Metformin ER question

[walkerwally1]

I have been taking Metformin regular for 23 years and I don't seem to have any problems from it.  I have always used regular Met., I think that was all that was available when I started, and fortunately never had any bad reaction to it so have never had to use the ER version but that is still the same thing, just time released.  Like Shanny said, Endocrinologist are specialist in the endocrine system and not specialist in Diabetes.  Some appear to be quite good in treating Diabetes and some not so good.  The AACE has guidelines that are a little better than the ADA but not by a lot.  I think a good PCP can often be just as good or often better than an Endo for Diabetes treatment but that is just my opinion. 

[Rhiannon]

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.

If any doctor had me use a freight scale, I would refuse and never see that doctor again.  I am sorry you had to experience that - it is callous and disrespectful! 

[Grammabear]

Update:

I just spoke with the nurse from my nephrologist's office.  She had given him my message from earlier this morning regarding the advisability of taking Metformin ER 3 x a day.  It is his opinion that since my kidney function has remained stable since I've started seeing him, that it is OK for me to continue with the Metformin ER.  I am so pleased as the Met really does help me control my bg.

I also sent the endocrinologist office a message respectfully requesting that Metformin ER be reinstated to my medication list.  I'm hoping he will honor that request.

[BobIA41]

 Grammabear,  Reread your post please.  You have listed several reasons to reject an endo.  A freight scale is not that bad, but if you are not but a few pounds overweight, yes, it can be an insult.  But if the endo has patients over 300 pounds, he is probably tired of spending money on new scales - thus the freight scale.  The second endo did insult you by talking too fast and that should have been a warning. 

I had to leave an endo because she wanted me to let my blood glucose levels rise above 7.5% and then lectured me for not being above this at the next appointment.  It wasn't because I was having readings below 70 mg.dl, but because of my age.  A member of my support group is a couple of pounds underweight and eats very low carb and has A1c's below 5.5 and the time he had an A1c of 4.9 on insulin, she told him not to come back unless he got his over 8.0%  He is now 80 years young and with his new doctor his last A1c was 4.6%.  Yes, he has readings down to 65 mg/dl, but not lower.  He found a doctor, not an endo that believed Dr. Bernstein and his law of small numbers. 

Best of luck in finding a doctor or endo that fits your needs.

[skb]

Well, if the nephrologist is happy, that surely overrules the endo. I'm sure he will add the met back. 

[Grammabear]

I can understand an endo wanting us 'older' people to have a target blood sugar a bit higher than it may have been when we were younger, but I really don't understand why they would scold a patient if there blood sugar was not above 7.5.  Don't they understand that complications rise when our blood sugar numbers are higher?  It seems that a lot of endos' have book knowledge but no heart knowledge.

I once had an old ear, nose and throat doctor that told me he wouldn't give a fig for a smart doctor who didn't know how to have compassion for his patients.

[BobIA41]

All the endos and most doctors are concerned about is hypoglycemia.  They don't follow Dr. Bernsteins "law of small numbers," and seem to have goals of age 65 to 69 of 7.0%, age 70 to 74 of 7.5%, age 75 to 79 of 8.0% and age 80 and above of 8.5%.   This is not a hard and fast rule, but when they are concerned about hypoglycemia, they seem to lose all sense of reason. 

I have no problems with doctors downloading my meter and looking at the readings, but when I don't go below 70 mg/dl or the lowest is only 66 mg/dl, and they go ballistic, then I feel it is time to change doctors. 

[Grammabear]

All the endos and most doctors are concerned about is hypoglycemia.  They don't follow Dr. Bernsteins "law of small numbers," and seem to have goals of age 65 to 69 of 7.0%, age 70 to 74 of 7.5%, age 75 to 79 of 8.0% and age 80 and above of 8.5%.   This is not a hard and fast rule, but when they are concerned about hypoglycemia, they seem to lose all sense of reason. 

I have no problems with doctors downloading my meter and looking at the readings, but when I don't go below 70 mg/dl or the lowest is only 66 mg/dl, and they go ballistic, then I feel it is time to change doctors.

I can't say I haven't gone below 70, and I don't know if that fact changes how a doctor looks at me as a patient.  This endo did ask me "why do you think you have lows"?  My response was "most of the food I eat I make myself, and since it does not come complete with a nutrition label, sometimes I over-estimate the amount of carbs in that food - hence I take more insulin that I need.  It is almost like he thinks I'm stupid and cannot count carbs. 

I've given up finding the perfect doctor as in my town, such a thing doesn't exist.  In my book, respect is earned, not given and so far I haven't found one that I respect.  I also detest having to disconnect from my pump for however long it takes them to download information from it. 

[RCG]

What is the rationale for a type 1 taking metformin?

[Grammabear]

What is the rationale for a type 1 taking metformin?

It is used to help with insulin resistance that plagues people of either type.

[Shanny]

The rationale? Because type 2s aren't the only ones with insulin resistance. Type 1 patients can also develop insulin resistance (often from weight gain due to intensive insulin therapy), and metformin is the best and essentially only drug which combats insulin resistance without causing other damage.

Patients with both insulin deficiency and insulin resistance are sometimes said to have 'double diabetes'. If a type 1 patient develops insulin resistance, obviously no amount of additional insulin is going to control their high blood sugar. Once their docs wake up & smell the coffee & prescribe metformin, better control can be achieved.

[RCG]

Thank you.

[BobIA41]

I have been taking Metformin regular for 23 years and I don't seem to have any problems from it.  I have always used regular Met., I think that was all that was available when I started, and fortunately never had any bad reaction to it so have never had to use the ER version but that is still the same thing, just time released. 

The length of time people use metformin often causes vitamin B12 deficiency and then many people need shots of vitamin B12 to start the process back to normal levels and then vitamin B12 supplements are required as your body had lost the ability to absorb B12 from your meats and fish that you consume.  Several of our support group members have need shots because of their deficiency and often this is discovered when they start complaining about neuropathy in their feet and having trouble walking.  The deficiency also causes other problems as it works with the other B vitamins to maintain our health.

[rocky]

my numbers r now steady at 102 - 108. shd i think of stopping the met ? what do u guys think ?

[Shanny]

Met helped get you here, and I think it's a little soon to be thinking about stopping it. It may also be helping with those foods you've said you aren't craving anymore - it is an appetite suppressant too.