Diabetes, Metformin and related issues
September 10, 2015 10:29 AM Subscribe
Help me decide if I need to revisit the doctor and increase my metformin dosage. YANMD and all disclaimers apply
I was diagnosed with Pre-diabetes/diabetes in Dec 2014 and have been on Metformin Extended Release till now (500 mg twice a day). As prescribed, I have been taking after food. My BG levels have come down the last time I took the test (in July) and the next set of tests are in Oct along with the visit to the doctor.
Over the last week, I have started feeling hungry sometimes even after having my meals. I must mention that I have cut down on carbs severely and also fats (all fried foods etc) to bring down my weight. I don't smoke, don't drink and am very strict about eating sugary foods, processed items etc. I am also a lifelong vegetarian.
My only worry is that if my BG is now poorly controlled and I might need more metformin or is it the other way. I have an appointment coming up after 2 weeks, but these hunger pangs (about 30 minutes after eating) have me worried.
I also might have Vitamin B12 deficiency, going by the symptoms: constipation/nausea/bloating in the upper abdomen, some tingling only in the toes and fingers (sometimes), which I heard is a common side-effect of metformin.
Should I ask for an earlier appointment with the doctor or wait?
I was diagnosed with Pre-diabetes/diabetes in Dec 2014 and have been on Metformin Extended Release till now (500 mg twice a day). As prescribed, I have been taking after food. My BG levels have come down the last time I took the test (in July) and the next set of tests are in Oct along with the visit to the doctor.
Over the last week, I have started feeling hungry sometimes even after having my meals. I must mention that I have cut down on carbs severely and also fats (all fried foods etc) to bring down my weight. I don't smoke, don't drink and am very strict about eating sugary foods, processed items etc. I am also a lifelong vegetarian.
My only worry is that if my BG is now poorly controlled and I might need more metformin or is it the other way. I have an appointment coming up after 2 weeks, but these hunger pangs (about 30 minutes after eating) have me worried.
I also might have Vitamin B12 deficiency, going by the symptoms: constipation/nausea/bloating in the upper abdomen, some tingling only in the toes and fingers (sometimes), which I heard is a common side-effect of metformin.
Should I ask for an earlier appointment with the doctor or wait?
Best answer: IANAD, etc. If you've cut way down on both carbs AND fats, your hunger might just be hunger. Your body is unlikely to get enough calories on just protein - that's "rabbit starvation" and not healthy longterm.
If you're going to cut back on carbs and eat protein, you need to be eating enough fat to meet your calorie needs. It won't make you gain weight - you'll probably still lose.
TL;DR, it may have more to do with your diet than your dosage.
posted by kythuen at 10:36 AM on September 10, 2015 [4 favorites]
If you're going to cut back on carbs and eat protein, you need to be eating enough fat to meet your calorie needs. It won't make you gain weight - you'll probably still lose.
TL;DR, it may have more to do with your diet than your dosage.
posted by kythuen at 10:36 AM on September 10, 2015 [4 favorites]
are you testing your blood? what do your numbers say?
and yeah - when we got the diagnosis in this house we cut carbs way, way down and protein and fat naturally went up. we still lost weight. stay off the fried food (bc that's carbs and fat) but toss your broccoli and seitan or whatever in as much olive oil as you want.
posted by nadawi at 11:08 AM on September 10, 2015 [1 favorite]
and yeah - when we got the diagnosis in this house we cut carbs way, way down and protein and fat naturally went up. we still lost weight. stay off the fried food (bc that's carbs and fat) but toss your broccoli and seitan or whatever in as much olive oil as you want.
posted by nadawi at 11:08 AM on September 10, 2015 [1 favorite]
Best answer: Low carb is a great approach for lowering blood sugar and reversing metabolic syndrome/type 2 diabetes. However, deep cuts of carbs and fat will leave you hungry. You need the fat. Eat good fats (not fried food) and feel satisfied. You'll still lose.
posted by quince at 11:58 AM on September 10, 2015 [3 favorites]
posted by quince at 11:58 AM on September 10, 2015 [3 favorites]
Best answer: I've been taking Metformin for about 10 years. IMO being hungry after a low-carb meal is very normal IF you don't include enough healthy fat. For example, I can have a low-carb lunch and feel starving by the time I get home on Monday, but if I eat the same thing on Tuesday along with half an avocado I'm not hungry for ages. If you're worried about the fat you eat, try healthy ones like olive oil, avocados, nuts, etc. Also try more healthy proteins like fish, lean meats, and nuts. An all-veg meal will definitely leave me hungrier than if I added a chicken breast or halloumi.
I also find that if I start the day with something higher in carb but also higher in fibre, such as muesli, my blood sugar throughout the day is a lot more even.
Memail me if you'd like to talk more!
posted by toerinishuman at 12:27 PM on September 10, 2015 [1 favorite]
I also find that if I start the day with something higher in carb but also higher in fibre, such as muesli, my blood sugar throughout the day is a lot more even.
Memail me if you'd like to talk more!
posted by toerinishuman at 12:27 PM on September 10, 2015 [1 favorite]
Best answer: FWIW, I'm a T2 vegetarian, four-years since diagnosis, and they hold me up as a poster child of what you should do. :-) Obviously, IANAD. That said, just being hungry isn't worrying; if by pangs you mean PAIN thirty minutes after eating, it could be an ulcer, but just being hungry half an hour after eating is no biggie. Depending on how much you changed your diet, it may be a matter of your body getting used to having either fewer calories overall, or fewer calories of a certain type, and you may have overmodified your diet. That's where a dietician comes in handy, and it should be covered by your insurance.
It sounds like you were given a diagnosis but not given complete education and instruction. More on that, below. So...
1) Metformin is long-acting; it's not like insulin. It doesn't have a quick effect on your blood sugar. It's not "making" you hungry or causing your hunger pains, but if you're not having enough carbs at a meal, you're going to feel it.
You're taking the typical beginning dose. Some people have the intestinal distress from Metformin all the time and need to go off of it; others adjust fairly quickly. I urge you not to make medical diagnoses on yourself re: deficiencies based purely on your symptoms. If you have a good doctor, you should have had a complete blood panel in the last year, probably at diagnosis; ask for a copy and it'll show all the places where you are in or out of normal range to help guide your discussions with a diabetes education counselor and dietician. Certainly ask your doctor if you have concerns, but please don't self-diagnose and then develop treatment plans based on your reading. ;-)
I'm not sure how you think Metformin works that a higher dosage would make you less hungry, but that's not how it works. Metformin Extended Release slowly lowers your blood glucose across the 12 hours. If you're truly hungry 30 minutes after you eat, you need to look at the makeup of what you are eating, and probably add more protein. Yes, as a vegetarian, it's hard, but by no means impossible. For me, it means Peanut Butter and eggs and nuts. What kind of vegetarian you are will guide your D-diet, and a dietician will have sample (free) cookbooks from the ADA to give you. (Nice, thick books. If I actually cooked, I'd be even more impressed!)
For what it's worth, hunger and blood sugar can often be completely unrelated, especially the better controlled you are. Yesterday afternoon, I was starving enough to eat my own elbows, and I was at a practically-perfect 103. Two days earlier, right before dinner, I was at 87 (which is about as low as I ever go) and I wasn't particularly hungry.
Yes, when you're hypoglycemic you may be super-hungry (as a T2; T1s have entirely different experiences from ours and we shouldn't mix apples & oranges here), and when you're nicely full from a huge, carby meal (like on Thanksgiving), your numbers may be high, but generally, don't assume that your hunger and your blood glucose are going hand-in-hand. That's what testing is for.
2) By testing, I suspect you mean testing your A1C. That test measures an average of your overall blood glucose levels over the prior 90 days (but leaning a bit toward the last month or so). But it's just an average, and it's not the right way to know anything about your blood sugar patterns regarding how your blood sugar reacts to eating, to specific different kinds of foods, to sleep patterns, or to exercise.
People with diabetes are supposed to test their blood daily, multiple times per day, particularly until they determine their best patterns of glucose control. (T1s do it all day, either manually or with a continuous glucose monitor; T2s generally do it manually, and usual upon rising, before meals, and often "testing in pairs" where you test before a meal or exercise and then after (90 minutes after eating, perhaps 15-30 minutes after exercising) so you can see how different things impact your glucose.
If you don't already have a meter, your doctor should provide you with one for free (it's generally covered by insurance or by pharma companies). You can buy them for about $15; note, it's like printers & ink. They *get you* with the price of the strips (ink).
Find out from your insurance company which testing strips they'll cover and have your doctor give you the meter that uses those strips. For example, Blue Cross Blue shield really likes the Accu-Chek Aviva, so you get that meter and then your strips are generally covered at a co-pay like your meds. (Your doctor will write a prescription for the strips. Lancets generally aren't covered, but they're cheap. You don't have to use the lancet type that comes with your meter. I find the Multiclix to be completely painless and much easier to use).
As an example, my diabetes is very well-controlled with diet at one Janument (50 mg Januvia/500 mg Metformin) per day, but I test four times a day to spot anomalies related to changes in sleep, hormones, exercise, etc. so that I can make adjustments as needed. If your doctor hasn't sent you for a class in diabetes management (which should be covered completely by your insurance), ask. The knowledge you gain will help you in SO MANY ways for daily living.
3) Cutting down on unhealthy carbs and fats is good, but not all carbs are unhealthy. Actual fruit is good for us; fruit juice (alas), not so much. The fat in nuts or avocados is good for people, diabetes or otherwise; fried foods are pretty not-so-good for all. But it's important that you don't dramatically reduce your carbohydrate level blow what is healthy for your body; the same with fats. Even people with diabetes should be getting the majority of our calories from (healthy) carbs, then protein, then fats. (50/35/15 is an example we often see.)
Please see the dietician at your endocrinologist's office (or whomever your doctor sends you to, if there isn't one on staff) to get a sense of what you should be eating. In general, the lesson for people with diabetes or pre-diabetes is usually 45-60 grams of carbs at each meal and 15 grams of carbs for a snack. (Guys can get away with more carbs than women.) If you cut too far down on your carbs, you may feel unwell, as that's the appropriate place in our diets from which we get most of our energy. It's balancing the appropriate carbohydrate/protein/fat mix that is appropriate for you that is key. You're much better off doing it with guidance and supervision than going by gut or internet advice.
It takes a while to learn how your body metabolizes things. I can eat a small bowl of air-popped popcorn, barely sate my hunger and my BG goes up. (This doesn't happen to anyone else in my diabetes group.) People are always shocked that a small portion of ice cream doesn't mess with their BGs the same way pure carbs might. It's because adding a little fat to the sugar changes how your body metabolizes what you're eating. So yes, sometimes your blood glucose will rise more with a "healthy" choice than less healthy one. That's why getting actual training/education in nutrition with a diabetes education counselor and dietician is so important.
Short answer: unless you're experiencing pain rather than pangs, just go to your appointment in two weeks. But then, demand the proper diabetes education and training (including testing methods) to which you are entitled. If you're seeing a general practitioner and not an endo, then get thee to an endocrinologist who will make sure you get the proper education to ensure you live a long, healthy life.
posted by The Wrong Kind of Cheese at 12:33 PM on September 10, 2015 [5 favorites]
It sounds like you were given a diagnosis but not given complete education and instruction. More on that, below. So...
1) Metformin is long-acting; it's not like insulin. It doesn't have a quick effect on your blood sugar. It's not "making" you hungry or causing your hunger pains, but if you're not having enough carbs at a meal, you're going to feel it.
You're taking the typical beginning dose. Some people have the intestinal distress from Metformin all the time and need to go off of it; others adjust fairly quickly. I urge you not to make medical diagnoses on yourself re: deficiencies based purely on your symptoms. If you have a good doctor, you should have had a complete blood panel in the last year, probably at diagnosis; ask for a copy and it'll show all the places where you are in or out of normal range to help guide your discussions with a diabetes education counselor and dietician. Certainly ask your doctor if you have concerns, but please don't self-diagnose and then develop treatment plans based on your reading. ;-)
I'm not sure how you think Metformin works that a higher dosage would make you less hungry, but that's not how it works. Metformin Extended Release slowly lowers your blood glucose across the 12 hours. If you're truly hungry 30 minutes after you eat, you need to look at the makeup of what you are eating, and probably add more protein. Yes, as a vegetarian, it's hard, but by no means impossible. For me, it means Peanut Butter and eggs and nuts. What kind of vegetarian you are will guide your D-diet, and a dietician will have sample (free) cookbooks from the ADA to give you. (Nice, thick books. If I actually cooked, I'd be even more impressed!)
For what it's worth, hunger and blood sugar can often be completely unrelated, especially the better controlled you are. Yesterday afternoon, I was starving enough to eat my own elbows, and I was at a practically-perfect 103. Two days earlier, right before dinner, I was at 87 (which is about as low as I ever go) and I wasn't particularly hungry.
Yes, when you're hypoglycemic you may be super-hungry (as a T2; T1s have entirely different experiences from ours and we shouldn't mix apples & oranges here), and when you're nicely full from a huge, carby meal (like on Thanksgiving), your numbers may be high, but generally, don't assume that your hunger and your blood glucose are going hand-in-hand. That's what testing is for.
2) By testing, I suspect you mean testing your A1C. That test measures an average of your overall blood glucose levels over the prior 90 days (but leaning a bit toward the last month or so). But it's just an average, and it's not the right way to know anything about your blood sugar patterns regarding how your blood sugar reacts to eating, to specific different kinds of foods, to sleep patterns, or to exercise.
People with diabetes are supposed to test their blood daily, multiple times per day, particularly until they determine their best patterns of glucose control. (T1s do it all day, either manually or with a continuous glucose monitor; T2s generally do it manually, and usual upon rising, before meals, and often "testing in pairs" where you test before a meal or exercise and then after (90 minutes after eating, perhaps 15-30 minutes after exercising) so you can see how different things impact your glucose.
If you don't already have a meter, your doctor should provide you with one for free (it's generally covered by insurance or by pharma companies). You can buy them for about $15; note, it's like printers & ink. They *get you* with the price of the strips (ink).
Find out from your insurance company which testing strips they'll cover and have your doctor give you the meter that uses those strips. For example, Blue Cross Blue shield really likes the Accu-Chek Aviva, so you get that meter and then your strips are generally covered at a co-pay like your meds. (Your doctor will write a prescription for the strips. Lancets generally aren't covered, but they're cheap. You don't have to use the lancet type that comes with your meter. I find the Multiclix to be completely painless and much easier to use).
As an example, my diabetes is very well-controlled with diet at one Janument (50 mg Januvia/500 mg Metformin) per day, but I test four times a day to spot anomalies related to changes in sleep, hormones, exercise, etc. so that I can make adjustments as needed. If your doctor hasn't sent you for a class in diabetes management (which should be covered completely by your insurance), ask. The knowledge you gain will help you in SO MANY ways for daily living.
3) Cutting down on unhealthy carbs and fats is good, but not all carbs are unhealthy. Actual fruit is good for us; fruit juice (alas), not so much. The fat in nuts or avocados is good for people, diabetes or otherwise; fried foods are pretty not-so-good for all. But it's important that you don't dramatically reduce your carbohydrate level blow what is healthy for your body; the same with fats. Even people with diabetes should be getting the majority of our calories from (healthy) carbs, then protein, then fats. (50/35/15 is an example we often see.)
Please see the dietician at your endocrinologist's office (or whomever your doctor sends you to, if there isn't one on staff) to get a sense of what you should be eating. In general, the lesson for people with diabetes or pre-diabetes is usually 45-60 grams of carbs at each meal and 15 grams of carbs for a snack. (Guys can get away with more carbs than women.) If you cut too far down on your carbs, you may feel unwell, as that's the appropriate place in our diets from which we get most of our energy. It's balancing the appropriate carbohydrate/protein/fat mix that is appropriate for you that is key. You're much better off doing it with guidance and supervision than going by gut or internet advice.
It takes a while to learn how your body metabolizes things. I can eat a small bowl of air-popped popcorn, barely sate my hunger and my BG goes up. (This doesn't happen to anyone else in my diabetes group.) People are always shocked that a small portion of ice cream doesn't mess with their BGs the same way pure carbs might. It's because adding a little fat to the sugar changes how your body metabolizes what you're eating. So yes, sometimes your blood glucose will rise more with a "healthy" choice than less healthy one. That's why getting actual training/education in nutrition with a diabetes education counselor and dietician is so important.
Short answer: unless you're experiencing pain rather than pangs, just go to your appointment in two weeks. But then, demand the proper diabetes education and training (including testing methods) to which you are entitled. If you're seeing a general practitioner and not an endo, then get thee to an endocrinologist who will make sure you get the proper education to ensure you live a long, healthy life.
posted by The Wrong Kind of Cheese at 12:33 PM on September 10, 2015 [5 favorites]
I also find that if I start the day with something higher in carb but also higher in fibre, such as muesli, my blood sugar throughout the day is a lot more even.
we absolutely found this to be true. mornings w/ a bit of carbs wrapped in fiber and/or fat gives better all day numbers here.
posted by nadawi at 12:45 PM on September 10, 2015
we absolutely found this to be true. mornings w/ a bit of carbs wrapped in fiber and/or fat gives better all day numbers here.
posted by nadawi at 12:45 PM on September 10, 2015
If you are pre-diabetic, why are you on Metformin?
You need less, not more. Pre-diabetes is a huge money maker for all involved.
posted by Oyéah at 9:37 PM on September 10, 2015
You need less, not more. Pre-diabetes is a huge money maker for all involved.
posted by Oyéah at 9:37 PM on September 10, 2015
Response by poster: @oyeah - When I was first diagnosed, my A1C was 9.1!, so my doc prescribed them. After 3 months, my A1C was 5.7 with Pre and post lunch sugars in just above normal ranges.
I hear you all about overmodifying my diet - I have started eating a cheese slice or two every day to add a little more fat. Being overweight (BMI of 26) is making me want to lose weight in an effort to limit the progression if not reverse it.
My dad was on insulin for a long time and his kidneys slowly deteriorated, even though he was also a vegetarian, watched very carefully what he ate and was regular with his medications. There may be a subconscious urge in me to avoid that!
YANMD or counsellors, so will keep this short: The last 6 months were good without any hunger pangs after eating, so this occurrence has me worried. I do go to the gym for some aerobic and weights every day, so not sure what's causing this.
@The Wrong Kind of Cheese: Thanks for the detailed explanation! I am not self-medicating myself based on internet diagnosis. I have asked for an appointment with an endo, although I meet with a diabetes specialist.
posted by theobserver at 9:50 PM on September 10, 2015
I hear you all about overmodifying my diet - I have started eating a cheese slice or two every day to add a little more fat. Being overweight (BMI of 26) is making me want to lose weight in an effort to limit the progression if not reverse it.
My dad was on insulin for a long time and his kidneys slowly deteriorated, even though he was also a vegetarian, watched very carefully what he ate and was regular with his medications. There may be a subconscious urge in me to avoid that!
YANMD or counsellors, so will keep this short: The last 6 months were good without any hunger pangs after eating, so this occurrence has me worried. I do go to the gym for some aerobic and weights every day, so not sure what's causing this.
@The Wrong Kind of Cheese: Thanks for the detailed explanation! I am not self-medicating myself based on internet diagnosis. I have asked for an appointment with an endo, although I meet with a diabetes specialist.
posted by theobserver at 9:50 PM on September 10, 2015
This thread is closed to new comments.
posted by theobserver at 10:32 AM on September 10, 2015