Metformin ER timing - any secrets?
RalfLott
Posts: 5,036 Member
Ok, intrepid low-carbers, here's a puzzle.
For those of you who have seriously experimented with the timing of your daily Metformin ER dose - what have you learned?
There's an excellent article here by Jenny Ruhl of Blood Sugar 101, but I suspect others' mileage has varied.....
Thanks in advance for your thoughts and whims.
For those of you who have seriously experimented with the timing of your daily Metformin ER dose - what have you learned?
There's an excellent article here by Jenny Ruhl of Blood Sugar 101, but I suspect others' mileage has varied.....
Thanks in advance for your thoughts and whims.
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Less tummy aches taken at nighttime.
I have been on 1500 daily, so I do 500 in the AM with food and 1000 in the PM. Not taking it at the moment though. We'll see if my doctor is cool with that or not ;-)1 -
Ah, yes. I go through enough Imodium in a day to plug up Moby Dick for a year.0
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I couldn't find the secret to timing..it started off like a love story gone bad......had to drop 'em like a cheating lover,after many great weeks together......I'm thinking we are meant for each other ...then BAM!! even thinking of eating makes me run for the stalls.1
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Time2LoseWeightNOW wrote: »I couldn't find the secret to timing..it started off like a love story gone bad......had to drop 'em like a cheating lover,after many great weeks together......I'm thinking we are meant for each other ...then BAM!! even thinking of eating makes me run for the stalls.
"Cheating lover." hahahaaaaa!
I've heard it called all sorts of names (e.g., "Notformin' "), but that's a new one, and pretty apt when inner feelings, while still warm, cease to be fuzzy. And to be amusing, at least to the bearer.0 -
Time2LoseWeightNOW wrote: »I couldn't find the secret to timing..it started off like a love story gone bad......had to drop 'em like a cheating lover,after many great weeks together......I'm thinking we are meant for each other ...then BAM!! even thinking of eating makes me run for the stalls.
Cheating and abusive for me. Forbade me from seeing my good friends of the Red Meat Crowd, and forced me to hang out with the toxic Starches and Sugars, all while leeching my energy from me.
Frankly, dumping that jerk was the best thing for me.
My numbers continued to improve when I did that, and I don't have to deal with the B12 deficiency risk.
Okay, more seriously, though -- I found nothing helped with the bathroom issues. When I first took it some 6 years ago, I got the bathroom issues, but they subsided after a couple of weeks and I learned that eating less sugar greatly helped the side effects. However, fast forward to more recently when I went back on it (after being off for about 5 and a half years), and the GI effects started after taking it for a while, and escalated to the point that any carbs (including fiber) were a trigger, regardless of timing (and I've been the unfortunate one where timing didn't matter much, since I had to take it twice daily, because I had to max out the dose to get any results). Went off of it due to losing my doctor, and a year or two later, went back on it. This time around, I was full-on carnivore, and it caused the taste of red meat to change and I'd get sick at the thought of eating it. It ultimately got to the point where I was practically living on little more than buttered rice (which, as you can guess, did not do me any favors).
It was like the Met was Tyrion and I was Cersi -- "I will hurt you for this. I don't know how yet, but give me time. A day will come when you think yourself safe and happy, and suddenly your joy will turn to ashes in your mouth, and you'll know the debt is paid."2 -
For me, dropping carbs to keto levels (20-50 grams total daily) helped in general. I also had to not have dairy 4 hours either side of my dosage, which I took in the morning, as it really helped my energy levels. I took the 500 mg ER version. (Carb loading well over 150 grams daily mitigated it somewhat too, but that was not maintainable for my health, as it had to be wheat/gluten/starchy foods...)
Additionally, my blood sugars, A1c, and fasting insulin levels improved more once I stopped the Metformin completely. I have every 6 month labs to support this, too.
But the complications and severe limits on my foods and such lead me to not want to continue usage, and after I proved to my doctor I could do as well as the medication (if not better) for my numbers, he was on board, too.0 -
Yea, It was smooth sailing at first...maybe one tricky time a day. Then after a month it turned UGLY...so......I had to stop !! I was in the Loo more than at my desk... I can take a little bit of it for a while, but when it is 5 or 6 x ....noway!! I started off with reg metformin...same results....so imagine my joy with the ER ...until he Cheated!!
that's when I turned to low carb....It's going to be a while before I see good glucose numbers, but I am not giving up.
Oh,
I kept buying all my scripts of the Reg. Metformin though...keeping them in the fridge...just in case... Last week I cut them up into 1/4 pc took them with food....still no luck.. So no secrets here. Hope it works better for you.
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Well I'm glad I'm not the only one with metformin issues. I was on Actos for years with my blood sugars well controlled, no weight gain, no side effects, then it was black boxed and eventually pulled off the market in the US. My doc put me on metformin and I felt like I'd contracted Ebola and will spare you any further gory details. Which is why I was promptly put on insulin.
If only I had known back then what I knew now! I could have spared myself 5 years of insulin agony. But I'm glad to say I'm down to 10 units a day from 310 units.
Hope you're able to get off your metformin soon!1 -
Towards bedtime with the largest meal of the day; divided doses if > 1,000mg/day, Metformin ER <<< GI upset/flattice/GERD/Dyspepsia/diarrhea vs. Metformin IR. Taken consistently to gain tolerance; typically titrated up 1,000mg/day increased 500mg/day every week until MAX effective dose of 2,000mg/day (MAX labeled dose = 2,550mg/day).
FYI confusing Actos (pioglitazone) with Avandia (Rosaglitazone); both thiazolidenediones/Peroxisome Proliferator activating Receptor agonists. Rosaglitazone only increased cardiovascular mortality when used in combination with Metformin or Sulfonylureas; it's ok to take mono therapy.0 -
Nope, not confusing with Avandia, I've never taken that medication. However, I was mistaken, it does appear that it is still on the market, with the black box warning. Shortly after the blackbox warning, my medical group promptly stopped prescribing it to any of their patients though and I was advised that my insurance would not pay for it either. I was willing to accept the risks, but no one else was was. I was actually in the process of moving to Washington state at the time and tried again there to get back on Actos and faced the same issues. So even though it may still be available, it's not easy to get. But I'm happy enough at this point because I'm nearly completely off my diabetes medication (insulin), which in turn is resulting in some very steady weight loss.0
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There should be no need for Metformin, if carbs are kept below 100 grams/day.
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Towards bedtime with the largest meal of the day; divided doses if > 1,000mg/day, Metformin ER <<< GI upset/flattice/GERD/Dyspepsia/diarrhea vs. Metformin IR. Taken consistently to gain tolerance; typically titrated up 1,000mg/day increased 500mg/day every week until MAX effective dose of 2,000mg/day (MAX labeled dose = 2,550mg/day).
I fear I was not clear in what sort of information I'm really after, though tips on avoiding the "Ebola effect" (and personal experiences) are always welcome.
Specifically - I'm looking to relate the timing of metformin, as the sole diabetes medication, with meals for best possible glucose control.0 -
Towards bedtime with the largest meal of the day; divided doses if > 1,000mg/day, Metformin ER <<< GI upset/flattice/GERD/Dyspepsia/diarrhea vs. Metformin IR. Taken consistently to gain tolerance; typically titrated up 1,000mg/day increased 500mg/day every week until MAX effective dose of 2,000mg/day (MAX labeled dose = 2,550mg/day).
I fear I was not clear in what sort of information I'm really after, though tips on avoiding the "Ebola effect" (and personal experiences) are always welcome.
Specifically - I'm looking to relate the timing of metformin, as the sole diabetes medication, with meals for best possible glucose control.
Metformin isn't a secretagogue; it's not going to dramatically lower post prandial BG but lowers fasting BG 25-30%. Metformin ER timing does not improve efficacy (HbA1C lowering); efficacy is dose dependent. Metformin ER can be dosed once-twice daily depending on an individual's tolerance and meal size. If you really want to know, peak onset is 4-8 hours....whether you are trying to have your peak overlap with your largest meal seems unnecessary for the first point made.0 -
Towards bedtime with the largest meal of the day; divided doses if > 1,000mg/day, Metformin ER <<< GI upset/flattice/GERD/Dyspepsia/diarrhea vs. Metformin IR. Taken consistently to gain tolerance; typically titrated up 1,000mg/day increased 500mg/day every week until MAX effective dose of 2,000mg/day (MAX labeled dose = 2,550mg/day).
I fear I was not clear in what sort of information I'm really after, though tips on avoiding the "Ebola effect" (and personal experiences) are always welcome.
Specifically - I'm looking to relate the timing of metformin, as the sole diabetes medication, with meals for best possible glucose control.
Metformin isn't a secretagogue; it's not going to dramatically lower post prandial BG but lowers fasting BG 25-30%. Metformin ER timing does not improve efficacy (HbA1C lowering); efficacy is dose dependent. Metformin ER can be dosed once-twice daily depending on an individual's tolerance and meal size. If you really want to know, peak onset is 4-8 hours.
Thanks.
That had been my understanding, but I came across this abstract, which concludes that metformin reduces postprandial glucose levels.
??
What led me to ask the question in this forum, is that this study (and every other I've happened upon) used carb levels grossly higher than I would ever voluntarily consume, and the abstract doesn't give timing info.....
So if you were to offer practical advice, it would simply be to take it in a way that minimizes side effects?0 -
Dragonwolf wrote: »Time2LoseWeightNOW wrote: »I couldn't find the secret to timing..it started off like a love story gone bad......had to drop 'em like a cheating lover,after many great weeks together......I'm thinking we are meant for each other ...then BAM!! even thinking of eating makes me run for the stalls.
It was like the Met was Tyrion and I was Cersi -- "I will hurt you for this. I don't know how yet, but give me time. A day will come when you think yourself safe and happy, and suddenly your joy will turn to ashes in your mouth, and you'll know the debt is paid."
Seriously, you don't sound one bit like Cersei, a narcissistic, envious troublemaker!
I tend to think of metformin and imodium like the tortoise and hare.
Or Laurel & Hardy, Penn & Teller, Mutt & Jeff.....
Or maybe you're Elmer Fudd, and metformin is Bugs Bunny and imodium is just a necessary carrot.
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PaleoInScotland wrote: »...My doc put me on metformin and I felt like I'd contracted Ebola and will spare you any further gory details. Which is why I was promptly put on insulin.
If only I had known back then what I knew now! I could have spared myself 5 years of insulin agony. But I'm glad to say I'm down to 10 units a day from 310 units.
Hope you're able to get off your metformin soon!
Well, I am not really expecting to get off it any time soon - would be nice, though.
For the foreseeable future, I expect instead to continue to enrich generic imodium manufacturers. I've been able to reduce the imodium slightly since I reduced my carb intake, but I really have no idea why (and am not about to look that gift horse in the ....mouth).
I would gleefully back off the imodium completely, but the only other solution I can think of would be to develop glutes so strong and tight that, as a fellow metformin sufferer put it, "you can't get a needle up your backside with a sledge hammer." I don't see that scenario playing out in this lifetime.1 -
Repaglinide wasn't titrated up properly as Metformin was; invalid comparison. Just like the under dosing of Enalapril vs. Sacubitril + Valsartan (ENTRESTO) for Heart failure; easy to make 1 treatment arm superior to the other when you fail to properly dose the "non-superior" treatment arm0
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Repaglinide wasn't titrated up properly as Metformin was; invalid comparison. Just like the under dosing of Enalapril vs. Sacubitril + Valsartan (ENTRESTO) for Heart failure; easy to make 1 treatment arm superior to the other when you fail to properly dose the "non-superior" treatment arm
That explains everything.0 -
PaleoInScotland wrote: »...My doc put me on metformin and I felt like I'd contracted Ebola and will spare you any further gory details. Which is why I was promptly put on insulin.
If only I had known back then what I knew now! I could have spared myself 5 years of insulin agony. But I'm glad to say I'm down to 10 units a day from 310 units.
Hope you're able to get off your metformin soon!
Well, I am not really expecting to get off it any time soon - would be nice, though.
For the foreseeable future, I expect instead to continue to enrich generic imodium manufacturers. I've been able to reduce the imodium slightly since I reduced my carb intake, but I really have no idea why (and am not about to look that gift horse in the ....mouth).
I would gleefully back off the imodium completely, but the only other solution I can think of would be to develop glutes so strong and tight that, as a fellow metformin sufferer put it, "you can't get a needle up your backside with a sledge hammer." I don't see that scenario playing out in this lifetime.
You'd be surprised, actually. Check out Dr. Fung's work. With tools like LCHF (if you're willing to go down to sufficiently low carbohydrate levels) and fasting, dramatic results have been seen in as little as a month, and most of them are far worse off than "just" needing Metformin (ie - hundred of units of insulin a day). Even Type 1 Diabetics have been able to go down to little more than just basal insulin in a few months.2 -
RalfLott , I never thought of Imodium...it helps?!! Duh!! Luckily , I've never had that problem , before Metformin..so I don't know the best way to dose for this......Would I need to take it before , during or after the fact?0
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Time2LoseWeightNOW wrote: »
RalfLott , I never thought of Imodium...it helps?!! Duh!! Luckily , I've never had that problem , before Metformin..so I don't know the best way to dose for this......Would I need to take it before , during or after the fact?
YES, Imodium works!
Imodium to Metformin to is like insulin to glucagon, beer to habanera peppers, or, in Groucho Marx's words, baking soda to spaghetti - you can have the latter without the former, but your joie de vivre may suffer.
Here's my drill: (You may be able to get by with less, if the symptoms of the Metformin Doublecross have never been a problem in any other context.)
1. Take 2 generic Imodium tablets before each meal that will feature Metformin as a palate cleanser. (Usually late morning breakfast & early evening dinner).
2. Take the Metformin in the middle off the meal.
Also:
3. In the event of gut aches, also take Donnatal (an antispasmodic) as needed.
4. Take more Imodium as needed* (like before a quadruple espresso or hot sauce chugging contest in your case, or life in mine).
5. Take psyllium husk in small doses a 2-3 times a day spaced a little apart from the Imodium, if possible. My preference is for about 30 minutes before a meal. The combination of imodium and psyllium keeps things moving without the Metformin pulling pranks when you're wearing light clothing.
* The directions on the Imodium bottle not to exceed 4 tablets per day is, like the ADA's direction to eat 150g of carbs per day, a mere suggestion that I simply ignore (as directed by my gastoenterologist and diabetes guru).
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Dragonwolf wrote: »
You'd be surprised, actually. Check out Dr. Fung's work. With tools like LCHF (if you're willing to go down to sufficiently low carbohydrate levels) and fasting, dramatic results have been seen in as little as a month, and most of them are far worse off than "just" needing Metformin (ie - hundred of units of insulin a day). Even Type 1 Diabetics have been able to go down to little more than just basal insulin in a few months.
I'm sorry, I was not clear.
I don't mean to downplay LCHF or Dr. Fung's teachings - they've been a great help to me, and I have no problem being on Metformin, which I seem to need to keep my fasting BG down. (I meant rather that I'm not likely to have glutes of cast iron in this life; I'd be delighted if I could maintain my current BG's while keeping the cheating side of Metformin on a tether.)
Thanks for your insights - much appreciated.
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Dragonwolf wrote: »PaleoInScotland wrote: »...My doc put me on metformin and I felt like I'd contracted Ebola and will spare you any further gory details. Which is why I was promptly put on insulin.
If only I had known back then what I knew now! I could have spared myself 5 years of insulin agony. But I'm glad to say I'm down to 10 units a day from 310 units.
Hope you're able to get off your metformin soon!
Well, I am not really expecting to get off it any time soon - would be nice, though.
For the foreseeable future, I expect instead to continue to enrich generic imodium manufacturers. I've been able to reduce the imodium slightly since I reduced my carb intake, but I really have no idea why (and am not about to look that gift horse in the ....mouth).
I would gleefully back off the imodium completely, but the only other solution I can think of would be to develop glutes so strong and tight that, as a fellow metformin sufferer put it, "you can't get a needle up your backside with a sledge hammer." I don't see that scenario playing out in this lifetime.
You'd be surprised, actually. Check out Dr. Fung's work. With tools like LCHF (if you're willing to go down to sufficiently low carbohydrate levels) and fasting, dramatic results have been seen in as little as a month, and most of them are far worse off than "just" needing Metformin (ie - hundred of units of insulin a day). Even Type 1 Diabetics have been able to go down to little more than just basal insulin in a few months.
My T1D daughter has been on an insulin pump for about 3 weeks now and went Keto right away. She went from using about 80-120 units of insulin a day to about 30-35, as of today. Her basal rate is 1.5 units per hour. So barely more than basal rate in only 3 weeks and she was slightly insulin resistant when she started.
She's actually still having some minor complications due to suddenly maintaining in range blood sugar for the first time in forever. So at that 120 units a day, she still had an A1C of greater than 14. It was so high, there is literally no measurement for it. It's just greater than 14... Who knows what it actually was. So 120 units a day wasn't even enough!
Now, she's purposely running about 150 to reduce her complications from getting into range so abruptly that her body couldn't deal.
She has had to lower the basal rate once already and may be needing to do it again next week since she experienced a couple lows in the last few days.1 -
Time2LoseWeightNOW wrote: »
5. Take psyllium husk in small doses a 2-3 times a day spaced a little apart from the Imodium, if possible. My preference is for about 30 minutes before a meal. The combination of imodium and psyllium keeps things moving without the Metformin pulling pranks when you're wearing light clothing.
Please stop posting misinformation about drugs0 -
I no longer take metformin except as a backup if I anticipate going higher on carbs than usual.
When I started LCHF I was taking it 3 times a day, with meals. What I found was that even though I could not stand the generic metformin my doctor had prescribed (I binned it after a few horrid days) I would be just fine when I changed to Glucophage so all I can suggest in that regard is that you try another brand. At the time I was going to diabetes.co.uk and from posts there it seems it's not uncommom to react violently to one brand and not at all to other, the active principle is always the same (metformin) but the specific formula does differ from one brand to other.
As for effectiveness in blood sugar control, as soon as I lowered enough my carbs my post prandial levels came to near normal. The dawn phenomenon was difficult to beat and that took me almost a year of going against my doctor's orders. As soon as my A1c got better she prohibited me from taking any metf after lunch time (she was worried I would die in my sleep from an hypo).
This made no sense to me so I stopped taking it during the day and instead followed Dr. Bernstein's advice and took the Glucophage just before bed, so that it would have most of its effect during the night, since that was clearly when I needed it the most. When my fasted levels entered the normal range I stopped taking it altogether.
As I said, I now take it only before a special occasion meal and before bed for a few days after that. I'm sure your doctor would be appalled at this way to use it but it works for me. By now my own doctor has no idea of what I'm doing (I tell her generic fibs) and she just congratulates me on the results.
::flowerforyou::2 -
KetoGirl83 wrote: »
This made no sense to me so I stopped taking it during the day and instead followed Dr. Bernstein's advice and took the Glucophage just before bed, so that it would have most of its effect during the night, since that was clearly when I needed it the most. When my fasted levels entered the normal range I stopped taking it altogether.
As I said, I now take it only before a special occasion meal and before bed for a few days after that. I'm sure your doctor would be appalled at this way to use it but it works for me. By now my own doctor has no idea of what I'm doing (I tell her generic fibs) and she just congratulates me on the results.
That's useful info!
Some of the best info I've gotten here has been the "your doctor may not agree" or "not quite on-label" uses of meds. I have yet to ask a doctor, especially a diabetes specialist, for an opinion about a non-standard use and not been told something like, "if it works and it's basically not unreasonable, give it a try."
I'll have to look back through Dr. Bernstein's material and see what I missed - do you recall if it was in one of his video lectures or in the Diabetes Solution book?
Thanks for the tips!
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RalfLott , Thank you! I am so excited! I quit cold turkey (metformin) ..because I couldn't go through it anymore. My DUh' brain never thought Imodium... I will try them again this weekend. My FBG #'s are sky high even with trying to do LCHF. And my 2hr after eating # are still too high. So I really need to get some meds back in while trying to get this LCHF eating instilled in me. I am a carb-aholic...so I still try to eat a sweet or bread every now and then, still staying under 50 to 100 carbs.... ( I haven't come all the way to the light side...still trying to dip my toes in the dark side. )But I want to go LCHF completely...so I can keep my toes!
Thanks again. Time2
edited: sorry haven't figured this quote stuff out yet...1 -
KetoGirl83 wrote: »
This made no sense to me so I stopped taking it during the day and instead followed Dr. Bernstein's advice and took the Glucophage just before bed, so that it would have most of its effect during the night, since that was clearly when I needed it the most. When my fasted levels entered the normal range I stopped taking it altogether.
As I said, I now take it only before a special occasion meal and before bed for a few days after that. I'm sure your doctor would be appalled at this way to use it but it works for me. By now my own doctor has no idea of what I'm doing (I tell her generic fibs) and she just congratulates me on the results.
That's useful info!
Some of the best info I've gotten here has been the "your doctor may not agree" or "not quite on-label" uses of meds. I have yet to ask a doctor, especially a diabetes specialist, for an opinion about a non-standard use and not been told something like, "if it works and it's basically not unreasonable, give it a try."
I'll have to look back through Dr. Bernstein's material and see what I missed - do you recall if it was in one of his video lectures or in the Diabetes Solution book?
Thanks for the tips!
Can't check now but it's either in the book, in the "how to cope with dawn phenomenon" or in his ebook "Beating Diabetes type 2", same topic.
You can get the ebook from his site, it's basically a transcription from his weekly Q&A podcasts. Mainly that's a repetition of info already in the book but because it is organised as answers to real questions made by real people, I found it easier to navigate when I wanted a specific answer (even though it gets very repetitive at times).
::flowerforyou::2 -
KetoGirl83, thanks for the idea...I would be just fine when I changed to Glucophage so all I can suggest in that regard is that you try another brand.0
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Here, I found one of the places he talks about it, it's in the ebook.
Question: "I am borderline type 2. Through following your teachings I am now blessed to be in the neighborhood of normal blood sugars. My daily BG after meals are on the normal ranges, but my fasting is over 115. What can I do to control my fasting blood glucose?"
Dr Bernstein's answer: "You can try something like metformin or Avandia at bedtime. Maybe that will do it, or you can try both of them. You also have to make sure that you're not overeating at dinner. An excessive dinner, whether it is carbohydrates, protein, or both, can be digested while you are sleeping. You could wake up with a high blood sugar. However, insulin always works. If none of these other things work, you can take a long acting insulin at bedtime and that should do the trick."
I know he talks about it in greater detail somewhere else but can't find the quote. I chickened at the idea of taking insulin without support from a doctor so maybe that's why it took me so long. Without meds I now have a fasting BG around 90-95. I would like to see it go a bit lower but I'm hoping it will get there in time.
::flowerforyou::1
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