There are some fantastic older threads about metformin and type 1, such as this one: Trying out Metformin... Wow!
A little while ago, I had a virtual meeting with someone from Integrated Diabetes and she made several suggestions to bring up to my PCP (who is currently taking care of my diabetes needs). One suggestion was to try metformin. She thought it might help with my post-meal spikes. I’m currently on MDI (Lantus) and taking Ozempic, which she also recommended increasing.
I was wondering for those who have been using metformin as T1Ds - how is it going? What’s the best strategy for when to take it, and how much do you take?
I was on metformin before I started insulin, and I continued taking it for a while afterwards. If I remember, I dropped it because I didn’t want to mess around with my B12 absorption (even though I take a supplement). I think I became a little less insulin sensitive after that, although it coincides with so many other changes it’s hard to know. Wouldn’t be against experimenting with starting it up again, though. I took 1000mg once at breakfast. Had no ill effects from it.
How did you determine how much and when to take the metformin? Since my PCP takes care of my diabetes stuff (only for the last few months), I’m not sure how to approach this with her exactly. I don’t know if she will want to try one thing or let me experiment with dosing.
So, we came to metformin as a compromise b/c I really wanted (still want) to try Ozempic and she was not comfortable with that for me. We started with 1000mg at night (I first broke the 500mg pills in half and went up very gradually) and then when my insulin sensitivity improved so well, added the 500mg ostensibly at breakfast, but since I typically don’t eat breakfast, I added it after lunch. I read the thread linked above and I probably should play around with being more precise about dosage timing to see what it does with BS control, but things are going relatively well for me swagging at dosage timing. (Sometimes I wind up taking the afternoon dose in the evening as well; life happens.)
My theory for me: I think everyone later in life starts to lose insulin sensitivity (not affected by type 1) and metformin is a great basic drug to help goose it. It is also long-standing in the market and shown to have relatively few side effects. Keep us posted if you give it a try!
Thanks again! I have been on Ozempic/Tresiba/Victoza for 10+ years and it has REALLY helped with my food intake, and therefore my blood sugars - I wish everyone could take it.
I’m wondering if the metformin will help smooth things out even more… will keep you posted
I am lost on all of these drugs. It would be great to have a wiki page on FUD that gives an explanation of the different types and how they actually work.
I always want to know how a thing works. If you ask “What does Metformin do?”, and someone says “It helps your blood sugar”, that’s not what I want to know!
I searched around a little bit and put together these explanations of the different types and what they do. But this is just scratching the surface of how these different things work. Googling them can be maddening!
Metformin reduces glucose production in the liver. How does it do this? It is a glycerophosphate dehydrogenase (GPD2) inhibitor.
(Others in this class are Glucophage, Fortamet, and others.)
Ozempic helps triggers insulin release. How does it do this? It does this by mimicking GLP-1 (glucagon-like peptide-1). It is a GLP-1 agonist.
(Others in this class are Rybelsus, Trulicity, and others.)
Jardiance removes extra glucose from your body. How does it do this? It helps your kidneys remove extra glucose and sodium from through your urine. It is a sodium-glucose transport protein 2 (SGLT2) inhibitor.
(Others in this class are Invokana, Farxiga, and others.)
From that, a person can take the term, like GLP-1, and see the chain of things that are connected to it and follow the path.
Insulin has a very complicated series of interactions too, but the simple explanation is to say it opens up the cells to allow them to receive glucose. Without insulin, glucose can’t get into the cells, so the glucose stays in the blood and blood glucose is high. That’s an easy one!
Thanks for this info! The person at Integrated Diabetes also recommended an SGLT2 but didn’t say what it does, and I hadn’t heard of it, so I wasn’t going to jump all over that one. Is it worth it? Idk!
I would like to add that Metformin has 2 actions besides reducing the conversion of glycogen into glucose..It slows the digestion a bit, which sort of meters the glucose entering the bloodstream and in increases insulin sensitivity.
The common gastric side effects are most likely due to the effect on the digestive system. This may also worsen or increase the risk of developing Gastroparesis.
I don’t know much about it. Personally I am nervous about tinkering with my body’s chemistry.
I take insulin, but that’s a natural hormone. Everyone “takes” insulin, in one form or other - from pancreas, injections, or pump. That one feels safe to me. But that’s just my feelings. Everyone has to find their comfort zone on these things.
SGLT 2 inhibitors decrease the kidneys, glucose threshold, so they cause glucose to be dumped into urine at a lower BG level.
The possible side effects include increased risk of UTIs, and genital yeast infection. A pro is they protect the heart and kidneys.
One really dangerous thing is even us T2DMs who are not prone to DKA, there is a high risk when under anesthesia. Guess what, many anesthesiologists and surgeons seem to be unaware. I was clued by my son who went into DKA while on jardiance and having surgery.
I was on Farxiga until after my radical bladder removal with a stoma to carry insulin out. They use a bit of small intestine for the conduit. This causes a positive feedback loop for us.
The glucose rich urine in that bit of small intestine will be transported back into the bloodstream. For me this caused my BG to roller coaster with the pump trying to work in an unstable situation.
But that’s just my feelings. Everyone has to find their comfort zone on these things.