I’ve just been having a hell of a time lately keeping my mealtime BG where I want them. With virtually any carbs I am spiking to near 200. Taking more and more novolog doesn’t seem to be helping as much as it should. I understand that some of the problem is my own behaviors, such as not prebolusing as far in advance with novolog as I know is optimal, and not exercising as regularly as I should… but I have a life to life and things to do and its just not always practical. Afrezza continues to be a godsend for corrections but seems to be working not as well as it once did when it comes to pairing to food… it actually seems too fast, so that when the insulin wears off my BG skyrockets… in the past I only experienced this with really high fat meals but it seems to be happening with everything but the most simple carbs nowadays.
I think I’ve pressed bolus insulins to the limits that I am actually willing to, and I’m no longer getting the results I want as frequently as I’m happy with. So I’m wondering what’s the next step. I am wondering if metformin may help, in addition to my insulins, in keeping the mealtime BGs in check. Looking for the experiences of other T1s who’ve added metformin to their regimen… how did it work out for you? Have any other oral meds helped tame your mealtime BG or improve your carb tolerance?
My basal I am very very happy with, it is absolutely perfect with 1x daily tresiba. There is no room for improvement in that department.
Thanks in advance for any tips. I dug out a long-since expired bottle of metformin 500mg tablets. I’m going to start taking them 2x daily for a couple weeks and see what happens…
Meaning I know I’ll have improved results if I actually prebolused with novolog a full half hour ahead of meals, but that’s difficult to do in real life… and the earlier I prebolus the more likely later corrections are to be necessary
I find it takes 45 mins although highly dependent on the time of day and type of food. I would suggest to at least try a 45 min prebolus as a test to see if it works. If that doesn’t work it may lead you in a different direction.
I understand that increasing prebolus times might help in some ways in some cases… but there just reaches a point of practical limits… as a semi-functional adult I just can’t devote 3 hours each day to getting ready to eat… that’s just not my reality…
I am only suggesting to try it and make sure it works. If so then you have one approach that you may be able to use at times while looking for additional options.
If it doesn’t work - you may need to be more aggressive in terms of figuring out why you are not able to balance the carbs with the insulin.
I can’t offer experience with metformin (but wasn’t there a thread on that on here recently?), but if a longer prebolus (I do 45 mins as well) and exercise aren’t an option, that may be helpful, as it sounds like you might be dealing with some insulin resistance?
@drbbennett@docslotnick paging all doctors… actually there’s a lot more here than that just thought I remembered you guys mentioning metformin and other things
For me it really cuts down on the prebolus time I need. If I am good I usually prebolus around 15 minutes and if I am bad I just inject right before the meal.
Right now I am finding life and bad weather are getting in the way of exercise and prebolusing. Ok - maybe the weather does not impact prebolusing.
My usual solution to getting less exercise is eating less carbs. When I exercise more I find I can eat more carbs without the spikes.
I haven’t tried FIASP, although I’d be willing too. It may be a partial solution, although more and more it just seems like sometimes my bolus is too fast, sometimes it’s too slow, and less often it’s just right…
Exercise is definitely a factor… it’s mass darkness and frozen solid time here in AK… seasonal depression, sedentary behavior etc… multiple factors
It doesn’t work for us either. And it is the most common, and probably best, advice, and no matter how hard I try, how many carbs I weigh, count, whatever, we forget or screw up the pre-bolus. Lucky for 15 minutes, usually closer to “hurry up, the food is getting cold”. Don’t feel alone in that regard. It makes me understand how much easier life would be if we just opened a package with nutritional labeling that told me how many carbs are in there. (Although on that note, we’ve just gone through a quart of eggnog that destroyed EH repeatedly even though we carefully measured it as a recovery for lows, it must’ve been off by 35% in the nutritional label).
Anyhow, I will look forward to hearing how your Metformin trial goes. Also, I agree that exercise seems to be the biggest factor here with insulin resistance and/or carb to insulin ratios. I am sorry you’re struggling with this stuff. Keep us posted!
One more thought - have you tried varying where you inject? Arm instead of belly, etc.? Don’t suppose it’d help, but worth a shot.
So I use metformin, but I’m not sure it will solve your issue here, but no harm in trying. It probably will be easy to get someone to prescribe you 500mg ER 1x a day, then you can go to 2x a day, and then up to 1000mg 2xday (but move up slowly, esp if you do have digestive effects, and consider supplementing B12).
What it did for me though was 1.) increase my insulin sensitivity, lowering my TDD, with effects most noticeable in my basal dose, not my bolus/corrections, and 2.) nearly eliminated my dawn phenomenon. It had no effect whatsoever on my need to prebolus, and for carbs, I definitely need to or I will spike.
I recommend doing what I do and have posted about—take at least a few units or part of your dose (minumum likely) 30+ min in advance, and then figure out the rest with a follow up shot later, so you don’t need to know exactly what you’re eating, but at least you get a head start. Honestly, all it requires is a rough idea of when I’m eating, and a rough sense of the likely carb count or range. Even if I end up needing a fair bit more, at least the peak gets blunted somewhat. Or for meals when you can’t plan, go more LCHF, which makes all the difference and gets rid of all need for me to prebolus.
Also, I think a huge part of metformin’s effects for me occur via suppression of liver release of glycogen, which makes sense as to why it would lower basal rates and dawn phenomenon, but not effect my insulin needs re: covering carbs much at all. It also means that its effectiveness may depend on how active your liver is, and, if your liver is active and reactive, your lows may be more severe or hard to treat on metformin (mine can definitely be a bit more stubborn).
Over-bolusing greatly reduces the need to pre-bolus. If you take more insulin than you need for the meal, you can take the insulin very close to mealtime. Of course you need access to some food/carbs/sugar a little while later. As long as you can eat a snack an hour or two after your meal, it is a very easy way to do it.
In times when you can’t risk going low after the meal, or don’t have access to a snack as a follow-up, then low-carb for those meals makes sense.
What might work for what you want is Symlin actually, but that’s another shot, and I found it to be more annoying than worth it. It seems more inconvenient to me (especially with side effects of feeling a nauseous sort of full) than prebolusing, but you may differ.
I’ve been using metformin (to see if it helps with monthly hormones) for about four months now and have noticed no effect on carbohydrate tolerance. I’ve only noticed an improvement in basals (elimination of dawn phenomenon).
For any meals/snacks beyond about 15 grams, I absolutely need to prebolus by 30 minutes (I’m using Fiasp; it used to be prebolus by 45-60 minutes) or else I spike to 200+ mg/dl. The exception is when I exercise, where I can get away with eating a lot more and no prebolus.
@Sam As others have said I too have found that metformin has no effect on bolus amount or speed. Basically what it does for me is keep me from ever getting up to 300.
Same for Jardiance, the SGLT-2 inhibitor that I take. Since I’ve been using these drugs I can’t even remember the last time I spiked over 300.
For the problem you seem to be having you might want to try a technique described by Dana Lewis. It’s written for #DIYPS users but is easily adaptable to MDI.
Don’t feel alone in that regard. It makes me understand how much easier life would be if we just opened a package with nutritional labeling that told me how many carbs are in there. (Although on that note, we’ve just gone through a quart of eggnog that destroyed EH repeatedly even though we carefully measured it as a recovery for lows, it must’ve been off by 35% in the nutritional label).