Any Metformin experts

[MammaD]

First of all, thanks for taking the trouble to read and answer these questions. I really appreciate it. I am a newly diagnosed diabetic (about 6 or 7 weeks ago) and I really need some answers to these questions:

As a background to this question, my fasting blood sugar when diagnosed was 20 UK (= 360 US). I have tested it myself a couple of times this week when fasting and it was 13.1 (=236) and 15.8 (=284) but it has also been 19.8 (=356) an hour after a meal.

(1) When should I take metformin - before, during or after a meal and why? I have heard some conflicting things.

(2) I have been prescribed 3 x 500mg but I very rarely eat three large meals. In fact, I eat about 5 or 6 half size meals so would it be okay for me to halve the dosage and double the frequency? i.e. does it depend on how much I actually eat?

(3) What is Metformin actually doing? (i.e. how does it actually work)

(4) Is the effect of Metformin simply a short term remedy in as much as, does it simply lower my blood sugar momentarily or should I expect to see a long term reduction in my fasting blood sugar?

(5) If I dont feel that Metformin is doing much then should I consider asking for the Slow Release version? Or should I consider going onto Insulin?

(6) Are there websites with charts etc which show how blood sugar levels should be on a typical day when meals are taken and when Metformin/Insulin are taken?

Once again, thanks

[Elisabeth C]

I take 1000 mg metformin twice a day with meals. Metformin works by suppressing glucose production. Don't halve your dosage to take some with each meal. If you are to take it 3 times a day just take it morning, noon and evening even if you aren't eating much. Metformin is usually the first drug that is given to treat type 2 diabetes. It may take some adjusting of dosage to get to the correct amount. I take 1000 mg twice a day, my sister takes 1000 mg 3 times a day. My diabetes is controlled by metformin but my sister recently has started taking Byetta. Metformin does not have many side effects, does not cause hypoglycemia when taken alone, helps reduce LDL cholesterol and triglyceride levels and can aid in weight loss.
As for websites, www.diabetes.org is the official website of the American Diabetes Association, and it has a lot of information.
Good luck

[toolchicx]

You didn't say whether you were diagnosed type 1 or 2. I am a type 1, also since recently, and I take metformin 500 twice a day PLUS insulin 4 times a day. I take a shot after every meal and the long acting "Lantas" at bed time. Your numbers suggest to me that your sugar is not under control so forgive me if I skipped to #5 - I think you need to get back to your doc. I am definitely NOT a diabetes expert by any means but my short experience with it makes me think you are type 1 and need to be taking insulin.

I'm not sure about the charts, but my endocrinologist said he didn't want to see me ever going over 200 and for sure never over 300. Over 200 is harmful and over 300 is dangerous

[LoJac963]

There are many other medications other than Metformin and insulin. Are you working with an endocrinologist or general practice doctor? If you are not seeing an endo, then it's time that you make an appointment. An endocrinologist can help much more than a general practitioner.

This site lists many available oral medications http://www.fda.gov/fdac/features/2002/chrt_oralmeds.html

There is also an inejectable medictions that may be helpful - Byetta and Symlin.

This is also a good site that lists catagories of diabetes medications and gives some info on how they work
http://www.diabetes.org/type-2-diabetes/oral-medications.jsp

I think looking at these two sites should convince you that a specialist really needs to help you find the right medication or combination of medications to get your sugar under control

[Zoey]

I take 3 500 mg tabs of metformin daily and have for about 8 years. Metformin works very well for me but I remember taking it for several months before it really took effect. I also lost 40 pounds on it. Metformin works in a couple ways. It blocks some of the sugar produced in your liver, and if you are still making some insulin yourself, it helps the insulin to work more effectively. My last A1c was 5.9, which is not bad. That means the metformin is doing it's job and my blood sugar is under control. I don't take the drug with meals. I just take 2 in the morning and one at night. I don't believe it's short term, but I know that if you are able to lose weight and eat right and exercise, you ay be able to get off of it. I don't know anything about the slow release version. Hope this helps a little.

[mrs_G]

Metformin is used to prevent large spikes in BS after eating. I take mine with my meal, 1000 mg in the morning and at night. However, I also take 5 mg of Glipizide, half an hour BEFORE my morning and evening meals.
When I first started my meds, it took a little fiddling around with doasage/time to get their full effectiveness. If after this much time you are still struggling with high readings, you need to go back to the doctor and readjust the meds. Don't halve medication unless instructed to.

Good luck!

[ladypam]

It seems that the Metformin that you are taking is doing its work, bringing your original FBS (fasting blood sugar) of 20 to 13.1 in a few weeks time. Although still high, at least there is an improvement seen. Blood sugar an hour after eating is definitely higher than FBS. This is to measure how well your body is utilizing the glucose in the body. You should try taking your blood sugar an hour and two hours after meals to check if the measurements do go down.


In answer to your questions:
(3) What is Metformin actually doing? (i.e. how does it actually work) Metformin acts on the cells, making it more sensitive to insulin. Diabetes often occurs either because there are low levels of insulin in the blood because of abnormal production, or because the cells have a problem utilizing insulin, even with their normal production. Metformin makes the cells utilize insulin, thus lowering levels of insulin and glucose in the blood. In the instance that insulin is deficient, then the doctor will recommend taking insulin shots to help lower glucose further.

(4) Is the effect of Metformin simply a short term remedy in as much as, does it simply lower my blood sugar momentarily or should I expect to see a long term reduction in my fasting blood sugar?
The effect of Metformin may be short term for some, and others long term. it all depends on how it will affect your body.

(1) When should I take metformin - before, during or after a meal and why? I have heard some conflicting things.
Metformin is often taken with meals, This is to make sure that the increase in blood sugar levels are acted on immediately by the insulin.

(2) I have been prescribed 3 x 500mg but I very rarely eat three large meals. In fact, I eat about 5 or 6 half size meals so would it be okay for me to halve the dosage and double the frequency? i.e. does it depend on how much I actually eat?
The doctor should have taken into account your diet and activity when prescribing you metformin. The dosage the doctor gave you should be followed. If you see the need to change it because of your diet, then you have to advise your doctor of it. Do not try to change it on your own.


(5) If I dont feel that Metformin is doing much then should I consider asking for the Slow Release version? Or should I consider going onto Insulin?

If you do feel that Metformin is not for you, then there are other medications for diabetes in the market that you can try. Just remember that medications at first are really hard to deal with since the body tries to adjust to it. Give it a few more weeks and see if does any significant change. If not, then go to your doctor for a change in prescription.

(6) Are there websites with charts etc which show how blood sugar levels should be on a typical day when meals are taken and when Metformin/Insulin are taken?

Since each individual has their own effect with Metformin as well as a different diet, then there are no typical figures. There are just normal values. If you want, you can try to monitor your blood sugar levels. Check it during fasting for several hours, then an hour and two after meals. Through this, you can see what is normal for you and if there is a change in your blood glucose levels.

Hope this helps!