Reducing/Eliminating Metformin

[p4ul]

I'm T2D and I want to reduce my dosage of Metformin from my current dose of 2g/day.

Having received a rather worrying heart disease diagnosis, I've lost around 18kg since the beginning of April (I am now outside the NHS Diabetes Remission Plan threshold) and exercise 5-6 times per week. My last A1c was 41, and I recently tested a CGM where I was in range for 99+% of the time, and had an average glucose reading of 6.6 mol/L and GMI of 6.2% across the 10 days.

I floated the idea with my cardiologist to make sure there was no interface with any of the heart drugs he has prescribed. He has no objection.

I think I am a good candidate and have a plan to do this, although the last nurse I saw (pretty sure not a qualified DSN) was a bit pill-happy for my liking.

So here's the question. When I suggested this to my cardiologist, his first reaction was “why would you want to do that?” I didn't really have a solid answer apart from it being a mission of us all to live symptom-free, drug-free.

So here's the question before I ask you about my plan: would you want to come off Metformin and if so, why? I couldn't say whether it gives me any specific side effects because I'm on a bag-full of pills a day.

 

[JITR]

As one who declined Metformin with HbA1c in three figures to focus (successfully) on weight loss of 15-22kg, I'd say aim to come off it.

Method: phased testing programme to make sure readings do not shoot up again.

Basic reason: Metformin interferes with metabolism.

 

[saffron15]

I'm not sure. I'm still upset that I wasn't tested for ten years, found out when went for a nudge about cholestral and asked for a test. Very upset when it was 69. Second test when id made some dietary changes was 64. By December despite lots of stresses it was 44. I was on 2 x 500 mg SR of metformin, a statin and a SGLT2. In February I was unexpectedly asked whether I wanted to drop one metformin or the SGLT 2. I wasn't expecting to be asked this. I had a second cataract op due a few weeks later where I expected a two week steroid course. I found the SGLT2 almost encouraged me to eat carbs but chose to drop one metformin so as not to upset the apple cart. I was warned initially BG would increase. A couple of weeks ago I booked a review. My hba1c is 52 which it was at end of September and I have a ferretin reading of 12 and been given iron tablets. I will be seeing the DN next Friday.
I can understand the wish to be less medicated. I have had high blood pressure for 18 years. I take two tablets one a diuretic and it has been stable for years. The diuretic was removed in September on basis the SGLT2 was a diuretic but when I went to casualty in November my BP was 198 over 103. My diuretic was added and it's stable again.
The SGLT2 was sold to me on basis it's good for cardiovascular health. My cousin's wife who was 5 days younger than me died of a heart attack bought on by type 2 complications 6 months before I was diagnosed. I take a statin reluctantly.

I've read articles saying metformin has benefits and others that it is the devil. Over the last year I've lost 2 and half stone and am disappointed my BP and BG are not better.
I hope you make the right decision for you.

 

[everydayupsanddowns]

So here's the question before I ask you about my plan: would you want to come off Metformin and if so, why? I couldn't say whether it gives me any specific side effects because I'm on a bag-full of pills a day.

Metformin is (generally) well tolerated, has been used for decades, and is cheap. Because it has been in use for so long various other observations have been made about its effects, and it does seem to have a positive effect on various other bodily processes

Metformin and Its Benefits for Various Diseases - PMC

Metformin is a widely used biguanide drug due to its safety and low cost. It has been used for over 60 years to treat type 2 diabetes at the early stages because of its outstanding ability to decrease plasma glucose levels. Over time, different uses ...

pmc.ncbi.nlm.nih.gov

On the flip side, it can apparently interfere with vitamin B12 levels. And some people who take it end up needing Vit B12 supplementation?

Do you think part of your reticence is the number of other meds you are already on? And wanting to reduce your meds where possible? At the end of the day, Met or no Met, it sounds like you’ll still be needing multiple meds per day?

 

[Lucyr]

So here's the question before I ask you about my plan: would you want to come off Metformin and if so, why?

No id stay on it. With an a1c of 41 you’re only just under the threshold for prediabetes of 42 and as you say it has no noticeable side effects I’d stay on it as removing it may put you back above.

 

[MarcR]

I'm T2D and I want to reduce my dosage of Metformin from my current dose of 2g/day.

Having received a rather worrying heart disease diagnosis, I've lost around 18kg since the beginning of April (I am now outside the NHS Diabetes Remission Plan threshold) and exercise 5-6 times per week. My last A1c was 41, and I recently tested a CGM where I was in range for 99+% of the time, and had an average glucose reading of 6.6 mol/L and GMI of 6.2% across the 10 days.

I floated the idea with my cardiologist to make sure there was no interface with any of the heart drugs he has prescribed. He has no objection.

I think I am a good candidate and have a plan to do this, although the last nurse I saw (pretty sure not a qualified DSN) was a bit pill-happy for my liking.

So here's the question. When I suggested this to my cardiologist, his first reaction was “why would you want to do that?” I didn't really have a solid answer apart from it being a mission of us all to live symptom-free, drug-free.

So here's the question before I ask you about my plan: would you want to come off Metformin and if so, why? I couldn't say whether it gives me any specific side effects because I'm on a bag-full of pills a day.

I've come off Metformin, but only when my fasting blood glucose was in the normal range, and sometimes down to about 4.3, I slowly came off Metformin and now my fasting blood is around 4.6-4.8, so it seems OK, I gradually reduced from 2g to 1g, testing my blood, then 1g to 500mg, then to nothing. If your fasting blood is in the prediabetic range, coming off it might increase it. I also found the amount of carbs I eat make a difference, reducing might mean you need less Metformin. I can't give advise but I would be hesitant to reduce if fasting blood is above the normal level.

 

[JimmyBlue]

I only ever took Metformin for about three months (Nov-Feb) and even then only 1 pill a day. My last HbA1c in June was 46 and it was agreed by the DSN I was in remission and didn't need the medication. However, when I saw the DSN in March to review my Jan HbA1c of 47 her view was that even that 1 pill a day of Metformin was having a positive impact and I think the nurse's advice to you is based on a similar premise i.e. you may have a HbA1c of 41 but how much of that is down to your Metformin and how much to your lifestyle changes?
The most appropriate approach from my perspective would be to reduce the amount of Metformin and see how that impacts on your blood glucose. A gradual reduction may provide you with the evidence you need to take back to the nurse to agree that you don't need the medication or at least only a reduced amount.

 

[silver minion]

I am also on the maximum dose of 2000mg per day. I do tolerate it well with minimum side effects. As yet my HbA1c is not low enough consistently to reduce my medication. Should I reach that threshold in the future I would choose to reduce the gliclazide rather than metformin.
The ancillary benefits of metformin make it a good choice for me,personally, to continue. If I develop any longer term side effects I may reconsider and discuss it with my HCP.