All about Insulin and insulin resistance at an advanced level

Question about the Metformin, Ozempic, Mounjaro, etc. types of medications.

Since they slow digestion, does that cause a problem if you are low and trying to treat a low? Does it impact that as well?

Most of the times when I am low, I eat something and have to wait a few minutes for my BG to come up. I know I have eaten enough, but just waiting on it. 10 minutes, 15 minutes, or whatever.

Would the delay get worse with those medications?

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@Eric This is a good question. I have only treated lows while on metformin, but I am going to do a week trial off of it soon and if I have one in that period I will report back.

For me, it depends on the kind of low. Drifting under 70 and still some insulin on board, I will have a few berries and that will work within 15 minutes or so as long as my stomach isn’t completely full. Occasionally I’ll have a cookie, with the same results. With a faster fall or a fuller stomach, I always go for glucose tabs, Skittles, or juice. But digestion speed isn’t an issue for those.

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@Eric I’m not using the products, so do not know the answer. However, I’d recommend a test of two parts: 1) using food (i.e. solid forms) that would presumably be impacted by movement through the system; and 2) using liquids that, my understanding, would go through the system much faster unless absorbed by solid chewed food. Juices, glucose tabs dissolved by water/spit week to have much faster impacts for lows. If I’m incorrect, I’d be glad to be corrected…

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Yes, I believe liquids are faster since they don’t require the physical breakdown.

I don’t use any of those meds either. I was just asking because I was low and had just eaten something and was impatiently waiting for my BG to come up, and the thought occurred to me - wouldn’t delaying a person’s digestion make them wait even more?

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Following up on the above discussion of metformin, I’ve been off it for a week now. I was taking 1000mg 1x/day for a couple of years. What I’ve noticed is:

  1. The severe constipation that I had has resolved, which is a relief. Probably this was due to the slowing effect of the medication on digestion.

  2. Have not seen any obvious or striking changes to blood sugar management. Insulin doses are about the same, and nothing radically different in terms of “spikiness” or time course of peaks. (Caveat that I am still in honeymoon so things change somewhat often anyway.)

So for me as a T1/LADA I don’t see any downside to having dropped the metformin. For others there may be benefits of course, but in terms of this one target (BG management) I personally will probably continue to stay off it.

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@Josie replying waaaay late here, have you decided?

Ginger and I have collaborated a bit, and metformin-extended release works for me, too. Really tamps down my dawn phenomenon. I started it way before my ozempic, and I actually got a bit of diarrhea in the beginning!

In me, it does not slow down my digestion, at all. My sensitivity to Insulin increased, so less insulin is great.

I know some people that take the extended release only at night for dawn phenomenon, but not during the day. *I found I have to take it at exactly the same time, within a 30 minute window, to get the predictability of it’s peak action time.

Whatever works best for you. As with all T1Ds: no one size fits all!

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I have also meant to give an update here. I have been using metformin for about 6 months now and its effect on dawn and FOTF phenomenon has been nothing short of incredible for me. It has also dramatically improved my insulin sensitivity, particularly in the morning (right now 1u Humalog drops blood sugar 125 points…!). I also take 1000mg XR close to bedtime to ensure it’s working well overnight and through the morning. At my most recent endo appointment, I pushed again to try Ozempic and was denied, but compromised on adding another 500mg of metformin at lunchtime to try to improve insulin sensitivity further throughout the daytime. I still would like the opportunity to test out the behavioral benefits (surrounding food) of Ozempic.

I will say that metformin possibly slows digestion in me some. For treating lows, if I stick with juice the time to bring blood sugar back up is just fine – I think sugar absorption begins through the stomach wall. If I use solids it seems to take a little longer. I am still working on what my real insulin ratios are with adding in metformin. This has been a real game-changer for me and wonderful to be able to sleep through the night with normal blood sugars.

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Thank you for your reply! I haven’t started yet. My next appointment is in May so I’m going to ask then. I’m guessing Metformin is so inexpensive and safe that my provider wouldn’t care. Did you find that metformin helped at all with hunger?

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@Josie it’s quite cheap, on almost all formularies, so it shouldn’t be any issue. I can’t say that it helped with hunger pangs, but def does help with insulin sensitivity.

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@JessicaD following up further: I found over the last 2 months that my timing on my metformin had to get tighter. Because it peaks at about 7 hours, that was enough to change my overnight basal rates, as well as my afternoons.

Now that I take it at 9am & 9pm (in the strict range of 8:45am/pm-9:15am/pm), my rates are spot on and time well with DF especially. It really has that much of an effect on me, as in previous posts I’ve shown how sensitive I am. While it’s a pain to have to be so regimented, the reward is worth it.

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I’ve tried over the years to get onto a low dose of metformin as a T1D for helping with the dawn phenomenon, but now after 10 years with various doctors I finally have an Endo after almost 30 years without one. And they flatly refuse like all the others. I would even try to ask about Ozempic, since I know I’ll be given that look. LOL

Canada’s healthcare system depending on where you live isn’t the greatest along with Pharmacare/Technology coverage​:rofl::crazy_face:. Maybe I’ll luck in though with this Endo signing paperwork for me to take part in the Vertex clinical trial here in Canada (I had warned the team about it earlier this month).

Wish me luck … there month long interview process to be accepted has been interesting due to no long distance plan on my mobile with FL interviews have been done by mobile text … which had red flags going through my head(no 1-800 number) . Here’s the link incase you’re wondering what I’m blabbing on about … it’s the VX22-264-101 which I think is similar or same as what Brian Skelton who died back in December was involved in … https://t1diabetestrial.com/?gad_source=1&gclid=CjwKCAiAivGuBhBEEiwAWiFmYf8OhQabpDL3VSOwS3BILrPCVZG5UCSkYRtoC3Dx0r-Rua0ViYzX3hoCsmgQAvD_BwE#find-study

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