Type 1 prescribed Metformin on type of Levemir/Novorapid

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Sean122

Sean122

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Hi, My daughter is type 1 and has been for 17 years. Recently her diabetic team have prescribed Metformin on top of her regular insulin, as she was showing signs of resistance to her insulin. This makes her very sick and she has had to take time off work. She eventually drops her dose from the 3 tablets a day prescribed to 1 or 2 and she feels better. The diabetic team keep telling her to push it back up to 3 tablets a day and that the symptoms should get better if she sticks with it for a week or 2.
Just wondered if anyone else has gone through anything similar ?
 
Sorry to hear your daughter is struggling with Metformin. I was started on it before I started insulin and made it up to a sustainable 4 tablets a day with occasional minor indigestion/nausea and intermittent colic pains/wind. One of the most important things for me was to take them mid meal with a substantial amount of food.
If your daughter can manage on 2 a day, then try 3 a day for one day the following week and then drop it down to 2 again the next day and then 3 the day after, so she is grading the dose up a bit more gradually.

Has your daughter been offered the slow/modified release version of Metformin to see if that will help protect her stomach better or possibly another drug to like Omeprazole to give stomach protection?

As regards the insulin resistance, exercise would be a good option rather than medication in my experience. I good brisk daily walk does wonders for reducing my insulin needs and improving insulin sensitivity and also makes me feel good. Ideally getting a bit out of breath sort of pace and making your heart pound a bit faster but at a pace that you can maintain for 40 mins is ideal. I live at the bottom of a mile long hill (in both directions 🙄 ) so yomping up the hill every day is a key factor in helping with my insulin sensitivity. I appreciate that not everyone is able to walk but it is wonderful exercise and really beneficial to your general health, if you are able. After your evening meal is probably the best time. Not sure if your daughter still lives with you but perhaps make it a family activity if she does to encourage her. Now the lighter nights are here and the weather is a bit better, it can be really pleasant.
 
Hi. Anyone with bowel issues with standard Metformin needs to be offered Slow Release Metformin (SR or MR). If the surgery hasn't offered that then insist.
 
rebrascora said:
Sorry to hear your daughter is struggling with Metformin. I was started on it before I started insulin and made it up to a sustainable 4 tablets a day with occasional minor indigestion/nausea and intermittent colic pains/wind. One of the most important things for me was to take them mid meal with a substantial amount of food.
If your daughter can manage on 2 a day, then try 3 a day for one day the following week and then drop it down to 2 again the next day and then 3 the day after, so she is grading the dose up a bit more gradually.

Has your daughter been offered the slow/modified release version of Metformin to see if that will help protect her stomach better or possibly another drug to like Omeprazole to give stomach protection?

As regards the insulin resistance, exercise would be a good option rather than medication in my experience. I good brisk daily walk does wonders for reducing my insulin needs and improving insulin sensitivity and also makes me feel good. Ideally getting a bit out of breath sort of pace and making your heart pound a bit faster but at a pace that you can maintain for 40 mins is ideal. I live at the bottom of a mile long hill (in both directions 🙄 ) so yomping up the hill every day is a key factor in helping with my insulin sensitivity. I appreciate that not everyone is able to walk but it is wonderful exercise and really beneficial to your general health, if you are able. After your evening meal is probably the best time. Not sure if your daughter still lives with you but perhaps make it a family activity if she does to encourage her. Now the lighter nights are here and the weather is a bit better, it can be really pleasant.
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Hi, Thanks for the info. I am not sure if she is on the slow/modified release version. I know that it is branded Metformin on the box, so i will check with her. That would be good to get her to try that if she isnt on it.
I know she has tried the approach you mention, 2 pills one day and then 3 the next. She wasnt 100% on that but better than she is on 3 everyday.
When she was first told to go onto it i did suggest she spoke to her doctor about trying to combat with exercise and diet but she wasnt too keen. I think i will have that conversation again
 
The Metformin packet will have the letters SR or MR to indicate if it is "Slow Release" or sometimes referred to as "Modified Release" They are often bigger tablets and the casing is designed to be tougher to release the active ingredient more slowly. In fact the casings are often so tough that they come out "the other end" undigested a bit like sweetcorn kernels, which can make it look like the tablet hasn't been effective but usually it has. Definitely something to ask about if she is just on the regular metformin and I am quite surprised her team haven't suggested it if they are aware of the issues she is having.
It is worth knowing that long term use of Metformin can impact the absorption of vitamin B12 from food, which can lead to cramps and tingling/nerve pain and tiredness, so keep that in the back of your mind if she sticks with the metformin. It is easy to panic and think it might be neuropathy when you have diabetes and some GPs don't think to test it. If B12 is low then injections are usually needed to bypass the digestive system because of the Metformin, so just something to keep in mind.
 
rebrascora said:
The Metformin packet will have the letters SR or MR to indicate if it is "Slow Release" or sometimes referred to as "Modified Release" They are often bigger tablets and the casing is designed to be tougher to release the active ingredient more slowly. In fact the casings are often so tough that they come out "the other end" undigested a bit like sweetcorn kernels, which can make it look like the tablet hasn't been effective but usually it has. Definitely something to ask about if she is just on the regular metformin and I am quite surprised her team haven't suggested it if they are aware of the issues she is having.
It is worth knowing that long term use of Metformin can impact the absorption of vitamin B12 from food, which can lead to cramps and tingling/nerve pain and tiredness, so keep that in the back of your mind if she sticks with the metformin. It is easy to panic and think it might be neuropathy when you have diabetes and some GPs don't think to test it. If B12 is low then injections are usually needed to bypass the digestive system because of the Metformin, so just something to keep in mind.
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Just checked the packet and they are just 500mg film coated. No mention of Slow or modified release. Thanks for the info. I will get her to mention this to her doctor. Keen to get her out and about a bit but she absolutely hates walking just for the sake of a walk whereas i love it 🙂
The doctors that look after her and her mum and sister dont seem to really seem to offer anything new. I wonder if the slow release is more expensive ?
 
Sean122 said:
Just checked the packet and they are just 500mg film coated. No mention of Slow or modified release. Thanks for the info. I will get her to mention this to her doctor. Keen to get her out and about a bit but she absolutely hates walking just for the sake of a walk whereas i love it 🙂
The doctors that look after her and her mum and sister dont seem to really seem to offer anything new. I wonder if the slow release is more expensive ?
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It is more expensive but it is not new.
 
What does she enjoy? Roller skating, bike riding, trampoline, dancing, swimming, climbing, tennis, golf, horse riding, gardening? The important thing with exercise is that you need to enjoy it, so it will be important to find something which engages her.

Good luck with trying the slow release. It is a bit more expensive but many people here on the forum have it prescribed because the regular Metformin upsets their stomach too much. Some people find the SR version upsets their system too, but most people find it an improvement and definitely worth trying but exercise will make a much bigger impact than the Metformin so I would put some thought into finding something she will be interested in and keen to do.
 
rebrascora said:
What does she enjoy? Roller skating, bike riding, trampoline, dancing, swimming, climbing, tennis, golf, horse riding, gardening? The important thing with exercise is that you need to enjoy it, so it will be important to find something which engages her.

Good luck with trying the slow release. It is a bit more expensive but many people here on the forum have it prescribed because the regular Metformin upsets their stomach too much. Some people find the SR version upsets their system too, but most people find it an improvement and definitely worth trying but exercise will make a much bigger impact than the Metformin so I would put some thought into finding something she will be interested in and keen to do.
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She was pretty active when she was younger, bike riding, trampoline and even joining me on the golf course but she isnt really interested in any form of exercise these days, plus shes 21 and works quite long hours. When shes not working she tends too take it easy. Cant say i blame her. At least i have a bit more info now so hopefully can have a chat with her, when the moment presents itself..
 
`The SR/MR metformin is dearer than the standard one - but quite honestly in the days one could access prices fairly easily, the price difference was literally, pence for a supply of 30 tablets, something like 60p for standard and £1.20 for modified, although I don't think it was twice as much - just that it's so little money whatever way you happen to look at it - that it really shouldn't be of great concern to the NHS or anyone else.
 
Sorry to hear your daughter is having difficulty with Metformin @Sean122 :(

We have had some members who had gastric upset to begin with, but found it settled down in time. Is she having the tablets with a decent sized meal? Has she seen any positive impact (eg a reduction in insulin doses) on the smaller Met dose?

I’m not qualified to commentreally, but the 2-then-3 gradual increase sounds like a good idea to me - as a halfway house to see if that helps things settle
 
everydayupsanddowns said:
Sorry to hear your daughter is having difficulty with Metformin @Sean122 :(

We have had some members who had gastric upset to begin with, but found it settled down in time. Is she having the tablets with a decent sized meal? Has she seen any positive impact (eg a reduction in insulin doses) on the smaller Met dose?

I’m not qualified to commentreally, but the 2-then-3 gradual increase sounds like a good idea to me - as a halfway house to see if that helps things settle
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Hi, She is still having gastric upsets but has got to the point where she is joking about it more than previously. She does try to take it with a meal. I am hoping that things will calm down over the next week or so as she is on Easter hols so will be at home for a few weeks. I did mention the SR tablets to her, but she seemed to think the doctor discounted it. She could be fobbing me off though as she didn't give a proper reason for the doctor not prescribing them, but i didnt want to push it. Will wait for the right moment to mention it again
 
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