Like many older T1s, I was first diagnosed as a T2, and given metformin. When i was correctly diagnosed, i stopped taking metformin and went on to insulin only, going in a couple of years from pens to a pump. I’ve been on a tandem pump with control-iq about 8 years now. I’m under pretty good control - A1C at 6.6 at last week’s 6 month check-in. I’m fortunate to be treated at the Joslin Clinic in Boston.
Thanks to a recent NYT article which I found referenced here, I’m going back on Metformin. I’ve looked through the archives, and there’s lots of bits about metformin here. Everyone knows a lot about it - it’s been studied for years.
My PA thought it was a good idea. So now I’m taking two big pills (500mg) with breakfast and dinner. Stay tuned - we’ll see what happens…
Considering how Metformin works it seems that it could be a good match for T1DM. It improves insulin sensitivity, slows digestion a bit. The inhibiting of glycogen conversion to glucose might be an issue because many with T1DM have Alpha cell disfunction.
Early days - but I notice a lot more dampening of spikes when on the Metformin (2 x a day - 500 mg a time). I am cautiously optimistic (cautiously is tough to spell - esp w/o any assistance).
A bit of a change in timing of my bowel movements - the PA says that can happen at the start of taking the medication. But no other noticeable side effects. The chart below from the last 24 hours is pretty flat for me - w/ no highs or lows.
It’s not a problem with the alpha cells, which produce glucagon, it’s a problem with the beta cells, which produce insulin; the beta cells are the primary regulator of the alpha cells so if they are not doing their job the alpha cells don’t get their primary regulation and, in the words, “There is an impaired glucagon response”.
Further impairing alpha cell function by directly reducing glucagon production (rather than expecting our non-existent beta cells to do it) reduces basal requirements. I’ve not seen any clear research as to what this does but that’s pretty much de rigueur for anything labelled “diabetic”.
I have my guesses about what might happen, but they are guesses and therefore total BS. The fact that you reported lowering of spikes in May is interesting (I would expect more spikes with lowered glucagon) so I’m somewhat interested in what has happened since.
My T2 wife is on 500mg/day and so far as I can see it makes no difference whatsoever. I just ordered a Lingo to see if we can detect some change with proper equipment
There is a relationship between healthy Alpha and Beta cells. They have receptors for the hormone secreted by the other. This, in my mind, is a good case for a negative feedback loop.
If what I’ve read is correct the Alpha insulin receptors only respond to endocrine produces insulin within the islet.
This means those with T1DM and some like me with dead Beta cells can have fully functional Alpha cells but they don’t lack data.
That’s approximately what the last paper I read says; it suggests that alpha cell glucagon response is only suppressed by the very high levels of insulin production from beta cells. Since they are in close proximity “very high levels” can correspond to not much at all; think how you respond when your partner is upset.
Fortunately we (T1s) don’t have that problem (or not).
Alpha cells do produce glucagon independently of the beta cells which we don’t have; the beta cells stop the glucgon response. Hence our basal. Nevertheless our whole metabolism is fail safe; when we lose those beta cells there is still a whole lot of us that survives, and we will!
Quick update - Now that I’m on the metformin, I have to reduce my basal rates. I tend to run lower now. This is what we’d expect, but the response isn’t linear (why should it be?). When I’m exercising, I’ll have to eat a lot more carbs to keep from going low now. And at night, I turn on Tandem’s exercise mode, to reduce the basal. Otherwise I’ll often go low in the middle of the night.
So, as we would expect, it increases my responsiveness to insulin (or you could say it increases insulin’s effectiveness?) but not in a simple or linear way. Much less change in the middle and upper ends of my glucose levels, and much more change on the lower extremes. So if I’m going down (via exercise, for example), now I’ll go down faster and further. But if I’m going up there doesn’t seem to be as much of an impact of the metformin - ie I stay up for about the same amount of time.
I swear that with diabetes some of us wake up in a new day every day. What worked well one day may or may not work the same the next, Oh, and as one gets older that seems to bring its own iinstabillity.
Thanks CarlosLuis - yeah that’s what the internet says. It is a relatively rare side effect … I can only report my own experience. It could also have had something to do with the increased exercise - I was doing about 55 miles a day of cycling and it was hot, so those things could have combined.
I’m wondering if anyone thinks I should give it another go?
“Constipation is possible with metformin treatment. In clinical trials of metformin, constipation was rarely reported.”
Are you going to be cycling at that level frequently? Are you able to be fully hydrated? I have been on metformin for a few years now and it helped dramatically with insulin resistance. I would hate to lose it. I also work out a ton (checked apple health recently and am at an average of 103 minutes/day for the past year (not extreme cardio, but cardio nonetheless). I do drink consistently and pretty big quantities of water daily. I would lean toward giving it another go, if you feel like your daily conditions could support it. Eric also recommends psycillium capsules if fiber is an issue.
Thanks Jessica - the hydration is a good question - quite possible that I was not fully hydrated initially … I agree with you about the insulin sensitivity. I might give it another go, maybe at a lower dose (500 mg/ day). See what happens.
