This is an update based on a Facebook discussion about how successful Metformin is, overall, at reducing weight in the general diabetic population.
Note: Studies don't show consistent weight loss with metformin use, that's for sure. My hypothesis is that in order to experience successful weight loss on Metformin, you have to meet some very specific conditions. First, you have to be euglycemic virtually all of the time before starting the metformin. This is hard to do, especially when you're on insulin. You also have to remain euglycemic as you continue to take the metformin. And insulin dependents have to do this by adjusting (read: reducing) basal and bolus dose calculations. This is not easy. But starting metformin while euglycemic and remaining euglycemic throughout the treatment will, I hypothesize, result in weight loss, because it results in less sugar in the blood, which means less required insulin, which means less fat storage. I was a sample size of one, of course. And my experiment was driven by personal curiosity, not scientific inquiry. I will post this on the blog to make that part more clear. I would like find some research on whether metformin has caused weight loss in people withOUT diabetes. I'm sure it's out there, and that I just haven't found it yet.
Now, continue on to the article below.
Many of you are aware that I recently started experimenting with metformin, which is a medication typically prescribed to people with type 2 diabetes. But, according to many reputable sources, metformin can also help type 1 diabetics (along with insulin, of course, which is required for type 1s) with blood sugar management.
I wrote about metformin in my I'm using a diabetes drug recreationally article a few months ago. Feel free to read that at your leisure.
My main goal in starting metformin was to see if this medication could help stabilize and flatline my blood sugar levels during and after exercise.
Exercise had been so frustrating. Every time I went to an exercise class with a perfect blood sugar, my blood sugar would go up by 60 to 100 mg/dL. Yes, you read that correctly. Exercise *raised* my blood sugar.
Now, you might be wondering, "Why the heck did your blood sugar go UP during exercise? Isn't it supposed to do DOWN?"
Let me explain.
I take insulin. I take basal insulin, which is used to counteract the baseline level of glucose that's always hanging around in my blood thanks to my liver's gluconeogenesis. I also take bolus insulin, which helps the food I eat (mostly carbohydrates), once it's digested into glucose, get into my cells. I also use bolus insulin to treat incidental high blood sugars. Insulin moves sugar from my blood into my cells. My cells like this, because my cells use that sugar for energy (and some other stuff).
I did a bunch of experiments with exercise. More specifically, I wanted to compare my blood sugar's reaction to exercise while my cells were in a starving state vs. my blood sugar's reaction to exercise when I had bolus insulin on board (non-starving state).
I started capturing blood sugar data surrounding my exercise events.
RESULTS OF EXERCISING IN A NON-STARVING STATE
Let's say I eat breakfast at 8am, and take 4 units of bolus insulin.
The insulin helps my breakfast carbs get into my cells to give me energy.
Yay! Now, let's say I exercise at 10am, with a starting blood sugar of 140. I still have some insulin in my blood, and I have some very satisfied cells that are full of energy.
But, during the exercise, my cells start using up that energy. And my cells start to run out of energy. So my cells get hungry.
But guess what. There's still some sugar in my blood because my blood sugar is 140, AND there's still some insulin in my blood because, well, even short acting insulin stays in the blood for up to 6 hours.
So, my body uses the remaining insulin to suck as much sugar as possible into my cells to give me more energy.
At the end of the exercise, my blood sugar is down to 40, and I'm shaky, clammy and need a snack.
Naturally, because I feel so awful, I eat and eat and eat, which results in a high blood sugar a few hours later, and then I get to enjoy a blood sugar roller coaster for the rest of the day.
RESULTS OF EXERCISING IN A STARVING STATE
I'd wake up, and I would NOT eat anything for breakfast.
Then, at noon, I'd go to my exercise class with a blood sugar of, for example, 120. I'd exercise for the full hour, and then check my blood sugar immediately after the exercise. 200. My blood sugar was 200.
Here's what happened. My cells were hungry. Since I hadn't eaten breakfast, those cells didn't have much energy to start with. So, I started exercising and I pretty quickly used up all the energy in my cells. But, since I didn't have any extra insulin in my body, there was no insulin available to pull sugar from my blood into my cells to give them more energy.
But it didn't end there. Did you know that you liver is supposed to store glucose, and give you a few squirts of that glucose when you need it?
Well, one of the times you need glucose is when your cells become starving. So, noticing that my cells were starved of energy, my liver helpfully squirted a bunch of glucose in my blood, raising my blood sugar to 200.
And...guess what. I didn't have any bolus insulin on board to carry that sugar into my cells. So basically, my cells were starving, and there was plenty of sugar in my blood to feed them, but unfortunately, the insulin required to move the sugar into the cells just wasn't there. So I had starving cells and high blood sugar.
So, HOW THE HELL is someone on insulin supposed to exercise while keeping their blood sugar at a flat line (or as close to target as possible)???
I contemplated three potential solutions to this problem.
One potential solution was to do my exercise in a starving state, and then use Afrezza, the super-fast-acting inhalable insulin, right after exercise, to lower my blood sugar. This is something suggested by my friend Dr. Gaja Andzel, whom I trust completely to give me diabetes-related advice. But, my doctor here in Wisconsin is pretty risk-averse, so I'm still in the process of convincing her to let me try Afrezza.
Another potential solution was to try metformin, a drug that suppresses the liver's glucose-squirting activities and reduces insulin resistance, to see if I could exercise in a starving state without getting that extra sugar kick from my liver.
Another potential solution was to try experimenting with the timing of my breakfast, insulin doses, basal rates, etc. I've been there, done that. It's pretty hit or miss at first, but you can eventually get it right. I know some athletes who've been really successful with this method. If you need some coaching on this, Dr. Matt Corcoran from Diabetes Training Camp is a great resource.
My goal was to flatline my blood sugar during and after exercise. Since I couldn't get access to Afrezza (that's coming soon, I promise!), and since mucking with my dosing and rates is not easy and affects everyone differently, I decided to try metformin to suppress my liver from squirting a bunch of sugar into my blood during exercise.
I did some research. Then I did some asking around. Then I talked with my doctor and she agreed to prescribe me metformin. Then I did some more research and wrote the I'm using a diabetes drug recreationally article. And then I started taking metformin.
I decided to take the extended release version of metformin (marketed as ER or XR), because I'd heard horror stories about side effects from the "regular" metformin. The effects of extended release metformin apparently aren't as severe.
That's not to say there weren't side effects. For me, the side effect was pooping. Lots of pooping. It lasted about six weeks and then I didn't have the effects anymore. Other than that, I've experienced no other negative side effects.
My instructions were to start taking 500mg/day for a week, then increase by 500 each week until I reached the max dose of 2000mg/day.
During the dose increases, my blood sugars were all over the place. I was playing with basal rates, recalculating insulin sensitivity factors, adjusting bolus ratios, etc., and my blood sugars were all over the place. I was high, and low, and high, and low and on a total roller coaster for a few months. I decided to stick with 1500 per day, and do somebaseline testing.
Once I reached a dose of 1500 mg per day and did some baseline testing, I noticed three things:
1. I didn't need as much basal insulin. Due to the metformin, I had to reduce my original basal insulin by about 15%
2. I didn't need as much bolus insulin. Due to the metformin, I had to reduce my bolus insulin by about 10%
3. I had VERY little, if any, increase in blood sugar during exercise. Metformin solved my "exercising while starving" problem.
Once I reached 2000 mg per day, I noticed two more things:
1. I had to reduce my original basal insulin dose by 20%
2. I had to reduce my original bolus insulin dose by about 15%
So, overall, I'm getting exercise without screwing up my blood sugar. I'm also taking less insulin overall. Do you know what that means?
It means that since I finished the baseline testing and got the initial metformin-induced roller coasters under control, I've lost about a pound per week.
Why? Well, insulin is a hormone that helps glucose get into your cells, which your cells use as energy. If there's an overabundance of energy in your cells, your cells store that energy as fat. Yep. Insulin is a fat storage hormone.
You NEED insulin to survive, though. If you don't have insulin (either from a vial, a pen, or from your own pancreas), you will die.
Striking a balance among exercise, blood sugar levels, insulin, metformin, eating, and weight loss/gain is hard. Like, really hard. But I'm not going to complain about that.
What I will continue to complain about, however, is how much we have to FIGHT to get the diabetes supplies, education, and care we need in order figure stuff out like this.
Next up, Afrezza. They're marketing it all wrong. I'm going to run some experiments with it starting in May, and perhaps we can set Mannkind straight.
With Betic Love,