Metformin: Another tool in my toolbox

My last appointment with my Endocrinologist was at the end of August. It was my second post-pregnancy appointment, and I was a little nervous about how things would shake out. You see, between colic and reflux for Lukas and insomnia and exhaustion for me, the Big D had sort of taken a back seat.

But things had been on the upswing for the last month or so, and while my A1C had soared from 5.4 to 6.2, I was still well within the acceptable range for an adult (non-pregnant) diabetic.

The doctor had little in the way of suggestions for improvement, so I asked him what he thought about either Metformin or Symlin. My weight had dropped off significantly during the first few months after the pregnancy, but had since leveled off and my BMI has been pushing the line between overweight and obese for years now. And try as I might, I just cannot seem to bring it down. No amount of exercise or dieting seems to help. And despite careful attention to carbs and calories, my insulin needs just keep going up. And up.

Like almost every other Endocrinologist I’ve ever had, my current doctor is not concerned about my weight. And my insulin needs, while much higher than they used to be, are relatively low when compared to those of other, more insulin-resistant diabetics. He is delighted that my A1cs are so good, and chalks up my extra weight to the extra calories consumed while treating frequent lows. But when it gets hard to find clothes that fit, and when it’s uncomfortable to bend over to tie your shoes, it’s time to do something.

I’m not sure that I convinced him that those extra calories were not at fault, but he was willing to try something new. We decided against Symlin because of the contraindication for patients with delayed gastric emptying. While I am not officially diagnosed with gastroparesis, we are fairly certain that my stomach empties slowly. And I tried Symlin when it first came out. Twice. It left me feeling like I had a lead balloon lodged in my stomach. So Metformin it was. He thinks that the extended release version works better, so I tried that. Luckily enough, one of the local grocery store chains offers Metformin for free, so I did not even have to pay for it.

I have to admit, though, the first few weeks were rough. The intestinal pain was enough to leave me, at times, unable to complete a sentence. It also gave me that full-stomach, lump-in-the-throat feeling, especially if I ate more than about 30-45 grams of carb at a time. And I occasionally experienced acid reflux. But my fasting numbers started to drop after just two doses. Before taking Metformin, I was taking about 18.5 units of basal insulin. Now I’m taking 16.8. Sure, that’s not a huge decrease, but I am back to almost the exact amount of basal insulin I was taking before my insulin needs started to rise.

And the intestinal distress is more or less gone now. Only occasionally, after a really carb-heavy meal will I feel the effects. I don’t mind this side effect, though. It works as a sort of negative incentive; I am less likely to eat a whole box of macaroni and cheese because I know that if I do I will have to deal with the consequences.

Unfortunately, the Metformin has not helped with my bolus needs, which are my biggest concern. Over the course of the last five years, I have gone from a carb ratio of 1:15 (one unit of insulin for every 15 grams of carb) to 1:9 (one unit of insulin for every nine grams of carb). I have found that Metformin does nothing to reduce this insulin requirement.

Interestingly enough, it does delay the spike from the carbs I eat, but does nothing to smooth out the spike. So if I eat a carb-heavy, but low-fat meal like spaghetti, the spike can occur a full six hours after I eat. Crazy, huh?

The one exception to this rule appears to be pizza, which seems easier to manage since starting Metformin.  That in and of itself could be considered a win, right? Since I started Metformin, I can predict that the post-pizza spike will occur at about 3 hours post meal and will last for about six hours. So I typically use a dual wave bolus, delivering 65% now and 35% over the course of the next three hours. And the clincher is that I don’t bolus until AFTER I eat. It seems that the delayed digestion of the high-fat food dovetails nearly perfectly with the peak of the insulin when I wait to deliver the insulin for this extra hour or so.

Another interesting tidbit: I was sick for about a week with the stomach flu and did not take my Metformin. As you might expect, my basal needs increased after about two days of not taking the med. When I went back on the drug, though, it was more effective for about the first week. That is, I needed even less basal insulin during that first week than I normally do when I am taking Metformin.

I have not lost any weight as a result of taking Metformin, which is disappointing. But I haven’t gained any, either. So I still weigh less now than I did before I became pregnant. It’s not exactly the result I was hoping for, but it could be worse.

So what’s the verdict? I wasn’t expecting a magic bullet when I decided to give Metformin a try. And I am happy that it is helping with my basal rates and my “pizza management”. So while the results are not overwhelming, I think I’ll keep taking it. It’s just another tool in my diabetes toolbox. And who couldn’t use more of those?

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One Comment on “Metformin: Another tool in my toolbox”

  1. I’m also a type 1 on Metformin. I recently went on Fortamet (a brand version) so I take 1000mg before bed. My basals have definitely gone down, but it hasn’t impacted my bolus ratios. This is because Metformin works with the liver’s glucose, not the sensitivity toward insulin. So that’s why. It hasn’t helped my weight, but it definitely has helped with my BGs a lot. So yeah, it works for some things. I don’t know many people on Metformin. I hope it’ll become more common for type 1s. I think there are a lot of people who need it who don’t consider it because it’s a “type 2” drug.

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