When to lower metformin

[Sussexmax]

My own view is that it is irresponsible for a GP to dole out the pills to a newly diagnosed T2 until that T2 has demonstrated that their blood glucose remains elevated even after they have brought their weight down by 15% or so, because otherwise those pills will lead the T2 down a road in which remission will become impossible, the pills will no longer be enough and the road ends in the way we all know.

That’s very interesting. Is it the case that remission can become difficult to achieve (if not impossible) if taking medications such as metformin, when they might not be necessary because of relatively low blood glucose levels?

 

[Drummer]

When my HbA1c had been steady at the top of normal for a while I decided to try to go down into the 30s and reduced my intake of carbs from under 50 gm a day to under 40, and after a year my HbA1c was exactly the same.
There seem to be a fair few people in remission on the forums, but so little help seems to be given by many GP surgeries and so many people are being diagnosed as type 2 that the numbers in the population at large can seem small. The huge difference it makes to the lives of the individuals involved is, of course, the good thing and it is sad that so many people are being put off by poor training or absolute ignorance of what can be achieved.

 

[childofthesea43]

That’s very interesting. Is it the case that remission can become difficult to achieve (if not impossible) if taking medications such as metformin, when they might not be necessary because of relatively low blood glucose levels?

I don’t think these drugs create a technical barrier to the pursuit of ‘true’ remission (restoring insulin sensitivity and insulin secretion). But if they reduce A1c they create the illusion that one has done something to remedy the underlying problem while all the time the pancreas is becoming ever more compromised by the insult of excess fat (just half a gram is sufficient). And so that illusion can encourage people to think the meds are sufficient for the long term. And that’s why half of T2s land up on insulin.

 

[Sussexmax]

I don’t think these drugs create a technical barrier to the pursuit of ‘true’ remission (restoring insulin sensitivity and insulin secretion). But if they reduce A1c they create the illusion that one has done something to remedy the underlying problem while all the time the pancreas is becoming ever more compromised by the insult of excess fat (just half a gram is sufficient). And so that illusion can encourage people to think the meds are sufficient for the long term. And that’s why half of T2s land up on insulin.

You’ve struck at the centre of my concerns. I would be quite happy to remain on metformin long term for its heart-related benefits, but if that came with an increased likelihood of needing insulin later then I might reconsider. I should add that my diet is sensible and I limit my carbs to help control my levels.

 

[childofthesea43]

You’ve struck at the centre of my concerns. I would be quite happy to remain on metformin long term for its heart-related benefits, but if that came with an increased likelihood of needing insulin later then I might reconsider. I should add that my diet is sensible and I limit my carbs to help control my levels.

The way i would view this is that if your A1c were to rise in the case that you came off the metformin, that would tell you that almost certainly there remained excess fat in either or both liver and pancreas. In which event you could consider a weight loss regimen, if you still have scope to lose weight. Reducing carbs is not sufficient for that fat clearance unless it is attended by concomitant weight loss, as Dr David Unwin, for example, has frequently stressed.

 

[Sussexmax]

The way i would view this is that if your A1c were to rise in the case that you came off the metformin, that would tell you that almost certainly there remained excess fat in either or both liver and pancreas. In which event you could consider a weight loss regimen, if you still have scope to lose weight. Reducing carbs is not sufficient for that fat clearance unless it is attended by concomitant weight loss, as Dr David Unwin, for example, has frequently stressed.

I’m still looking to lose weight, and so until then I imagine the metformin is doing a good job for me. Also, given its additional benefits I’m in no hurry to stop taking it. It was more that I was worried about seeing the possibility of future remission reduced by remaining on medication.

 

[everydayupsanddowns]

Is it the case that remission can become difficult to achieve (if not impossible) if taking medications such as metformin

I think it’s more about definition than any potential negative impact of Metformin personally.

The currently agreed (or suggested?) definition of diabetes in remission (at least the Newcastle Diet version) is 2+ HbA1c results at 48 or lower without taking any diabetes medication. So being on Metformin, by that definition, means one would not be in remission.

I have heard some ponderings about some other classes of oral diabetes meds which work by pushing the pancreas to release more insulin than it naturally would, as a means of overcoming insulin resistance (by making more insulin available). There were questions about whether this might put the islet cells under stress and ‘burn them out’, but I don’t know whether or not (or to what extent) that concept has been demonstrated and verified in research trials?

 

[Anji53]

A real concern to me is the lack of consistency in treatment between different doctors or surgeries ( some diabetics like myself have only ever seen a diabetic nurse never a doctor) The original poster asked about reducing metformin dosage Mine was reduced from 1000 twice a day to 500 when my hbA1c was 34 ( 6 months before it was 117, 3months before 67) last month it was 37 and all metformin has been stopped. I’m 70 by the way and was diagnosed a year ago

 

[JanetT]

In feb my blood sugar readings were between 9 and 13. I am on low carb and intermittant fasting diet, since feb I have lost 2 stone. My blood sugar readings have all been in the 4s and 5s for the last couple of weeks, I start to feel a little shaky when it goes down to 4.2' I am on 1000mg of metformin twice a day. At what stage would one usually start to reduce medication?

Hi Libby,
My hba1c got down to 46 one tablet a day Metformin. My DN let me come off. Last HbA1c in Feb was 49 which she was still happy with me managing with diet and exercise.

 

[Dragonheart]

Why all this talk about being “let” or ”allowed” medications? The medical staff advise us, we as adults get to make the decisions what we do, taking that individual’s professional advice, any other information we seek out and our preferences into consideration. A discussion about pros and cons should always be part of prescribing advice as well as part of informed consent. We are not children so why be infantilised?

 

[Drummer]

I was in a bad place after just a few weeks of Metformin and Atorvastatin, so I stopped them rather than go on into such a dark place, but I was decidedly cheered up to realise that even without them I could get down to the top end of normal HbA1c, but my after meal levels were (and still are) under 7mmol/l all the time, and would seem to match the levels of those with lower HbA1cs, but somehow my levels were not connected.
I am 72 years old now, so the recycling of red blood corpuscles might have slowed down and be giving me higher HbA1c results than someone younger with the same blood glucose levels.

 

[JanetT]

Why all this talk about being “let” or ”allowed” medications? The medical staff advise us, we as adults get to make the decisions what we do, taking that individual’s professional advice, any other information we seek out and our preferences into consideration. A discussion about pros and cons should always be part of prescribing advice as well as part of informed consent. We are not children so why be infantilised?

Yes you are right and actually my DN nurse said it is all up to me to do whatever I think.

 

[Dragonheart]

Yes you are right and actually my DN nurse said it is all up to me to do whatever I think.

That’s good she made that point. My comment wasn’t aimed specifically at you. More at the sort of “worshipping of gods in white coats” and surrendering of free will I see a lot. A good dr/patient relationship is a two way thing

 

[Sussexmax]

Why all this talk about being “let” or ”allowed” medications? The medical staff advise us, we as adults get to make the decisions what we do, taking that individual’s professional advice, any other information we seek out and our preferences into consideration. A discussion about pros and cons should always be part of prescribing advice as well as part of informed consent. We are not children so why be infantilised?

You’re obviously right, but I understand why people talk about being ‘let’ or ‘allowed’ medications etc. Diabetes is initially something new to most of us, and it’s understandable to bow to the knowledge and experience of medical professionals. Add to that the feelings of shock and disappointment of becoming diagnosed, and I for one wouldn’t have felt comfortable ignoring the advice of my GP and diabetic nurse!

 

[Anji53]

Problem is, certainly in my experience, there is very little discussion
I would certainly have been more comfortable reducing my dosage and monitoring my readings but wasn’t given the option. Told to ‘ stop taking it’
no dietary advice, told no point in self testing
I think if I’d followed that in 3 months I’d have been back on metformin
I’m following low carb and have started monitoring of my own volition not from any advice or guidance ( except from this forum)

 

[Dragonheart]

You’re obviously right, but I understand why people talk about being ‘let’ or ‘allowed’ medications etc. Diabetes is initially something new to most of us, and it’s understandable to bow to the knowledge and experience of medical professionals. Add to that the feelings of shock and disappointment of becoming diagnosed, and I for one wouldn’t have felt comfortable ignoring the advice of my GP and diabetic nurse!

Of course There’s a learning period and shock etc, or there certainly was for me anyway. But it’s worth remembering how hugely varied that official response is depending on the individual you speak to and as a result following up that advice with your own learning. Very few options cannot be changed later once you’ve learned a little more and decided your preferences.

And I’m as much talking about the manner in which we are ”told” what to do rather than given choices and potential outcomes for us to decide on with the dr/nurse

 

[Dragonheart]

Problem is, certainly in my experience, there is very little discussion
I would certainly have been more comfortable reducing my dosage and monitoring my readings but wasn’t given the option. Told to ‘ stop taking it’
no dietary advice, told no point in self testing
I think if I’d followed that in 3 months I’d have been back on metformin
I’m following low carb and have started monitoring of my own volition not from any advice or guidance ( except from this forum)

This ^^^

Too often there simply isn’t the two way discussion there should be.

 

[everydayupsanddowns]

Too often there simply isn’t the two way discussion there should be.

There is definitely a knack in having positive appointments with a Dr / nurse / consultant - and I think it is a skill you generally develop with time lived with a long-term condition.

Before diagnosis I almost never had any need to see a Dr, much less develop a collaborative relationship with one. It’s only really the diabetes, and how individual and occasionally contrarian it can be (plus the need for weighing the pros and cons of preventative meds/measures to reduce long-term risks) which changed that for me.

 

[Macca]

My own view is that it is irresponsible for a GP to dole out the pills to a newly diagnosed T2 until that T2 has demonstrated that their blood glucose remains elevated even after they have brought their weight down by 15% or so, because otherwise those pills will lead the T2 down a road in which remission will become impossible, the pills will no longer be enough and the road ends in the way we all know.

Apologies for dragging up an old thread but I am new to the forum, recently diagnosed and only 12 days on metaformin. I kind of saw my diagnosis coming and had already dropped my weight by 10% by the time of my second blood test and by 15% by the time I had the consultation where I was informed of the diagnosis and given the prescription. I have been doing my finger prick test for some time (like I said, I saw it coming) and my at home measurements went down and down as I lost weight and changed my lifestyle. At the time of my first blood test I was an average of 8.5mmol with a range from around 7 to 12, by the time of my second I was averaging 6.7mmol and a range plus/minus 1.5 and for the last week I have been between 4 and 5 mmol, with an average of 5.2.
I’ve been through a range of emotions the last fortnight (guilt, anger, grief etc), mainly because I hoped that after my initial efforts I would be given the advice to manage this through lifestyle and that if my weight loss trajectory continued then perhaps even arrive at remission…but finally arrived at acceptance and the thought that the metaformin was a good thing if it prevented damage to my veins etc, however, I’m intrigued and slightly worried by the last line in your post above. Could you explain that please, or at least point me to more information? I was prescribed the metaformin by a prescribing nurse after a pretty shitty consultation where she essentially just delivered a speech about what diabetes was gave me a prescription and told me to follow up with a foot check and blood test in a month (no interest in my losing 3 stone in the last 6 months or my lifestyle changes, or indeed my emotional state), so I have been worried that I haven’t necessarily received the best advice as yet.

 

[childofthesea43]

Apologies for dragging up an old thread but I am new to the forum, recently diagnosed and only 12 days on metaformin. I kind of saw my diagnosis coming and had already dropped my weight by 10% by the time of my second blood test and by 15% by the time I had the consultation where I was informed of the diagnosis and given the prescription. I have been doing my finger prick test for some time (like I said, I saw it coming) and my at home measurements went down and down as I lost weight and changed my lifestyle. At the time of my first blood test I was an average of 8.5mmol with a range from around 7 to 12, by the time of my second I was averaging 6.7mmol and a range plus/minus 1.5 and for the last week I have been between 4 and 5 mmol, with an average of 5.2.
I’ve been through a range of emotions the last fortnight (guilt, anger, grief etc), mainly because I hoped that after my initial efforts I would be given the advice to manage this through lifestyle and that if my weight loss trajectory continued then perhaps even arrive at remission…but finally arrived at acceptance and the thought that the metaformin was a good thing if it prevented damage to my veins etc, however, I’m intrigued and slightly worried by the last line in your post above. Could you explain that please, or at least point me to more information? I was prescribed the metaformin by a prescribing nurse after a pretty shitty consultation where she essentially just delivered a speech about what diabetes was gave me a prescription and told me to follow up with a foot check and blood test in a month (no interest in my losing 3 stone in the last 6 months or my lifestyle changes, or indeed my emotional state), so I have been worried that I haven’t necessarily received the best advice as yet.

With an average of 5.2 mmol/L why would you be considered in need of pills? As far as I can see you have done very well indeed and have brought your blood glucose into normal range.