient Information Leaflets, but people often don't read the long worded, small printed, sheets / booklets, so a bit of "highlighting" of important issues by prescribers / pharmacists is helpful.

So, yes, do ask your doctor, MargB - and feel free to quote BNF, as anyone can sign up to website www.bnf.org

 

[PattiEvans]

Metformin doesn't work quite like most other tablets i.e. it doesn't address one particular meal or time of day. It sort of "ramps up" until it soaks your whole system. This usually takes around 3 weeks. If you stop taking it then it takes about the same length of time to completely clear your system. So missing an individual pill doesn't actually do very much.

Obviously slow release does what it says and I'm not sure it makes all that much difference when you actually take the pills. I could never remember to take it with the evening meal, so I take it all 4 x 500mg tablets with lunch. It's made a significant difference to the amount of insulin I take, reducing my total daily dose by about 30%. So you can see what a difference it can make for T2s.

(Just for those wondering why I am on metformin as a T1. I was struggling with my weight (most of it put on some years ago when I followed the dietitian's advice that I needed vast amounts of carbs) which in it's turn gave me IR. I also was on a losing wicket with hypothyroidism. However, I've now managed to stabilise my weight and Metformin has curbed my appetite too.)

 

[Mark T]

Metformin doesn't work quite like most other tablets i.e. it doesn't address one particular meal or time of day. It sort of "ramps up" until it soaks your whole system. This usually takes around 3 weeks. If you stop taking it then it takes about the same length of time to completely clear your system. So missing an individual pill doesn't actually do very much...

Yes, this is what I found too.

In the beginning it was important for me to be very regular about taking the metformin and eating food (I found it best to take metformin with food, usually at the start of the meal). It was also important to try eat at the same time each day. If I got either of these wrong then I was almost assured that I'd be running to the smallest room at some point in the future.

But once it was in my system I could have the odd forgetful moment without any major impact. Although to put that into context, I perhaps forget to take a pill once or twice per year and take it late maybe a few times more then that.

 

[Highlander]

My dear wife has been on 4x500mg of modified Metformin for many years now. She still gets quite a lot of side effects, but she does get the odd hypo, sometimes below 3. A lot depends on what other meds you are on and your weight. My wife is not over weight but does take a lot of other medication. If she goes out in the garden for a few hours, then there is always a chance of a hypo. Medication effects us all differently, so while some people on Metformin will never experience a hypo others will. So I believe that there is a need for people with type 2 to test, particularly before and after any strenuous activity. Just to be on the safe side. Hypos are not nice.