Metformin ER question

[Grammabear]

I saw a new Endo last week, and among other things he said was "I want you to stop taking Metformin ER as you don't really need it, besides it is bad for your kidneys."   He caught me by surprise, so I agreed to stop taking it.  I take it as a person with type 1 because I have a fair amount of insulin resistance.

Recently I had a basic metabolic panel done which indicated my creatinine level is 0.97 and my gfr is 57.  Since I saw the Endo, I've had nothing but trouble with my insulin doses.  I have increased the insulin by 30% across the board and it took all day today for it to start coming down.  My average was 150-200 which can't be good for any part of me.

Has anyone else had their doctor give them grief about taking Metformin ER?

[BobIA41]

Some doctors don't believe type 1's should take medicine that is for type 2's.  My endo did allow me to add metformin ER since I am a type 2 on insulin, both basal and bolus.  You are right that it helped reduce the amount of insulin required.

After being on this for close to five years, my VA nurse practitioner showed me the results of my tests and suggested that I stop for at least a year as I was in stage 2 (near stage 3) of kidney disease.  (I had quit my endo about a year earlier).  I have seen many studies saying that small doses (500 mg) can be taken into stage 4 with out causing kidney damage.  My year is up this July and it will be interesting to see the test results.  At least she did not order me to stop, but gave me her reasons and suggested that I stop - which I did.  Since my wife is also a type two on metformin and she was able to use the remainder of the medication (about 80 pills).

My insulin requirements only went up 10 to 15 percent which surprised me as I had gone down about 25 percent. 

Best of luck and you may need to talk to another endo or another doctor that knows diabetes for a second opinion.

[Shanny]

I have never been told to stop metformin, but then I'm not on insulin. What my doc DID do a few months ago, was put me on losartan to protect my kidneys. I know it's a hypertension drug - I already take atenolol - but his reason for adding this is specifically for my kidneys.

As for it being strictly a type 2 drug, what it IS is an insulin-resistance drug, and which type of diabetes has nothing to do with it. Since type 1 patients can also develop insulin resistance, it makes no sense that they should not avail themselves of this excellent insulin-resistance drug.

http://www.medicinenet.com/script/main/art.asp?articlekey=185963

[BobIA41]

What you say is true Shanny, but I have heard doctors tell type 1 patients they should not take any drug that was for type 2 and would not prescribe metformin to two that had developed insulin resistance.  Go figure! 

[skb]

Since I don't take any pills, except thyroxine for my hashimoto's I wouldn't know what doctors in this part of the world opt for. But, they do follow the US blindly & I would be surprised if they didn't follow the same protocol.

We do go for bloodwork every 3-4 months, and I checked to see that my creatinine has stayed between 0.68 - 0.72 for the past 3 years. Men have slightly higher levels, and those figures are well within normal range.

Given that your levels are higher, I think Bob's approach of giving up the met for a year and retesting would make sense. Hopefully your insulin requirements may stabilise with time and lesser would be required. A wait and watch does make sense.

[Kelly]

So if at some point my dr says I need metformin, I should ask for the EX?

[BobIA41]

Kelly, That would be my suggestion as in general the metformin is released over time and creates less stomach irritation rather than receiving the full dose in an hour.  It is not recommended to crush any tablet as this causes the medication to be absorbed in an matter of minutes and the upset stomach will plague for several weeks unless you are among the few that can tolerate it.

Also, do not expect to take the pill or pills one day and see results the next day.  Normally it takes 2 to 4 weeks for the body to adjust and show results that the doctor says will happen and your blood glucose levels show this is happening.

[Kelly]

Thank you Bob for that information. I am still hoping to get control with diet, but it seems so hard.

[Grammabear]

I have never been told to stop metformin, but then I'm not on insulin. What my doc DID do a few months ago, was put me on losartan to protect my kidneys. I know it's a hypertension drug - I already take atenolol - but his reason for adding this is specifically for my kidneys.

As for it being strictly a type 2 drug, what it IS is an insulin-resistance drug, and which type of diabetes has nothing to do with it. Since type 1 patients can also develop insulin resistance, it makes no sense that they should not avail themselves of this excellent insulin-resistance drug.

http://www.medicinenet.com/script/main/art.asp?articlekey=185963

I am caught between a rock and a hard place.  The Endo says stop Metformin.  The Nephrologist said (back in December 2015) that it was ok to take it.  Having a blood sugar average of 150-200 can't be good for my overall health.  I had only 30 carbs yesterday and my blood sugar was through the roof.  I am not a happy camper w/o the Met.

[Shanny]

If you're still a patient of the nephrologist and he will prescribe metformin for you, I think if I were you, I'd ignore the endo and continue with what works. You obviously DO need met, or your blood sugar wouldn't be wacko without it. Even as a pumper, you have a constant battle to control it, and why this dogmatic endo can't see that is more than I can understand. ((((Grammabear))))

[Grammabear]

If you're still a patient of the nephrologist and he will prescribe metformin for you, I think if I were you, I'd ignore the endo and continue with what works. You obviously DO need met, or your blood sugar wouldn't be wacko without it. Even as a pumper, you have a constant battle to control it, and why this dogmatic endo can't see that is more than I can understand. ((((Grammabear))))

I thought when I made the appointment with the endo, that it would be a good thing because he could teach me things to make my job of managing diabetes easier.  I guess I was wrong because I did not think he would pull the rug out from under me.  Thanks Shanny for the encouragement.

[Shanny]

While endocrinologists do specialize in glandular diseases/disorders, that doesn't necessarily make them diabetes experts. Our bodies contain many glands, some endocrine and some exocrine. Anyone who is shopping for an endo to treat their diabetes would be wise to interview their candidates as to their expertise in pancreatic issues, and specifically diabetes.

[rocky]

Shanny, i take 2 metformin a day. so i should continue n not think too much abt it. my numbers hv fallen like 50 points.

[Shanny]

Met is one of the oldest & safest drugs in use - there are only a rare few patients who don't tolerate it well after a few weeks of adjustment.

It does not force the pancreas to produce more insulin as do sulfonylurea drugs (diabinese, amaryl, glynase, glucotrol, et.al.) and other hot new and expensive concoctions, it simply coaxes the liver to stop secreting so much glucose, and it coaxes the recalcitrant cell receptors into allowing the circulating insulin into the cells. It is commonly thought of as a type 2 drug, but that is erroneous. It is a drug for anyone with insulin resistance, and that encompasses all types.

[Grammabear]

While endocrinologists do specialize in glandular diseases/disorders, that doesn't necessarily make them diabetes experts. Our bodies contain many glands, some endocrine and some exocrine. Anyone who is shopping for an endo to treat their diabetes would be wise to interview their candidates as to their expertise in pancreatic issues, and specifically diabetes.

How does one determine the expertise of the endo they are interviewing?  The endo I interviewed in January told me straight out "I don't like your pump" in addition to weighing overweight patients on a freight scale, which I might add was really humiliating.  The endo I saw last week spoke so fast that I had great difficulty hearing him as I am severely hearing impaired and he was well aware of that fact.  It is hard for me to process the spoken word if it is spoken so fast I can't hear but half of what is being said to me.