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Long Lost Member
Nita13
Total Posts: 243
Registered on: ‎10-09-2013
Helpful Response

Why is the Metformin not working to lower fbg?

My doctor increased my Metformin to 2 x 500 mg ER/day on October 18.  The morning blood sugar is still not budging.  It stays in the 100-120 range, which is where I was without the Metformin.  Is this too small a dose?  I am a big girl.  On the positive side, my bg is always low in the evenings, in the 90s before dinner and low 100s after dinner, no matter what I eat.  I can have an orange or a banana in the evening and the bg does not rise (tried at 1 hr, 2hr, and 3hr to make sure it was not a delayed reaction). I even ate a good sized portion of fried green bananas (yum! - think plantain chips) with dinner and did not see a rise over 15 points.  I have tried the protein snack at bed time, and saw no improvement. It is getting a bit frustrating.  I will never join the "5" club if I can't get that morning number down, which is the only high number of the day.

Nita
Dx T2 7-16-13 A1c 6.6, FBG 112
10-18-13 A1c 6.2, FBG 107
1-10-14 A1c 6.2, FBG 108
Metformin 2000 ER

Trusted Contributor
maryd98
Total Posts: 4,494
Registered on: ‎08-07-2012

Re: Why is the Metformin not working to lower fbg?

[ Edited ]

Nita13 wrote:

My doctor increased my Metformin to 2 x 500 mg ER/day on October 18.  The morning blood sugar is still not budging.  It stays in the 100-120 range, which is where I was without the Metformin.  Is this too small a dose?  I am a big girl.  On the positive side, my bg is always low in the evenings, in the 90s before dinner and low 100s after dinner, no matter what I eat.  I can have an orange or a banana in the evening and the bg does not rise (tried at 1 hr, 2hr, and 3hr to make sure it was not a delayed reaction). I even ate a good sized portion of fried green bananas (yum! - think plantain chips) with dinner and did not see a rise over 15 points.  I have tried the protein snack at bed time, and saw no improvement. It is getting a bit frustrating.  I will never join the "5" club if I can't get that morning number down, which is the only high number of the day.


Hi, Nita,

 

Personally, I'd say 100-120 BG in the morning is a pretty good range. I know there are some people on this site who insist on having their BG under 100 or under 90 in the mornings, but I'm not one of those people. My BG is often 110-115 in the mornings, and my A1c has been under 6 consistently.

 

If your only "high" number is 100-120 in the mornings, I don't think this is what's keeping your A1c above 6. I think there are two main possibilities:

 

1) Your BG is going high at other times and you're not catching it/not testing at those times.

 

2) (more likely) It may be that you just need to give yourself more time. You were diagnosed in July, right? And between July and October you went from 6.6 to 6.2? You are on the right track--your A1c is going down, it's just not quite where you want it yet. It's easy to get frustrated, but you need to remember that you've got a lifetime ahead of you--the first few months are just that (a few months)--be patient with yourself. Keep up the healthy habits you've been practicing. Maybe increase the exercise a bit? Oftentimes regular exercise has more longterm effects so that your BG is affected not just immediately after exercise.

 

Good luck!

Till next time,
maryd98
the diabetic formerly known as 14 and counting, aka Mary
-----------------------------------
Diagnosed T2 July 1998
First A1C (July 1998): 13.6
First BG (July 1998): 537
Latest A1C (February 2014): 5.2
On oral meds for about 9 months after diagnosis
"Just" diet and exercise for 15+ years
Valued Contributor
marty1955
Total Posts: 6,319
Registered on: ‎05-12-2013

Re: Why is the Metformin not working to lower fbg?


Nita13 wrote:

My doctor increased my Metformin to 2 x 500 mg ER/day on October 18.  The morning blood sugar is still not budging.  It stays in the 100-120 range, which is where I was without the Metformin.  Is this too small a dose?  I am a big girl.  On the positive side, my bg is always low in the evenings, in the 90s before dinner and low 100s after dinner, no matter what I eat.  I can have an orange or a banana in the evening and the bg does not rise (tried at 1 hr, 2hr, and 3hr to make sure it was not a delayed reaction). I even ate a good sized portion of fried green bananas (yum! - think plantain chips) with dinner and did not see a rise over 15 points.  I have tried the protein snack at bed time, and saw no improvement. It is getting a bit frustrating.  I will never join the "5" club if I can't get that morning number down, which is the only high number of the day.


Mary is right, many of us do strive to keep our numbers down lower than what many of the diabetes authorities consider fine.  I have not had a reading higher than 90's as a fbg in a very long time.  This does not mean that I don't get some higher PP readings; I just don't have a problem in the am.  Maybe this will ease your mind; it is a post at Lizzy's blog that gives the criteria for bg control from 3 different agencies.  I base what I do on the AACE figures (American Association of Clinical Endocrinolist) rather than the ADA or Joslin.  http://lizzysdlounge.com/2012/03/18/recommended-glucose-goals-by-agency/.  Some people fight with the higher fbg levels and here is an article from the ADA that might help you http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/dawn-phenomeno...

 

 

On the evening snack....I found this to work for me 15 g carb or less that includes proteins and fats.  Nuts are great....they have lower carb, good fats, and protein.  Sometimes what we eat the day before can mess with our bg levels at fasting....or I have found that to be true with me anyway. 

 

Nita, give yourself some time,  you are doing great!

 

Marty

"The road to success is always under construction."
- Lily Tomlin

01/2013 - diagnosed with T2 and hypothyroidism
A1c - 7.2
04/16/2013 - A1c 6.1
07/24/2013 - A1c 5.8 (bayernow)
09/21/2013 - A1c 5.6 (bayernow)
10/10/2013 - A1c 5.7
500 mg Metformin/1 per day
Low Carb
Beginning weight - 183
08/27/2013 - 143
10/03/2013 - 141
12/05/2013 - 138
Blood Pressure 12/05/2013 - 118/60
T2 paternal grandmother, father, two sisters, my current and my ex husband


Super Advisor
powerwalker2
Total Posts: 5,209
Registered on: ‎11-02-2009

Re: Why is the Metformin not working to lower fbg?

Hi, Diana ~ do you have an exercise plan?  Exercise should help get your overall and fasting numbers lower.  Exercise lowers insulin resistance ~ increases heart rate, metabolism and insulin sensitivity, gets excess blood glucose out of blood stream and moving into body cells where it belongs, and keeps on working overnight, which means lower, more normal fasting numbers in the morning.  When you have low 90s before dinner and low 100s after dinner, blood sugar is just going to stay there, unless you get it back down.

Nancy ~ T2 since '98 ~ 16 yrs ~ D&E 11yrs ~ treadmill, elliptical, bike 15-20 minutes 3x/day (including evening), dumbbells/resistance training, small portions heart-healthy high-fiber/low-fat fuel/carb-counting, 500mg Glucophage XR x4, 2.5mg Glucotrol XL x6, 6000IU Vit. D/day ~ RHR 53 ~ A1cs mainly between 5.9-6.9 av. 6.5
Frequent Advisor
jonblate
Total Posts: 276
Registered on: ‎04-09-2013

Re: Why is the Metformin not working to lower fbg?

It is pretty comon to have issues in the morning with higher numbers do to the dawn phenamon.  Taking metformin er at bed time helps with this effect.  I take 1000 mg of met er right before I go to bed and that seems to take care of the issue for me. 

9/15 2010 a1c 12.4
7/7 2103 a1c 5.2
Insulin insulin level in blood= 2
bp 100/60
cholesterol ldl 82 hdl 66 triglycerides 67
in insulin resistance test, not considered insulin resistant
bp 100/60
Diet and Exercise as outlined in the Blood sugar solution By Dr. Mark Hyman.
alan_s
Total Posts: 13,715
Topics: 189
High Fives: 1,223
Solutions: 140
Registered on: ‎10-30-2009

Re: Why is the Metformin not working to lower fbg?

[ Edited ]

Nita13 wrote:

My doctor increased my Metformin to 2 x 500 mg ER/day on October 18.  The morning blood sugar is still not budging.  It stays in the 100-120 range, which is where I was without the Metformin.  Is this too small a dose?  I am a big girl.  On the positive side, my bg is always low in the evenings, in the 90s before dinner and low 100s after dinner, no matter what I eat.  I can have an orange or a banana in the evening and the bg does not rise (tried at 1 hr, 2hr, and 3hr to make sure it was not a delayed reaction). I even ate a good sized portion of fried green bananas (yum! - think plantain chips) with dinner and did not see a rise over 15 points.  I have tried the protein snack at bed time, and saw no improvement. It is getting a bit frustrating.  I will never join the "5" club if I can't get that morning number down, which is the only high number of the day.


 

Metformin builds slowly to effectiveness over several days or weeks. 2 x 500mg daily is still below the usual effective prescribed dose of 1500mg or more per day. It appears that your doctor, like many, is wisely ramping your dose up slowly to minimise possible side effects.

 

I am on 2x1000mg daily but still have a problem with morning numbers. It may not be resolved by the metformin, but that remains to be seen as your dose increases with time.

 

Please read this, it may help: I Ate Nothing! Why Are My BGs high?

Cheers, Alan, Type 2, d&e metformin 2000mg, Australia.
Everything in Moderation - Except Laughter.
There is nothing I could eat I like more than my eyes.
Type 2 Diabetes - A Personal Journey (latest: Simple Low Carb Soups II - Asparagus)
Born Under a Wandering Star (Latest: Lisbon: Food and Fado)
Frequent Responder
jimssnell
Total Posts: 550
Registered on: ‎09-11-2012

Re: Why is the Metformin not working to lower fbg?

My read is different on this story for a number of reasons as well as spending last 5 years working the met as well as a year and half watching cgms and taking does of metformin.

 

The latest science on this matter has findings not theories also backed up by other research. When dose of metformin is up to a sufficient strength in the blood, the liver is told (signalled directly) to cut off excess liver glucose release when fasting. The amount required to cause this cutoff varies per individual and for me 500mg min is required on me.

 

A single dose of metformin standard only lasts about 2 hours in blood at level to sufficiently block excess glucose release.

 

I have watched my liver cut off excess liver glucose release on each and every dose of metformin. String it around the clock and the liver can be cut off longer.

 

I see no value on the residual values of metformin in body and their so called one to three weeks "coming up to strength" and notice no effect outside actual ingestion of a pill and being up to strength in blood to cut off excess liver glucose release. SIngle large doses have also proven a failure on my body contray to scientific data to contrary and stock pill jocky answers. Single large doses DO NOT redistribute meformin around clock like pills strung spaced on clock!

 

If uncontrolled excess liver glucose is not the reason for your excess glucose levels while diet under control; this is a complex system and maybe metformin is no help in your condition. There are other reasons from kidneys and other raindnaces that cause problems resulting in your difficulty.

James (Jim) W. Snell
30+ years as type 2 diabetic
40 years as Digital Microprocessor System designer
Stroke in 2007 and retired.
Metformin, Humalog Lispro, 1200 calorie Diet and 1.5 to 2 miles walking exercise A1C = 6.4
http://db2jimcaresta.com
Long Lost Member
Nita13
Total Posts: 243
Registered on: ‎10-09-2013

Re: Why is the Metformin not working to lower fbg?


powerwalker2 wrote:

Hi, Diana ~ do you have an exercise plan?  Exercise should help get your overall and fasting numbers lower.  Exercise lowers insulin resistance ~ increases heart rate, metabolism and insulin sensitivity, gets excess blood glucose out of blood stream and moving into body cells where it belongs, and keeps on working overnight, which means lower, more normal fasting numbers in the morning.  When you have low 90s before dinner and low 100s after dinner, blood sugar is just going to stay there, unless you get it back down.


Hi Powerwalker,

I definitely need to do more cardio.  Right now I work out at the gym 2-3 mornings a week and play golf at least twice on weekends, three if I get a lovely Friday off from work.  Some folks in the exercise forum walk after dinner, so I may give that a try.  Maybe I just need to be more patient.  The weight is still coming off, though not as fast as before.

Nita
Dx T2 7-16-13 A1c 6.6, FBG 112
10-18-13 A1c 6.2, FBG 107
1-10-14 A1c 6.2, FBG 108
Metformin 2000 ER

Super Advisor
powerwalker2
Total Posts: 5,209
Registered on: ‎11-02-2009

Re: Why is the Metformin not working to lower fbg?


Nita13 wrote:

powerwalker2 wrote:

Hi, Diana ~ do you have an exercise plan?  Exercise should help get your overall and fasting numbers lower.  Exercise lowers insulin resistance ~ increases heart rate, metabolism and insulin sensitivity, gets excess blood glucose out of blood stream and moving into body cells where it belongs, and keeps on working overnight, which means lower, more normal fasting numbers in the morning.  When you have low 90s before dinner and low 100s after dinner, blood sugar is just going to stay there, unless you get it back down.


Hi Powerwalker,

I definitely need to do more cardio.  Right now I work out at the gym 2-3 mornings a week and play golf at least twice on weekends, three if I get a lovely Friday off from work.  Some folks in the exercise forum walk after dinner, so I may give that a try.  Maybe I just need to be more patient.  The weight is still coming off, though not as fast as before.


Good job you're doing with the daily exercise, Diana!  A little in the evening should improve the morning BG levels.  Please let us know how it turns out.  By the way, I'm not the only one who has had success with that.  It should also help with further weight loss, although weight loss will taper-off as you approach normal weight.  You're also building muscle.  All good!  :smileyhappy:

Nancy ~ T2 since '98 ~ 16 yrs ~ D&E 11yrs ~ treadmill, elliptical, bike 15-20 minutes 3x/day (including evening), dumbbells/resistance training, small portions heart-healthy high-fiber/low-fat fuel/carb-counting, 500mg Glucophage XR x4, 2.5mg Glucotrol XL x6, 6000IU Vit. D/day ~ RHR 53 ~ A1cs mainly between 5.9-6.9 av. 6.5
Established Advisor
lynnkb
Total Posts: 356
Registered on: ‎09-27-2011

Re: Why is the Metformin not working to lower fbg?

While I don't think this may apply to the original poster, I do want to add this possibility to this discussion in case it might help someone else.

 

There are people (could be 5-10% of all type II diagnosed diabetics) who don't have type II, but have one of a set of identified genetic flaws collectively called MODY. In these cases, metformin doesn't do much, if anything, because the root cause isn't insulin resistance. This was my experience. I was on the max dose and all it seemed to do for me is give me stomach problems.

 

Just something else to consider if Met doesn't seem to be making any difference.

 

**********
Diagnosed 9/2011, Ha1C 9.6
1/13/2012 - 6.2
9/20/2012 - 5.7
12/26/2012 - 5.1
8/21/2013 - 5.7
9/15/2013 - 5.8
11/18/2013 - 5.6
1/10/2014 - 5.4 (Home test)
2/24/2014 - 5.6

Suspected MODY.