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The Pill Popper.

March 29, 2010

A couple of weeks ago, I had my quarterly endocrinologist appointment and folks, it wasn’t pretty. Although my A1C had dropped over .5%, I was still ringing in at 8.0%, which is a full percent higher than I was when I graduated from college.

Diabetes management is supposed to get better after college, not worse.

I have also gained a shocking forty pounds since moving to the East Coast, and between the high A1C and the high weight, it was time for me to put my foot down. It was time for being to do something drastic.

It was time for me to go on Metformin.

Say what?

You’re probably wondering if perhaps you clicked on the wrong blog this morning and stumbled upon a twentysomething New Yorker with type 2 diabetes, but no, my faithful friends and readers, it is true: I am on Metformin. Lemme ‘splain:

In November, when I was at my last endocrinologist appointment, my doctor, Dr. G, and I were discussing my shocking insulin increase in such a short period of time (two-three years) in which my insulin intake had essentially doubled. I wasn’t sure what to do about it since exercising for my bike ride didn’t seem to do squat and my body seemed to laugh at the insulin I took. Dr. G suggested I go on Symlin, which I scoffed at having tried it unsuccessfully for a few months in college. Symlin reacted poorly in my body; it was unpredictable, erratic, and bloody painful (bruises, people, we’re talking internal bleeding here!). So my answer was a firm “No way, Jose.”

She suggested Metformin. Apparently people with type 1 diabetes shockingly enough can develop symptoms of type 2 diabetes. It happens in teens and it can happen in people who are overweight (something I have always been, not just since post-college). My thinking was that with some family history of type 2 diabetes (not a lot, but some), my history with obesity, and my history of just kind of sucking in the food and exercise department made me a pretty classic case for double diabetes.

Metformin also seemed like it would be hella easier than Symlin. First of all, it’s a pill, not an injection. Plus one. Second, you only have to take it once a day (if you’re on the extended release variety), rather than before every meal. Plus two. And thirdly, the dose stays the same every single day, instead of constantly manipulating your dose depending on what you’re eating. Plus three. Where do I sign up?

Dr. G gave me a prescription for Metformin, which I filled that night. She gave me instructions to start slowly. 500 mg (a.k.a. one pill) in the evening to start for a week. She told me some people get upset stomachs and nausea, but that it will probably go away. My first week on Metformin was actually great; no nausea at all. I started noticing better reactions to my insulin almost immediately. As in: when I took a correction bolus, my blood sugars actually came all the way down, rather than just part way. In some cases, I could even shave off one or two units.

I started my second week of Metformin last week and bumped it up to two pills. Now I have noticed a bit more gastrointestinal issues. Not so much nausea as just stomach aches and cramping, but it doesn’t seem to last more than a little while. My blood sugars continue to be fairly stable, and I’m even hitting a few more low blood sugars than before. My 30-day average is slowly starting to drop and is now coming in under 200 mg/dl. My 7-day average is about 160 mg/dl. I’m still having some high blood sugars, but Metformin isn’t a cure! I still have to bolus correctly and make sure I’m not going crazy with the carbs. I am also in the process of making adjustments to my basal rates and those fluctuations are bound to cause a disturbance in the force.

I’ll keep you posted on my progress.

But that’s not all!

A few months ago, I noticed a painful sensation in my feet in the mornings. It was if I was walking around on hot coals. It made getting out of bed very unappealing! After doing some research, I noticed many people discussing using Alpha Lipoic Acid to treat diabetic neuropathy. I thought that since my neuropathy (if that’s what it even is…) was pretty time-sensitive and went away after I started moving my legs, that using a supplement would be a good first plan of attack. I have been taking between 300 and 600 mg a day (one or two pills, depending on if I remember taking both of them) during the week and I have already noticed an improvement in how my feet feel in the morning. My hope is that between taking ALA and lowering my blood sugars through Metformin, that eventually the pain will go away. Of course, I have also heard that Metformin can cause neuropathy symptoms because of its effect on B12, but I take a multi-vitamin, so hopefully that will not be the case for me.

Are you on any supplemental medication to manage your type 1 diabetes?


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12 Comments
  1. March 29, 2010 9:57 AM

    I tried to talk my endo into puting me on metformin but she said she wasn’t comfortable just yet doing that. So I’m trying Symlin (for the 3rd time, I’ve been writing about it on my blog.) I started gaining weight after I graduated from college *gulp* 6 years ago. I’ve always been insulin resistant but my insulin needs are absurd (over 100 units a day!) The Symlin has helped but I would prefer a non-painful way. Symlin just stings like a b*tch! I’m really interested in how you do on metformin. Good luck!

    • March 29, 2010 9:59 AM

      Yes, Symlin does sting like a b*tch! It was horrible. It’s definitely new. Hopefully you can use me as an example!

  2. March 29, 2010 10:04 AM

    Wow. Very interesting post, Allison. Hadn’t heard of this and also hadn’t heard about ALA as far as neuropathy. In the past, I’ve been on neurontin periodically but have found that as my BGs were consistently better the pain did ease. My mom has had more intense neuropathy and she echoes that more activity does well, but it often hurts too much for her to even begin moving around. I’ll mention the ALA to her. Another point is the quote: “It must get worse, before it gets better.” A past Endo explained that this will happen because the nerves are slightly healing and that causes the same kind of neuropathy pain as you get better. I did experience this during my mid-20s or so. Haven’t had MUCH of a problem in a few years, but every so often I feel some pain and my feet do fall asleep quite easily and are also very prone to being cold thanks to subpar circulation. Will have to keep ALA in mind, should things get worse.

  3. March 29, 2010 10:25 AM

    I’ve thought about doing this type of thing too. I know with all the extra weight I’m carrying that I’m also dealing with a lot of insulin resistance. Glad you posted about it, and am anxious to see how it all shakes out for you.

    I’m still trying to stick with the symlin. It’s magical when it works, but a pain in the ass when it doesn’t. There’s just a lot of challenges to it, and when it is not a *required* shot, those challenges make it all too easy to just skip it.

  4. tmana permalink
    March 29, 2010 10:32 AM

    Metformin has a number of plusses to it (side effects include weight loss, for starters!). One thing to watch out for is that metformin seems to inhibit glycogen conversion to sugar, so you may not “recover naturally” from lows the same way you would have done without it. As always, logging is your friend.

    And speaking of bike rides… mine is less than three months away (and so is my 50th birthday — where did the years go?! — but then, my ride will be on my birthday)… My sponsor page is up at http://main.diabetes.org/goto/bfbell Now for some weather in which I can safely work on hills and distance…

    • March 29, 2010 10:34 AM

      I’ve had a few lows on Metformin and so far haven’t noticed any issue in getting my blood sugar back up to where it’s supposed to be. But thanks for the head’s up!

  5. March 29, 2010 11:15 AM

    I’m so glad that the Metformin is working for you. I have been struggling with similar weight gain and increased insulin needs since college (about ten years now,) and my docs have been resistant to my requests for Metformin … up until the last year or so.

    I’ve not tried it yet because I’m pregnant and things seem to be going pretty well (knock on wood.) I don’t want to rock the boat so to speak. But I’m thinking maybe I could use it afterward to finally get back into a healthy weight range.

    Please keep up posted on your experiences.

    Nici

  6. March 29, 2010 12:21 PM

    I’ve read about metformin and type 1’s recently but before that never knew the combo exsisted. I had asked my endo about trying Symlin quite a while ago and although she gave me some I have never tried it for two reasons mainly … 1) it’s an injection. I happily gave up injections over 3 years ago when I went on a pump. 2) It makes people nauseaous. I do NOT do nausea well at all. I’m glad you’re seeing an improvement with it and would love to hear more updates from you about it. I may just have to bring it up at my next appointment to hear her take on it. My insulin needs just keep creeping up. I hope the ALA continues to help your feet as well. I wouldn’t wish neuropathy on anyone!

    • March 29, 2010 12:41 PM

      As I mentioned, I am definitely getting occasional stomach pains and an upset tummy from the Metformin. And the nausea from Symlin wasn’t too bad for me either (it was more the unpredictability and pain that was my issue with the drug). But like Symlin, the gastrointestinal issues are supposed to go away. We’ll see if that holds true!

  7. Laura G. permalink
    March 29, 2010 10:25 PM

    I started having random, “bee sting” sensations (only once every week or so, but sudden and sharp enough to make me really notice) in both feet six or seven years ago and assumed that after 25 years of diabetes these were the beginning signs of neuropathy. I started taking ALA at about the same dosage as you, and also asked my acupuncturist to target the problem at my appointments. It has not progressed, I have no numbness or pain, and these days I only get the occasional mild bee sting every few months after a run of higher BGs. Also I noticed when I started ALA, resumed it after running out, or increased the dose that I tended to need a little less insulin and needed to watch out for lows. Hope it helps you and hope you can ward off further pain!! Good luck with Metformin too.

  8. April 4, 2010 2:27 PM

    It’s really interesting to read about a type 1 taking metformin. A few hours ago I read Robert Scheinman’s post about Liraglutide (Victoza) for type 2 diabetes. The way he explained it made me wonder whether it would be an effective treatment for type 1.

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