Adjusting to Metformin
December 27, 2018 5:16 PM Subscribe
I've been on Metformin a month and a half. I take 500 mg ER in the evenings. I've been feeling wiped out and I have no appetite, but it's hard to know what's the med and what's the season. YANMD--not looking for medical advice but hope to hear experiences and also things that have proven helpful.
I don't remember when the malaise and fatigue began, but I almost always experience a slump this time of year. Especially given how gray it's been. I've been using a SAD light, taking vitamin d and b, exercising, sleeping, keeping up psych meds and therapy, and even increased my Zoloft a little over a month ago, but I'm still tired all the time. My GP and psychiatrist both say that Metformin is unlikely to cause psychiatric side effects, but it's still good to hear consumer opinions.
In the past week or so, I haven't had any appetite, really, and it's starting to bother me because food would probably make me feel better. It's hard to find anything appealing. My limitations are that I'm ovo-lacto veg and too poor for takeout. I'm trying to think how to move beyond nuts/yogurt/Luna bars and feed myself better. (I have a smoothie plan in the works so don't need further tips on those.)
If you had these experiences on Metformin, how did you work through them? Did they go away once you got used to the med? What did you eat? How did you have enough energy?
I don't remember when the malaise and fatigue began, but I almost always experience a slump this time of year. Especially given how gray it's been. I've been using a SAD light, taking vitamin d and b, exercising, sleeping, keeping up psych meds and therapy, and even increased my Zoloft a little over a month ago, but I'm still tired all the time. My GP and psychiatrist both say that Metformin is unlikely to cause psychiatric side effects, but it's still good to hear consumer opinions.
In the past week or so, I haven't had any appetite, really, and it's starting to bother me because food would probably make me feel better. It's hard to find anything appealing. My limitations are that I'm ovo-lacto veg and too poor for takeout. I'm trying to think how to move beyond nuts/yogurt/Luna bars and feed myself better. (I have a smoothie plan in the works so don't need further tips on those.)
If you had these experiences on Metformin, how did you work through them? Did they go away once you got used to the med? What did you eat? How did you have enough energy?
Is there a chance you could be pregnant? You don't say why you are taking metformin but it's a common treatment for pcos. My experience with it is related to conception and early pregnancy which also causes those symptoms.
posted by peanut_mcgillicuty at 5:56 PM on December 27, 2018
posted by peanut_mcgillicuty at 5:56 PM on December 27, 2018
I was on metformin for quite a few years. It gave me a constant low grade nausea which made it hard to eat healthily. I found I trying to be lower carb on it impossible - when I felt like you describe I needed to eat things like toast or plain bagel.
If my stomach was even slightly empty I felt especially terrible. I don't associate it with fatigue specifically but I did feel like crap a lot. So no, not psychiatric effects directly but feeling constantly ill does get you down.
It did get easier eventually - I was on 1500 for years. But I was eating badly so I wouldn't feel sick which defeated the point of the Metformin. I ended up stopping around the time my endo retired. By then I had unrelated health issues that required other medications and I just couldn't bear going back on it.
FWIW Zoloft makes me very tired.
posted by kitten magic at 6:00 PM on December 27, 2018
If my stomach was even slightly empty I felt especially terrible. I don't associate it with fatigue specifically but I did feel like crap a lot. So no, not psychiatric effects directly but feeling constantly ill does get you down.
It did get easier eventually - I was on 1500 for years. But I was eating badly so I wouldn't feel sick which defeated the point of the Metformin. I ended up stopping around the time my endo retired. By then I had unrelated health issues that required other medications and I just couldn't bear going back on it.
FWIW Zoloft makes me very tired.
posted by kitten magic at 6:00 PM on December 27, 2018
Response by poster: I have a history of low b12 and was on the shits at one point. I just wrote my drbabout testing. Thanks!
Definitely not pregnant, thank god.
I’m taking the Metformin bc psych meds had me put on so much weight that I haven’t been able to lose.
And I’ve been on/off Zoloft for 20 years and never felt this wiped out.
posted by mermaidcafe at 6:08 PM on December 27, 2018
Definitely not pregnant, thank god.
I’m taking the Metformin bc psych meds had me put on so much weight that I haven’t been able to lose.
And I’ve been on/off Zoloft for 20 years and never felt this wiped out.
posted by mermaidcafe at 6:08 PM on December 27, 2018
Response by poster: *shots, not shits. Autocorrect knows me too well.
posted by mermaidcafe at 6:23 PM on December 27, 2018 [8 favorites]
posted by mermaidcafe at 6:23 PM on December 27, 2018 [8 favorites]
If you're dealing with nausea, then speak to your doc about a slow-release version of Metformin. I was told repeatedly that I would get used to the dose I was on (1000mg split morning and afternoon) but it never happened and I endured months of feeling like crap. My appetite came back (the raging munchies didn't however, to my undying gratitude) and my energy levels picked back up as well.
I was also deficient in B12 and iron (related to my horrendous periods) amd was also very vitamin D deficient as well. No-one thought to do testing until I complained but supplementation did help. However, if your levels are very very low, you may need an injection to bump things up to a level where OTC supplements can take over. If you haven't had your levels tested recently, please try to get those done - you may need more than a simple vitamin capsule can do.
posted by ninazer0 at 6:51 PM on December 27, 2018 [1 favorite]
I was also deficient in B12 and iron (related to my horrendous periods) amd was also very vitamin D deficient as well. No-one thought to do testing until I complained but supplementation did help. However, if your levels are very very low, you may need an injection to bump things up to a level where OTC supplements can take over. If you haven't had your levels tested recently, please try to get those done - you may need more than a simple vitamin capsule can do.
posted by ninazer0 at 6:51 PM on December 27, 2018 [1 favorite]
I like the appetite-suppressing effects, so that works for me, but yeah, your mileage may vary. I got increased anxiety from taking vitamin B12 along with it, so I stopped taking that with it, and dropped my metformin dose down to what you're taking, also 500 mg of metformin once a day. I've found that taking it in the morning, with my first small meal of the day (a yogurt, caffeine water, vitamin D3, and vitamin C, usually) generally leads to my having fewer side effects and a steadier day in terms of any ups and downs in blood sugar. I can't quantify that exactly because I don't test my blood sugar, but I have fewer periods of fatigue or gastrointestinal issues from it if I make sure to take it first thing in the morning. When I take it later in the day, I often end up feeling miserably sick from it.
I was also vitamin D–deficient a few years ago, and I work from home, so I don't go outside a ton, so my D3 dose every day is 5,000 IU. With your fatigue, I'd suggest getting tested for that and other vitamin deficiencies for sure.
One thing to note as well is that if you eat a lot of carbs (which I've heard can tend to be a somewhat larger part of a more vegetarian diet), you might need to revisit that while on metformin. That'll help with the weight loss as well. On days when I eat mostly carbs (like today!) and take metformin, I tend to feel exhausted, have more gastrointestinal issues, etc. Metformin definitely helps guide my diet away from carb-heavy stuff because the side effects can be so unpleasant if that's what I eat. Don't do what I did this morning, which was start my day with cold pizza plus metformin and the rest. I crashed hard not long thereafter and ended up taking most of the afternoon off.
posted by limeonaire at 8:15 PM on December 27, 2018 [3 favorites]
I was also vitamin D–deficient a few years ago, and I work from home, so I don't go outside a ton, so my D3 dose every day is 5,000 IU. With your fatigue, I'd suggest getting tested for that and other vitamin deficiencies for sure.
One thing to note as well is that if you eat a lot of carbs (which I've heard can tend to be a somewhat larger part of a more vegetarian diet), you might need to revisit that while on metformin. That'll help with the weight loss as well. On days when I eat mostly carbs (like today!) and take metformin, I tend to feel exhausted, have more gastrointestinal issues, etc. Metformin definitely helps guide my diet away from carb-heavy stuff because the side effects can be so unpleasant if that's what I eat. Don't do what I did this morning, which was start my day with cold pizza plus metformin and the rest. I crashed hard not long thereafter and ended up taking most of the afternoon off.
posted by limeonaire at 8:15 PM on December 27, 2018 [3 favorites]
I had that effect big time on my first two weeks of Metformin - I was able to dress myself and drag myself to work, but I was only able to cogitate at work when someone was in direct conversation with me, and once home I had to get horizontal immediately - I was barely able to read a book and bathe before sleep. The exceedingly acute exhaustion passed within ten days, but it coincided with some high stress that really forced me to get my act together. I do think it was also a question of my D3 deficiency improving, because I got a 6000UI dose and noticed energy improvement around the same time as a rapid immune system improvement.
Since my problem, on top of hard to lose weight, is diagnosed insulin resistance, I'm on a low glycemic index diet. I eat very little meat, so it was a question of skipping non-chocolate sweets, exchanging rice for whole-wheat pasta and rice noodles for mung bean noodles, dark rye sourdough bread only, avoiding some boiled vegetables (potatoes and carrots), and making sure each meal has some fat and protein - eggs and dairy are both very GI-friendly, thankfully. Most fruit is okay but juices are out, and of course no soda etc - green tea is recommended, though I also have the occasional flat white and mainline black tea. The learning curve's a bit steep, with lots of googling for the GI of various foods. I'm better now that I'm sure about most of my staples and I've learned some hacks - potatoes are all right once they've been boiled or roasted and cooled, even if they're later rewarmed.
Recent research recommends less frequent meals for insulin management, so I've had to limit myself to 3-4 meals a day with absolutely no snacking. My breakfast is generally oatmeal microwaved with milk, with a generous helping of Greek yoghurt and some yummy toppings once it's done, plus some nuts; lunch can be a dark-bread cheese sandwich with a cup or so of vegetables or a big apple and some more dairy; a typical dinner is a stir fry of some kind, with enough protein to keep me full for long (equivalent of three eggs), and maybe a pot of yoghurt or skyr if I'm hungry just before sleep.
I notice a marked energy correlation to the amount of protein I eat - if I fail at the low GI thing with too many simple carbs, I'm sleepy and headachy an hour or two after the meal. Metformin makes your insulin work faster, so if you spike your blood sugar the drop's much more pronounced. My blood pressure also dropped, which may contribute to feeling less energetic but is good for me.
My doctor also ordered aerobic exercise for 30 minutes every other day (walking, biking, elliptical). This definitely helped the weight loss and energy , even if at the beginning I had to drag myself to do it by my teeth and claws. I also added B12 because Metformin-induced absorption problems on top of not getting enough from my diet, and a B complex. My doctor's happy about those but planning to test for B12 in a while just to see where I am.
I'm still somewhat tired, but able to accomplish work and self-care. I just had a three-month checkup and my endocrinologist added synthroid to kickstart my metabolism some more, since my TSH is a little high for my age. I've already gone down nearly two sizes in clothing and my mood is dramatically better, plus my hair is improving!
In your case I'm wary that your Metformin seems to have been ordered without a full workup to see if you have the metabolic problems it's indicated for. Tests you might ask for:
- insulin and glucose at fasting and 1 and 2 hours after a dose of glucose
- TSH and other thyroid function tests (I think I had about six in all to rule out various thyroid problems that run in the family)
- vitamins and microelements: potassium, calcium, ferritin, D3, B12
My doctor says thyroid function, insulin and D3 are a system that usually goes out of whack together, and causes the difficulty in weight loss. Good luck with your treatment!
posted by I claim sanctuary at 12:47 AM on December 28, 2018 [2 favorites]
Since my problem, on top of hard to lose weight, is diagnosed insulin resistance, I'm on a low glycemic index diet. I eat very little meat, so it was a question of skipping non-chocolate sweets, exchanging rice for whole-wheat pasta and rice noodles for mung bean noodles, dark rye sourdough bread only, avoiding some boiled vegetables (potatoes and carrots), and making sure each meal has some fat and protein - eggs and dairy are both very GI-friendly, thankfully. Most fruit is okay but juices are out, and of course no soda etc - green tea is recommended, though I also have the occasional flat white and mainline black tea. The learning curve's a bit steep, with lots of googling for the GI of various foods. I'm better now that I'm sure about most of my staples and I've learned some hacks - potatoes are all right once they've been boiled or roasted and cooled, even if they're later rewarmed.
Recent research recommends less frequent meals for insulin management, so I've had to limit myself to 3-4 meals a day with absolutely no snacking. My breakfast is generally oatmeal microwaved with milk, with a generous helping of Greek yoghurt and some yummy toppings once it's done, plus some nuts; lunch can be a dark-bread cheese sandwich with a cup or so of vegetables or a big apple and some more dairy; a typical dinner is a stir fry of some kind, with enough protein to keep me full for long (equivalent of three eggs), and maybe a pot of yoghurt or skyr if I'm hungry just before sleep.
I notice a marked energy correlation to the amount of protein I eat - if I fail at the low GI thing with too many simple carbs, I'm sleepy and headachy an hour or two after the meal. Metformin makes your insulin work faster, so if you spike your blood sugar the drop's much more pronounced. My blood pressure also dropped, which may contribute to feeling less energetic but is good for me.
My doctor also ordered aerobic exercise for 30 minutes every other day (walking, biking, elliptical). This definitely helped the weight loss and energy , even if at the beginning I had to drag myself to do it by my teeth and claws. I also added B12 because Metformin-induced absorption problems on top of not getting enough from my diet, and a B complex. My doctor's happy about those but planning to test for B12 in a while just to see where I am.
I'm still somewhat tired, but able to accomplish work and self-care. I just had a three-month checkup and my endocrinologist added synthroid to kickstart my metabolism some more, since my TSH is a little high for my age. I've already gone down nearly two sizes in clothing and my mood is dramatically better, plus my hair is improving!
In your case I'm wary that your Metformin seems to have been ordered without a full workup to see if you have the metabolic problems it's indicated for. Tests you might ask for:
- insulin and glucose at fasting and 1 and 2 hours after a dose of glucose
- TSH and other thyroid function tests (I think I had about six in all to rule out various thyroid problems that run in the family)
- vitamins and microelements: potassium, calcium, ferritin, D3, B12
My doctor says thyroid function, insulin and D3 are a system that usually goes out of whack together, and causes the difficulty in weight loss. Good luck with your treatment!
posted by I claim sanctuary at 12:47 AM on December 28, 2018 [2 favorites]
I never had the low-energy thing (have been taking 1000mg of the ER for about 6-7 years now). I know you don't FEEL like eating, but the way I fought this was to only take the Metformin after I ate. Still do now...I take two after my breakfast and two after dinner. Maybe that would help?
posted by kuanes at 4:27 AM on December 28, 2018
posted by kuanes at 4:27 AM on December 28, 2018
I agree with other posters- try taking it in the morning after your first meal and see if that makes a difference. I've never been on the XR version - what about going with the standard version and starting with a small dose? I start with about 1/8 of a pill for a couple days, then 1/4, then so on.
FWIW, Metformin helped me lose a lot of weight when nothing else would. You know those people who say they tried every other diet and nothing worked? That was definitely me, and Metformin along with diet was the key. I am grateful that my doctor decided to go off-label for this about 5 years ago for me.
posted by getawaysticks at 2:03 PM on January 1, 2019
FWIW, Metformin helped me lose a lot of weight when nothing else would. You know those people who say they tried every other diet and nothing worked? That was definitely me, and Metformin along with diet was the key. I am grateful that my doctor decided to go off-label for this about 5 years ago for me.
posted by getawaysticks at 2:03 PM on January 1, 2019
This thread is closed to new comments.
posted by Green Eyed Monster at 5:27 PM on December 27, 2018 [4 favorites]