Metformin - pros, cons, side effects - when all else is failing

(Tash) #1

Hey all,

I’m 8 months keto and IF to treat predicates at 31. first 4 months saw a 50lb drop, blood sugars consistently under 5, insulin dropped from 40 odd to 13. :ok_hand:

I discovered a raft of health problems around the 5 month mark though, turns out a full on case of reverse t3 hypothyroidism.

Any who, let’s cut a long story really short - my blood sugars have crept back up to the 6/7s (worse than pre keto), even fasting, cut nuts, dairy, ect. Nothing would bring them down, leading me to assume some physiological insulin resistance.

My endo offered me a handful of horrid drugs, none I’ll take. But, I’m considering the metformin.

I’m looking for side effects experienced, particular women in their 30s, the hormonal effects experienced.

Is there a ‘type’ of metformin that’s worked well, or not?

Thanks for your info :slight_smile:

(Mark) #2

You could ask Richard about metfornin he talked about it on the podcast he did a four month experiment of not taking metfornin but just recently started taking it again and said he will probably take it for the rest of his life,he seems to be a believer

(Richard Morris) #3

Yes I don’t need it for glucose control - my HbA1c stayed the same when I went off Metformin but my fasting insulin jumped. Indicating that I can still make enough insulin to keep my glucose under control but I make a LOT of it. And of course a lot of insulin makes you need to make even more … and drives hypertension and atherosclerosis. I take the lowest dose 500mg/day and expect to for life as I try to become as insulin resistant as I was as a teenager.

Tash does appear to need help keeping her blood glucose in a safe range. I suspect her doctors are right to suggest metformin as it’s cheap, commonly used in a good percent of the population without major side effects (gut distress being the main).

The problem may not be as simple as glucose / insulin … and things get very complicated very quickly in endocrine disorders. In her situation I would certainly try to get glucose stable with metformin, but she may not be able to without also treating her hypothyroid condition - and there I am sadly ignorant of the nuances (my only experience is managing the complication of a dog with a tumorous adrenal gland).

(Cindy) #4

I’m insulin resistant and use Metformin to keep my insulin levels under control even while on a ketogenic diet. A few things you need to know/stock up on. Your gastrointestinal system may not like Metformin at first. Mine protested quite a bit for the first month. The pharmacist recommended GasX and immodium, which helped considerably while I was adapting. My doctor also suggested KingChlorella, which I still take with the Metformin. There was something else I took for nausea early on, but can’t remember any more. Your pharmacist will be able to help with over the counter stuff that won’t cause interactions.

Also, never ever take it on an empty stomach. You’ll regret that. I try to take it in the middle of a meal so there’s already some food in my stomach. May be psychological, but it seems to not cause issues for me that way.

(Jessica K) #5

I’m PCOS and insulin resistant. Female, 27 and have been taking Metformin 750mg 2x a day for about a year (this started at 500mg 1x day and was gradually increased). It changed my life in more ways than one. My A1C went from 5.5 to 4.8, I dropped a bunch of weight, and generally feel better. I will say, there was absolutely an adjustment period filled with lots of GI issues. I feel like keto works even better for me now that I control my insulin resistance with both the meds and the WOE.

Like said above, don’t take it on an empty stomach… that leads to nausea and this unpleasant things that come with that. I take it after a meal morning and night, totally adapted at this point and am completely fine. The GI issues are the only side effect I experienced and that went away after about a month of being strict with taking it.

(jketoscribe) #6

Another PCOS IR person on Met, I’ve taken up to 1500 mg/day.

As others have pointed out, the worst symptoms are GI symptoms. I’m going to be very frank instead of beating around the bush–it’s the worst and most sudden diarrhea I’ve ever experienced. But, there are ways to avoid it.

First, ask for Extended Release (ER) forms of Met. They will be much gentler on your stomach. My thin, IR 16 year old daughter takes 1000 mg of ER Metformin and has never had an issue with diarrhea at all. If you have trouble with one brand, another may do better. My HMO uses Teva brand, and they have been the easiest on my stomach of any brand I’ve tried. That’s what she takes as well.

Second, you must increase your dose S-L-O-W-L-Y. Start with the smallest dose (500 mg) once a day. Take it WITH food. It’s best if you wait until the middle of a meal and take it then–not at the beginning of the meal when your stomach is mostly empty–and snacks may not be enough. Wait a week or more before increasing the dose. Then wait another week or more if you have to increase again.

I personally have found that when I “cheat” by eating too many carbs, there’s almost instant retribution by Met (happened to me this weekend, it was NOT fun!). I’ve seen others report that different foods trigger their issues with Met, so you may have to wait and see which causes issues for you. I kind of like that effect because it definitely keeps me honest. OTOH, If I know I’m having an “indulgence” and going off the rails, I will skip a dose to ensure I don’t have to deal with that.

The side effects don’t always occur right away when you start taking Met. It can take a few weeks to build up in your body before you start experiencing side effects. If you have already increased the dose, try backing down to a lower dose rather than giving up entirely on it. You may be able to increase the dose again after giving your body some time to adjust.

The side effects can be unpredictable, especially at first. If you are taking Met and feel crampy and your tummy rumbles, RUN to the nearest toilet as fast as you can. I’m NOT kidding. If you feel like you have to pass gas, wait until you are over a toilet. I’m not saying this to scare you. It gets better over time and it’s certainly better than losing your eyesight or your toes. But it’s a reality. I wish someone told me these things before some embarrassing moments occurred.

Some people just can’t take Met and I get that, but when you have looked at the potential dangers of other oral meds (see ) it may solidify your determination to make Met work for you. If you really cannot tolerate it, talk to your doctor about the supplement called Berberine. This may be as effective as Metformin without such severe side effects.

And it’s ALWAYS worth ruling out other potential causes. Is your fasting practice causing spikes in cortisol that raise your blood sugar? Have you been tested for sleep apnea to see if that’s causing you to bathe in stress hormones all night long? How is your stress management? Are you getting enough sleep? How are your thyroid and adrenal glands functioning? Do you have an occult infection (dental infections are likely candidates) that are causing the rise in blood sugar?

(Stephanie Hanson) #7

I’m starting metformin soon and I’m wondering if the fat in my morning BPC is enough to buffer the effects.

(Jessica K) #8

That’s how I take it! I find that it’s totally enough, but I am also seasoned at this point and used to it. Not sure how it would go if you are just starting it.

(mwall) #9

yep, for many, but you may have to work up to it with a little more…like adding an egg to your bpc or cooking one. Worked great for me and I’m so fat adapted now I can take it with just regular coffee too…just can’t fast without starting off with the fat. :yellow_heart:

(Stephanie Hanson) #10

@richard I’m curious to know what benchmark or test you’ll use to know you’re insulin sensitive again. Also, is there any data that indicates IR can be healed permanently?

(Richard Morris) #11

Nope. It’s so rare to see remission that it’s in the same category as remission of NAFLD (fatty liver) - although I did cure that so who knows.

My end goal is to see fasting insulin scores down around 2-6. As waypoints to that goal I am using the HOMA:IR calculation which calculates Insulin resistance and beta function compared to a 35 yo healthy male. The 4 months I went off metformin was a retrograde step.

(Stephanie Hanson) #12

As soon as I read NAFL I smiled. Maybe we’ll be blazing new trails with IR too.

(Tash) #13

Thanks for the replies! It’s exactly what I wanted, hard truths!

I’m slowly gaining some traction on the rt3 issues, which do cause a level of insulin resistance/blood sugar issues.

I was given a mf rx, but I think I’ll ask for a delayed release version instead, I already suffer from tummy troubles easily, so don’t want to make that worse!!

And I think I’ll grab a hba1c update; as I got new bs strips for my other machine, and I’m in normal ranges for the most part! 4.5-5.8!

My insulin skyrockets 20 points during that time of the month, and depending on hormonal levels, so met might help with my IR that’s not resolving solely with keto/fasting.

I stopped fasting during t3 therapy, as it was negatively affecting cortisol levels.