T2D - Glucophage (name brand) > Metformin (generic) ?
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@RalfLott @bjwoodzy Do I understand this right that you are running 200's on LCHF and dr. is not willing to prescribe meds?! If it were me, I would be looking for a new dr. Depending on where you are in the 200's. If you are consistently running below 225, you will feel sluggish, probably hungry, and tired. But short-term effects below 225 are confined to symptoms. It is the long-term effects that you need to worry about. Even at 140's consistently for long periods of time will produce long-term effects. Things like circulation issues, long-term vision problems (also, your eyes might start bleeding), charcos foot, etc. are related to consistently high BG's, which recent science shows us is a risk when above 140. So you can't keep on at that level.
Have you had an anti-body test to rule out type 1 (LADA) diabetes? At those levels and low carb, it might be a good idea to be certain that you are actually resistant to insulin (type 2) rather than that your pancreas is slowing production (and will eventually stop) due to an auto-immune attack. It might turn out that you are only resistant, but based on the little I'm seeing so far, it is worth a check. In either case, Metformin / Glucophage should help... it's just that it won't be enough if you have LADA (which is actually type 1 with adult onset, but you would be in the type 1 "honeymoon" stage still if that is the case - and it lasts much longer in adults). At those numbers, it might not be enough regardless... at least not until you are able to decrease resistance.
Personally, I had both type 1 and type 2 (so I make no insulin - type 1 - AND I was insulin resistant - type 2). Now there is a lot of argument as to whether people can every be technically "cured" of type 2, or whether to call it "remission" or whether they technically are type 2 and are asymptomatic. So whatever you want to call it, I've been able to decrease insulin resistance through weight loss below levels that would be used to clinically diagnose type 2 diabetes. Reducing carbs been a big help to accomplishing that. However, I still take metformin as to a lot of type 1's because there is still a benefit for us (even if we take it in addition to insulin, which type 1's would die without once past the "honeymoon" phase).3 -
@RalfLott @midwesterner85 - My doctor has me on Metformin and my health insurance plan does not cover INSULIN. And I never even mentioned either one! Sheesh.0
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If you're running around fasting BG=200, then I don't get why your doctor would refuse to prescribe metformin, (except in the unlikely event you have one of the few conditions mentioned in the product info - link below).
I have no idea who you are talking to, but I never told you anything about my doctor, or her refusing me anything.
In fact, I've been avoiding my doctor - I have to give her a urine and blood lab next week so she can check my kidneys and my A1C (and won't refill my Metformin til I do and now I'm OUT) - She doesn't know I'm high or that I'm out, it's for me to tell her.
IN any case, I certainly did not bring that up in this thread.
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@RalfLott @midwesterner85 - My doctor has me on Metformin and my health insurance plan does not cover INSULIN. And I never even mentioned either one! Sheesh....
In fact, I've been avoiding my doctor - I have to give her a urine and blood lab so she can check my kidneys and my A1C - but I certainly did not bring that up in this thread.
@bjwoodzy - Yipes! My bad. Sorry to mix threads. Leviticus specifically tells you not to.
(Was responding to your July 6 post about metformin and BGs in the coconut oil thread, Seemed like this might be a better place for metformin items.)
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midwesterner85 wrote: »However, I still take metformin as to a lot of type 1's because there is still a benefit for us (even if we take it in addition to insulin, which type 1's would die without once past the "honeymoon" phase).
@midwesterner85 - Is this because these T1Ds are also insulin resistant?
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midwesterner85 wrote: »However, I still take metformin as to a lot of type 1's because there is still a benefit for us (even if we take it in addition to insulin, which type 1's would die without once past the "honeymoon" phase).
@midwesterner85 - Is this because these T1Ds are also insulin resistant?
For some it is... and it is originally why I started Metformin. But now that isn't really true, but it still is helpful.
Here's what is often overlooked in T1D: First, not only do we not make insulin, but we also do not make amylin. Second (and this is the overlooked item relevant to this discussion), since our pancreas doesn't make insulin, there is nothing to tell our liver to stop pushing glucose into our blood. So T1's take a basal insulin to deal with this constant flow of glucose. The way metformin works is that it signals the liver to slow down glucose production. In a normal insulin-producing T2**, this helps reduce the amount of glucose added to blood, thereby helping to reduce the amount of glucose to a level lower than what the pancreas would have expected. So after the insulin resistance (which is a nice way of saying that insulin is not absorbed and used at full efficiency), enough glucose is still removed from blood. In T1's who are not insulin resistant, there is less glucose in the blood all the time and more predictability plus less insulin is needed to be taken.
In short, you want the equation to match:
Insulin capability = excess glucose
Metforming reduces the 2nd half of this equation (excess glucose).
By reducing excess glucose to match insulin capability in T2's, the goal is to get that equation to match.
In T1's, reducing excess glucose helps us to better manage insulin input, which we have to do manually.
**2 groups make up most T2's: (a)someone who is T2, and not also T1; and (b)someone who is T2 not because of a genetic attribute, but because of metabolic factors - 98% of T2's are not directly linked to genes... I can explain this further in another post if there are still questions, but just trying to include the small exclusions.4 -
Thank you. You have a great ability to explain this stuff, which is especially nice in view of all the simplistic and often contradictory things written about both diabetes and its treatment.
Q - If metformin gets the liver to turn its attention to something other than glucose production, what happens to whatever the liver would have converted to glucose (glycogen?) once the metformin wears off? It would seem like it either has to be stored by the liver for future use or converted to glucose. If the metformin's in your system long enough for your glucagon levels to settle back down, then it ought to be the former. ??
(But this would seem to make the timing of metformin more important than docs let on. And you'd want to take it before, rather than during the meal, at least the immediate-release type.)
PS If you're inclined to take the time for further explanations, I'm all ears!
Thanks again.1 -
Glycogen is still there when it doesn't get converted to glucose. For a T1, when metformin wears off, there is just more conversion into glucose than when metformin is active. In theory, those of us who are on metformin will always have full glycogen stores. But in practice, that isn't how it works... when taking a consistent level of metformin, there should be a consistent reduction of glucose production. But while the reduction is consistent (in theory), the demand is not always consistent. When my BG runs low, I still usually see (if I don't treat the low BG) a big glycogen dump eventually.
For a T2 who is making insulin and signaling for the liver to back off on glycogen production when BG is rising, then the fast-release metformin would be best served after a meal. I'm not sure exactly how fast it is released, so maybe during a meal is better than afterwards because it does actually take a little bit of time to be absorbed. The more relevant question is how long that takes... and I don't know the answer to that.3 -
Thanks!
So ... would it make sense to time exercise for when the metformin levels are dropping in order to use the glycogen that would otherwise be dumped into your system?2 -
Right, it makes sense to exercise when metformin is not active so you can use the glycogen to fuel your exercise.3
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Ah, I may pass this class yet....
Thx!2 -
I'm really smart, but goddangit, if there's a reason I pay for all this crapola like insurance and whatnot, it's because I DON'T WANT TO KEEP UP WITH IT (all the learning). I already spent half my life going to school, lol. I've got enough on my plate as it is (quite literally) with the strict keto and whatnot and LIFE, and my job, which I'm married to.
I'm very frustrated and I guess I thought after more than a month I would be doing great and some stuff would just start to go away, or at least start pretending like it's heading somewhere else, and not sticking around on me. I don't like being on Metformin if it's going to not work, and I don't like the idea of flooding my body with more insulin that it's going to probably ignore...and if it doesn't, and helps my BG to level off to something more normal, then yeah, well, OK...but isn't that kind of counter-productive to this new WOL I'm trying to master? I'm still sorta losing weight, but honestly...that's just a bonus to my end-game, which is being rid of this monster of a disease.
Sorry for popping off like this, I've just really got no time to do all the science and whatnot, and also, I hate when this thing replaces my swearies with "kittens" and "sugar." Or whatever. Although, I do like kittens, just not censorship![:\](https://community.myfitnesspal.com/en/resources/emoji/confused.png ":\")
I may also be PMSing a bit.
PS - I lowered my daily protein goal by 20% and increased my fat goal by 5%, because I just decided to try that out awhile to see if protein is what's keeping my BG higher than I'd like. I'm on day two. We shall see.1 -
My only issue with my insulin resistance is the dawn phenomenon. My liver seems to go into hyper drive in the morning ESPECIALLY if I had a late night snack that had carbs. Eating LCHF seemed to stop that for about 6 months but it came back. My morning BG is usually around 6. Not horrible but not great. Lately I have been out of ketosis, so my BG is higher. The other day I had about 10 marshmallows in the evening (bad - I know) and my morning BG, 10 hours later, was 8.2. Yuck. Because of that I am considering talking to my doctor about metformin.
To time an issue like that with metformin (ideally Glucophage) I would be taking it in the middle of the night. Does that sound right? During the day my BG is pretty good.
I have heard that metformin can be beneficial in the long run. Lower risk of CAD and cancer. Long term, does it have some side effects? I know it can make BMs unpleasant. But are there other reasons to avoid it? Does it not work for some people? I know Peter Attia is using it just as a longevity/preventive measure. That got me thinking about it even more.2 -
To time an issue like that with metformin (ideally Glucophage) I would be taking it in the middle of the night. Does that sound right? During the day my BG is pretty good.
I have heard that metformin can be beneficial in the long run. Lower risk of CAD and cancer. Long term, does it have some side effects? I know it can make BMs unpleasant. But are there other reasons to avoid it? Does it not work for some people? I know Peter Attia is using it just as a longevity/preventive measure. That got me thinking about it even more.
Taking 500mg of the XR version right before bed and avoiding both carbs and a lot of protein in the evening (plus eating LCHF, of course) have pretty much done the trick for me. You could look at the curve for the immediate-release version to see how much more quickly it gets into your system. (Not something I could tolerate, so I didn't do much experimentation with it.). A comfortable walk about an hour before bed might also help.
I am not aware of any long-term downside risks - certainly none that outweigh the perceived benefits. Even Dr.Bernstein likes it.
FYI, @Midwesterner85 is a great source of info about Metformin.
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Thanks, guys. I'm really trying. Just frustrated by an overwhelming amount of info.0
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Update - so just to be clear, what happened was this...
I was formerly on a regimen prescribed by doctor as follows:
Metformin 1000mg/day
Victoza pen 1.2mg/dl 1x/day
Lantus pen 116 units/day (58 a.m. (just before breakfast) / 58 p.m. (just before dinner)
I also take
Losartan 25mg 1x/day
Low dose aspirin 85 mg/day
Fenofibrate 160mg/day and
Atorvastatin/Lipitor 20mg/day for cholesterol/heart disease avoidance
I still take these ↑↑↑
I went into LCHF mode officially on May 31. I was still taking Metformin 1000mg/day but I increased it to 1000mg/twice per day after I ran out of Insulin May 20-ish
I'm sure I was doing something wrong. But ALL insulin wasn't covered with me still being stuck in the donut hole of my high deductible ($36X.XX to go before 80/20 - 80% being HMO, 20% being me) and so my Rx monthly bill is $1260.00+ for insulin alone. I am working on finding out if I can change plans, but I don't think I can do that til October. #ThanksObamaCare
As of this week, I ran out of the 90-day supply of Metformin that I refilled May 12. I attempted to refill my Rx for that plus the other non-diabetes meds online and my doctor's nurse called to let me know she is requesting a urinalysis to check my kidneys and might as well get an A1C while I'm at it. I was really frustrated because I know for a fact they called because my pharmacy emailed to tell me all my Rx were ready EXCEPT for the Metformin and the Losartan. The nurse leveled with me and said if I would schedule the lab ASAP the doctor may still or may not approve my refill - it was 95 degrees + 80% humidity that day and I was frustrated AF to have to find a day to go deal with getting on two buses in the heat & mugg to go do a lab test so I can get my damned drugs...weather forecasts online were predicting more of the same. I was being selfish. My pharmacy refill status has not changed even though an hour later, I scheduled a lab test for next Thursday.
I have not been on Victoza since early May, which is when my last pens ran out, which cost me $470+, which I had to literally scrape from donations from friends. I have not taken Lantus since around the same time, but I got about 28 day supply of Novolin insulin at Walmart (hate Walmart) and that ran out in early June. So I've just been taking the double dose of Metformin since, until Wednesday, and now I'm out of everything.
My fasting BGs are in the mid-200s and my post-lunchtime peak at ~240-260. I know this is not good. But prior to getting on ANYTHING - right after my diagnoses in 2007, I was coming in with my first BG reading at 435.
I'm always high, and when I was pre-LCHF, I also was sort of even struggling with highs on ALL the meds above - like, if I was feeling like I was having a LOW sugar reaction, I'd have a reading anywhere between 109-145, with 9 times out of ten, it being closer to the higher side of that range. If I was getting a high reading (often first thing in the morning--dawn phenomenon will be the bane of my existence), it would be 180s EVEN with a doctor-approved diabetes-friendy WOE and exercise AND alllllllllll the meds I could pump into me.
That's where I'm at. This is only week 6 for me, of LCHF and I am almost always hitting my macros
6% carbs/73% fat/21% protein - formerly
5% carbs/80% fat/15% protein - as of yesterday - this isn't going very well - I lowered my protein to see if that would help with BG lowering...and raised my fat (couldn't raise carbs? Or could I?)0 -
@bjwoodzy You need to ask your dr. for an anti-body test to rule out LADA. Then you need to ask for help getting insulin for the next few months. Ask about samples or switching to a generic basal insulin like NPH that would be much cheaper.4
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@bjwoodzy here's a few links for you to check out.
https://rebates.com/lantus-coupon?utm_medium=search&utm_term=free lantus insulin&adid=70253925174&matchtype=b&ct_Network=g&SiteTarget=&utm_campaign=uscs&utm_source=google&mkwid=sqzzb0kBM_dc|pcrid|70253925174|pkw|free%20lantus%20insulin|pmt|b|&utm_medium=search&utm_term=free%20lantus%20insulin&adid=70253925174&matchtype=b&ct_Network=g&SiteTarget=&utm_campaign=uscs&utm_source=google&gclid=Cj0KEQjwwYK8BRC0ta6LhOPC0v0BEiQApv6jYQsbwcwkPoM0aSXWPf2EH5RgC98VswTBjmsANtGUIIMaAual8P8HAQ
& another
http://www.diabetes.org/living-with-diabetes/health-insurance/prescription-assistance.html?referrer=https://www.google.com/
1 more
https://www.diabetesdaily.com/forum/type-1-diabetes/67963-yes-free-insulin/
My heart goes out to you, I hope these will help.
or 
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I hope you get some help in this.