Not long ago, I reported here on the possible benefits of Metformin for people with type 1 diabetes. It is of course an oral medication traditionally aimed at type 2 diabetics who are not on insulin. Today, we revisit that issue with a real live test case — my friend and colleague Allison Blass, who’s recently added Metformin to her own regime:
A Guest Post by Allison Blass
Over the past few years, since graduating from college, I noticed something peculiar happening. My insulin requirements had slowly but surely gone up dramatically, to the point that I was taking nearly double the total daily dose of insulin that I was taking just 3 years earlier. Not only that but my blood sugars were actually get worse, and my weight had also slowly gone up.
During a discussion with my endocrinologist in November, she mentioned the possibility of going on Metformin or Symlin. I was familiar with Symlin, having tried it unsuccessfully in college. I had never heard of anyone with type 1 diabetes going on Metformin, but I was intrigued. My endocrinologist and I decided that I was going to try amping up my work-outs at the gym first, and if I didn’t find that successful, I would go on Metformin.
In the meantime, I had read more about people going on Metformin and heard from people with type 1 on the TuDiabetes community who were starting to explore the possibility of taking Metformin to help increase their sensitivity. Last month, I had my next appointment. While my A1C had dropped (about .5%), it was still higher than I wanted and I was still have unexplained and stubborn high blood sugars. I requested Metformin.
My endocrinologist explained how it would work: unlike people with type 2 diabetes, I would still have to take insulin using my pump, but the Metformin would help my body use this insulin more effectively. I would be more sensitive to the insulin. We were going to start titrating the dose of the extended version of Metformin, starting with 500 mg, then moving up to 1,000 mg after a week since Metformin can cause gastrointestinal problems like nausea.
Boy did I have gastrointestinal problems! I won’t get into the TMI details, but I became good friends with the bathroom for the first couple of weeks. Now in my third week on Metformin and using 1,000 mg, the side effects have started to subside and it’s much more infrequent. I didn’t have any nausea and unlike Symlin, which burned and worked unpredictably, this was the only frustrating part of Metformin but it was something I knew would go away. The burning and unpredictability of Symlin never ended, even after three months of using it.
My blood sugars immediately started to drop. By the time I was up to 1,000 mg, I was going low at least once a day. I have already started to lower my basal rates and dropped my sensitivity factor. Now that I’m taking insulin, I am also seeing more high blood sugars when I miscalculate the carbohydrates I eat.
Metformin is certainly not a cure, but my body seems to respond to insulin much more effectively than it did before. Combined with visits to the gym, my goal is that by this summer I will be taking less insulin and my A1C will have dropped. My endocrinologist said that Metformin is most effective at 1,000 mg to 1,500 mg, so I am thinking about increasing my dose once again just to make sure I’m getting the “biggest bang for my buck.”
After reading Hannah’s post about being respectful of the amount of insulin that people take, I wanted to share my story; I think it’s important for people to understand that it isn’t about what other people do, but to do whatever works — and is best for your own health. So after giving careful consideration to my own health history, I have decided to do something unconventional and different to take control of my health in the best way I can see. Hopefully people will be encouraged to try new things, and not give up when something isn’t working out.
Thank you Allison, as always, for your level-headed contribution to our D-world.
I am not an expert but 12-2009 I started a no carb diet and forced myself to walk no matter how long(arthritius in left knee and partial replacement right knee). My Lantus dose was 85 units and Novolog was 15 to 25 units per meal.
I have lost 28 lbs and my Lantus dose is down to 45 units and my Novolog is under 20 units per week.
I am type 2 so this may not relate to a type 1 but the no carb portion does.
I only have 1 kidney(birth defect) so my Endo keeps a close eye on me. My last visit he asked how long can I stay on my diet. Also my A1C was 5.5.
My walking is not arobic because my knees are go bad you just have to walk.
I am a T2, 16 years, with very little insulin production (c-peptide of 0.2). I am on a pump, and tried to go without metformin as an experiment. After 3 weeks, my total daily dose required to maintain good glucose control had doubled and was still going up! I decided this was not a good trade off, and resumed metformin in addition to insulin.
If your body will adjust to it, I think metformin is a very good idea for most pwd that have insulin resistance.
-Lloyd
“I think it’s important for people to understand that it isn’t about what other people to do, but to do whatever works — and is best for your own health.” — Wonderfully stated, Allison, and I am glad the metformin is working well for you!
[...] over at DiabetesMine today sharing my story about using Metformin. Feel free to drop by and check it [...]
The main effect of Metformin is hindering the liver from delivering too much glucose.
In a healthy person the alpha- and beta-cells of the pancreas play sort of supply pingpong. With the bg sinking below its basic line the betas lower their insulin output and the alphas up their glucagon delivery thus stimulating the liver to deliver more glucose. With the bg rising above its basic line the alphas lower their output of glucagon while the betas rise their output of insulin and vice versa on end. That way our main logistics contractor bloodstream delivers anything up to 100g of glucose and more per hour without any fluctuations large enough to make for real differences in test readings.
Type2 defect the alphas keep on dumping glucagon well beyond the bg basic line up to three times the amount and more of what can seen in a healthy person, and Metformin can hinder the liver from dumping up to 50% of what the alphas order. So where Metformin does measurably helps keeping the bg down, there is that type2 superactivity of the alpha-cells – obviously not limited to type2s.
I’ve been taking metformin for about a month now too and can totally relate to your story
I’ve finally gotten over the *stigma* (in my own head!!) about taking a perceived T2 drug for my T1 condition. I’m super sensitive to the “TMI effects” so am still building up to a therapeutical dose. But I’m willing to try anything that helps me keep my A1c down, and on a more practical level, mean less refills of my pump 
[...] insulin should I take? Should I pump or use MDI? Oral medications or insulin (for type 2’s)? Symlin or Metformin? But for me, the choice I’ve been having to make lately is a quintessential question every [...]
I believe I responded to another one of your posts. But, I too am a T1 diabetic that has over the years become insulin resistant. My insulin requirements have double from what I can calculate in less then 3 years. I started Metformin today and my numbers are looking great already and I did have a bout of hypoglycemia. This could be the Metforming already kicking in (although I have been told it takes up to 2 weeks to get the full affect) or it could be a late effect of me increasing my activety by going to a gym. I have been having issues with my GI most of the day is the only side effect so far. I think it is great you have taken the step to adjust your insulin resistance. I look forward to hearing how this works out for you.
I’m a T1. I started Metformin a few months ago. At first I experienced 1. better BG control, if barely. 2. Very loose BM (I know. TMI) and 3. Trouble sleeping. This was on 500MG twice a day of normal Metformin (not time released). It took over 1 month to get over the bathroom issues, but unfortunately the problem went completely 180 and I experienced strong constipation. Basically went from bad to worse in that aspect! Now after about 3+ months, the bathroom issues have all but gone, and my sleep is finally getting back to normal. I’m also on 1000MG twice a day. I may try the time released version after my next Endo visit.
After the first 3 months, The BG control at first was amazing. And I lost about 5 lbs. But since the BG control has somewhat become a little worse again. I’m not sure if I’m resisting the Metformin, or just not doing so good in my personal control of my diabetes. Overall, I’d recommend it. My insulin use was going up and up. Since Metformin, it’s gone down somewhat.
I’m a little concerned about the other reported side effects, like heart issues. But if the BG control continues, I think it’s worth the risk. I’d recommend Metformin, just be ready for a month or two of “adjusting” to say the least.
I’m scared stiff of Metformin. My new endo suggested it, but I have fecal incontinence problems, and don’t think I could endure Metformin for a month before the problems went away.
I have begun reduced-carbing (about 70g a day), and my insulin dose is
30 – 40u a day — I don’t think that’s over the top.
They say a lot of good things about Metformin — it has been used in Europe for decades, and so has a good safety record — but I think I’m going to avoid it unless it’s absolutely necessary!