I have also hit well over 300 numerous times on metformin. I wish it had that effect on me…
In addition to the 45 min pre bolus, which I can do most of the time because I’m at home a lot, I do as @Eric and @cardamom suggest and sometimes overbolus (generally for more carby meals) or bolus a conservative guess up front if I’m not sure exactly what I’ll need, and more later if I think I’ll need it. Ha, that last strategy really helps in making me stay lower carb or have better portion control because a lot of the time I don’t want to bother with an extra shot later. 
Well I still mange to avoid 300… I am truly eating like a squirrel to not spend much of any time above 180 though. And that’s not ok with me… I’m an eater. Careful bolus and a fried egg with a slice of toast is shooting me from 80 to 180ish
The other day I ate some dark chocolate equal to 14 grams of carbs and shot from about 5.5 mmol/L (100 mg/dl) to 14.5 mmol/L (250 mg/dl). I turned around and came back down into range within two hours, but that’s what not pre-bolusing does to me. Even with Fiasp, the insulin just can’t keep up with the food, so I end up with a giant spike even if I’ve taken enough insulin. Pre-bolusing by 15-30 minutes eliminates the spikes entirely.
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I don’t go into the 300s often these days, but if I really miss on the time or dose on a high carb meal, I definitely can, and metformin hasn’t changed that one bit. It’s much of why I try not to eat high carb most of the time, because the mis-estimations have such drastic results. To be honest, I think it’s pretty normal for most T1 diabetics to have to prebolus, eat low(er) carb, and/or exercise a ton (both to increase need for carbs and to make a strategy like overbolusing make sense calorically) to not have spikes.
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I switched from Humalog to Fiasp because, especially at breakfast and dinnertime, a long prebolus time was not practical, but unfortunately I did not find it was significantly faster than Humalog (5 minutes, maybe, but that doesn’t make any difference when you’re talking an ideal prebolus time of 45 or even 30 minutes).
The above-mentioned “eating soon mode” sounded like a great approach, but again, I did not find it effective, and it was actually a pain having to change pump settings every time I bolused.
Have you experimented with super-bolusing? It does reduce spiking, but the backlash can be a spike hours later. If you find you’re still going too high, you could try super-bolusing without the following zero temp/suspended basal. But then you risk running into the problem of taking Just Too Much Insulin.
A workaround for the dinner prebolus time for me has been to have a small carby snack with my evening cocktail (bonus!) and include with that bolus insulin for some or even all of the known dinner carb. The snack prevents me from dropping too drastically (which I’m dangerously prone to do) while those 45 minutes pass rather pleasantly. (Unlike in the morning, when 45 minutes is a long time to fill before breakfast. It would be a perfect time to fit in some exercise, but unfortunately exercise early in the day literally nauseates me.)
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Metformin might be a good idea. We all know that metformin helps with insulin resistance. My experience is from t2 treatment.
Metformin helps to restore 1st stage insulin response ( not sure how or if this works in t1 ) by reducing resistance it help basals to work more efficiently thus allowing more of basal to go toward building stored insulin necessary for first stage response.
Not sure if this revelant to a t1.
Sam, I have seen someone suggesting take Afrezza both before and after meal and they are getting good results. This seems to be a different approach than yours as I recall you generally just take one puff somewhere after your start your meal, with follow-up doses later, if needed. Perhaps you can experiment with this approach to see if this approach also works for you.
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@SLEE Yes it is relevant to T1’s. T1’s and T2’s (and gluconormal people) are all essentially the same as far as insulin is concerned, we just get it from different places.
And before you all correct me, I am just talking about how we get insulin, not all of the other physiologic differences.
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THanks @livingandlearning201
Taking it before I eat doesn’t really fit my profiles… I’ve been experimenting some with other means of timing and pairing with novolog… one thing not about insulin of any kind is you’re never done experimenting
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Started out with 2x daily 500 a couple days ago which were the instructions on the bottle (my marching orders for the first day I was diagnosed with diabetes until the doctor called me back into the office and put me on insulin). I’m thinking maybe o should have tried 1x daily for a week or two instead. The gastro side effects have definitely been noticeable and not real pleasant.
Blood sugars have been quite good but too early to tell if that’s anything to do with metformin, though last night did have a couple uncharacteristic over night lows, one of which may have been a false alarm on the cgm because the meter disagreed, the other seems to have been legit…
Think I may reduce to 1x daily for a week or two and see if I can build up a tolerance
They don’t call it Metfartin for nothing.
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I’m the weirdo who had no noticeable GI effects from it (I know of a few others too, but we seem to be a minority), but I did start with 500mg 1xday, then 500mg 2xday, then 750mg 2xday, then 1000mg 2xday.
I would def assume you’ll need to reduce your basal insulin as it kicks in.
How long would I expect for it to be fully working? Is this a one pill at a time sort of thing like ibuprofen? Or something that builds up for weeks to start working, like Prozac?
I don’t think it takes that long. Prozac and things like that are unusual, because like most meds, they get to full blood levels almost immediately, which is why side effects occur immediately, it’s just that the brain is slower to respond in terms of up/downregulating neurotransmitter receptors. I noticed metformin effects fully within a few days, and I notice it if I miss a dose by the end of that day (blood sugars start running a bit high).
I started metformin this past summer. I started at 500 2x per day and still on that. I started with 1 per day for first 2 days, then added 2nd dose.
However, being summer and crazier schedule and meal times, I was not consistent at which meals I took it at, and sometime only once per day. So I didn’t have any side effects.
Now I have been taking regularly at breakfast and dinner, and BG results are much better. I have reduced pump basal and bolus by about 10%. My bolus seems to kick in faster and have cut back on using Afrezza.
This corresponds to my understanding that metformin prevents or reduces glucose dump from liver, so bolus is just dealing with what I eat.
So working great as long as I remember to take it!
Think I’m going to skip tomorrow mornings dose since I’m going fishing and don’t want to have my guts in a knot while out on boat