Insulin With & Without Metformin

[acstokes]

Hello everyone!

First, a little background: I have been on insulin (Levemir plus Novalog) plus 2000 mg of Metformin for about 3 years. Until a year ago I was seeing an endo, then I lost my insurance coverage and moved. When I regained insurance coverage in May, I got a new physician, an internist, because the closest endo is about 75 miles away. Also, about a month ago I went on a MiniMed 722 pump and have been adjusting to that.

When the internist checked my A1c, it was 6.4 (about what it was a year ago) and my c-Peptide level had decreased from about 3.0 to 1.3. My internist then said he wanted me to discontinue the metformin since with my low c-Peptide the metformin was only stressing my beta cells and contributing to their early death.

I've noticed over the past week since I've discontinued the metformin my BG readings have increased significantly, I'm having to use more insulin, and I'm having a hard time keeping my BG under control.

Does the discontinuance of metformin sound like the correct thing to do? I thought metformin also helped improve insulin sensitivity. Which is better, use more insulin or continue using metformin and less insulin?

Please help. Your experiences and/or opinions will be appreciated.

Fred

[GeishaGirl]

All I know is that my sensitivity is rock-bottom and I'm on a pump and 1000mg of Met per day. I'll probably go up to 2000/day when I see my doc in two weeks.

Frankly, I don't see how this will help. If met improves your sensitivity, shouldn't that help? Is it possible your doctor (Gods help us all of this is true!) got the Met mixed up with an insulin-spurring medication, like Glipizide? It's true that something like Glip would force your beta cells to overwork, and thus contribute to a problem.

[dbc]

From the experience of a few folks on this forum, if you stop using metformin you can expect:
1. Insulin requirements to increase - maybe by as much as 50-80%.
2. To be more hungry/eat more. Some folks report that metformin does suppress the appetite.

The combination - more insulin and more food - implies possible weight gain, but if that's not issue, no problem.

I've been on 1500mg metformin (recently the XR version) for about 2 years or so, on insulin for most of that period as well. It works OK for me, & I'm a firm believer in "if it ain't broke, don't fix it", so would be reluctant to change the regimen unless there are compelling reasons to do so.

The doctors assumption that the met is stressing your beta cells concerns me - it's my understanding that metformin does not have any effect on beta cell insulin production???

[NoraWI]

Metformin does not affect the beta cells. Metformin has two actions -- to increase insulin sensitivity and to curb liver dumps. When I went on insulin after about 2 years on metformin due to a misdiagnosis, I found that discontinuing metformin caused me to use about 30% more insulin, which was OK because it was still a small amount. It also cleared my head of the cobwebby feeling. The most important part for me was that it allowed my liver to "save" me with a glucose dump in the event of a hypo.

[MiniMoe]

When I was in the hospital last month with the seizures, they took me off metformin and put me on lantus and novolog.

[sumi]

Fred, I agree with what you and the other posters are saying. Perhaps you could take a few sites worth of info on met to your next appointment ( I would make sure that they are from 'official' sources). If your endo has some other info on met, we'd love to hear about it. I agree with not further stressing your beta cells, but it sounds like a case of mistaken identity.

[acstokes]

Thanks everyone for your replies. My BGs are definitely trending higher, I'm using more insulin to combat the higher BGs, and I think the Metformin was improving my insulin sensitivity. My doc is confused---no doubt about it. I have an appointment soon and plan to print off some official data to take with me.

Thanks again,
Fred

[foxl]

I am very interested in this topic since I am on Actoplusmet but considering initiating insulin therapy for the autoimmune component of my LADA.

I am trying to find more info on how IR typically increases with age, in insulin-dependent T2s, and T1's. All I know so far is, it does increase.

I am 51, perimeno female and a tad heavy (BMI 26 on a small frame), so I figure this is a piece of it. I'd hate to stop met in order to start insulin.

[acstokes]

Well, to throw another kink into my high BG problem, I just learned Medtronic has issued a recall on their Quick-Sets. All Q-sets with lot numbers beginning in "8" are being recalled due to a venting problem. The sets I have been using have the "8" lot number.

According to a couple of threads under the Pumping Insulin forum, at least some of those nwho have used the affected sets have experienced unusually high BGs.

This is now something else I need to deal with before I can say definatively that its lack of Metformin that causing my higher BGs.

I hope those of you who use the Medtronic Quick-set will check out those threads.

Fred

[nikki75]

I definitely think you should seek a second opinin about discontinuing the metformin. I was diagnosed type 2 in 2003 but just recently, after a c-peptide test, was told that my insulin levels are almost non-existent due to stress to the pancreas over time. My doctor told me that I will always have to use insulin in conjunction with an oral medication. It just makes me angry to think that some doctors may be doing more harm than good. I think you should ask him/her for supporting documentation regarding metformin's affects on the beta cells. In addition, did he/she tell you that your BG levels may rise and tell you how to deal with that? I think the best thing to do is to keep reaching out to people in forums like this and alos continue to do further reasearch on your own about your condition. Learn as much as you can and go into your doctor's visits informed.

[foxl]

Thinking about hwat I ahve been reading more recently, I wonder if metformin WOULD stress your beta cells, when what it is doing primarily is suppressing gluconeogenesis? I would think this would lower your BG and rest your betas?

I can see where other meds -- SUs in particular are NOT recommended in T1.5, would stress betas (and that recommendation can be found in the Cochrane database), but metformin? I do not think so ...