I'd like to eat more than cheese and butter.

February 25, 2008 7:33 AM

Insulin Resistance Filter: I've just been put on metformin. What next?

I'm overweight and my insulin levels are a little high. As the big D (diabetes) runs in my family, I take this seriously. I'm on Weight Watchers to lose the weight, and just requested a prescription for metformin as my online research said it can help prevent full-blown diabetes sometimes. A friend is on it, too, and it has helped her levels.

My doctor guffawed when I asked about it and said "if I buy into the insulin resistance notion" then I need to act like it and immediately cease any and all sugar and carb consumption. A.) Is this just a notion? My limited research seemed to confirm it wasn't a snake-oil situation.

B, C, and D.) Life is nuts right now, I work three jobs, and we have three straight weeks of visitors coming soon. Not a great time to make gigantic changes cold-turkey. What are some baby steps to take to make some lifestyle changes? What bigger changes do I need to eventually make? What resources can tell me more? Any and all experience stories are helpful.

posted by orangemiles to health & fitness (15 comments total)

a) No, it's not a "notion." It's the currently-held theory as to the cause of Type 2 diabetes. I'm wondering if by "buy into it" your doctor meant "If you're going to want to start taking a medicine to treat it, you should really be looking at the reason your body is becoming resistant--ie: your weight." There are plenty of books and websites that discuss health diets for diabetics, and that doesn't just mean no sugar or carbs. A healthy diet will also help you lose weight, which can certainly reverse insulin resistance.

b) Portions, portions, portions. Eat until you're not hungry, instead of eating until you're full. Cut out snacks. Take the stairs. Walk more, drive less. Get 30 minutes less sleep and wake up to exercise. Pack your meals.
posted by gramcracker at 7:49 AM on February 25, 2008

Baby steps: get a whole lot of carrots and celery and eat them whenever you would otherwise eat pasta or bread, drink diet soda only or better yet water, don't eat anything late at night. Longer term: Atkins is closer than Weight Watchers to the ideal diabetic diet and regular exercise is important.

You might also want to consider finding a new doctor. I agree with gramcracker's speculation that your doctor was probably suggesting you treat the cause before the symptom, but she or he apparently didn't communicate that to you very clearly and you should really have a doctor who is better able to educate you in caring for your own health.
posted by scottreynen at 7:59 AM on February 25, 2008

Exercise as much as you can. Incorporate something into you life that you'll enjoy do and thus keep doing. It doesn't matter what is, even if it's just walking a mile or two several types a week or training to be an Olympic athlete, but you need to get your body moving, so it'll do a better job of handling sugar on it's on.
posted by Brandon Blatcher at 8:36 AM on February 25, 2008

Oh yeah, I'm Type II, so if you have something specific, ask away...
posted by Brandon Blatcher at 8:50 AM on February 25, 2008

As a baby step? When you think you want a snack (or especially a soda!) get a glass of water. I've heard people say that a lot of times you're really more thirsty than hungry, and in any case, it's a reasonably simple distraction.
posted by epersonae at 8:58 AM on February 25, 2008

My doctor put me on metformin a few years ago, and I found it made the sugar cravings much easier to handle. I do recommend that you cut not only sugar, but anything that tastes sweet - don't use artificial sweeteners. This makes your taste much more sensitive to sweetness and you will naturally use less sugar. Eating a small cube of cheese whenever I had a sweet or carb craving helped me get through the first week.

Another thing that will greatly help you regulate your blood sugar is exercise. It doesn't have to be vigorous. Do you live close enough to one of the jobs that you can walk or bike? Try to create a situation where you can't skip doing it.

I just had a houseful for several weeks while my dad was in hospice; watch out for stress eating and craving comfort foods. I wasn't able to refrain, but I kept it in check by being aware.

Good luck to you.
posted by figment of my conation at 9:10 AM on February 25, 2008

First things first, have you actually started taking the Metformin yet? If not, I would hold off until all your visitors are gone. One well-known side effect of taking Metformin is crazy, explosive poop ... for some people. Not fun. I was on it for a few months and it took two weeks for the gastrointestinal problems to subside.

Second, I would work on my diet before I'd start taking it. Rein in your sugar and carb intake. This is something that you can definitely do gradually. Drink diet drinks instead of full sugar ones. Reduce the portion size of starchy foods. Ditto the Atkins recommendation. Slowly incorporate more exercise.

Good luck.
posted by SoulOnIce at 9:20 AM on February 25, 2008

Metformin is not a magic bullet. It is only one small part of the treatment of diabetes. It will aid in weight loss if combined with sensible eating.

I was diagnosed with Type II diabetes 6 months ago. Take this all very seriously, as the complications of diabetes are HORRIBLE. By all means take metformin, if and only if you plan to make the necessary changes to your diet and lifestyle, otherwise you are just fooling yourself. You need to find low carb and good carb foods, that you can substitue for processed foods. You need to walk 30 minutes a day, 5 days a week (and eventually add resistance training to your weekly schedule).

Call it Insulin Resistance, Syndrome X , Pre-diabetes, Type II diabetes, it doesn't matter. What does matter is that you lose weight, increase activity levels and quit smoking if you do that.

Consult a nutritionist post haste. Make good food choices 80% of the time, skip high Glycemic Index foods whenever possible. Increase activity levels, and you may be able to reverse some of the damage and avoid a lot of misery. You don't have to become an ascetic monk, you just need to wake up and begin making good decisions that will improve your health. Only you can do this. And there is never a good time to make radical changes in your llife, especially if you don't really want to. Do what I do. Picture them removing your toes with a pair of bolt cutters. Okay, maybe that only works for me. This is your wake up call. You can do it. Its not the end of the world, its the beginning of conscious health.

Read books, look at blogs and forums, join a support group, buy a crockpot.
glycemic index, eating well , excellent book , great blog/resource
posted by SMELLSLIKEFUN at 9:57 AM on February 25, 2008

There's a long pre-diabetic stage for Type 2 where insulin resistance/need increases, and insulin production increases to match. For lots of people, they stay at elevated insulin and never progress into overt diabetes. There are two things you might want to consider:

1) Aggressively screen yourself for glucose intolerance. Get a BG meter at the pharmacy for $20 and check your glucose two hours after eating.

2) You reduce your risk of developing diabetes enormously (58%) by exercising 30 minutes per day. One of the studies cited in that article shows equal effect by

Diet group. In clinics assigned to the diet-only intervention, participants with BMI <2>or= to 25 kg/m2 were encouraged to reduce their calorie intake so as to gradually lose weight at a rate of 0.5-1.0 kg per month until they achieved a BMI of 23 kg/m2. Individual goals were set for total calorie consumption and for daily quantities of cereals, vegetables, meat, milk, and oils. This was accomplished by providing a list to each individual of the recommended daily intake of commonly used foods and a substitution list to allow exchange within food groups. Patients received individual counseling by physicians concerning daily food intake. In addition, counseling sessions (in small groups) were conducted weekly for 1 month. monthly for 3 months, and then once every 3 months for the remainder of the study.

posted by a robot made out of meat at 10:19 AM on February 25, 2008

Echoing some of the sentiments already presented. I am a Type II, diagnosed twelve years ago at a young age. I would suggest the foillowing. Don't start taking the Metformin yet as it could possibly cause GI troubles, and if this is a crazy time, adjusting to medication that has you running to the bathroom every 10 minutes may not be good. I speak from experience, as I was never able to tolerate it.

Instead, cut your carbs and exercise. I have been very successful with this plan in the past. With low carb and exercise alone, I had my A1C measurments at 5.4, which was even a little lower than my endo wanted it. Of course, complications interferred with that plan...

Which is why no matter what work is like, or how crazy your life is, get to work on this now. As I type this, I can only see out of one eye as I have had yet another hemmorhage over the weekend due to retinopathy. This after having 5 previous laser treatments in my right eye, and 3 in my left. I also have peripheral neuropathy, and have had two surgeries in the past to remove bone spurs that aggravated foot ulcers and extended their healing for months, or in the last case, over a year. Complications are real, and intrude on your life much more than any dietary changes or exercise. Don't end up like me, be smart. Lower your carbs, this will also help lower your hunger, and exercise every day.

Good luck.
posted by genefinder at 10:24 AM on February 25, 2008

Sigh, of course HTML stole my baby.

Diet group. In clinics assigned to the diet-only intervention, participants with BMI <25 kg/m2 were prescribed a diet containing 25-30 kcal/kg body wt (105-126 kJ/kg), 55-65% carbohydrate, 10-15% protein, and 25-30% fat. These participants were encouraged to consume more vegetables, control their intake of alcohol, and reduce their intake of simple sugars. Subjects with BMI >or= to 25 kg/m2 were encouraged to reduce their calorie intake so as to gradually lose weight at a rate of 0.5-1.0 kg per month until they achieved a BMI of 23 kg/m2. Individual goals were set for total calorie consumption and for daily quantities of cereals, vegetables, meat, milk, and oils. This was accomplished by providing a list to each individual of the recommended daily intake of commonly used foods and a substitution list to allow exchange within food groups. Patients received individual counseling by physicians concerning daily food intake. In addition, counseling sessions (in small groups) were conducted weekly for 1 month. monthly for 3 months, and then once every 3 months for the remainder of the study.

posted by a robot made out of meat at 10:34 AM on February 25, 2008

What are some baby steps to take to make some lifestyle changes?

Exercise Exercise Exercise. You can do Pushups, Pullups, Situps, Squats, Lunges in any room of your house, at any time, for 5 or 10 minutes here or there.

Exercise is the natural way to reverse insulin resistance. Read up on GLUT4
posted by tiburon at 11:58 AM on February 25, 2008

There are tons of books on low-carb eating, aka regenerating insulin sensitivity. South Beach is one of them, it's easy to do, and I know tons of people who really like it.
posted by Mr. Gunn at 2:43 PM on February 25, 2008

I am not a diabetic; however, I was a carer for a Type II for a couple years, and one of my very good friends is a Type I. Additionally, whilst diabeties of either type isn't in my family tree, I am incredibly sensitive to sugar levels, to the point where I have to do a fasting test every couple of years, on the advice of my doctor.

First of all, the idea that eating until you're not hungry will help you lose weight may be bullshit. I tried this - and gained 60lb in 6 months, because I was eating a low-fat, mid-protein, high-carbohydrate diet. Through experimentation, I have discovered that carbohydrate - high or low GI, it doesn't matter - triggers a hunger response as soon as it hits my bloodstream. Where most people feel 'full' about 20mins after starting a meal, I feel 'hungry'. And 20mins after finishing a meal, I feel nauseous from hunger - if it's been a high-carbohydrate meal. Due to the fashions in diet of the day (the food pyramid; diets that were low- or no-fat, but high in complex carbs), I was eating almost precisely the wrong foods for my system. I need to eat a lot of protein, and I have to eat very, very little in the way of carbohydrate, otherwise I feel like I'm starving all the time. These days I eat very differently, and for the first time in my life, I actually don't feel hungry between meals.

Secondly, exercise. Be careful with this, especially if you're already overweight. Injury will set you back something chronic. Gentle exercise first, then work your way up to something more vigorous and longer. Sit down, look at your schedule, and find 30mins a few times a week which you can use to form a habit of exercise. Don't go all out, get really sore and tired, and drop it as a bad idea.

In practical terms, re:diet, there are small changes you can make. First, look at your snacks. Consider having a (small!) handful of unsalted, raw nuts. Protein, fats, small amount of carbohydrate. Cheese (but watch the crackers). Yoghurt (be careful of sugared and sweetened ones). Tuna (in springwater) with low-gi rice or couscous. Second, look at your main meals. Switch to brown bread and pasta where possible; consider basmati instead of plain white rice. Have less of the heavy-carb portions and more colourful veges. Eat small amounts of lean protein throughout the day (low-fat lunch meat; eggs; cottage cheese; fish; etc). Thirdly, look at your desserts. Consider replacing icecream, for example, with fresh fruit. Still sweet, but rather better for you. Lastly, consider drinks. Do you drink soda or diet sode? Try switching to water, or non-caffienated unsweetened tea (herbal tea, for example). Kick the booze.

Don't try to do it all at once; focus on changing a single meal for a week, with maybe one or two exercise sessions. Next week, try to change your drinking habits, while maintaining what you changed in the previous week. And so on. Draw up a schedule of changes and try to stick to it. Also, tell your family and friends and ask for their support. It helps.
posted by ysabet at 5:06 PM on February 25, 2008 [1 favorite]

Seconding ysabet- "eat when you are hungry" is not advice for people with weight/eating problems. It's a challenge.

Proper eating hygiene isn't just "eat fewer calories than you burn." It's also about timing and type of meals that are eaten. Doubly so for someone with blood sugar regulation issues.

Specifically to the original poster, it probably would be wise to enlist the help of your doctor rather than just ask for prescriptions you think might work. Unless I misinterpreted what you wrote.

Small and big changes-

1- Food isn't a reward, it's fuel. Feed yourself before expending energy, not after.
2- Double your protein, half the carbs. Instead of two thin sandwiches, have one thick one. (I like the Pepperidge Farm Very Thin bread.)
3- Eat real food. "Low carb" ice cream, chips and bread are silly, they don't taste good and are unsatisfying. And aren't really all that much lower in carbs. Look at the calorie count on some of these things, it's sometimes more than the real food!
3b- When they say "eat more grains", that doesn't mean eat whole grain cookies or whole grain pasta. Look at the labels on that stuff- higher in calories sometimes, and a barely perceptible increase in dietary fiber.
3c- What they mean is choose foods that are naturally whole grain. All Bran instead of Kix. Corn instead of potatoes. (Corn is a grain not a vegetable!) A nice bran muffin instead of a roll.
4- Look at the calories of meat. Very, very low.
5- Go easy on cheese, as well as other condiments. If something doesn't taste good without being slathered in ketchup, you shouldn't be eating it.
6- Budget your food. If you are looking forward to a delicious slice of cake, eat a light entree and enjoy the cake guilt-free.
7- It is really hard to make lasting changes and stick too them. Don't beat yourself up for a slipup here and there, but remember to get going again.
posted by gjc at 7:58 PM on February 25, 2008