Most people think diabetes comes from pancreas damage, due to autoimmune problems or insulin resistance. But for many people diagnosed “Type 2,” the big problems are in the liver. What are these problems, and what can we do about them?
First, some basic physiology you may already know. The liver is one of the most complicated organs in the body, and possibly the least understood. It plays a huge role in handling sugars and starches, making sure our bodies have enough fuel to function. When there’s a lot of sugar in the system, it stores some of the excess in a storage form of carbohydrate called glycogen. When blood sugar levels get low, as in times of hunger or at night, it converts some of the glycogen to glucose and makes it available for the body to use.
Easy to say, but how does the liver know what to do and when to do it? Scientists have found a “molecular switch” called CRTC2 that controls this process. When the CRTC2 switch is on, the liver pours sugar into the system. When there’s enough sugar circulating, CRTC2 should be turned off. The turnoff signal is thought to be insulin. This may be an oversimplification, though.
According to Salk Institute researchers quoted on RxPG news, “In many patients with type II diabetes, CRTC2 no longer responds to rising insulin levels, and as a result, the liver acts like a sugar factory on overtime, churning out glucose [day and night], even when blood sugar levels are high.” Because of this, the “average” person with Type 2 diabetes has three times the normal rate of glucose production by the liver, according to a Diabetes Care article.
Diabetes Self-Management reader Jim Snell brought the whole “leaky liver” phenomenon to my attention. He has frequently posted here about his own struggles with soaring blood sugars that were not controlled by 75/25 insulin, pioglitazone (brand name Actos), nateglinide (Starlix), and glyburide (Micronase, Diabeta, Glynase, Prestab). All the medicines were overwhelmed by his liver’s dumping glucose.
The best tool medicine has found for controlling the liver is metformin. Metformin has been known for decades; it has been the first-line oral diabetes medicine in the United States since the 90’s. But until recently, we really haven’t understood how it works, so it has usually not been used to best advantage.
Metformin prevents the liver from dumping more glucose into the blood. Scientists used to think it worked by telling CRTC2 to cooperate with insulin (in other words, reducing insulin resistance.) But new studies have found that metformin actually works by bypassing CRTC2 and directly telling the liver cells to hold the sugar.
So if your CRTC2 switch is busted, you need some metformin in your blood at most times, to prevent the liver’s dumping glucose. Jim discovered this one night when he forgot his dinnertime metformin and took it at bedtime instead. In the morning, he had very little dawn effect; his morning sugars were much better. Working with his doctor, he figured out that taking 500 milligrams of metformin at 10 PM and another 500 milligrams at midnight kept his sugars down until 5:30 AM.
It seems that for people whose leaky livers are the main factor in their sugar levels, taking 500 milligrams of metformin four or five times a day might be optimum. But everyone’s different, and it takes some work (with your doctor) to find what pattern works best for you.
Metformin takes a couple of hours to fully absorb, and lasts about five hours in most people. (Half-life in the body is about six hours.) There is also an extended release form that can be taken once or twice a day.
What causes leaky livers in the first place is not really known. It seems that people with fatty livers may be up to five times as likely to develop diabetes, so liver fat, which is loosely associated with abdominal fat, may be part of the story. But thin people can have leaky livers, too, so there’s more to it.
It might help to learn when your liver tends to dump sugars. This might require frequent monitoring for a while. Jim has a continuous glucose monitor, which enabled him to get his regime right. According to him, if his sugar goes low, or his metformin level goes low, or sometimes after eating (for some unknown reason), his liver will dump glucose into his bloodstream, as he can see on his monitor. The only thing that stops it is having enough metformin in his system. (I’m sure Jim will correct any mistakes I’ve made in the comments section.)
People without diabetes sometimes take metformin for weight loss or for conditions like polycystic ovary syndrome (PCOS). It’s one of the best, most affordable and most successful chemical medicines ever invented.
When the dose is too low, however, it may not seem to work at all. Bottom line is that many people with diabetes may not be getting enough metformin or not getting it at the right times. You might be one of them, especially if you have a dawn effect, especially if you’re already on a basal insulin.
There is a lot more to learn and say about these topics, but I want to hear from you first. Does any of this ring a bell for you? What have been your experiences?
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If you ever feel swamped and pressed for time, I’ve got a meditation about time that will help you relax, at my blog Reasons to Live.
I remember taking 1500 mg of metformin in the beginig of my diabetes and it did nothing. could be that just was not enough. Now I pop some along with tonnes of insulin and it does seem to do some good. Jeanne Wagner has great success with it at 2800 mg/day. Many people cannot take it because of GI upset or like me makes me feel DEAD tired.
Posted by calgarydiabetic | Sep 07, 2011 at 4:47 pmGreetings, The cytomegalovirus switches the kidneys’ bloodpressure raising activities into overdrive: RAA system renin-angiotensin-aldosterone.
Posted by Caroline Comings | Sep 07, 2011 at 6:30 pmDoes your research indicate the possibility that this hyperactivity of the liver might too be caused by a virus?
Best wishes.
My metformin prescription says to take
Posted by Anne | Sep 07, 2011 at 7:02 pmwith a meal. If I forget to take my
my dosage at dinner time which is usually
when we eat out, the next morning there
is no difference in my blood sugar level.
I had been eating nuts, seeds and whole
grain products. I had some female surgery
in June and my GYNO told me to stay off
of them. I have been losing weight since
then, not really weight but inches. All
my clothes need altering again.
There is nothing worse than going to bed at 115 blood sugars and fasting next morning test at > 200. It just seems unfair.
Posted by Bill | Sep 07, 2011 at 11:37 pmI am a Metformin user. I find that if I take Metformin about an hour before my dinner time, my morning glucose levels are much better. I am not sure why; it seems to be contraindicated by this article.
Posted by Krishna Kumar | Sep 08, 2011 at 3:42 pmDon’t forget … in insulin dependent diabetes even if a patient is releasing a lot of unwanted glucose, it can be dangerous. It’s not like metformin is selective. If someone goes low in the middle of the night and they are taking metformin there’s a good size risk of the liver NOT doing it’s job when it is needed.
Posted by Doris J Dickson | Sep 10, 2011 at 6:05 pmresponse as follows:
Using CGMS and by careful testing:
a: If BG is low at night AND no snacks after dinner ( 5 to 6 pm); checking bg at 3:00 am and 6 am should smoke out liver if its is doing the nmonsense - 150 at 3:00 am and 238 at 6:00 am is liver overloading body. Metformin willl stop
by taking 500mg dose at 10:00 pm and 12:00am midnight. Single large dose does not work.
i have used this since may 2010 and bg dropped from 13.3 to 6.9.
krishna kumar:
i have found taking one hour before meals most effective and stops any spurious liver dumps when gut/intestine ends and drops glucose output. any turbulance in bg dropping can cause sympathetic liver dumps to 278 or higher.
i do this.
doris j. Dickerson:
very good and interesting comment but :
i run on cgms with alarms set.
i ensure any loose insulin is worn off before i go to sleep (other than lantus)
i make sure bg is 122 to 133 when i go to sleep and it usually can drop to 110 to 119 when asleep.
during day i run a 500 mg dose one hour before every meal. i have not seen any spurious liver dumps i used to get once or twice a week since running this dose approach.
one needs to check dose upt tp strength on standard met. for me 2.5 hours up. lasts up to strength 2 to 2.5 hours and 20 minutes to clear system. data sheets show 1 to 3 hours at strength.
i see no benefit from any residual met hanging around.
each time pill comes up to strebgth; i watch body bg drop as liver cut off and as it exits system; i can see bg gradually crawl up to ceiling.
single large dose useless once a day while paking smaller doses around clock gives consistent results.
teva er and regular teva useless while most met standard generics work.
its a shame that ada and endo’s doing nothing or it seems that way to resolve liver leaks.
after 30 years and a stroke and numbers all over map; mess is cleaned up; liver leak stopped, actos and starlix and 75/25 insulin all booted out;
on tight mediterranean 1200 calorie diet and 1 to 2 miles walking, issues stopped - I did not say cured. Feel way better.
Insulin was NOT key medicine but metformin telling liver to shut up is. I now take 3 to 4 units of humalog lispro and now in 30 years I have predictable numbers that one can track with handheld if desired.
I realize that this is not the 23 century with Dr McCoy’s magic wand and the computer processing power of the starship Enterprise processing data and helping fix patient; but we can offer an electronic pak of CGMS and some chemical analysis that new type 2 insulin resistant patient wears for 2 to 3 days and then brings in and data is processed and Doctor gets full picture on all key orghans from gut, liver, pancreas, kidneys, thyroid so doctor can than apply medicine tool kit to adjusting patients system better as well as getting diet and exercise instruction to enable his hunter gatherer old gene super eficient digestion system not to overwhelm body with overage of glucose constantly in this day of plenty and marginal exercise.
The order of Merlin, divinening rod and educated gueses in this day in age remind one of when Dr. McCoy is wandering around a 20th century hospital and runs into a lady - when asked says she is in there for dialysis. McCoy says - what the devil is this - the dark ages - here take this pill and call me back if any trouble. Of course - later in show women is magically cured.
Posted by jim snell | Sep 12, 2011 at 10:06 pmThis has been a very good read. I found comments that answered so many questions.
Posted by donna | Sep 14, 2011 at 12:29 pmI don’t take metformin but would like to see if you have an idea that can help me understand why my readings take about 4 hours to fall back to the reading before eating. I take 31 units of Lantus daily, in the morning, 5 or 6 units of Humalog depending on my early morning reading. my mornings readings range from 106 to 130, average.
Posted by MILDRED MCNAIR | Sep 14, 2011 at 1:53 pmI work hard to keep meals within diabetics range.
I take synthroid, for an inactive thyroid gland,
any suggestion will be greatly appreciated.
Metformin use has also been linked to longevity (1) and a general reduction in incidence of cancer (2). It makes sense if it reduces blood glucose levels without a large increase in cellular uptake of glucose. Actos, on the other hand, increases cellular uptake by improving insulin resistance and has recently been implicated in increasing the incidence of bladder cancer. Personally, for this precise reason, I have reduced my dose of ActosPlusMet from twice daily to once daily and replaced it with Metformin alone. I have not noticed any changes in my blood glucose readings from dropping Actos.
(1) http://www.worldhealth.net/news/the_most_effective_and_under-appreciated/
(2) Metformin and cancer: Doses, mechanisms and the dandelion and hormetic phenomena
Posted by Tony Kumar | Sep 14, 2011 at 2:04 pmCell Cycle, 2010, vol. 9, no6, pp. 1057-1064
I knew years ago I had some liver damage caused by being on pain killers for so many years. I was told I have Type 2 Diabetes and the Doctors say that from all the neuro damage I have in my body including having a minor heart attack and then recently in the hospital for mini strokes, I never took the seriousness of taking my metformin, I would go weeks forgetting to take it and I am bad about taking my insulin shots. I have so many pills I have to take, I had lost 65 lbs and still battle highs and lows of my sugar. My insurance company will not pay for me to get a one on one training about how to care for this issue, all I know about it is it runs high in my family from my grandmother, mother, myself and 1 of my daughters. I feel like there is no help for me because I have read so many things and everything is different that I have got to the point where food to me is something I dont want in my life, I usually go all day without eating anything until dinner time and then I eat less then my 5 year old grandson, I never even finish what I am eating. I like this story about the Leaky Liver. Even when I was told I was diabetic and I had to go on med and 60 units of insulin that was all that was explained to me. I am still clueless as to what I am suppose to do.
Posted by Sapphyre | Sep 14, 2011 at 2:08 pmYears ago, I used to take Metformin (1,000 mg in the morning when I wake up and 1,000 before going to bed)for PCOS and lost weight. I did great on it all around but my doctor at the time took me off of it because he said that my liver panel tested too high. My weight came back with a vengeance! I have been off of it for 10 years.
I want so bad to be on Metformin again! Now I have a new doctor and we are going to see what to do for my PCOS and maybe I will be on it again.
Posted by Hala | Sep 14, 2011 at 2:12 pmI used to be a metformin user. I took it for several years for my Type II diabetes. Last year I became anemic and also had knee replacement surgery. While in the hospital they determined the cause of my anemia was from taking the metformin so they took me off of it and now doing just long and short acting insulin. One of the things that I notice is that from the time I get up in the morning until I get a shower and get dressed and ready to go downstairs to eat breakfast (usually 1.5 hours), my blood sugar level can go up 20 to sometimes 50 points in that period. I’m wondering if what you’ve described is what is happening with me regarding my liver dumping sugar into my system. I’ve even taken insulin right at getting up and it doesn’t seem to have the same effect on my blood sugar levels as it does at other times of the day. Is it really true that metformin can make you anemic?
Posted by Mike Moore | Sep 14, 2011 at 2:34 pmThanks everyone for these comments and questions.
Mike, you’ll have to ask your doctors to explain why they think metformin caused your anemia. It can lower vitamin B12 levels, which can cause anemia, but other than that, it’s not a commonly reported adverse affect. They could be wrong.
Hala, perhaps you can go back on metformin. They probably didn’t think the metformin was hurting your liver, just that it’s not safe to take metformin with a bad liver. So perhaps retesting and restarting is possible.
Sapphyre, I’m sorry you are having such a bad time. It certainly sounds like metformin could help you, IF you take it regularly. Since you don’t have access to diabetes education, perhaps you could join a diabetes support group? They often help.
Mildred, maybe you could start taking Humalog before each meal. Or perhaps metformin would help. Diet changes are also possible, but it would be helpful to work with a dietitian or somebody on that.
Caroline, the virus theory of liver dumping is interesting and quite plausible, but I don’t know anything about it. If you find out more, please let me know.
Posted by David Spero RN | Sep 14, 2011 at 3:51 pmI have only been on Metformin since I was diagnosed with type 2 diabetes about 10 years ago. It has been doing a very good job of keeping my blood sugar under control. My last A1C which was in July was 5.8%! I do not watch my diet as closely as I should but I REALLY watch my sugar intake. My doctor also told me that in order for Metformin to work the right way YOU MUST TAKE IT WITH YOU FIRST BITE OF FOOD OR IT WILL NOT WORK!
Posted by John | Sep 14, 2011 at 4:58 pmi am type 2 diabetic and my dr prescribed metformin and i was put into the hospital and was told that metformin was shutting down all my organs they took me off of it and put me on glypicide and my body returned to near normal function so for some i do not think metformin is good just my experience with it i have also heard from others metformin was working great for them i guess it just was not right for me
Posted by virginia | Sep 14, 2011 at 5:25 pmWAS WONDERING WITH MY LIVER BEING SHUT DOWN FROM TAKING LIPITOR, COULD I STILL GO ON METFOTMIN ? IT REALLY SEEMS FROM WHAT I HAVE READ THAT I WOULD BENEFIT FROM IT,, I’M ON JANUMET 50/500 TAKE 1 TWO TIMES DAILY PLUS GLYBURIDE 4 A DAY , THE JANUMET IS SO EXPENSIVE AND OUR INSURANCE HAS CHANGED I CANT AFFOARD IT, SO I NEED AN ALTERNATIVE OF WHAT TO TRY AND THIS MIGHT WORK,,,
Posted by VICKIE BOGUE | Sep 14, 2011 at 9:10 pmI’ve been on varying doses of metformin er for most of the 11 yrs that I’ve had type2. Taking it at bedtime seems to work best for me, no matter what the dosage.
I read a very interesting little article about the different generic brands of metformin ER and how they don’t all work the same. Some people had better control with the Teva brand,some could cut their metformin doses, and some had worse side effects from it than with the other brands they’d been taking. I’m not sure that it’s readily available, as I’ve picked up mine from two or three different places and have never had it. I don’t know if/how/where you can choose which generic brand to get, but I think I’ll call the different pharmacies around here and see.
The article is at: http://diabetesupdate.blogspot.com/2011/02/differing-brands-of-generic-metformin.html
Posted by marciejoy | Sep 15, 2011 at 12:06 amMike — As already mentioned in my above post, I’ve been on metformin for 11 years. I had read in two or three places that it can lower your B-12 level, so I’ve been taking an oral supplement. Same with Co-Q-10. You might consider this approach.
Posted by marciejoy | Sep 15, 2011 at 12:13 amI take metformin 1,000 in morning 1,000 before bed my morning bs are still in the high range 129-160 and they go up and down like a yo-yo at nights depending on what and how much i eat. they aren’t much better than before i didn’t take them. I am not thirsty and my sores heal rather fast even though dr. said i was diabetic. the only thing is my bs levels.my sugar levels weren’t that high until my dr. put me on Hydrochlorothiazde for blood pressure. wondering if this med. can be causeing the high bs levels? i also take 2 other blood pressure meds. and chorestroal med. since i went to, to 2,000 mg on metformin i get bad heart burn dr. gave me meds for this also.
Posted by linda | Sep 15, 2011 at 1:43 amI’m not sure what liver dumping is? To read all the other comments, y’all sound like medical professionals. In 1980, my gallbladder was removed. As a result, my liver has been dumping bile (at times to be quite embarassing). All of this has been happened without being diabetic.
I have now been Type II (after 2 gestational pregnancies) since about 2000. I was initially put on metformin that I took twice a day (500mg in morning, 500mg before bed). My readings were not urgently out of line but doc wanted to get a handle on it.
I do not have high blood pressure, high cholestrol, anemia, or anything other than being diabetic. I was progressed to actos (whoa, big time vertigo issue on first dose).
After a sever bout with edema (I gained 60 lbs in one month) it was discovered that I not only had a GYN issue resulting in a complete hysterectomy (with 4 units of blood given before the surgery to put color back into my face and more during surgery). I am now waiting to get this extreme weight gain down to replace a defective aortic valve (that I was born with but never was treated for). Hard to exercise when you can’t get your heart beating to hard or breathing becomes an issue.
My current diabetes meds are Lantus 70 every 12 hours, 1.8 shot of Vitoza in morning, and Novolog with each meal. I also take Lasix for the heart issue AND I am manic depressive and take lamectal, clonopin and paxil for that.
I gotta believe that ALL this medication and surgeries have affected everything about my diabetes. HELP.
Posted by Denise | Sep 15, 2011 at 6:33 amI asked my new dr to change my advandia to metforman in January and have gotten along very well with it I take 500mg every 12 hrs . I was having chest pain and weight gain while taking advandia my previous Dr would not change my RX. I did discover that I had to do a NO FAT diet for about 3 months after starting the Metforman. I still am very careful about fats , also the information that came with the metforman says not to drink alcohol at all so I stay with that also .
Posted by Maria Huff | Sep 15, 2011 at 6:34 amI come from a family of diabetic’s. My younger sister is the only one insulin dependent with a pump.. I take 500 mg of metformin 2x’s a day. one with my morning meal and the other with my evening meal or around 6:30. My sugars have been under control, but it seemed to take a week or so of the pattern in order to keep it under control. I don’t seem to have the real highs or real lows that I had before. However, I have learned always check my sugar before taking the medicine. If it is 100 or less, I do not take the medicine. Thanks for the info
Posted by Jewel | Sep 15, 2011 at 7:46 amNow that you mention it, I realize that my sugar count in the mornings is lower when I have not taken my Metformin immediately after supper, but forgotten until later in the evening and sometimes just before going to bed. I’ve been on 1000mg of Metformin - doctor wanted me to take that in the mornings with one 10mg GlyburideXL and then take another 100mg at supper.It lowered my blood sugar too much, so I cut out the morning Metformin and only take it if my blood sugar is really high at lunch and then only take 1/2 a pill (500 mg)which works wonderful.
Posted by Ernestine York | Sep 15, 2011 at 11:15 amThank you for your article. It really helps me.
Metformin was the first medicine the doctor tried me on and it made my blood pressure sky-rocket! I take two different meds for high blood pressure and it did’nt seem to stay down at all while taking metformin. I am now taking Amaryl and it’s not keeping by blood sugar down where it should be. It’s always higher than it should be in the mornings.
Posted by Angie S | Sep 15, 2011 at 10:00 pmI used to take Metformin for my diabetes but my endocronologist put a stop to this since it may harm my kidney. NIH website also puts out a warning on this point. So what is the effect of Metformin on kidney?
Posted by Dick | Sep 15, 2011 at 11:07 pmA key and a comment/question:
The key is that while metformin is the most commonly prescribed and often the most effective drug for diabetes, it does not work for everyone. A couple of people have mentioned that it did not work for them, and the reason is that diabetes can stem from a couple of underlying conditions. If indeed the problem is with how the liver responds to blood sugar levels, then metformin can be hugely effective. But if the problem really is elsewhere, then other drugs and/or insulin might be more effective. When I started 8 years ago, I rapidly got up to the max met of 2550 mg/day and my blood glucose had come down but not yet to normal until I started taking Glipizide XL. When I then quickly got down to below a 5 A1c we started cutting back the metformin gradually, over the course of a year, and my blood glucose never went back up. For me the liver clearly was not an issue, but my pancreas was. 7 years later I still don’t take met, have reduced the Glipizide, and still maintain around 5.0, but if I skip a dose, I jump about 20-30 points the next time I test…
The comment/question is that I have read before the point made here, that WHEN you take the met can make a huge difference; and in particular that a nighttime dose sometimes can lower morning numbers. But for a huge number of people who try that, it fails to have that effect. The more common wisdom is that met works by building up to a level in your body, and that each day’s pills maintain that level, and that in fact it does not matter much when you take them. That is why when people start met, it can take a few weeks to even a few months to really kick in and start being effective, and also why when people stop, the effect is often not noted for a few weeks also.
So that is pretty different than the idea that dosage timing makes a big difference. My guess is that both theories may be right, but for different people, that how our biologies react is not identical. I haven’t heard of any research that might help identify which outcome is most likely for an individual based on a blood test or genetic marker, but suspect that in time it will become more predictable, so that instead of playing trial and error, the tests will say from the get-go what is likely to be the most effective treatment regime…
Posted by Morris | Sep 16, 2011 at 12:59 amwhat the effects of metformin on the kidneys? My Dr. just took me off metformin becuse it was causing damage to my kidneys.
Posted by gary | Sep 16, 2011 at 12:45 pmGood points.
Type 2 diabetes Insulin resistance is not a uniform disease caused by a single common organ/hormone misfiresame that cause blood glucose control mucked up but by a multi-organ-multi hormone complex system. That is key critical point.
That is whay a careful scan of key organs and hormone signalling on a 24 hour/48 hour basis with a compact portable analysis loaner system is needed to catch the data.
Single lab test while catching out right failure is not tracking action through empty stomach, eating, digestion cycles, exercise and all going on.
Metformin appears most effective if ones liver leaks and that has been confirmed with monitoring bg throughout full 24 cycle and especially at midnight.
For those whose liver and its buffering - emergency glucose functions work correctly, then value of metformin may be greatly reduced.
For those whose livers may benefit may need larger doses. John Hopkins study did say that they believe there are conditions that metformin will not help and for those, they had a proposed test that could identify those and dose size that works. For me; 250 mg has no effect; 500mg appears to work.
In my case; my Doctor has recommended that I ensure my BG does not go sub 100 and trigger any of the liver dump functions that for me dump in uncontrolled amounts of glucose. For me that has required metformin to keep liver messing up picnic.
Judging by writing to this web site and others, most folks livers are working reasonably well and they can avail themselves of the livers extra glucose add functions without blowing up average bg and destroying - rotting out body.
This whole field is just now getting attention and release of some of the additional powers of metformin as well as type 2 diabetes insulin resistance stopping and cure thoughts.
So far, the most happening right now showing any real gains surrounds lap band, bariatric bypass surgery, small intestine liner, starvation/reduced carb diets and hearty exercise.
The bigger problem is that as body ages, the degredation of the human body may not be uniform across the major organs namely stomach, intestine, pancreas, liver, kidney and thyroid such that a Doctor may have to adjust these as one ages.
In my case, while insulin was not fix, yet due to aging my pancreas was down and needs a small boost of meal bolus and basil insulin assists but for this body liver was they key pest at this time.
After 30 years of too much insulin not really fixing anything, my body booted out the excess of 26 units 75/25 humalog, starlix ( and the dam glyburide) and that other charmer actos.
ENergy intake - Carbs ingested in daily diet and respecting old hunter gathere gene set digestion system and its supper efficient capability grabbing extracting every possible calories out of food and guarding against excess quantities of super grains, rice, starches and getting sufficient heraty exercise are also part of the whole puzzle.
A terrible dis-service to all type 2 diabetic insulin resistance types is the unfortunate treating as a simple monolithic disease for which adding tons of insulin will fix.
Today we are starting to see a tool kits of meds dealing with glp-1, gpp-5 , leothyroxin, metformin.
The Salk institue felt that the effects described by Dave Spero’s article on Metformin suggested we should be able to create new drugs to better do the effects found on metformin that is still not properly described in many other web site data other than Diabetes Self-management for which I send my deepest thanks.
My other read as a layman that not fiixing serious liver leaks will overide any diet efforts to stop rot and body - eyes, kidneys, et all and body will be condemmed to rot out.
Posted by jim snell | Sep 16, 2011 at 1:16 pmgary:
Without knowing your whole situation, drugs and meds on, it is impossible to comment on what your good doctor has done. Your kidney’s may no longer able to handle the metformin load.
In my case:
my kidney doctor zeroed on the actos and wanted that dog out now. that said I did the followiing:
a) diet set to 1200 calories adn watching items that may acerbate.
b) remove actos.
c) remove excess insulin whne body on low diet booted out 75/25 insulin, starlix.
d) got 1 to 2 miles exercise.
e) took vitamin supplements to make up for any loss.
f) used met to get a1c from 13.3 to 6.9
AFter lab tests every 3 months since May 2010;
kidneys stabalized and all key numbers stable and in spec.
My read was that actos and excess body glucose were source of rot for me on kidneys. Their gone/under control and kidneys now stable.
Posted by jim snell | Sep 16, 2011 at 1:27 pmi have been taking metformin for 12 years, started off with 500 to 1000 then 2000, then 5 mg Glipizide twice a day, my sugar started yo yoing, the Glipizide would drive it down to fast, sweats and dizziness , like wanted to pass out. stated getting weaker with no energy. started going into depressions and neuropathy got worse, had to quit job, balance was getting so bad. i read how metformin effected your b 12 levels i started getting b12 shoots at lab once a week my energy level came back up for 2 to 3 days. so cut half metformin down to 1000 at evening meal, my depression lifted and suger level dropped and is stable. started reflexology for feet and shoulder.
Posted by leonard | Sep 16, 2011 at 2:58 pmi guess we have to get touch with our bodies it will tell if some is good or not.
Leonard: Thanks for sharing!
Your experience and comments bear out my suspicions and method of taking pills is that super size doses only provide massive dose over the pill lasting time of 1 to 3 hours and providing serious side affects . Taking smaller doses spread around the clock provide a more even dose without hammering body.
i am unclear who in the drug industry thinks because you put in huge dose, the human body then spreads these doses conveniently around clock.
Absolute bull and I have had this discussion with a safety officer of some heart pills.
He even suggested to take bigger single dose. When I told him that does not work and I do not want to hammer my body - oh well spread around clock.
I have verified my metformin as well a heart medicine and found only way to get even proper control was thru the normal small dose spread around clock. Spent 2 weeks checking hour by hour.
my honest take (at least for me) is that single large doses are useless and waste of money and drugs. One can build a skyscrapper on initial large dose in one’s body with short duration interval or take smaller - normal doses spread around clock at proper intervals ensures more even continuous dosage. My results and success come from spreading the dose at regular intervals.
Posted by jim snell | Sep 16, 2011 at 9:00 pmI am on glimepiride and metformin. I have been on several different diabetes meds during the last 15 years or more. With some I have had adverse effects and had to stop taking them(Actos, DPP-4 enzyme inhibitors and most insulins). However,the Somogyi effect was the worse in the past when I was on insulin. I would wake up out of a sound sleep around 4:00 AM and could not get back to sleep for an hour or two. My blood glucose kept rising.
Posted by Nancy | Sep 17, 2011 at 2:08 amI then got back to the current meds and the effect of Somogyi is almost gone. Now I can sleep through the night. But my morning BG is still about 50 to 70 pts. higher in the morning than at bedtime. After reading this article, I have decided to try changing when I take the metformin and to take one 500 mg with my bedtime snack. If it does any good I should know in a week.
More great comments and questions
Vicki — Janumet combines Januvia with metformin. You definitely could take Januvia and metformin separately, which might save money, although Januvia is still pretty expensive. You and your doctor might need to come up with another plan. Metformin itself is extremely cheap, and you may not be getting enough of it.
Virginia’s and Gary’s experiences show that metformin is not for everyone. However, the evidence shows that kidney damage from metformin is unusual. It can happen, though. If your doc says met is too dangerous for your kidneys, ask him what evidence makes him think that. Perhaps ask your pharmacist, too. No medicine works for everyone.
Posted by David Spero RN | Sep 19, 2011 at 2:13 amI have had PCOS, now I’m in menopause, such a releif in its own way. Regarding this particular blog I think you are on something here. I work nights and sleep days and I find that when I get home I still feel full from my lunch from 5 hours before, the odd time I have taken meformin before bed and find I sleep better and when I wake my belly isn’t so bloated feeling. I also find my bs #’s are more reasonable. I’m also now taking something (can’t remember the name of drug)for my liver in regards to lowering my cholestrol (the bad one), seems its a hint over the normal range.
Thank you for this info, it seems to ring true with my own accidents.
T
Posted by thea | Sep 19, 2011 at 5:35 amDavid:
I believe your excellent article hit the super lode on these issues and certainly provided excellent comment and feedback.
As the lady early on said: your blog answered many questions.
Ah men to that and thank you.
Posted by jim snell | Sep 19, 2011 at 10:15 amFirst time in my life I am understanding what metformin actually does. I knew it interacted with my liver and reduce the conversion of other bodily masses (starch, fat and what-not) into glucose for energy, but “how”, was a mystery until now.
While I was on oral medication, my pill regiment was to take 1000mg metformin tabs, twice a day. BUt at the same time, one of my old endocrinologists scared me by saying my liver size is larger tha that of a normal person of my age and size. So, I was keeping a tight control over what I eat and take that is making my liver function outside its natural ways. So, when I went from oral medication to insulin regiment, I kept taking metformin upon my doctor’s advise. But one day my prescription ran out and my doctor apptmt was a week away. And I got distracted to call the nurse for a new prescription. With the insulin regiment that I was on, I noticed, lack of metformin did not make any changes in my glucose levels. So, next week I asked my doctor if I can stop taking it. He said we can try. And I am not taking it for the past 2+ years. As long as my insulin injections are timely and sufficient, I am good.
On the other hand, I am battling with weight problem. And one of the comments made in the article as well as my ex-wife (who is a morbidly obese person) had one of her doctors prescribing her the metformin pill as a help for weight loss, making me think about my decision. Later in the week, I have my second appointment with my endocrinologist and I will run this by him to see what he will say.
I would like to hear from others who are in the same or similar situation like myself.
Thanks
Posted by M. B. | Sep 19, 2011 at 6:21 pmThere is a mistaken idea here about metformin timing.
If one needs to shut down dawn effect of liver over loading glucose; then taking metformin at 10:00pm and 12:00 am will for some shut down dawn effect from 12:00 am through 5:30 am.
If one has spurious liver dumps during falling glucose output at end of digestion from gut/intestine; then taking met pill one hour before meal usually ensures met a strength in blood and liver stalled out from doing a spurious dump even though BG at fingertips can be between 140 through 210.
In all cases the timing of met and when to take should be per Doctor’s instructions.
The timing was established from hard data from CGMS watching BG and activity and effects of metformin timed to ensure up at strength at optimal time. At all times dosgae and taking of metformin must be per your Doctor’s direction and advise.
Posted by jim snell | Sep 19, 2011 at 10:19 pmweight loss and metformin:
prior to shutting off liver dawn affect that dropped a1c from 13.3, i was on tight diet of 1200 calories and exercise and could not lose an ounce for 2 years.
After metformin used to shut down dawn effect and same calorie meal program and 1 to 2 miles walking every day - finally lost weight from 330 to now 260 and still dropping.
ones liver can overload diet and cause massive weight gain. For me; metformin shut down the over sugaring of my body. Exercise and 1200 calorie diet did not change prior and after metformin timing optimization.
Posted by jim snell | Sep 20, 2011 at 8:46 pmHi Linda,
Thanks for your question. According to WebMD/ “If you have diabetes, hydrochlorothiazide may affect your blood sugar levels. Check your blood sugar levels regularly as directed by your doctor. Your doctor may need to adjust your diabetes medication, exercise program, or diet.”
I hope this helps.
Best,
Posted by Diane Fennell | Sep 23, 2011 at 11:50 amDiane Fennell
Web Editor
This is all very confusing. I have problems with side effects of taking medformin. One medical person said that could be fixed by injecting insulin. Then another said to take medformin at the end of my meals not at the beginning. Those simple instructions took care of the problem. Hard to know who to believe.
Posted by Ferne | Sep 30, 2011 at 12:38 pmThankfully I just stumbled upon this website which I find full of very good info. I have been type2 for about 12yrs and on metformin for about6yrs. Not one Dr has explained what it actually does or when to take it. It has just been left up to me. (Of course I keep a very tight control with all tests remaining constantly good. a1c around 6.6-6.9. The later shook me up and I got back on track. Didn’t know the term morning dawn but I do have higher readings at that time. 115-144. I will try these 2 things: taking 500m at bedtime with snack, and taking met with first bite of food throughout the day.
Thank you all for your input and I will report back. Hopefully my info will help someone else.
Posted by Carol | Oct 05, 2011 at 5:52 pmVery interesting read, I appreciate everyone’s input.
Sypphyre - Here in Florida our local Extension Office - University of Florida IFAS extension provides classes on diabetic education and they are free. Maybe in your county the local extension office does it as well.
Thank you for providing this space to help us all understand this disease.
Posted by Kim | Oct 05, 2011 at 11:42 pmI have stumbled on this discussion quite by accident after Googling “Glycogen”. I have been looking for someone on the same line of thinking as me for a long time and hopefully you, David, are that person. Lucky you that I live in UK!!!
All the above seems to be about Type2, but thats not the end of the story. I have been Type1 for 63 years and now have a pump.
I have been teling my diabetes team about this “phenomenon” for over 5 years now and they simply tell me to counter the “sugar” with more and more insulin. I actually counter it by reducing my insulin requirement by 10% for a few days and the glycogen effect gradually disappears. How long depends on how long the Glycogen has been being produced. Now that I have found the solution to the problem my “highs” last about 12 hours only.
Its taken me a long time to find out this remedy and my team simply look at me and my charts with disbelief. The breakthrough came by injecting 3units insulin and retesting after 1 hour to find the sugar level had increased; perversely I ate 40 grams carbohydrate and found the sugar level went down. My team said I simply pee’d it away!!
In my case it appears that what I call my “hypo floor” varies. So far as high as 100. When this floor is reached my BS spikes upward dramatically fast and treating with insulin merely accentuates the problem.
It is my belief that this liver dump occurs when my BS reaches my hypo-floor and creates a “false BS reading” around 50 higher than my true BS level. Eating carbs to raise my “true BS level” stops the liver dump and the BS lowers to a normalish level.
I recently postulated that i believed that glycogen was the cause of Type2. How strange?
If you want to further this outside of this discussion I expect you can access my email address.
David
Posted by David Taylor | Oct 30, 2011 at 11:55 amI can understand every word,because I am really suffering from liver dumping, every night when I am going to bed, .I have no blood sugar and I am monitoring since 6 months all the day whatever I am eating, I am under max levels,my problem starting in the evening ,after a heavy or light dinner ,my blood sugar is going to approx100, but in the ti me of bed my bs. Start to go up ,in the morning it comes to 130 135if I eat light 126 if I had havier dinner ,the problem is not over here ,I have my breakfast ,and than immediately my blood sugar goes up to up to 225 before it start to go down after 1 hour,to be normal after 2 hours ,and than in lunch and dinner it never goes up more than 140 during the 2 hours. to face this I am trying to shorten my night and at 5 am I am having my breakfast and than going imdtly to have fast walking in treadmill for 1 hour. ,taking my bs every 20min I have it max 145, than I am swiming. 40 minutes .my blood sugar after completing this process goes down to 90 and stayed normal till night bed time.
Posted by Cristian | Apr 28, 2012 at 11:31 pm