Metformin causes low BG?

[eddiemcm]

My aunt has just joined the diabetes club.Her FBG is
in 130's.Doctor puts her on 2000 mg of metformin a
day(too much?)-two doses of 1000 mg.
Her BG is constantly going low after being put on
metformin.She points this out to the doctor and the
idiot tells her not to worry because her A1C is okay.
Has anyone here had metformin to drive their glucose
low right away?It surprised me.I thought it took awhile
for metformin to have any effect at all.
Eddie

[Lisa N]

It certainly didn't have that effect on me right away but I was taking half that amount in the extended release form.
It wasn't long after starting low carb, though, that I started having low enough readings to produce hypo symptoms (upper 60's and low 70's) which was a clear sign to me that I needed to reduce my dosage. My doctor agreed.
While it's not terribly common, Metformin can cause hypoglycemia especially when the dosage is higher than needed.
If her doctor is blowing her off even after being told what her low readings are, I'd suggest she get a second opinion or find another doctor. I know I would if it were me.

[eddiemcm]

Thanks for the information,Lisa.
I'll pass it on to my aunt.
I agree with you about her doctor.
He sounded like a complete idiot.

[camaromom]

Is your aunt eating regularly? Has she recently changed her diet? Did they only give her the Metformin or something else as well? How low is she going? Is it a true low by meter or only her "feeling symptomatic"? The only reason I ask is that Metformin is not typically known for causing low blood sugar. Typically the way Metformin works is to prevent the glycogen dump from the liver. It doesn't usually cause a low blood sugar.

[eddiemcm]

camaromom
My aunt does the Jenny Craig thing.
Her BG gets into 60's.
She uses a meter.
I didn't think metformin would cause lows either
but the doctor prescribed way too much metformin for someone whose FBG is in 130's.
Seems that Lisa had a similar experience.
Thanks for the reply
Eddie

[MizKitty]

Wow, that seems like a really high dose. My BG's were in the upper 300's, and my doctor started me on a smaller dose and increased me gradually over a course of months to my current (what is considered high dose) of 1500 per day.
My son is also diabetic, and his doctor started him on a low dose and brought him up over a course of months to his current 850 per day.
I've never heard of anyone being put on such an initial high dose, but I think the reason for the slow increase is because of the adverse affects it has on the digestive system for a lot of people - upset stomach, nausea and diarrhea. I think it's increased slowly to help develop tolerance.
Is your mom having those problems?
Is metformin the only diabetic drug she's on?

[CNYMom]

My FBG was never over 120 and my doctor put me on 2x850 of metformin. This was after they tried starlix (which caused some serious lows). It did help me to lose weight initially, and lowered my FBG by about 10 points on the average. There was no ramp up, but my doctor is a jerk.

Metformin doesn't cause the pancreas to create more insulin, though, so I don't understand how it can cause a low. Regardless, if your aunt has documented lows and her doctor is blowing her off, it's time to fire him (or her) and get another doctor.

[eddiemcm]

Metformin causes the liver to make less glucose.
I would think the liver would normally spew out
some glucose when glucose level is getting low.
From this,it would appear that metformin could
cause low glucose levels not to be corrected.
Just a guess
Eddie

[dancinbr]

Wow, that seems like a really high dose. My BG's were in the upper 300's, and my doctor started me on a smaller dose and increased me gradually over a course of months to my current (what is considered high dose) of 1500 per day.
My son is also diabetic, and his doctor started him on a low dose and brought him up over a course of months to his current 850 per day.
I've never heard of anyone being put on such an initial high dose, but I think the reason for the slow increase is because of the adverse affects it has on the digestive system for a lot of people - upset stomach, nausea and diarrhea. I think it's increased slowly to help develop tolerance.
Is your mom having those problems?
Is metformin the only diabetic drug she's on?


Hi,

I am new to this forum and just diagnosed with Diabetes.

My Doctor has me monitoring FBG before breakfast and before dinner. Right now my numbers are in the 120-150 range. Just started dosing 1mg of amaryl per day and 500mg Metformin a day. Starting doses. I am sure he will adjust as we proceed. Too soon to tell if I have stomach issues; I generally do not so there is hope. I want to get this under control.

I am 290 and want to continue to lose weight. Have had an awful time doing so with WW. But now I know why !!

So low carbs it is. I am aiming for 60-100gms carbs per day for now and probably will reduce that as we go along. I remember Atkins going for 20gms per day the first two weeks; maybe I should drop to that and then back to 60gm. So much happening so quickly. But I am happy to have found this forum.

Thanks for being

[RobLL]

Hi Dancinbr - not an expert but imagine that standard advice particularly for a type 2 newly diagnosed who is on medications would be to do a lot of metering when you make major changes in your diet

[dancinbr]

Hi Dancinbr - not an expert but imagine that standard advice particularly for a type 2 newly diagnosed who is on medications would be to do a lot of metering when you make major changes in your diet

I have thought about that as well.

I am seeing the Doctor weekly. I am sure he will make adjustments as we go along. I think he is focusing on BFG right now more than anything else. My average is 250 based on one of the tests.

I have also found a site and I am learning about glycemic index and glycemic loads. This sounds important as well. Low glycemic foods keep your glucose from spiking and vice versa.

Not all carbs are created equal. So while I am lowering my carbs, I must also pick the right carbs.

[RobLL]

Glycemic load and rating may not be as helpful as a number of us thought it would be. If you follow Bernstein he has something he calls the law of low numbers. The way your body absorbs and turns carbs into glucose is only inaccurately shown by charts. Likewise the way your body absorbs injected insulin is likewise inherently variable. Both figures can be up to 30% off, particularly in the timing. Hence hypo and hyper glucose readings and problems.

The solution is to eat as few carbs as is consistent with your health, in effect he recommends no fruit (except avocados), no grain products except for a little Scandinavian style rye krisp. As a pre-diabetic I assumed that I would be able to give myself a lot of slack and eat an occasional piece of lower carb bread, my homemade no sugar berry jams, an apple now and again. After I started metering those things cause largish spikes -145- which take hours to go below 100.

I have not done a lot of experimenting with these foods and spiking, and maybe I could have a little slack if I did some tighter experiments, and more testing, but for now my goal is to have lots of readings below 100.

[eddiemcm]

"I have not done a lot of experimenting with these foods and spiking, and maybe I could have a little slack if I did some tighter experiments, and more testing, but for now my goal is to have lots of readings below 100."
Good goal.Average person,after "medium carb"
meal supposedly has BG around 160 after
one hour and BG around 120 after two hours.
Two many variables to really be sure about that-
GI of food etc.
Does anyone know how high BG has to get and
for what period of time to cause damage?
Always searching for information...
Eddie

[dina1957]

"I have not done a lot of experimenting with these foods and spiking, and maybe I could have a little slack if I did some tighter experiments, and more testing, but for now my goal is to have lots of readings below 100."
Good goal.Average person,after "medium carb"
meal supposedly has BG around 160 after
one hour and BG around 120 after two hours.
Two many variables to really be sure about that-
GI of food etc.
Does anyone know how high BG has to get and
for what period of time to cause damage?
Always searching for information...
Eddie
To play safe: 2 h pp <120, 1h <140. Anything over 150 - glucose spilled into urine, so you do the math.
regards,
D.

[RobLL]

Dr. Bernstein asserts, as I recall, readings above 100 are potentially damaging, and especially as more time is spent above 100. I have ordered his new revision, despite having just bought and read the previous version. It is still enough up to date I will pass it on to someone.

[dancinbr]

Dr. Bernstein asserts, as I recall, readings above 100 are potentially damaging, and especially as more time is spent above 100. I have ordered his new revision, despite having just bought and read the previous version. It is still enough up to date I will pass it on to someone.

I will buy Dr. Bernsteins new solutions book.

Sounds like a lot of good information.

The target for my readings BFG is <100. I understand that, but as I understand things and I could be wrong is BG goes up for anyone after eating and it should return back down to the 70-110 range after a couple of hours.

I asked the same question about when is damage done. I would like to see something on that somewhat official. I cannot believe the "normal ups and downs above 100 that occur for normal folks causes damage; but again I need to learn more about this as well.

I have two friends that have been lifelong diabetics, both on insulin and one on a pump.

I am going to see what their experience is. I know one of them we have had to feed her orange juice many times when her BG went too low. She gets really funny, but it is serious. We sit her down and pour either a OJ into her or a Coca Cola to get her BG back up to the 80-100 range.

It happens a lot when we used to go dancing. We always watched her closely since when the low BG starts to happen for whatever reason she doesn't notice it in time!

[eddiemcm]

"I asked the same question about when is damage done. I would like to see something on that somewhat official. I cannot believe the "normal ups and downs above 100 that occur for normal folks causes damage; but again I need to learn more about this as well."
I don't believe 100 is the damage threshold
either.Probably more like 150.Certainly admit
uncertainty on that one.
Eddie

[RobLL]

My corrected A1Cs are about 5.5, (original readings of 5.7 equals an average BG of about 120). Originally I believed that was an acceptable BG. But after having two sessions of retinopathy, and learning that 8% of those diagnosed 'prediabetic' do have problems with retinopathy I am far more concerned about my above 100 readings that I was a couple of years ago. I expect a big shift in recommended treatment for prediabetes in the next few years.

Incidentally Opthom. tells me that retinopathy usually relates to your BG from about five years ago. If this is so, then it should stop in about a year and a half.

Some other experiences are clues to me that prediabetes is a misnomer. It is in fact evidence of an impaired glucose-insulin metabolism. Fasting for a test I experienced BG of 49 and 39, I took half a bottle of gator aid after each metering. A person with normal metabolism will not have that kind of low reading, I understand. I have also discovered that I cannot skip lunch without my BGs going up fairly sharply.

And without steps taken to improve BG you are likely to progress to full T2 diabetes. I shudder at what kind of BGs I was experiencing back in the old days (three and a half years ago) following the low fat 12 servings of carbs a day gov't pyramid.

Sometime when I get up, take a reading and it is below ninety I am going to go and get a whopper and a small fries, then check my BG every thirty minutes until it is back below 100. I will report on line with the results.

[eddiemcm]

"I expect a big shift in recommended treatment for prediabetes in the next few years."
Ditto to that.A wise prediabetic will treat
himself/herself as a diabetic.My FBG labels
me as a prediabetic but my BG readings go
down too slowly after a medium carb meal
for me to consider myself anything else than
a full fledged diabetic.
Bye for now
Eddie

[Lisa N]

The target for my readings BFG is <100. I understand that, but as I understand things and I could be wrong is BG goes up for anyone after eating and it should return back down to the 70-110 range after a couple of hours.

Someone who is not diabetic will experience a small rise in blood sugar after eating (a lot smaller than a diabetic) and will return to normal a lot faster than a couple of hours (more like 60 minutes reach 100 or less and no more than 90 minutes to return to fasting levels). http://www.geocities.com/jenny_the_bean/bloodsugar.htm
This is because non-diabetics still have their phase 1 insulin response intact where the body can excrete insulin immediately after a person begins eating wheras many, if not most, T2 have lost the phase 1 response (or it is greatly diminished) and must rely on the phase 2 insulin response to kick in about 70 minutes after they've eaten.
From what I've read, sustained levels of 150 or greater are where damage occurs.

[dancinbr]

Someone who is not diabetic will experience a small rise in blood sugar after eating (a lot smaller than a diabetic) and will return to normal a lot faster than a couple of hours (more like 60 minutes reach 100 or less and no more than 90 minutes to return to fasting levels). http://www.geocities.com/jenny_the_bean/bloodsugar.htm
This is because non-diabetics still have their phase 1 insulin response intact where the body can excrete insulin immediately after a person begins eating wheras many, if not most, T2 have lost the phase 1 response (or it is greatly diminished) and must rely on the phase 2 insulin response to kick in about 70 minutes after they've eaten.
From what I've read, sustained levels of 150 or greater are where damage occurs.

Lisa,

Thank you.

I followed your link and did some further reading and found this:

http://www.phlaunt.com/diabetes/14045621.php

The suggestion here is 125.

I also thought 150 until I came upon this URL above.

Your thoughts

Thanks,

Ralph

[Lisa N]

That's some interesting reading, Ralph. Thanks for posting the link. I didn't see specifically where the recommendation was to keep blood sugar below 125 but the majority of the studies did state that damage occurs any time blood sugar goes over 140.
My personal goal has been to not let my blood sugar spike more than 30-40 points after a meal and I usually am below 100 pre-meal.

I did find one comment in the link to be sobering: doctors can afford to set less demanding standards for their patients because they are not the ones who are going to lose their eyesight, kidney function or a limb and to add to that, I think many honestly believe that a) their patients are not capable of better control and/or b) tighter control is pointless because the disease will progress regardless. I don't believe a to be the case at all if the patient is sufficiently motivated and b) is probably true if their patients are given the standard diabetic diet. :p

[dancinbr]

That's some interesting reading, Ralph. Thanks for posting the link. I didn't see specifically where the recommendation was to keep blood sugar below 125 but the majority of the studies did state that damage occurs any time blood sugar goes over 140.
My personal goal has been to not let my blood sugar spike more than 30-40 points after a meal and I usually am below 100 pre-meal.

I did find one comment in the link to be sobering: doctors can afford to set less demanding standards for their patients because they are not the ones who are going to lose their eyesight, kidney function or a limb and to add to that, I think many honestly believe that a) their patients are not capable of better control and/or b) tighter control is pointless because the disease will progress regardless. I don't believe a to be the case at all if the patient is sufficiently motivated and b) is probably true if their patients are given the standard diabetic diet. :p

Hello Lisa - On the chart you will see that you must take the 140 and divide by 1.12 = 125 for the blood measure rather than the plasma measure.

So far with my meds my morning "dawn effect" is 140-150 and a good day when I am behaving myself is in the 120s. When I exercise it drops below 100 but then creeps up over time again to the 120s. Still adding meds, so I am not "under total control" yet.

Need to find and endocronologist. My family physician found the problem and started treatment, but I think I am better off working with a specialist.

I am equally concerned about diet since many Doctors tend to fall behind on research and what works and the attitude, etc., etc. I just switched Doctors for the same reason. My former family physician was getting quite arrogant. I told him off and left.

There are so many people out there that still believe low carbs is dangerous !

I have a question on carb counting. I am targeting for 60-100gms per day and getting better at it. When I do the numbers don't jump all over the place (like up to 190 or 250 two hours after eating) I read some where about subtracting carbs from the count that are fiber carbs. Is this correct?

I await my Dr. Bernstein book. It will be delivered in early to mid April.

In the meantime, I need to begin exploring his website as well.

Thanks.

Ralph

[Lisa N]

I have a question on carb counting. I am targeting for 60-100gms per day and getting better at it. When I do the numbers don't jump all over the place (like up to 190 or 250 two hours after eating) I read some where about subtracting carbs from the count that are fiber carbs. Is this correct?

Many people do subtract the fiber from the total carb count to get what is referred to as the 'net' carb count. The theory being that the body is not capable of digesting fiber, so why count it? For the most part that is an accurate statment, but in diabetics, high fiber amounts and large meals can cause blood sugars to spike higher than the carb count of the food eaten can account for (the moral of that comment being don't stuff yourself! ;) ).

If your blood sugars are improved but still not in normal range, perhaps 60-100 grams is still too high for you and subtracting the fiber would make things worse, not better?