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Metformin

Discussion in 'Parents of Children with Type 1' started by nanhsot, Jun 11, 2014.

  1. nanhsot

    nanhsot Approved members

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    Ok, so this is all second hand information,and filtered through a teen in college so I'm dealing with sketchy details indeed. My son saw a new endo at college today (last one was HORRIBLE, he's going to be traveling to see this one and...LOVE THIS...Skyping ). Both the endo and his wife/nurse are Type 1 so I feel a lot of confidence he's in good hands (vs the cattle call style treatment he had before at a major medical center near his campus).

    Phone conversation with the teen to find out how he liked the new office and he said she brought up using a drug to increase insulin sensitivity, Met..something. I'll assume metformin but if there are others please inform me. Like I said, details were sketchy at best! You guys just WAIT until you are sending your teens to MDs alone, it's maddening to those of us who like to be informed!

    He said she said something about injected insulin in high amounts leading to heart issues later and this drug helped the liver stop dumping so much sugar and therefore lowered insulin needs. This is news to me, I thought metformin increased sensitivity.

    What are the indications for metformin in Type 1 and would you consider it, in a well controlled teen with high TDD. Basal alone is close to 40, he's not eating a ton so TDD is probably 70-100, not horrible but no slacker either. They do a blood draw A1C so I don't have that, but his last one was 6.6, so he's doing amazing for a kid out on his own for the first time. To his credit he told her he didn't want to change anything until he saw his A1C and asked me to research it.

    So if there is recent research regarding metformin, injected insulin and later heart issues, etc, can you point me in that direction. Thanks.
     
  2. Brenda

    Brenda Junior Member

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    I believe Metformin is usually given to those with type 1 and insulin resistance. I don't know a lot about it. I do know that AACE (American Association of Clinical Endocrinologists) recently suggested that those with type 1 could take Victoza (an injectable type 2 drug) OFF LABEL. It is my understanding that it is good for reducing post prandial spikes and may help lead to weight loss. See http://www.medscape.com/viewarticle/825713
     
  3. Lakeman

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    Metformin is not commonly used for type 1 diabetics but IMO it should be considered more than it is. It does have side effects which should be considered. I also agree that large amounts of insulin can lead to problems but that is true of us who produce our insulin just as much as for those of us who inject it. Eating less carbs can reduce the need for insulin.

    Insulin sensitivity can also be increased by exposure to cold (unpractical), consuming ginger, cinnamon, and/or turmeric. In our house a favorite staple is turmeric cookies - think ginger snaps with four teaspoons of turmeric added per batch. They really do work. And they stain whatever they touch. Th cookies will not cause nausea like metformin might and the ginger might even combat nausea.

    Exercise also increases sensitivity and many of us need more of it anyway... As little as a walk around the block can increase sensitivity but moderately strenuous amounts seems more likely to be beneficial. Lastly, high blood sugars decrease sensitivity and low numbers increase it.
     
  4. Brenda

    Brenda Junior Member

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    Metformin does not cause nausea, though initial doses of Victoza do. Metformin causes gas and diarrhea.
     
  5. Michelle'sMom

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    Metformin is well known among users for causing nausea, along with gas & diarrhea. For most the symptoms subside, & beginning on a low dose with a gradual increase helps. It works by reducing the amount of glucose released by the liver, but it also slows carb absorption & increasing insulin sensitivity in the muscles. If you read current studies, you'll find there is much still not understood about the way it works.

    My dd has taken it for 2 years for PCOS. It works as an anti androgen but is prescribed off label.

    High circulating insulin levels are believed by some researchers to be linked to PCOS in adolescents/adults with T1. I don't have any information relating to males.
     
  6. wilf

    wilf Approved members

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    It is an option, but shouldn't be considered until alternatives have been considered. These include:
    - lower carb diet
    - lower GI foods in diet
    - more (or more regular) exercise, which will reduce basal insulin needs and increase insulin sensitivity for boluses and corrections
    - making sure he's properly hydrated (an issue for coffee drinkers at college!)

    Also I would ask for a reference re the "high" insulin leading to heart issues. I've not heard that before, not at your son's levels.
     
  7. Melissata

    Melissata Approved members

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    I have only seen it used in women with PCOS and type 1. My daughter has been on it for years now. I let one endo talk me into taking her off, and regretted it. His thinking was that it didn't matter if her insulin needs were about 35% less on Metformin. She stayed off for maybe a year and now back on. If he decides to give it a try, make sure he gets the extended release, my daughter had no stomach issues at all starting with 500mg dose and ramping up weekly to 2000mg. He would have to be prepared to make changes to his basal and bolus both, and there will be some lows. Also, the amount of carbs to treat lows now will likely increase. When she isn't on Metformin, one or two glucose tabs is all that it takes to bring her up. Now she takes two right off the bat, and sometimes needs a 3rd. I had been interested in Victoza, but there is no way insurance would cover it. Endo wouldn't even try, and it is VERY expensive.
     
  8. misscaitp

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    In terms of studies there was a Japanese study done on mice that stated that high insulin usage increased risk of heart disease in Type 1 diabetes. And it only seemed to matter if they had chronic high blood pressure. That was done in 2010. Though, I do wonder how high insulin dosages would have to be in human beings as this study was done in mice, the study did not directly state how much insulin would have to be used in humans.
    There are a few studies that back insulin resistance and heart disease, they primarily focus on Type 2 Diabetes, primarily from the mid-1990s:

    In 2012, there was a study done in Canada that stated the that long-term insulin usage does not cause an increase in heart disease, stroke, etc, this doesn't address high insulin doses though.

    It was recently asked on a Type 1 Diabetes Facebook page how many people use metformin. It seemed like most of the responses were from females with T1D. I use it, even though I've always used less that 1 unit of insulin per kg.
     

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