Diabetes Self-Management Blog

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?

**
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.

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Comments
  1. 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 |
  2. Greetings, The cytomegalovirus switches the kidneys’ bloodpressure raising activities into overdrive: RAA system renin-angiotensin-aldosterone.
    Does your research indicate the possibility that this hyperactivity of the liver might too be caused by a virus?
    Best wishes.

    Posted by Caroline Comings |
  3. My metformin prescription says to take
    with 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.

    Posted by Anne |
  4. 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 |
  5. I 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 |
  6. Don’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 |
  7. response 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 |
  8. This has been a very good read. I found comments that answered so many questions.

    Posted by donna |
  9. I 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.
    I work hard to keep meals within diabetics range.
    I take synthroid, for an inactive thyroid gland,
    any suggestion will be greatly appreciated.

    Posted by MILDRED MCNAIR |
  10. 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
    Cell Cycle, 2010, vol. 9, no6, pp. 1057-1064

    Posted by Tony Kumar |
  11. 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 |
  12. Years 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 |
  13. I 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 |
  14. Thanks 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 |
  15. I 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 |
  16. i 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 |
  17. WAS 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 |
  18. I’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 |
  19. Mike — 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 |
  20. I 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 |
  21. I’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 |
  22. I 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 |
  23. I 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 |
  24. Now 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.
    Thank you for your article. It really helps me.

    Posted by Ernestine York |
  25. 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 |
  26. I 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 |
  27. A 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 |
  28. what 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 |
  29. Good 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 |
  30. gary:

    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 |
  31. i 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.
    i guess we have to get touch with our bodies it will tell if some is good or not.

    Posted by leonard |
  32. 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 |
  33. I 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.
    I 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.

    Posted by Nancy |
  34. 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 |
  35. I 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 |
  36. David:

    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 |
  37. First 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. |
  38. There 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 |
  39. weight 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 |
  40. Hi 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,
    Diane Fennell
    Web Editor

    Posted by Diane Fennell |
  41. 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 |
  42. Thankfully 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 |
  43. Very 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 |
  44. I 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 |
  45. I 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 |
  46. I am presently on metformin 500mg to1000mg and it makes me stay in the bathroom. my doctor suggest that i take immodium to help control the stool. However, by reading your articles there are somethings that I am going to try. I blood glucose is usually high in the morning around 147 but the minute I empty my stomach the readings begin to drop below 120.

    Posted by joyce |
  47. David, I can’t tell you how much your article has helped me! I was diagnosed last October with Type 2 diabetes and since then have been following a carb-restricted diet with daily exercise. I’ve lost close to 40 pounds, but my blood sugar hasn’t stabilized.

    What’s more, I discovered within the past two weeks that exercise makes my blood glucose RISE. That’s when I began to investigate this “liver dump” phenomenon. I saw my Dr. yesterday and he was surprised to get my results. We took blood for a new A1C, and he said that he may prescribe metformin based on those results.

    After reading your article, I’m convinced that my diabetes is a combination of factors. I had my gall bladder removed in 2006, and I had thyroid cancer in 1997, so my thyroid was removed and I’m on levothyroxine. I’ve been insulin resistant all my life; my whole family is. I wish I could get that “all systems” monitor, but I’m already on high-risk health insurance because of my high blood pressure, so I doubt my insurance would cover such testing.

    In any event, your article has really educated me and I’m going to forward it to my doctor. Thanks so much!

    Posted by Cynthia Astle |
  48. Dear Sirs,
    I am type 2 Diabities and i was taking 2 850 mg twice a day now they cut me back to 2 500 mg a day. I still have the sweets when i eat about 1 to 2 houres after i eat it starts it last about 2 hours.i sweet real bad and my body will get real clamming and then I get week. but then it goes away. could you tell me whats wrong…. Thanks Pam king.and God Bless….

    Posted by Pam king |
  49. Pam, I don’t know if your sweating and weakness is a side effect of the metformin, or if the metformin is taking your sugar too low (hypoglycemia.) Hypos in response to metformin would be unusual, but perhaps it is possible.

    What does your doctor say about this? If the metformin is causing it, it might not be the drug for you. Maybe our readers have some other ideas, but I think you should ask your doctor again.

    Posted by David Spero RN |
  50. Can exercise cause your liver to dump sugar? My bg goes up when I exercise rather than down. I’ve tried taking Metformin before exercising, and after, with no noticeable difference in my bg. I can test at 98 before exercise, and at 160 afterward.

    Posted by Toni |
  51. I have gotten my A1C down to below 6 and my daily glucose averages to under 110 with weight loss, exercise, supplement and 2550mg of metformin taken 850mg at breakfast, 425mg at lunch, 850mg at dinner and 425mg at bedtime. I still get a liver dump with pre-breakfast readings of 120-150 which take till well after lunch to settle down to 90-110 bgs.

    Recently, my cardiologist halved my morning Plavix to 35 and my aspirin 75% down to 81mg which I take at night. Now my glucose readings have jumped up with higher dump readings taking longer to drop. If this keeps up I will be running a 120ish-130ish bg daily average of about 6 readings.

    My research just showed me that more aspirin will probably cause lower bg readings and that plavix might do so. I am tempted to add the aspirin back in.

    I am also tempted to completely swap my metformin schedule to see if that affects liver dump.

    I would appreciate any help or further comments.

    Posted by John Sykes |
  52. I take 1000 mG metformin with 5 Mg glyburide and my insulin is about 120 at 600 am before I eat and heart meds of Effient 10 Mg, Lisinopril 5 Mg, Corvedilol 25 Mg, Asprin 325 Mg. I then measure the sugar again at 12:00 pm and it is at 151. I then take Humalog 75/25 quickpen 4 units and eat lunch. i then measure again at 6:00 pm and the sugars at 117. I then take Humalog 75/25 quickpen 3 units and eat dinner. I then measure at 6:00 am then next morning and start all over again. The Metformin does the job in the morning, and when I take the insulin twice a day it allows full absorption of sugar and stop the CRTC2 from producing sugars I guess. I take the the three med every day. I thought it was the pancreas not producing insulin but it is the liver producing too much sugar release, because metformin work together with insulin treatment. Though close monitoring of sugar is recommended to combine the two meds. I am have high neuropothy pain at night and the level sugar helps a whole lot.
    hope this helps someone else with the same issues.
    Laz

    Posted by Lazaro Gonzalez |
  53. hello docter.
    my father 40 year old .he is the one businessman and also manage one hotel.he has diabetes at 160 point..we regular checkup the diabetes..and i want to know simply that what type of care should be take for him..what type of fruit and food match him at this stage..what type of exercize suit him…..pleaze give me best guidance at minimum time .i am waiting for ur positive response……..

    Posted by mira |
  54. I was diagnosed with Type 2 Diabetes around 2004 and I took my metformin 500mg in AM and 500MG at dinner time. Everything was great I never needed Insulin unless I had to take Prednisone then I took Humalog when sugars were high. Recently my Husband passed away and my Diabetes seems to have gone crazy. I was switched to Lantis 10mg at night. In the middle of the night about 4am my stomach starts to growl and drive me nuts. Sometimes my sugars are fine sometimes they are high 160-which is high for me. I know I can’t be hungry because I had dinner and have really been watching my sugar intake. No sodas unles diet,lots of water and vitamin water. I have breakfast about 9am usually hot cereal and my pills. I can’t seem to eat very much at one time. So I wait about an hour after breakfast to see if my stomach has stopped growlly etc. I check my sugars and they are fine 120 but the hunger etc is still there. I am waiting to see my Endocrinologist which is going to take a few weeks. Now that I understand the the liver might be causing the problem. I will see my primary care and discuss this situation with her again.
    If anyone has any information about this type of problem please let me know.
    Posted by judy 11-24-12

    Posted by Judy Stanley |
  55. IF I DO TAKE MORE THEN 2000MG IS THERE A RISK?

    Posted by wilma |
  56. Re: Krishna Kumar

    taking metformin 1 hour before meal helps - There is a reason and it is not properly discussed nor understood by all the experts.

    It has to do with timing of the digestive track.

    Using cgms, I found by experimentation, taking metformin 1 hour before meals usually ensures met is up to strengh in blood 2 hours after meal ingestion and blocks the liver form doing false liver dumps because some sensor in gut tells brain - glucose going low ( yet fingetip blood is 140 to 200) as glucose generation in gut is falling.

    I have found this approach stops a bunch of false liver dumps as gut is emptying. And why by golly - average BG stays under much better control.

    There neads to be much better testing and understanding of the power of met given much of the “experts” are fixated on insulin sensitivity rtaher than excess glucose cut off in the liver caused by direct signalling of the metformin.

    Posted by jim snell |
  57. I have been a diagnosed diabetic for 30 years. I have ‘progressed’ through all the stages , slowly and now am on insulin; 4 units Novorapid before meals, 20units Lantus at night.
    My ‘contro;’ is very uncertain and i cannot work out diet or dosage.
    I recently had a ‘tummy bug’ and now feel slightly nauseous much of the time. I feel that my liver area gets swollen at times.
    I am wondering if the addition of metformin to my regime might help ?

    Posted by Zela Charlton |
  58. Well on jAN 6, 2013; here is latest findings ( not theories) that metform works to block liver glucose release and directly bypassing the ampk chain:

    Science News
    … from universities, journals, and other research organizations

    Most-Used Diabetes Drug Works in Different Way Than Previously Thought
    Jan. 6, 2013 — A team, led by senior author Morris J. Birnbaum, MD, PhD, the Willard and Rhoda Ware Professor of Medicine, with the Institute for Diabetes, Obesity, and Metabolism, Perelman School of Medicine, University of Pennsylvania, found that the diabetes drug metformin works in a different way than previously understood. Their research in mice found that metformin suppresses the liver hormone glucagon’s ability to generate an important signaling molecule, pointing to new drug targets. The findings were published online this week in Nature.
    ________________________________________
    For fifty years, one of the few classes of therapeutics effective in reducing the overactive glucose production associated with diabetes has been the biguanides, which includes metformin, the most frequently prescribed drug for type 2 diabetes. The inability of insulin to keep liver glucose output in check is a major factor in the high blood sugar of type 2 diabetes and other diseases of insulin resistance.
    “Overall, metformin lowers blood glucose by decreasing liver production of glucose,” says Birnbaum. “But we didn’t really know how the drug accomplished that.”
    Imperfectly Understood
    Despite metformin’s success, its mechanism of action remained imperfectly understood. About a decade ago, researchers suggested that metformin reduces glucose synthesis by activating the enzyme AMPK. But this understanding was challenged by genetic experiments in 2010 by collaborators on the present Nature study. Coauthors Marc Foretz and Benoit Viollet from Inserm, CNRS, and Université Paris Descartes, Paris, found that the livers of mice without AMPK still responded to metformin, indicating that blood glucose levels were being controlled outside of the AMPK pathway.
    Taking another look at how glucose is regulated normally, the team knew that when there is no food intake and glucose decreases, glucagon is secreted from the pancreas to signal the liver to produce glucose. They then asked if metformin works by stopping the glucagon cascade.
    The Nature study describes a novel mechanism by which metformin antagonizes the action of glucagon, thus reducing fasting glucose levels. The team showed that metformin leads to the accumulation of AMP in mice, which inhibits an enzyme called adenylate cyclase, thereby reducing levels of cyclic AMP and protein kinase activity, eventually blocking glucagon-dependent glucose output from liver cells.
    From this new understanding of metformin’s action, Birnbaum and colleagues surmise that adenylate cyclase could be a new drug target by mimicking the way in which it is inhibited by metformin. This strategy would bypass metformin’s affect on a cell’s mitochondria to make energy, and possibility avoid the adverse side effects experienced by many people who take metformin, perhaps even working for those patients resistant to metformin.

    Posted by jim snell |
  59. I have been taking metformin for approximately 20 years. I started with 500 mg twice a day with food. I did not always take the medicine as required, or follow a healthy diet and exercise plan. Consequently my doctor increased my metformin to 1000 mg twice a day. Because of my unhealthy actions I developed high blood pressure and high cholesterol, and I am taking medication for that: quinapril, amplodipine, pravastatin, and hydrochlorathiazide. I also have arthritis so I take tramadol as needed for pain. Two years ago I lost 50lbs by exercising and eating right. The doctor put me on 850 mg twice a day. I have had at least five doctors in the past 20 years. A few days ago I took both doses of metformin within 30 minutes of each other, I forgot I had already taken one. I was driving from church and I became very sleepy. I pulled into a parking lot and slept from 30 to 45min. A phone call woke me up. I drove home and slept hard for about 5 hours. How long will the metformin stay in my liver and have I done any damage to myself? I am 69 years old.

    E,

    Posted by Margaret Hart |
  60. I was recently diagnosed with diabetes and is on the starvation diet and now the BGL are normal. However I have noticed even with the strict diet my FBGL some times are higher, this happens randomly. I have looked in e dawn phenomenon and if this is happening frequently should I ask for medication when I visit my Dr Next time?

    Posted by Indira |
  61. Hi there,
    I have been taking metformin for last 6 months and my BG levels are just about as much as I started, I have been asked to increase my dinner time metformin to reduce my morning BG, but it only seems to go higher even further when I doubled my dose.

    I think metformin is not working for me.

    Your theory does make some sense to me and i will try and see if that controls my breakfast time BG.
    My day time glucose is fine, most evenings it comes to 7. But morning time readings are always more than 10-11.

    I hope this will help me
    thanks,
    NK

    Posted by Nk |
  62. Hi NK,

    Yes, it sounds as if metformin isn’t working for you. But try checking your morning glucose at different times, and try the metformin at different times. You might also check your blood glucose at 3 AM to see if you are dropping low, then rebounding in the morning. If that is what is happening, a midnight snack can help.

    Or there may be some other problem. You should keep your doctor informed of what’s happening.

    Posted by David Spero RN |
  63. I have had type 2 diabetes for some time,, and I am on metformin, and I figured that’s all I need I Have had four pregnancy’s and each one I didn’t have the diabetes, just border line, then with my last child I had it pretty serious and my age really didn’t help it non, he is now five years old and I still am fighting it and really didn’t care at the time apparently and then my doctor said if I don’t get it under control with excersize that I would be put on insulin and I don’t want that, so I went to a nutrition class and I learned a lot about my diabetes and apparently I have a leaky liver, my numbers are high in the morning and then I started a carbohydrate diet and my numbers went down, still high in the mornings so now I am on the slow release metformin, and I am told that this will help with my high’s in the morning,,, I do hope so,, I have lost weight and carbohydrate diet has helped my allot thank you for the information that you have given me and it is nice to find that other’s like me are having to do this as well,,,, sincerely P.J.

    Posted by Patricia |
  64. This explains my delima. I take 1000 mg metformin twice a day. When I first get up at 6:30 AM and again at bedtime, usually around 9:30 PM. At bed time, I also take lantus. I can take my blood sugar any time of day up until 7:30 PM and it will be under 170. Then suddenly it will shoot up to 250-300. When I get up the next morning, it will be back to 100.

    I guess I need to take my metformin around 6 PM so that it is in the bloodstream before the glucose numbers go up. I thought the 24 hour insulin was only lasting 21 hours. This information helps. Thanks!!!!

    Posted by Linda |
  65. I have the dawning effect. I am on an Insulin pump using Novolog. I like tight control where BG is 80-90 fasting. For 2 years this was the case until recently. I also take Symlin 120 mcg. With meals or snacks over 240 calories. I take Metformin 1000 mg. XR twice daily with meals. My fasting BG rises 50-60 points every night. I adjust temporary basal rates and can control it to some extent but not as much as I want. The doc gave me Byetta to try only at the evening meal to see if my fasting BG comes down. It made me kind of nauseated but went away. I ate at 8 pm and by 11 pm my BG was 94 at 1 am it was 72 and by 5 am it was 128 at which point Zi took 1.4 units Insulin as a corrective dose. By 8 am fasting it was 123 not much change. On another meter the BG read 133 at which point I took another. 1.9 units of Novolog as a corrective dose. I take an average if 120 units of Novolog daily and don’t want to keep increasing it. I don’t know why the fastings are starting to go higher but they are. If my am fastings are good my numbers are good all day but if not they are all high all day. Last A1C was 5.7 6 months ago and it was 5.2 6 months before that. So there is something going on, I just don’t know what. But before taking insulin I had fasting BG about 180-190. The pump got it stsight but it is starting to go back up. Basal rate at 10 pm is 2.75, at midnight 2.45, 3 am was incrrased to 3.3 units/hr. What can I do to get the fasting BG back to 80-90 upon rising in the morning?

    Posted by Phil |
  66. I have early morning high sugar, stays high till noon then drops from noon till 5 or 6 pm. I found some help. I have ‘Dawn Phenomenon’. I found 2 ways to stop the high sugar in the mornings. Per the Dawn Phenomenon articles, the liver starts to shut out 4 hormones from 2 to 8 am. Each persons timing differs, for example mine starts about 6 am. However, if I wake up and move around, it will trigger the process to start earlier. It’s after I get up to move around that that the liver starts so that could be 4 or 5 am and just going to the rest room. But after 6am it starts to shoot out the hormones anyway. So for me to keep this from happening and which causes the glucose to rise caused by the liver and not by eating, I must prevent it. To do this, the minute I was up I must get straight up, take my Glucophage with a lot of water, cook an egg and 1/2 piece of bacon and eat it quickly. The liver shoots out the hormones and the glucose quickly you only have minutes to do this and its rising as you do it. But within minutes after the egg and bacon is eaten it will stop shooting out and I check my sugar what ever it is then will be the same 3 and 1/2 hours later. Don’t think this is the end, after much testing of this it works fine but I must then take my Glucophage again before 10:30 and eat more protein or it will start again shooting out but not as fast and as bad. after this I am ok for the day. I avoid bread fruit etc until after noon then at 2pm on can eat that also and it continues to stay down. If I don’t do both these and the liver shoots out this, my sugar rises fast until noon and no medicine will work to get it down till after noon. The dawn phenomenon articles will tell you to eat protein and fat early for this to work but they don’t help with the times and urgency of the eating early. You can do your own test early to see when yours starts. I can get up with sugar of 72 and If don’t do this will be 175 in 20 to 30 min’s in one hour will be 230 or more and in 2 hours 275. … the second help I found was vegetables, I stopped doing the above and went on vegetables and 100% fat free beef or chicken broth and found that after the 4th day sugar was down to 145 or less in the mornings and continues as long as I eat vegetables and broth only. … I found a happy medium, its to do the egg and bacon at 6:15 am and then eat vegetables for other 2 meals, then I can also eat fruit and carbs after noon till about 5 pm and then avoid them after that time. God is the one thru prayer that led me to the dawn phenomenon and he let me know it was to be and egg and bacon. It worked from day one. …. If I go for days without eating green vegetables it won’t work as good. Oh yeah when I ate the veg’s only I wasn’t taking any sugar meds and it worked fine. … now for the cinnamon, it really does help lower the sugar but you must continue to take it. .. and I had my hormones checked and they found they were very low. I have a cream to put on my skin, when I use these hormones correctly they help keep my sugar down and just the opposite when I don’t use them correct the sugar is higher that day. … Last eating a variety of foods and at each meal works best. so eat the protein and fat for 6am and then protein, non bread veg’s and nuts for 11 am lunch then protein, vegs and non bread vegs nuts and fruit for 2 pm snack and 5 pm dinner. use protein or vegs and nuts after that. hope this helps its nice to have low morning sugars ….. even if it means getting up earlier than you want to…

    Posted by MollyAnn |
  67. Hi Phil,

    Your case report is way too complicated for me to safely give advice. One thing I would think about is changing your times for the metformin, and possibly changing from XR to regular. That sometimes fixes dawn phenomenon.

    I encourage you to talk to a diabetes educator about the details of your treatment.

    David

    Posted by David Spero RN |
  68. I have the problem of my liver releasing to much sugar. I have to take a little metformin and acarbosa with a bedtime snack even if my blood sugar is 70. And I also take 750mg of metformin between 4 and 5 am or my blood sugar will be to high in the morning. I also take metformin and acarbosa with every meal, and I follow a low carbohydrate diet to keep it in control. This routine allows me to to keep my blood sugar levels when I get up and before meals between 70 and 99, only once in a while will it be a little over 100. It took me several years to get it the proper doses of meds and my diet right to keep it where it should be. The diet also stops my post meal blood sugars from going up to high. I believe this is vital to avoid the potential diabetic complications from to high blood sugars. It takes a lot of work to get it right but it can be done.

    Posted by Rebecca Sinha |
  69. Neat, Rebecca. I also time my metformin doses to achieve similar effect and control. Thank you for sharing.

    Posted by jim snell |
  70. Is there really a difference between generic metformin and the brand name Glucophage? I’ve heard the brand name is far better. Plus, I was taking Lantus for 9 months and about the 6-7 month mark I started having weird side effects such as extreme dizziness, stomach bloat, nausea, dry heaving and tiredness. I also gained 15 pounds. I stopped taking it cold turkey and all those symptoms went away, my energy levels went up and I lost the 15 pounds. Lantus, which is synthetic, is bad news. I would rather take my chances with Metformin and diet alone.

    Posted by mark |
  71. have been taking metformin for years. because of this I have developed fatty liver that has now turned into cirrhosis. I have been diabetic for over 30 years. I am now 58 years old and my liver is not functioning because of the medicine taken for my diabetes. . I will need a liver transplant within the next two years. metformin is not the wonder drug that everybody thinks it is.

    Posted by kendra |
  72. Hi Kendra,

    I’m sad to read of your liver problems. The government’s LiverTox Web site says metformin “is an exceedingly rare cause of…liver injury.” It almost never happens. You drew a very bad number in the lottery.

    I hope things get better. There are a number of things you can do to help your liver. Some of them are on this Web site.

    Posted by David Spero RN |
  73. have been taking metformin 500mg in the morning plus glyburide 5mg for a long time and my sugars have been normal with the last 2 weeks. My blood sugar has spiraled out of contol. it has been 225 or more in the morning and 210 or more in the evening. My doctor has me taking 500mg 3 times a day with breakfast lunch and dinner and blood sugar is still gigh over 200 with sweating and diareah I dont understand the change I also have alot of burning and numbness in hands legs and feet I am wondering if i need more Metformin to control susar levels or if it just stop working or how long it will take before my sugar levels start to drop below 210 I have valot of shaking too help

    Posted by John |
  74. John,

    If metformin suddenly stopped working, something must have changed. Sweating and diarrhea don’t necessarily go along with high blood glucose levels. If possible, please ask your doctor to investigate what’s going on. You might have an infection or some other change.

    I suppose it’s also possible you have a bad batch of metformin. Might want to take it into a pharmacist to check.

    Posted by David Spero RN |
  75. I take metformin in the morning and night I still urinate frequently at night I probably go to the restroom 5 to 7 times at night to urinate? What do I need to do to control this? During the day I urinate frequently I was told that sugar was pouring in my urine

    Posted by Jawwaad Ali |
  76. Hi Jawaad,

    There are many reasons for frequent urination. High blood glucose is certainly one of the main ones. Can you get that checked? If glucose is causing your frequent urination, you need to get that down. Metformin alone isn’t doing it for you.

    In case blood glucose isn’t the problem, many other causes, and their treatments, are listed at this Web site.

    David

    Posted by David Spero RN |
  77. Interesting posts. I took metformin after reading an article about how the liver works and affects fatigue and/or brain fogs/depression brought on by poor food choices. It actually helped me lose weight perhaps but the main reason I took it at about four in the afternoon was to fight tiredness that I thought might have been brought on by overloading my liver with bad foods. Being less tired helped prevent me from overeating in the p.m.
    I was careful to drink more water while using metformin as I have read that it can lead to kidney failure. My question is whether it helps cleanse the liver or whether it forces it to work properly while we change our diets.

    Posted by Jenny |
  78. After reading this article I am confused.
    Another article that you posted states:
    September 13, 2013
    Metformin and Impaired Thinking
    Diane Fennell
    According to new research from Australia, the
    oral diabetes medicine metformin is linked to impaired brain function, but supplementation
    with vitamin B12 may reduce some of the
    cognitive effects. Metformin is the most widely used diabetes drug in the world, with over 61 million prescriptions for the medicine filled
    in the United States alone in 2012.
    So how can you say that metformin is good for anyone.

    Posted by Lisette |
  79. Hi Lisette,

    Every drug and herb that has benefits also has side effects. Relatively few people report the brain fog you mention. You will have to decide for yourself if metformin is worth it for you.

    Jenny, I haven’t seen anything about metformin as a liver cleanse. I think it just helps the liver store glucose like it’s supposed to.

    David

    Posted by David Spero RN |
  80. Hello my name is jackie and I was diagnose with type 2diabetics and Im current taking metroformin twice a day but this morning woke up at 6am with a blood sugar of 260 cant figure out what I did wrong I did eat a little halloween sweet on last night

    Posted by jacqueline buckner |
  81. RECENTLY MY HUSBAND HAD HIS FINGER AMPUTATED AT WORK DUE TO AN ACCIDENT, 2 YRS LATER NOW HE HAS BECOME INSULIN DEPENDENT TYPE 2 DIABETIC, NEVER BEFORE ANY SYMPTOMS.
    CAN ALL OF THE PAIN MEDICATION HE HAD TO TAKE FOR THIS ACCIDENT CAUSED A REACTION IN HIS BODY TO OVERCOME HIS LIVER AND BECOME DIABETIC PLEASE LET US KNOW
    THANK YOU
    HE WAS TAKING 3 NORCO AT A TIME FOR 4X DAILY FOR MONTHS

    Posted by MARYANN DEES |
  82. Hi MaryAnn,

    Norco has acetaminophen (Tylenol), and three tabs at a time, four times a day could be hard on the liver. I don’t know whether this contributed to his diabetes. I didn’t find any studies making this link, but perhaps it could happen. It wouldn’t be “THE cause,” but might be a contributing factor.

    Posted by David Spero RN |
  83. Hi,

    Thank you so much for your informative article. This may be a long post, as I have much to explain and ask. :)

    I am an LPN, who stopped working in the medical field to persue music, and have been happy with that choice. In 1997, I was diagnosed with Type 2 diabetes, after entering the ER with Severe Ketoacidosis and a BSL of over 700. They put me on insulin, I had a horrid reaction to it. Later when I saw my GP, he explained that from what he saw, my body was still producing insulin, and all I needed was Glipizide to control with proper diet.

    Being a Musician means sometimes you don’t have health insurance, and my meds were sporadic at best, once my reg doc retired in 1999. I ended up in the ER in 2000 again, but something was different. The Attending looked at my hairy face and male pattern baldness and diagnosed PCOS with insulin resistance. He added metformin to my regiment at 250 twice a day.

    Now, again, I’ve had a real problem with getting meds. Sometimes my only recourse was ER’s and believe me that sucks. Over the years though, I’ve noticed a pattern…

    My BSL would rise and STICK. In other words, even when doing EVERYTHING right, as in Low Carb diet, Regular Meds, and proper exercise, I’d see numbers in the 200-300 range AFTER Glipizide… Now one thing I’ve always seen, is that it would be say, 210… I’d take 10mg Glip and eat… It would go UP to say 300… Then go back DOWN to 220 or so…

    Now, here’s the thing… The times would be odd… My dose of metformin always brought it back down to “normal” ish numbers like 120… Then when that was gone it would start up again, and NO amount of Glip would lower that part of it. It was like I never took it!

    Now of course, the lack of proper management led to severe depression… Being a nurse I KNOW the risks, complications, etc… For several years I’d given up completely… Eating high sugar foods, no meds to speak of… I’m talking TEN YEARS. My mind was like, well, it seems meds or no meds, diet or no diet, this ain’t gonna stop, so whatever, just let it go. However the nurse in me was always trying to think of alternatives. I tried Bitter Melon, Gymnema, Chromium, when I couldn’t get meds.
    Still the same pattern where it seemed like there was an overabundance of sugar in my system.

    In 2010, I did see a clinic where the doc upped my metformin AT MY INSISTANCE, after checking my Liver to make sure it would be ok. Helped a little, but still… SAME pattern. I got frustrated again, and when the meds ran out, I stopped.

    Three more years of eating like a 20 year old at thanksgiving, in the deep south… LOL.. NO ketocidosis, NO hospitalizations for extreme thirst, dizziness, etc… You know, the whole “NCD” thing… :) I still felt good enough to function. DO NOT lecture, I gave em enough, but depression can do that… :)

    Now here’s the happy ending… I know WHY.

    2 weeks ago, I finally got hooked up with a GREAT Medical practice that charges only 89 bucks a month and offers FULL medical maintenence of any problems, NO copays, no deductables, it’s not insurance, its concierge membership. The doc was amazing, he drained an abcess I Had due to Hydradentitis Superativa (complication of PCOS I’m told) and gave me the regular dosage of Met and Glip, told me to “clean up my numbers” and come back in 2 weeks to see if this works.

    The first day was GREAT… I saw 119, 88, and even 73 after Glip and Met… But the next day, I ate NOTHING in the morning, as is my habit, and it skyrockets back up to 200s! Here we go again, I thought… I guess i’m gonna be on insulin, I’ve ruined my body, I’m stuck for the rest of my life as a type 1… Right?

    WRONG!!!

    I Knew how Glipizide worked, but I wanted to know more about Metformin, and how it’s linked to PCOS… I found your wonderful blog, and read it through. Suddenly it made sense!!!

    Now mind you, I had eaten NOTHING all day, and my BSL was slightly over 200… So I took an extra dose of 500 Metformin, and waited… I tested my BSL about 50 times that day… I had to see what it was doing hour to hour… (These are actual readings off my meter that night) 204… 188… 167… 155… 147… 131… 126… 118… 107… 101… 97… 89!!! BINGO!!!

    Two hours after the dose (Metformin ONLY, No Glip) it DROPPED LIKE A ROCK!!! I took the 500 at around 4:30… By 8pm it was 89!

    I ate a light low carb meal, and took NO Glipizide with it, made sure it had enough carbs to cause a noticeable rise… (Cheeseburger with a potato roll bun and 1 tbsp Ketchup)… Watched it go up to about 143, then drop back after 2 hours to 114. SO… It would appear my Pancreas did indeed clean up the food, wouldn’t it? :)

    Took my final nightly dose of Metformin and went to sleep. Woke up with a BSL of 119! First time I’ve seen that in years!

    The next day I took the morning metformin, at 10am… Didn’t eat. Shot up to 200 something… 12 noon I took 500 more. Dropped again to 108 by 5. Ate dinner, no glip, didn’t rise higher than 140. Was back down to 121 by 2 hours post meal.

    Today… Normal morning. No food… 500 Met. Went out the the pharmacy, got a splitting headache. Noticed it had again shot up. Took the Second 500 and ate a low carb meal… 177… It’s dropping again. :)

    So here’s what I’ve concluded so far… Time and my Doc will verify…

    1- My main problem is LIVER DUMPS, NOT INSULIN RESISTANCE.

    2- I appear to dump in the AM Upon not eating for 2 hours… I guess my liver senses that I haven’t fed my body so it goes ballistic. 2 500mg Metformin at the intervals described by Jim (2 Hrs apart) seems to clean that right up, shut it down. Tomorrow morning I’m going to eat early while the sugar is normal(low carb high protein) and see what that does to the dump.

    3- I’m theorizing here that perhaps my Pancreas is over taxed from all the dumping by the Liver, and will eventually adjust once I get that problem under control. I’d love it if I only need a little Glipizide or none at all. I’m betting that’s going to be the case since I’ve seen that taking only ONE with a low carb dinner can sometimes crash me. Taking none and there’s no rise but a little.

    So far, I feel like there’s hope for me, for the first time in literally DECADES. I will be seeing my GP and going over all of this with him next week, we will do the Bun, Creatnine, LFT, all that stuff, as well as Hormone levels to deal with the PCOS. Probably a progesterone BCP for that too, he said.

    Love to hear your thoughts on this, Please no warnings about treating myself… :) Sometimes you have to prove you know what works for you, and that is all i’m doing. :) I know the risks, am well within the “Recommended Metformin Dosage”… So far, the end has justified the means, I’ve had numbers under 200 most of the day for the last few…

    My doc said do what I normally do, and show him a lower a1c (first was 12.5) in 2 weeks… Let’s see if I can!

    Any thoughts on the morning dumping? That’s what I’m most curious about…

    Posted by Barb |
  84. Also want to share with you guys who have Mac/iPhone/iPads…

    There’s this GREAT App called “Diabetes Pilot” that makes monitoring everything you need fun and easy! The thing actually has a food database containing everything sold in stores and all fast food chains… Down to the Carb!

    It has customizable settings and you can input Glucose levels, Foods, and even BP/Pulse readings. You see it all laid out so it’s super to note. You can set your own “high” level (mine’s at 140) and anything over that is displayed in Red.

    I suggest anyone who has any type of management needs get this, even if you’re just looking to lose a few pounds, it has weight settings as well, and food nutritional info.

    It’s 11.99 in Itunes App store. Got it for a Birthday gift from a Fellow Nurse friend, she KNEW my detail oriented, anal OCD ‘nursey” brain would adore it, and she was RIGHT!

    Posted by Barb |
  85. Re: LPN Barb post Jan 11, 2014.
    Dear Barb - Like you, I believe my type 2 is caused primarily by liver dump (dawn phenomena). I’m taking extended release (ER) Metformin 500mg 1x in the morning with breakfast. My AM pre-breakfast numbers range from 125 to 200. My numbers during late day, afternoon and evening are in the normal range. Questions for you. (1) Would you see any advantage or disadvantages between using regular Metformin vs ER Metformin for mitigating dawn phenomena (if so, please explain)? (2) What and when are you eating to help mitigate dawn phenomena? (3) What Meds (type/dosage/frequency) are you taking to mitigate dawn phenomena?

    Thanks for sharing!

    Posted by JmmyS |
  86. JimmyS:

    As one who has been following/fighting this issues I have the following comments:

    Research by Salk and others suggests it takes a
    minimum level of metformin in the blood to tell liver to shut up. That level apparently varies from person to person.

    Standard met gets processed and takes 2.5 hours on average to achieve sufficient levels from a dose of metformin.

    For me ( using cgms) it takes a solid 500mg dose to work. 400 and under are useless.

    Extended ER metformin have a delayed response due to binders in Pill that slow the release of metformin. Yes they can work but one needs to get to a minimum does in blood to signal liver to shutup. My experience says to me it may take bigger doses of ER to achieve similar responses as good standard metformin.

    Many of the generic metformin standard work well, some put out sub standard levels in blood and fail.

    There are a bunch running around claiming it takes weeks to achieve useful levels. Nonsense; I have seen doses work on every sufficient dose taken on a CGMS. I have seen NO advantage to residuals and remaining met in body as many claim. I simply see every sufficient dose work according to the drug timing charts watching the liver get told to shutup and stop dumping in excess glucose.

    On top of that and due to that response; doses taken around the clock are far more effective and useful rather than this single mega dose that upsets the system, enhances the bowl issues and a general nuisance.

    Best wishes and good luck.

    Posted by jim snell |
  87. It is well-known that when people follow a ketogenic diet (VLCKD) and get into what nowadays is called [dietary] ketosis, the glycogen stores in the liver must get depleted first before that state can be reached. Maybe not “zero”, but definitely highly depleted. In this state, there is nothing substantial to be dumped regardless of what “signalling” is or isn’t happening.

    It seems that some diabetics are unable to achieve this and no matter what they do or eat, their livers apparently still have plenty and keep on dumping it uncontrolled. Why can’t these people have a low enough level of glucose from diet to empty the liver of its stores?

    Posted by SMorgan |
  88. I take slow release metformin twice a day and only get problems if I leave to long a gap between eating so I have small but regular meals and no added sugar I am ok with natural sugar in small quantities but have a bad reaction when I am given processed sugar I discovered this when round a friends having a curry they could see a change in me I went pale and asked if I was alright I told them no and then it was revealed that sugar was added to the curry as a cheat like so many people do today I find this very interesting though because if my sugar levels do go down I suffer for it so perhaps I need a stronger dose of metformin but when I was first on it taking 1800 mg twice a day that used to make my head bad I couldn’t think on reducing my dosage it was like a fog had cleared.

    Posted by Paul smith |
  89. Metformin works for me too - but with the diarrhea side effect. I run about 220 without it, and a 500 cap takes it down to about 145.

    Unfortunately, it averages about 2 hours to return to over 200.

    Atkins diet, no carbs or sugars.

    Reason for this post - through trial and error, I found out what works: walking.

    Last night for example, after a light dinner at 4PM, went out at 6PM for a walk. My sugar was at 218 at 6PM, and after a 3.2 mile walk, in one hour, it was down to 160.

    My average drop in sugar from a 1 hour / 3 mile walk - is about 60 points on the average - with no drugs(such as metformin).

    If I exercise more, like 4 hours a day (2 + 2), my sugar level runs right at 150 - no drugs (and no diarrhea).

    No walking for the day, regardless of diet:>200 easy.

    I am fortunate to be retired, so I can do what is needed to fight this problem. 4 hours of walking a day, healthy diet and no metformin.

    Works for now …

    PS: I beat diabetes 4 years ago by losing over 70 pounds (245>170). My doctor was proud of me, probably uses me as an example to share with other type II patients.

    Thought it was over, and then gained 50 pounds back (227 this morning). II came back with a vengeance. Bottom line: obesity is taking many of us down - we have to drop the weight to beat this thing.

    I have two friends who have lost a foot apiece feet due to this type II diabetes. Both were obese, not to an extreme - but apparently to the extent that not enough blood flow reached their lower extremities.

    Don’t totally rely on the pill - get rid of the fat, make that lifestyle change.

    Posted by Harry Linden |
  90. Wow liver dump is an weird thing. I have been a diabetic for over 15 years and not one person ever talked about liver dump. I have been on every med on the market. I am now taking Invokana 300 mgs and amaryl and just this week added back metformin cause I could not get control of them numbers. One dose of 500 mgs of metformin brought them numbers in check. I did quit metformin after going on Invokana. My fault not my doctor !!

    Invokana covered me for the most part but kept getting them high spikes and FBS was out of this world. I done what the author said instead of taking the 1000 mgs of met in the am and 1000 mgs in the pm I started taking 500 mgs every six hours. My numbers are almost that of a non diabetic !!

    Also please know I am not over weight I am 5′10 164 lbs and workout a great deal and an avid runner. Exercise is not always the answer it really helps but there are other problems in our bodies that cause diabetes.

    I suggest we all read this forum one more time so that the things that you read are ingrained in your mind and talk with your doctor about what you see that’s working for others. As most say not everyone is the same and might not have the same results.

    Bless all of you and hope that some day we have what should be a cure instead of a way of life.

    Posted by Ken Napier |
  91. David,
    I realize this is a very dated post but it seems to address what I am experiencing as a newly diagnosed (pre) diabetic. The dx seems to depend upon who I talk to.
    I am also a cancer patient and was taking 500 mg Metformin even before this dx came I to play. My elevated numbers happen during the night when I am not eating. Lately, I have been taking four 500mg ER at night with little effect. So, based on this post, I should have more. I am committed to keeping tight control because even slightly high BG skews my PET scans.
    Do you have some current research about this approach that I can show my doctor?
    Thank you!

    Posted by Susan Coleman |
  92. Does Glucophage (name brand) control blood sugars better than Metformin (generic)?
    I take 1000 mg AM & PM of Metformin, plus I inject Victoza 1.8 ml after supper.
    The past few months, my sugar levels have spiked!
    260-280/PM Take 1000 mg Metformin and 5 mg Glyburide ——- AM sugar 89-100
    Take 1000 mg Metformin AM —– by 2:00 PM sugar levels 190-210
    I watch my diet, but I am very perplexed by these sugar levels.
    I learned I was a type II diabetic after having a heart attack 16 years ago. Two stents later,COPD,Sleep Apnea and HBP, I am very thankful to be here.

    Posted by William |
  93. I am on metformin and have notice that in the morning is when my sugar levels are higher am I taking it to early in the evening? I take 500 twice a day.

    Posted by Glenda Davis |
  94. In Years, How long can a person take Metformin ?

    Posted by Ernest H. Harris, Jr. |
  95. Glenda, Go to Jenny Ruhl’s Diabetes 101 website and see her pages in regards to dose timing. You will get information much faster as this page is not apparently being monitored on a regular basis any longer- at least from my experiences.
    Mumsies

    Posted by Mumsies |
  96. Ernest,
    Indefinitely as long as it is working for you.
    Mumsies

    Posted by Mumsies |
  97. Glenda, you might be taking your metformin too early. Or not taking enough. Try taking it later and see what happens.

    Ernest, you can stay on metformin indefinitely, unless your liver enzymes start to go up. Your doctor should check your liver once a year.

    David

    Posted by David Spero RN |
  98. Your blog is very interesting as I recently read an article about the production of sugar by liver and kidneys.

    I have been taking METFORMIN SR 500mg (GLYCIPHAGE SR 500)and GLIMEPRIDE 1mg (GLIMY-1) for the last 10 years. I TOOK METMORMIN HALF HOUR BEFORE EVENING MEALS (AROUND 7.30pm.) AND GLIMY HALF HOUR BEFORE BREAKFAST IN THE MORNING AROUND 7.00AM.

    I have testing only Fasting blood glucose levels once in a month. I used be always below 130.

    Recent development:

    The monthly test showed a gradual rise of 5 points. When I consulted my Doctor, he told me to test also my PP blood glucose. This surprised me!In the month of June PP was just 73 (low) In July it was 74. In August it is 133. what makes the Fasting Glucose high? Shall try the METFORMIN AT BEDTIME (10pm?)
    PAVAR

    Posted by Pavar |
  99. Why we cann’t prepared vaccines or any parenteral formulation of those drug used type-2 diabetes excepet insuline.

    Posted by Vinod Kumar Yadav |
  100. I’m type 2 diabetic. When my sugar levels get too low my stomach gets bloated and kind of painful

    Posted by elsa |
  101. how long does it take to see results while taking Metaforim?

    Posted by Bonnie |
  102. good day i haven’t insect my self for 3 days insulin was up bud i getting from my diabetic accession to day will it harm something my sugar level is 17.9 what can i do to drop it quick

    Thanks
    Floris

    Posted by floris |
  103. metformin or any other diabetic medication..but especially metformin cause me to have persistent lingering headaches all day and everyday…For the the last 5 of 7 years since my diagnosis. i did not even know it was the metformin because initially, there was no headaches. i had been to neurologists and lab techs trying to find and underlying cause. i stop taking every med wether it be vitamin or not….but i continued to take my diabetes medication cause i needed it….one day i ceased that cause i did not want to live anymore…i would feel that bad…the next day….no headaches..no pain…no anything…i continued headache and pain free until my endocrinologist appt…we, him and i, had been working with different meds, cause i thought the glyburide that was with the metformin might have been causing the headaches…every other drug gave me a slight headache and did not bring my sugars down…when the were pretty controlled before. i even thought maybe the reason for the headaches were due to the fact that i was on meds but was not really a diabetic because my sugars would run so low, after meeting with my endo and my a1c rapidly rose it was clear i needed to be on something…he put me on metformin by itself and thats when i knew…as soon as i took it immediately got a headache that put me in the bed for the rest of the day. i refuse to take anymore… my endo insisted that i need to be on something..and nothing else worked but the metforim with glyburide. so he put me on insulin(20 long-acting lantus and 5 short acting before meals novolog)…no headaches..but my sugars sometime are not low enough…i just do not know what to do anymore….i forgot to add that i had my gall bladder removed prior to my diagnosis and always thoght it factored in some way….i know i need to lose weight but when you feel bad everyday..how can you?

    Posted by patricia |

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