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Metformin for Type 1 Diabetes – Really? Why?
You’ve heard it before: someone with type 2 diabetes goes on insulin. That’s no surprise. But how often have you heard the reverse — someone with type 1 going on Metformin?
Since the launch of Symlin in 2005, it’s not uncommon for people to treat their type 1 diabetes with a supplemental injectable medication. But hang around long enough, and you too might get to know someone with type 1 who takes insulin and oral meds, those formerly known as “type 2 only” drugs.
Really? Type 1’s taking oral meds alongside insulin? To clarify this, I just had to query some experts.
Just like in type 2 diabetes, people with type 1 diabetes can sometimes suffer from insulin resistance (when the insulin that’s present can’t perform it’s work properly), and Metformin can lower your insulin requirements by helping the body make better use of the stuff — in this case coming from an injection or insulin pump.
Gary Scheiner, CDE, author, and head of Integrated Diabetes Services in Wynnewood, PA, explained it this way: “Some of the more creative and aggressive endos are prescribing Metformin for type 1’s, particularly if they are overweight or requiring very large basal insulin doses. In addition to having some mild appetite-suppression effects, it will enhance insulin sensitivity by hepatic cells (in the liver) and limit the amount of glucose secreted by the liver. Personally, I think it can be helpful during adolescence as well. As long as the patient has good liver and kidney function, the side effects and risks are negligible.”
I also learned this: a couple of other uses of Metformin for women to consider are PCOS (ovary disease) and pregnancy.
Kelley Champ Crumpler, RN, who is a diabetes nurse educator and a type 1 diabetic married to an endocrinologist with type 1 diabetes (how’s that for keeping it in the family?), explained that, although PCOS is a cousin of type 2 diabetes, it can occur in women with type 1 diabetes.
She explains the science behind it: “High levels of insulin antagonize the production of hormones in the pituitary gland, which then signal for the ovaries to release higher amounts of testosterone. This extra testosterone then causes developing ovarian follicles to clump together and become sticky, which results in a cystic appearance. This can prevent ovulation from occurring, and also cause irregular menstrual cycles. In fact, PCOS is the No. 1 cause of infertility in American women. One in four of us has it.”
Using Metformin to treat PCOS helps decrease insulin levels. Who knew?!
In pregnancy, insulin resistance increases a ton during the second and third trimesters. As the pregnant diabetic increases insulin intake to keep blood sugar as close to normal as possible, the risk for preeclampsia and pregnancy induced hypertension also increase. Both are very dangerous for the mother and the baby.
“We began prescribing Metformin to these women, and suddenly, their insulin needs were going down. We have, at this time, had 20 successful deliveries of healthy infants to mother’s of type 1 diabetics who used Metformin during the pregnancy,” Kelley says.
And guess what else? Kelley is currently pregnant herself! She shares her experiences: “I, personally, have taken brand-name extended-release Metformin for two years. I also suffer from PCOS. It has allowed me to use less insulin during my current pregnancy, and I plan on continuing the use of Metformin throughout the remainder of the pregnancy, and into the postpartum state.”
Sam (a patient who refrained from sharing his last name) is a 30-year-old with type 1 diabetes. He also used Metformin to lower his insulin requirements. His doctor recommended it to him after Sam explained that he wanted to lose weight.
“My doctor suggested that Metformin could help both with reducing the amount of insulin I need (and therefore helping me to stop gaining fat), as well as reducing my appetite,” Sam explains.
Starting out was bumpy, with nausea and vomiting occurring a few times in the first two weeks, but Sam says he pushed through and the side effects went away. Although Sam isn’t using Metformin anymore, he was able to lose 42 pounds and reduce his insulin dosage by nearly half, which he says helped with the weight loss. (After the weight loss, Sam naturally doesn’t require as much insulin as before and has thus taken himself off the Metformin.)
Hmm, help with weight loss is always good, but those side effects don’t sound pleasant. Both Gary and Kelley say the instance of side effects is relatively low, yet Kelley adds: “Most often, we hear complaints of gastrointestinal side effects, most often diarrhea, cramping, nausea and flatulence. For many, this will go away with continued use, for others, they are just unable to tolerate the drug.”
So what if you don’t suffer from insulin resistance or PCOS? Is it still worth considering Metformin?
“We’ve seen about a 50/50 split, as to some receiving the benefit of decreased insulin use, and sometimes resulting weight loss — which then makes you question if there wasn’t SOME degree of insulin resistance to begin with — and others who receive no benefit at all,” Kelley says.
In short, this is completely new territory for me, because I’ve always considered oral diabetes drugs completely off the map for type 1s. So… do you or someone you know use Metformin to treat type 1 diabetes? What have your experiences been? Would you could considering going on Metformin if your doctor suggested it?
(Editor’s note: Kelley and her husband are located near College Station, TX. If you’re in the area, you can contact their office by email.)
I have metformin to thank for my 1 year old son. There is a reason why it’s on the WHO’s list of essential medications!
Posted by: kdroberts | January 25th, 2010 at 6:41 amGreat Post Amy!
Posted by: k2 | January 25th, 2010 at 6:58 amMy Dr. prescribed Metformin for me about almost 2.5 years ago, 500mgs, twice a day. He did so because he feels strongly that MF protects the bodies vascular system, AND he’s seen tremendous success in reducing spikes in his T1’s who take MF .
I definitely noticed less spikes in my bgs, I lost about 7 lbs, and my a1c went down.
The first few weeks played a number on my stomach, but that went away within a month.
After a few months I reduced the amount to once a day, 500 mgs before bed (my Doc was fine with it) because I wasn’t hungry at all.
I stopped taking the Metformin this past July because even only taking 500 mgs a day, I had almost no appetite at all.
Plus, I noticed my hair was thinning a bit.
I’m not sure if that was related to stress, genetics, age, or the MF, but I decided to take a break.
I was also nervous that since I had no appetite, I’d screw up my metabolism.
I’ve managed to keep the 7 lbs off and my a1c’s have remained under 7, except for my last one, which was 7.1
My Doc was still pleased because he expected to be in the mid 8’s after all the stress that life brought my way in December.
I might go back on MF, I might not. My Dr says it’s up to me. I’m marinating on my decision for a while.
Kelly K
I had no idea PCOS was that common.
Posted by: mollyjade | January 25th, 2010 at 7:31 amI was originally diagnosed as a Type II and put on metformin. I tolerated it very well, no side effects as others have reported. I was recently re-diagnosed as LADA Type 1.5, given insulin but also kept on metformin by my family practioner. I thought it was strange too, but will ask my endo about it this week. Interesting post, thanks!
Posted by: Barbara Campbell | January 25th, 2010 at 7:38 amAnother informative piece. My Wife who is T1 has been taking Metformin ever since she was ‘upgraded’ from T2 to T1 along with 2 different Insulins.
Posted by: Tom Moore | January 25th, 2010 at 8:13 amI have type 1 and PCOS. Metformin has been a godsend. Thankfully my endo is up on current treatments for PCOS and was more than happy to prescribe it for me. I’m taking more than half the amount of insulin I was taking before starting met. I also lost 20 pounds without trying within the first 3 months. It makes taking insulin a little tricky sometimes and my low-lows (in the 40s) can last quite a long time (an hour or more) but I’m happy to be on it.
Posted by: Sarah | January 25th, 2010 at 8:18 amAs someone who was placed on Metformin for 7 months and who is not insulin resistant, does not have PCOS, and is not in need of weight loss (I currently weigh in at 90 lbs), I feel confident in saying that Metformin is NOT an appropriate drug for anyone (type 1 or type 2) who does not meet those basic criteria. It did very little for me except to give me all of the gastrointestinal problems, reduce my appetite, cause me to lose 14 lbs (which I didn’t need to do and which I had spent nearly 10 years trying to put on), and heighten my insulin sensitivity so much that my initial dose of Lantus was only 2 units and my first insulin-to-carb ratio was 1:50. Metformin has its uses and I have believed since its initial approval back in the 1990s that it could have a place in the treatment of type 1 dm with concurrent insulin resistance or as an adjunct to weight loss. For people like myself, though, it is not a useful drug.
Posted by: AngelaC | January 25th, 2010 at 9:10 amI have been Type 1 for 64 years. In the early/mid 1990s I was using Humulin insulins and gaining weight. I did not know why, so I decreased my carb intake and increased my exercise but could not lose the weight. My total daily dosage had increased 40% by 1998 and I had gained 57 pounds. I was diagnosed with insulin resistance. It sure took a long time for my doctor to come up with that diagnosis. I began taking Avandia in 1999 and have been taking it for 10 years. It works very well for me. My daily carb intake averages 130g and I have lost 34 pounds. My total daily insulin dosage is now 34 units.
I have so much trouble losing the weight I had gained. Maybe I should try Metformin instead of Avandia. I have read that Avandia tends to cause weight gain, but Metformin is more likely to reduce our insulin dosages and out weight as well.
Richard
Posted by: Richard157 | January 25th, 2010 at 10:37 amI am so glad to read this post.
I have had increasing insulin resistance for the last five years or so, and have problems convincing my Endos of it, even though my insulin-to-carb ratios have more than doubled and I have gained 20 pounds. Only one Endo, the one I had when I lived in Germany, admitted that insulin resistance is common in type 1 women due to female hormones and that it does not usually go away until menopause.
I am pregnant now, and don’t want to add any new variables, but am gathering evidence to present to my current Endo after the pregnancy.
My mom, also a Type 1, struggled with the same type of insulin resistance during her 30’s and 40’s. The only way she could manage the weight gain was by severely limiting her calorie intake. Her insulin resistance basically disappeared after she had a hysterectomy (menopause).
Posted by: nici | January 25th, 2010 at 11:19 amBeen a type 2 for about 12 years now. I was on insulin for 4 years at first then I was on Actos for 2 years and finally metformin for the last 6. Not too many side effects on the metformin except loss of appetite but it also helps with the weight loss so I cant complain much.
Posted by: the poor diabetic | January 25th, 2010 at 11:43 amIts news to me however that type 1’s are taking it too.
a little update on Typ2?
Posted by: Hans | January 25th, 2010 at 11:48 amhttp://www.dlife.com/dLife/do/ShowContent/inspiration_expert_advice/expert_columns/garnero_0608.html
Thank you for posting this Amy. I have gained about 30 pounds in the last 7 years but a lot of it in the past 2 years or so. I know there are numerous factors that have contributed to this gain overall but more recently I have not changed any eating or activity habits and my insulin needs have also increased significantly in the past few months. My old CDE asked me once if I had any type 2’s in my family and when my answer was yes, my maternal grandfather was type 2, she thought that was the reason for my insulin resistance. So it appears I am resistant. I have an appointment with my endo this week and as I was already going to discuss my weight & insulin rates, I just may add this to the discussion as well. She gave me Symlin to try last year but I honestly don’t want to be taking injections again since I gave that up when going on the pump!
Posted by: Stacey D. | January 25th, 2010 at 11:56 amSecond try. My first comment disappeared.
I am so glad to read this post!
I have had type 1 for 27 years and have been fighting insulin resistance for the last five or so (since my late 20’s.) I have had little luck convincing my Endos of this though, even though my insulin-to-carb ratios have more than doubled and I have gained 20 pounds.
I did get one Endo to admit that insulin resistance is common in Type 1 women during their childbearing years due to increased female hormone levels. He said it will go away when I go into menopause. Great! What do I do in the meantime?
I am pregnant right now, so don’t want to add another variable to the mix, but I am gathering evidence to present to my current Endo for adding Metformin to my regimen after the pregnancy.
My mother, also a long-time Type 1, had insulin resistance in her 30’s and 40’s, too. The only way she could keep her weight in check was to severely reduce her calorie intake (think less than 1000 calories per day.) Her insulin resistance basically disappeared when she had a hysterectomy.
Posted by: nici | January 25th, 2010 at 12:21 pmI just wanted to pass on some useful info regarding the side effects of Metformin. If you take your dose before your meal, along with a serving of yogurt and a glass of water, it can reduce or eliminate the gastric distress this medication causes. We use the “No Sugar Added” yogurt by Danone to keep the carbs down.
This worked great for my husband, and many, many friends I have recommended it to.
I hope you can pass this info along. I always enjoy your informative articles,
Emmy
Posted by: Emmy | January 25th, 2010 at 3:06 pmI agree with Angela C — metformin has limited use in type 1s, and it has some unpleasant side effects. Exercise and weight training will also dramatically increase insulin sensitivity, so that would be first-line in my opinion. I am a type 1 woman in my twenties and I am very insulin-sensitive, probably due in large part to daily exercise.
As for 1 in 4 women having PCOS, I’d like to see the references supporting that statement.
Posted by: Lauren K | January 25th, 2010 at 5:16 pmgood to know if, after 30+ years of T1, somewhere down the line I become “insulin-resistant” (moreso than, say, average insulin-resistance from illness, lack of exercise, etc.). Everything written here is news to me!
Posted by: T1 in Boston | January 25th, 2010 at 6:36 pmThis may help someday soon with the metformin side effects:
WORCESTER, Mass., Jun 29, 2009 Generex Biotechnology Corporation (www.generex.com) / announced today that the company has reviewed the positive data from its bioequivalent study with MetControl(tm), its proprietary metformin chewing gum product study conducted in November 2008. Results of the fully compliant ICH-GCP conducted study indicate that MetControl(tm) chewing gum and traditional Metformin tablets are bioequivalent in respect of both the rate and the extent of systemic absorption. Management believes the results provide convincing evidence that MetControl(tm) and Metformin tablets are therapeutically equivalent and therefore interchangeable. / The company is currently preparing the data in a form for submission to various regulatory authorities throughout the world. Management intends to complete a marketing assessment in the coming months in order to determine the number and order of regulatory submissions it will undertake and anticipates making submissions beginning in the first quarter of 2010. / While Metformin is currently the most prescribed drug for Type 2 diabetes, there is a significantly large population of diabetics who do not use it for a variety of reasons, including gastrointestinal side effects, large pill size and bitter taste. These are particularly important factors when considering the expanding population of children with Type 2 diabetes. Management believes MetControl(tm) overcomes these obstacles making the drug more acceptable to patients which will not only lead to more compliance with the therapy but also increase its usage substantially among the diabetic population.
http://www.generex.com/press_release_desc.php?id=118&year=MjAwOQ==
Image available
http://www.diabeteshealth.com/media/images/article_images/5755.jpg
There are a lot of interesting and promising advances on the horizon. Hopefully, they are successful.
Posted by: rjs | January 25th, 2010 at 8:55 pmAngela seems to be the only one here besides myself who questions the use in people who are neither insulin resistant nor overweight. My experience, after five years popping two pills a day was that I was forever grateful when I got off this drug. Changing endos was the main factor (always question what your doctor wants you to take). After five years of taking this pharmaceutical medicine, and then suddenly stopping, my blood-sugars improved. This medicine had the effect in me that I couldn’t how the carbs I was eating would flow into my bloodstream. I often suffered long terms of extreme lows untreatable with glucose (it could take up to two hours to raise my bs), followed by a miserable high. So, consider what you are taking and what for before you go on it…
Another thing, it was such a relief NOT to have to think about taking those pills, not having the detritus of the packaging, not having to carry it around–just to simplify an already complicated condition.
Posted by: DS | January 25th, 2010 at 10:30 pmI am a T1 who takes Fortamet, the extended release version of Metformin, and I couldnt be happier. I started this long before my pregnancy ( I am currently 13 weeks pregnancy with my first child) and immediately saw a drop in the amount of insulin that I was pumping into my body. I am also looking forward to this medicine helping me through the second and third trimesters when insulin resistence really starts setting in.
I’ll admit I looked at my Edno funny when he suggested trying Metformin…and it took me a little while to agree…But I am very happy with the results
Posted by: Stacey | January 26th, 2010 at 6:19 amI want to make clear that my problem with Metformin was less with its common side effects (nausea, gas, bloating, diarrhea, etc) than with its ineffectiveness *for me*. It did lower my fastings, from 170 mg/dl to 100 mg/dl, but it did *nothing* for my post-meal numbers, which remained in excess of 200 mg/dl for 3-4 hours at a time after every meal. It also caused me to lose 14 lbs (13% of my starting body weight) fairly quickly — the majority of it within a few weeks. It did increase my insuin sensitivity, as it is supposed to do, but my problem was not with insulin resistance. Since I stopped taking Metformin, my insulin needs have remained minimal: I need only 5 u of Lantus *per day* and my insulin:carb ratio is between 1:15-1:20. Hardly the “massive” doses of insulin that would be expected if I were insulin resistant. Thus, in answer to Amy’s question, “So what if you don’t suffer from insulin resistance or PCOS? Is it still worth considering Metformin?”, my answer, based on my experience (and my experience ALONE) is an unqualified NO.
Posted by: AngelaC | January 26th, 2010 at 8:23 amAngelaC, I think you are agreeing with everyone here. this article, and comments are saying that if you are type 1 you can still have PCOS and/or insulin resistance. And if you do, Metformin may help.
Posted by: Chrissy | January 26th, 2010 at 1:59 pmAs a thin person with (autoimmune) Type 1 diabetes, I don’t think I would add a pharmaceutical to my insulin. I do think it would be helpful for overweight T1s, PCOS sufferers, and/or those with a genetic predisposition to insulin resistance, but not for the Type 1 community at large. I am so insulin sensitive that sometimes I only need less than half a unit for a large correction. For people like me, adding a drug to the mix would probably do more harm than good. For overweight T1s, there are other effective ways to lose weight with medical supervision and not turn to Big Pharma. Many T1s think they can eat whatever they want as long as they cover it with insulin…that’s a good way to become insulin resistant and gain weight, just like anyone else (non-diabetic) who does the same. Although most T1s are very insulin sensitive and thin, if you make bad choices, you are not automatically immune to their effects.
Posted by: Sarah | January 27th, 2010 at 5:32 pmWhen my daughter Type ! was 13 her insulin requirements skyrocketed along with her weght. After several endo’s and using the internet we finally convinced our endo to try Metformin. Her basal insulin dose was cut in half with no gastrointestinal issues. She has been unable to lose any weight despite vigorous daily exercise and decreased caloric intake. We have wondered if there could be any other medication that could assist in assisting with weight loss. Has anyone tried any other medication for insulin resistance? At 19 now she is extremely frustrated as it appears she will remain 40 pounds overweight despite eating extremely healthy, etc.
Posted by: Kris | January 27th, 2010 at 8:28 pmI am currently type II with a possible type 1.5 in the near future. I am prescribed a heavy dose of metformin(4 tabs of 500 a day) and 10 mg of glipiside). My Glucose levels are around 200-300 levels with low of 150 with plenty of exercise. I am 67 years old and have been type II for about 7 or 8 years.
Posted by: Dave | January 29th, 2010 at 7:00 amI have been able to counter the gas and loose stool that accompany this dose with a good krill oil tablet. Sometimes 2 pills are necessary. I have been countering the high glucose with 500 mg tablets of Cinnamon once an hour until the levels come down. That is why I have been able to keep off insulin. I suspect those days are going away soon. I can drop the sugar levels a 100 points using the cinnamon which makes me suspect the natural production of insulin is quite low. Why the Krill oil has that effect I have no idea. All I know is it works. Be very careful to only take one and watch the effect before taking more. Otherwise you will have the opposite problem. I caution that I can only tell you what works for me. I am not a doctor. I am just a person with a similar problem.
The cinnamon approach might work with the type Is. First it works in a parallel way to the insulin. If the insulin resistance is there, it is there for a reason. I personally believe we are a very sophisticated biological machine with genetic errors built in. The insulin resistance is to keep you from overdosing your sugar levels in the cells and killing yourself.
The common mistake by the drug companies and doctors is to take the high glucose levels in the blood and ignore the leptin levels and ignore what is going on inside the cells. Strangely you can have high glucose in the blood and low glucose in the cells at the same time.
Cinnamon is not an answer. It is a temporary solution. It has the advantage of shutting down if you accidentally overdose on it which makes it fairly safe. Most drugs do not do that. I would recommend asking your doctor if it will do you any harm to try it. What works for me might be harmful to someone else. But if it gives relief from the insulin resistance in a type I it might be worth a try.
The side effects of metformin are gas and loose stools. That is considerably less than the other drugs on the market. I would suggest a good fish oil tablet or the krill oil might help.
I have been a type 1 for 19 years. My endo put me on the Metformin for over a year. It was not any help to me. It didn’t increase my insulin efficiency nor did I lose weight. In fact, I gained weight with it. I didn’t experience any side effects other than an increase in psoriasis.
Posted by: candy | January 30th, 2010 at 9:37 amMy daughter, 16 years old & has been on a pump for nine years, went on Metformin about 8 months ago. She was experiencing high resistance that is common with teens & type 1.
She has lowered her overall daily dose of insulin, slimmed out, and experienced no side effects.
Posted by: Susan | February 3rd, 2010 at 2:15 pm