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Metformin Forever

David Mendosa Health Guide April 26, 2012
  • Metformin controls the insulin resistance of people who have type 2 diabetes so well that, if possible, all of us should be taking it. That's what Roderic Crist, M.D., told me at the annual convention of the American Society of Bariatric Physicians in Denver this weekend. Dr. Crist specializes in fam...

31 Comments
  • Stan Slonkosky
    May. 13, 2013

    I'm coming back to this topic more than a year after the article was originally posted because my doctor has cut my metformin extended release dosage in half (1000 mg per day instead of 2000 mg). She says this is a precaution to prevent further kidney damage. She admitted that she does not know exactly what caused excess protein in my urine and what caused...

    RHMLucky777

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    I'm coming back to this topic more than a year after the article was originally posted because my doctor has cut my metformin extended release dosage in half (1000 mg per day instead of 2000 mg). She says this is a precaution to prevent further kidney damage. She admitted that she does not know exactly what caused excess protein in my urine and what caused elevated creatinine levels in my blood. It may have been high blood pressure and the blood and urine used for this test was taken just after my blood pressure medication was changed (losartin deleted and lisinopril, hydrocholorthiazide and hydralazine added) and I probably wasn't taking them long enough for them to fully affect me. These tests were done in late April.

     

    Earlier tests done in mid-March showed that my random urine microalbumin/creatine ratio was 3020 (should be <=30) mcg/mg. and that my A1C had increased to 5.6% (previously 5.3%), probably because I got careless and ate too much carbohydrate. I wonder if having my A1C rate go up contributed to the kidney problem. I also wonder if there is any documented evidence of metformin actually causing kidney damage or is this simply an inference that it might based on the fact the it has a similiar molecular structure to phenphormin, which apparently has been been shown to damage kidneys. I did read that the protocols call for cutting meformin dosage in half is the GFR is below 60 (mine was estimated to be 61 by plugging the amount of creatinine in my blood and my age into a formula); I do not know if this is justified.

     

    I complained to my doctor that cutting my dosage of metformin is going to make it more difficult for me control my blood glucose levels. She offered to prescribe glipizide, but I rejected that on the grounds that it causes pancreatic beta cell damage. I asked if I could have some insulin instead. She said no, but did not give a reason.

     

    I was referred to a nephrologist, but all he did was check my blood pressure, listen to my chest with his stethescope while I breathed and tell me to come back in July. I am scheduled to have more blood and urine tests and then see my G.P. again in mid-June.

     

    In the meantime, I'm trying to do whatever I can to keep my blood sugars as close to normal as possible, though I've never been able to get my A1C below 5.3% even using the maximum does of metformin. Maybe I need to limit protein intake to not much more than the minimum required (about 55 mg for someone like me who weighs 150 lb.) because some percentage of it (how much I don't know) can be converted to glucose, but I think this is going to be hard to do without going hungry.

    • David Mendosa
      Health Guide
      May. 13, 2013
      Dear Stan, Yes, the standard treatment for kidney disease is to limit protein to no more than the recommended level rather than to limit metformin. But I don't see why that should make you hungry. A very low carb diet is, after all, a high fat diet, not a high protein one. Namaste, David
    • Stan Slonkosky
      May. 13, 2013

      David, thanks for replying. The idea of limiting protein was mine and not suggested by any of my doctors (at least not yet). It came from an interview I saw (on dietdoctor.com, I think) a while back in which a California M.D. (http://eatingacademy.com0, who sometimes likes to swim from the mainland to Catalina Island, said that he was experimenting with his...

      RHMLucky777

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      David, thanks for replying. The idea of limiting protein was mine and not suggested by any of my doctors (at least not yet). It came from an interview I saw (on dietdoctor.com, I think) a while back in which a California M.D. (http://eatingacademy.com0, who sometimes likes to swim from the mainland to Catalina Island, said that he was experimenting with his own diet and decided to limit himself to 120 g of protein per day.

       

      I haven't paid a lot of attention to how much protein I eat, but I believe that 9 ounces of meat and/or cheese (I know cheeses vary) contains about 55g and I often eat more than that. I doubt that I eat more than double that. Some moths ago, I did increase my consumption of fat by eating more butter and cream and my most recent lipid tests were HDL 72 and triglycerides 50, which are better figures than I had in the past. I don't remember what LDL was but my total cholesterol level was slightly above what is generally recommended and my doctor suggested I take a statin. I declined, referencing the dueling JAMA articles on cholesterol from about a year ago.

       

    • David Mendosa
      Health Guide
      May. 13, 2013
      Dear Stan, I'm traveling now and have a very slow Internet connection so I can't easily look it up. But you need to check to see just how LITTLE protein we need. I remember that the Institute of Medicine set the number at somewhere less than 60 grams per day for men. Namaste, David
  • LindaCC
    Oct. 17, 2012

    I too am keeping in the 5's with low carb, excercise and Metformin. I have been concerned however with the reports I had heard regarding Metformin and Dementia. My mother has progressed dementia and has taken Diabetes meds for years although I do not know if it was metformin. Of course uncontrolled diabetes in itself can attribute to dementia.

    Is...

    RHMLucky777

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    I too am keeping in the 5's with low carb, excercise and Metformin. I have been concerned however with the reports I had heard regarding Metformin and Dementia. My mother has progressed dementia and has taken Diabetes meds for years although I do not know if it was metformin. Of course uncontrolled diabetes in itself can attribute to dementia.

    Is there any concern with Metformin and dementia or was this just an attempt to cast a dark cloud on Metformin now that we can get generic forms of it.

  • Anonymous
    Arvetro
    May. 02, 2012

    Does anyone have experience with taking a very low dose of Metformin with A1c levels which are already reasonable. Over the last 20 years I have progressively developed a more restrictive lifestyle in order to finally achieve an A1c in the 'normal' range without the use of any meds. I would love to be able to step back a little and have some additional freedom...

    RHMLucky777

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    Does anyone have experience with taking a very low dose of Metformin with A1c levels which are already reasonable. Over the last 20 years I have progressively developed a more restrictive lifestyle in order to finally achieve an A1c in the 'normal' range without the use of any meds. I would love to be able to step back a little and have some additional freedom in what I eat and how I live. There have been a number of times that I have considered Metformin as a way to reduce the daily battles which frequently occur. Has anyone tried to use Metformin on a single low dose, no more than daily, and hopefully every other day.

     

    While I hesitate to initiate the use of medications, it appears that this may be a better long term approach utilizing both the benefits of the Metformin along with with the low carb diet, exercise, and supplements.

  • carl
    May. 02, 2012

    Great Article David, I have also been thinking of adding Metformin to my diet(Atkins)/exercise diabetic control. Thanks for your great work! As always I enjoy your posts.

    Carl

  • David
    May. 01, 2012
    Had side effects and eventually we relished it was the metformin, seems you need to regulate it against your sugar levels though rather than just adjust it up slowly. His method is worth a try but not if your sugar intake varies a lot as mine does due to shift work and variable meal times!
  • Anonymous
    BlueGreenJean
    May. 01, 2012

    The Life Extension Foundation makes a case that metformin is something everyone should consider due to its many positive benefits, including reducing the risk of cancer. http://www.lef.org/magazine/mag2010/nov2010_The-Drug-Virtually-Everyone-Should-Ask-their-Doctor-About_01.htm?source=search&key=metformin

  • Anonymous
    mghu
    May. 01, 2012

    Sadly, I am one of the diabetics who also has failing kidneys-- a not uncommon association.  When my kidney readings set off alarms, I was cold turkeyed off of metformin ASAP.  Apparently, it is processed through the kidneys, so is not at all benign for everyone.

     

    • Gordon
      May. 04, 2012

      The reason physicians take patients off metformin when they exhibit decreased kidney function is related to a concern about metabolic acidosis. However metabolic acidosis was more of a problem with phenformin than metformin. I am not aware of any reports of acidosis caused by metformin. Acidosis can worsen kidney function.

       

      When kidney function decreases,...

      RHMLucky777

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      The reason physicians take patients off metformin when they exhibit decreased kidney function is related to a concern about metabolic acidosis. However metabolic acidosis was more of a problem with phenformin than metformin. I am not aware of any reports of acidosis caused by metformin. Acidosis can worsen kidney function.

       

      When kidney function decreases, the insulin in the body is not metabolized at a slower rate and hence has longer lasting effects.

       

      My physician had me stop my metformin when my kidney function decreased 50% inspite of A1C levels of less than 6.0. I went to a very low carbohydrate diet and my fasting blood sugars have been around 85-90. My kidney function has improved 25%. I am now wondering if the diabetes complications we see are related more to the concentration of glucose within the cell. We take medication that forces glucose into the cell so our serum levels look good. I believe we develop insulin resistance because the cell can not handle the excess glucose. Over the last 10 years my physicians told me  my control was excellent --but I suffer from neuropathy, decreased kidney function, and had to have a lens replaced due to post capsular diabetic growth.

       

      I have slowly come to the conclusion that Dr. Bernstein's ideas about diabetes is correct.

       

       

    • Anonymous
      JG
      Jun. 12, 2012

      I am on metformin and some protein is starting to show up in my urine-

      For many years the MICROALB/CREAT RATIO stayed at 26.

      Latest test it went up to 73

      How do you translate this to a % kidney function LOSS?

      If you could answer, I would appreciate it.

                                                           ...

      RHMLucky777

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      I am on metformin and some protein is starting to show up in my urine-

      For many years the MICROALB/CREAT RATIO stayed at 26.

      Latest test it went up to 73

      How do you translate this to a % kidney function LOSS?

      If you could answer, I would appreciate it.

                                                            JG

    • Gordon
      Jun. 12, 2012

      Talk to your physician about the Glomelluar Filtration Rate test which helps determine the degree of kidney function. If your BUN and Creatinine is rising, you may need to see a nephrologist.

    • Anonymous
      JG
      Jun. 12, 2012

      THANKS GORDON for your Prompt answer.

      I did have the test and the eGFR was 83.

      Thanks again

                                         JG

    • Gordon
      Jun. 12, 2012

      Anyone with GFR less than 30ml/min has kidney damage. GFR declines with age.

      Male GFR = (140-age) x (weight)/(Serum Creatinine x 72). GFR over 90 mls/min/1.73m(squared) is considered normal unless there is other evidence of kidney disease in which case Chronic Kidney Disease is stage 1 (proteinuria present).

       

      If GFR is 60-90 mls/min/1.73m(squared) ...

      RHMLucky777

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      Anyone with GFR less than 30ml/min has kidney damage. GFR declines with age.

      Male GFR = (140-age) x (weight)/(Serum Creatinine x 72). GFR over 90 mls/min/1.73m(squared) is considered normal unless there is other evidence of kidney disease in which case Chronic Kidney Disease is stage 1 (proteinuria present).

       

      If GFR is 60-90 mls/min/1.73m(squared)  (note: 1.73m(squared) is average body mass)

      and proteinuria or hematuria or other evidence of abnormal kidney function is present is Stage 2 kidney disease.

       

      Remember, eGFR is an estimate especially at more nearly normal levels.

       

      Stage 3 kidney disease is eGFR 45-60

       

      Risk factors: proteinuria, hematuria of renal origin, declining GFR, young age

  • Anonymous
    Pamsc
    May. 01, 2012

    In the studies where tight control led to problems, tight control was achieved by using drugs other than Metformin--the results show the dangers of those drugs.  Also don't worry about the effects of Metformin before trying it; they vary a lot. The only side effect I had was a little constipation.

  • Rich
    May. 01, 2012

    I have only used the XR version of non-generic Glucophage. I was wondering if the regular Metformin might provide better or different results. Do you have any thoughts or information on this...

  • Lloyd
    Apr. 30, 2012

    I am a type 2, and I've been on the maximum dose of metformin for about 17 years.  When I first went on an insuin pump, I did an experiment to see how well I I would do without metformin.  After 3 weeks, the insulin I needed to keep the same good numbers had doubled, I decided that was not a good trade off and resumed metformin.

    The combination of...

    RHMLucky777

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    I am a type 2, and I've been on the maximum dose of metformin for about 17 years.  When I first went on an insuin pump, I did an experiment to see how well I I would do without metformin.  After 3 weeks, the insulin I needed to keep the same good numbers had doubled, I decided that was not a good trade off and resumed metformin.

    The combination of metformin, an insulin pump, and limiting my carbohydrates to 80 a day has resulted in 20 A1c's in a row of 5.4 or better, the last 3 being 5.0, and 49 pounds weight loss sustained for 5 years.

     

    -Lloyd 

    • David Mendosa
      Health Guide
      Apr. 30, 2012

      Dear Lloyd,

       

      That is a great testimony to metformin and to your great management of your diabetes.

       

      David

  • Anonymous
    Scott
    Apr. 29, 2012

    I've read your article as well as your 2009 blog post that brought me here.  I do not have any experience with Metformin in its singular form.  Instead, after a single 7.1% A1C result in an initial Basic Metabolic Panel (BMP) screening in early 2011, I was diagnosed with diabetes and placed on Janument 500mg.  No oral glucose tolerance...

    RHMLucky777

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    I've read your article as well as your 2009 blog post that brought me here.  I do not have any experience with Metformin in its singular form.  Instead, after a single 7.1% A1C result in an initial Basic Metabolic Panel (BMP) screening in early 2011, I was diagnosed with diabetes and placed on Janument 500mg.  No oral glucose tolerance or alternate second test was performed to support/confirm the diagnosis; and I have my reasons for suspecting a misdiagnosis.  But, to be fair, the reason for my seeing a doctor was due to neuropathic issues with my toes.  So, with that additional indicator, a high A1C is considered sufficient for diagnosis.  But whether I believe I'm diabetic or not isn't the point of this message. 

     

    The point is my experience with Metformin, as compounded with Sitagliptin, in the drug branded as Janumet.  Janumet appears to have a side-effect that is not mentioned anywhere.  It can cause bad cholesterol (LDL) to rise quite quickly to unhealthy levels. 

     

    At my follow-up visit to go over my various test results (including the BMP and a nerve-conduction study), I was informed that the diagnosis was diabetes and that the nerve conduction results indicated "moderate bi-lateral polyneuropathy of the lower extremities" (both motor and sensory nerves".  I was also borderline deficient in Vitamin D.  So, I was given prescriptions for Janumet 500mg and Vitamin D2 50000 UI.  When I returned for a 3-month follow-up, urine and blood samples were taking for testing.  My Vitamin D issue was apparently corrected, my A1C was 5.8% but my HDL Cholesterol=32, Triglycerides=153, and my LDL Cholesterol had risen to 116 (should be <100).  Total Cholesterol level=179 (Healthy range is <200)

     

    The doctor recommended that I begin taking Fish Oil suppliments to lower the LDL (bad) cholesterol and another "quarterly" follow-up was scheduled.  The results of the tests from that meeting showed my A1C=5.7% (without any dietary changes).  However, my HDL=35, Triglycerides=166, and my LDL=128.  Now, the doctor wanted to put me on cholesterol lowering medication, which I declined.  During the 9 months that I was taking Janumet, my A1C remain stable at 5.7/5.8%.  However, my LDL Cholesterol had jumped from 128 to 152 and my Total Cholesterol was now 221.  Within a couple of days after the visit that provided these test results, I was notified that my doctor left to accept a position at a hospital and a new doctor specializing in diabetes was being assigned to me as a replacement. 

     

    At that point, I ceased taking the Janumet because that was the only change I'd made during my "treatment" that I could attribute my rapid rise in my cholesterol levels.  At the next quarterly appointment (the first with my new doctor), I was subjected to the "finger stick" glucose test for the first time to check my fasting glucose levels.  The reading was 107 on their meter.  Blood and urine tests were performed again using a Comprehensive Metabolic Panel (CMP) instead of the BMP) and all results came back as "Normal".  After 3 months without taking Janumet, my A1C score was 6.1 (Normal but still in pre-diabetes range), Total Cholesterol down from 221 to 193, and LDL Cholesterol dropped from 152 to 124. 

     

    Based on those results, I would say that my suspicions that my rising cholesterol was a side-effect of the Janument is provisionally supported.  Whether it is due to the Metformin, the Sitagliptin, or the combination together, I cannot guess.  I am eagerly waiting my next quarterly appointment to see if the improvement in cholesterol levels continues to progress to my pre-Janumet levels.  I also want to see how my A1C levels look after 6 month off the Janumet. 

     

    Before someone wonders, although the previous doctor didn't bother, my new doctor has me performing two daily self-checks on my glucose (a morning "fasting" test and a postprandial test after dinner).  After a month, my meter shows my fasting glucose is never higher than 94 mg/dl (generally 82 +/-5) and my 2-hr postprandial readings are <140 (typically <135 with only a few readings at 141-144).  Of my own volution, for the first two weeks, I preformed "pre-meal" tests upon arriving from work, before dinner.  The results ranged between 88-107 mg/dl, which is part of why I have serious doubts about being diagnosed as diabetic, rather than pre-diabetic. 

    • David Mendosa
      Health Guide
      Apr. 29, 2012

      Dear Scott,

       

      You may indeed be someone who gets higher LDL levels from Janumet or Januvia. I don't think this is a common side effect, but side effects do vary widely from individual to individual.

       

      I do think that for you it doesn't matter much whether you have diabetes or just insulin resistance (pre-diabetes). In either case you have to do the...

      RHMLucky777

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      Dear Scott,

       

      You may indeed be someone who gets higher LDL levels from Janumet or Januvia. I don't think this is a common side effect, but side effects do vary widely from individual to individual.

       

      I do think that for you it doesn't matter much whether you have diabetes or just insulin resistance (pre-diabetes). In either case you have to do the same things, the most important of which is what you eat and how much you eat. If you are even a bit chubby, losing that weight has to be your first goal. I know from my own experience how hard this can be, but I also know that following a very low-carb diet works best.

       

      Getting down to a normal BMI (a body mass index of less than 25), and probably even lower is something you can do with a very low-carb diet. And eating that way -- for the rest of your life, whether or not you have fullblown diabetes -- will also keep your A1C levels low, because protein and fat will not raise your A1C (blood sugar) levels. Only carbs do that.

       

      While an A1C level of 6.0 is generally considered the cut-off of normal, you will have less chance of complications if you keep your level below 5.0. See The Normal A1C Level at http://www.healthcentral.com/diabetes/c/17/59130/-a1c-level

       

      Best regards,

       

      David

    • Anonymous
      Newport Carl
      May. 01, 2012

      David... What is the 'real deal' with Metformin and alcohol. I drink 2 glasses of wine per day and understand there is a real danger to take Metformin and consume any alcohol. What's the straight poop???

    • David Mendosa
      Health Guide
      May. 01, 2012

      Dear Carl,

       

      I never heard that before. But I did a Goggle search for

       

      metformin alcohol

       

      and from what I read there, you shouldn't drink excessive amounts of alcohol while using metformin. But who ever said that drinking excessive amounts was safe even if you aren't taking it!

       

      David

    • Kate
      Jun. 13, 2012

      I would also like to know about Metformin and wine.  If I have a glass of wine with dinner or a gin and tonic and take my second dose of Metformin (500 mg) I will get terrible leg cramps in the night.  If I skip the second dose of the day I do not get leg cramps.  What is the connection?  Thanks, Kate

  • Anonymous
    mary
    Apr. 27, 2012

    Great article David!  I love my Met and it, plus a very low carb diet,  has  helped me get down to a 5.0 A1C.  I have also lost a good bit of weight from it and  had to change wardrobes three times as I ave gone dwn from a tight size 2x to a loose size 12.   My size continued to get smaller and smaller and I give Metformin partial...

    RHMLucky777

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    Great article David!  I love my Met and it, plus a very low carb diet,  has  helped me get down to a 5.0 A1C.  I have also lost a good bit of weight from it and  had to change wardrobes three times as I ave gone dwn from a tight size 2x to a loose size 12.   My size continued to get smaller and smaller and I give Metformin partial credit for that.  I was informed yesterday by a friend that my size 12s are too baggy, so I guess the warcrobe will have to go down again soon.  I am now where people are telling me I dont need to lose anymore, but my mirror, and my scale, tell a different story...wink wink.  I still weigh in excess of 150 pounds, but more is  muscle than used to be.

  • justgeo1
    Apr. 26, 2012

     I've been taking metformin since I was diagnosed in 1998 and have had to add other meds along the way. I feel that the metformin is probably still working but my pancreas isn't...

  • jerseyhiker
    Apr. 26, 2012

    David,

    I thought you said your A1C was in the low 5's?  If so, why do you think you need metformin.  I have been weighing this same dilemma-- I have a high fasting b.g., but A1C ranges from 5.3 to 5.7.

     

    • David Mendosa
      Health Guide
      Apr. 26, 2012

      Dear Lee,

       

      Dr. Crist says that even if our A1C is down to 5.0 or less, we all should be taking metformin to prevent the progression of diabetes -- even when our diabetes is in complete remission. I am glad that I am able to manage my diabetes so well without any drugs, but this is a provocative idea that I am carefully considering.

       

      David

    • Stan Slonkosky
      Apr. 27, 2012

      In his most recent teleseminar, Dr. Bernstein was asked about A1Cs between 5 and 6% and he said he didn't think they'd cause life-threatening or make you go blind in the way that those over 6% do, but that they still cause less severe complications. He said he has observed at least 15 complications in patients with A1Cs in the 5s. These include neuropathy. ...

      RHMLucky777

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      In his most recent teleseminar, Dr. Bernstein was asked about A1Cs between 5 and 6% and he said he didn't think they'd cause life-threatening or make you go blind in the way that those over 6% do, but that they still cause less severe complications. He said he has observed at least 15 complications in patients with A1Cs in the 5s. These include neuropathy. 

       

      My most recent A1C was 5.4% and my doctor told me that was as good as a non-diabetic and that although "we" (I think she meant MDs in general) used to recommend tight control, a study has shown that this results in higher mortality. I told her that if she was talking about the ACCORD study, one of the doctors who participated in that study reanalyzed the data a couple of years ago and found that the higher mortality rate only applied if the patients didn't succeed in getting their A1Cs under 7%. This is detailed at http://care.diabetesjournals.org/content/33/5/983.full . I didn't yet read that entire article only the summary that was at diabetesincontrol.com (I recommend signing up for the Diabetes in Control email list if you want to know about diabetes news.) I don't believe the article offered an explanation as to why these diabetics didn't achieve better control, but I suspect that they were eating lots of carbohydrates.

       

      My doctor asked me what my A1C goal is and I told her 5 (I though it prudent not to tell my doctor that if I ever achieve that, my new goal will be 4.2 to 4.6%, which Dr. Bernstein reports is the normal range for non-diabetics.) She agreed not to reduce my prescription for metformin. I buy it a Costco and since I have no insurance, I found I could save even more by signing up for Costco's prescription discount plan.

       

      I just checked and you can still listen to a recording of Dr. Bernstein's most recent teleseminar at http://instantteleseminar.com/?eventid=27979968 . I don't know how long you will be able to listen and/or download the mp3 for free, because those recordings eventually get moved behind a paywall.

       

      Dr. Bernstein was quite displeased with the new guidelines issued by the ADA last week which allow for target A1Cs of between 7 and 9% for certain older patients. I haven't yet had time to read the entire aritcle, but you can find it as the item for April 19, 2012 at http://care.diabetesjournals.org/content/early/recent#content-block

       

      I notice that the most stringent control they recommend is 6 to 6.5%. That's the range I was in when I got two foot ulcers (about a year apart) and had a vitreous hemorrhage that made it impossible for me to work or drive until I was able to have a vitrectomy. I do not want either of those things to happen ever again and that's why I want to get my A1C as close to normal as possible.


      Dr. Bernstein said in the past that he doesn't know why, but that with people he has treated the brand name Glucophage works a lot better than generic metformin. I considered trying Glucophage, but it's considerably more expensive. I just checked costco.com and 100 tablets of Metformin HCL ER, 500 mg, cost $7.18, while the same number of Glucophage XR, 500 mg tablets costs $106.95. I take four of these per day (the maximum recommended dose). The reason I get the extended release is that I sometimes got diarrhea from the regular version.

    • David Mendosa
      Health Guide
      Apr. 27, 2012

      Dear Stan,

       

      Many thanks for you great comments. I would have said the same thing about the ACCORD study -- and have said that. I also think that one of the problems with that study is they were using so many drugs, which of course have multiple side effects, to reduce A1C levels. Keep striving for as low a level as you can, and I will too!

       

      Davide...

      RHMLucky777

      Read More

      Dear Stan,

       

      Many thanks for you great comments. I would have said the same thing about the ACCORD study -- and have said that. I also think that one of the problems with that study is they were using so many drugs, which of course have multiple side effects, to reduce A1C levels. Keep striving for as low a level as you can, and I will too!

       

      Davide

    • tmana
      May. 22, 2012

      One issue with using only the HbA1c reading as a benchmark for diabetes control is that it does not account for the vicissitudes in blood glucose levels. For many, achieving a low A1c is done at the expense of many hypoglycemic episodes, which can cause as much -- if not more -- damage than persistent low-level hyperglycemia. 

       

      It would seem that...

      RHMLucky777

      Read More

      One issue with using only the HbA1c reading as a benchmark for diabetes control is that it does not account for the vicissitudes in blood glucose levels. For many, achieving a low A1c is done at the expense of many hypoglycemic episodes, which can cause as much -- if not more -- damage than persistent low-level hyperglycemia. 

       

      It would seem that the best course for managing Type 2 diabetes would be to introduce continuous glucose monitoring, or at least the level of spot testing that is common to most people with Type 1 diabetes (10-20 tests/day), with the goal of using diet and medications to minimize both high and low excursions.