My FBG (~140 mg/dl) doesn't go down, Glucophage uneffective

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makesense777@yahoo.com - 16 Oct 2005 21:43 GMT

Hi all,

I'm type 2 diabetics for almost 5 years, controlling my BG with diet
and exercise. For the last 6 month my FBG climbed up to 140 mg/dl
(stable), although my HbA1c hasn't change (5.9%). Three month ago I
started with the minimal dose of Glucophage (850 mg) with no effect
what so ever. A week ago I doubled the dose (2 X 850 mg), but nothing
has changed. I had a complete BG & Insulin test which showed normal
insulin response before and after meals. I'm looking for an idea what
is the cause for the high FBG and why the med doesn't do it.

Thanks,
Avi

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Priscilla Ballou - 16 Oct 2005 22:10 GMT

> Hi all,
>
[quoted text clipped - 6 lines]
> insulin response before and after meals. I'm looking for an idea what
> is the cause for the high FBG and why the med doesn't do it.

This increasing dawn phenomenon could be an indication of the
progression of your DM. Try a snack before bed. That helps a lot of
people with dawn phenomenon, which is what often drives up fasting BG.
You may need to experiment a little with proportions of protein, fat,
and carb.

Priscilla

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the hell happened." -- Cora Harvey Armstrong

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Larry - 17 Oct 2005 00:42 GMT

Avi: Are you overweight? I've been reading lately that metformin has a
greater effect on lowering FBG levels in obese individuals. Otherwise
the effect can be slight in some individuals who are not overweight. I
going to try regular metformin (not ER) to see if i get a better
response in lowering BG levels, fasting and/or post prandial. I've
looked at "passed through" ER metformin on occasion and have found the
inner core to be completely undissolved (dry powder) which concerned
me. I am suspicious of some generic sustained release pills in terms of
reproducable biequivalent data. Good luck.

Larry

> Hi all,
>
[quoted text clipped - 9 lines]
> Thanks,
> Avi

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makesense777@yahoo.com - 17 Oct 2005 18:38 GMT

Larry,

1. I'm not overweight. (well... BMI~25).
2. I have regular metformin and not the extended release type.
3. What bothers me is that what happenes is contrary to the model, i.e.
the morning glucose is dumped by the liver and since metformin is
suppose to act on the liver to dump less glucose, why the FBG doesn't
change at all?

Thanks,
Avi

> Avi: Are you overweight? I've been reading lately that metformin has a
> greater effect on lowering FBG levels in obese individuals. Otherwise
[quoted text clipped - 20 lines]
> > Thanks,
> > Avi

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None Given - 17 Oct 2005 19:53 GMT

> Larry,
>
[quoted text clipped - 4 lines]
> suppose to act on the liver to dump less glucose, why the FBG doesn't
> change at all?

It may take a couple more weeks to see if that dose is adequate. I'm on
2500mg and I still get a rise, I don't want to know how high it would be
without the met.

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W. Baker - 17 Oct 2005 23:14 GMT

: Larry,

: 1. I'm not overweight. (well... BMI~25).
: 2. I have regular metformin and not the extended release type.
: 3. What bothers me is that what happenes is contrary to the model, i.e.
: the morning glucose is dumped by the liver and since metformin is
: suppose to act on the liver to dump less glucose, why the FBG doesn't
: change at all?

: Thanks,
: Avi

I had the problem of clowly increasing FBG''s while on 1000grs metforming
2 X a day and my endo put me on 1 mg of Amaryl, a sulph, at night and the
FBGs are now in the 80's and 90's/ this dose is aobut 1/4 the normal dose
of the drug adn has tken care of the problem. apparantly, as time passes,
one cannot live by mertformin alone.

O guess is it a sign of the progression of the disease, even with good
control.

Wendy

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oldal4865 - 17 Oct 2005 13:33 GMT

makesense777@yahoo.com wrote in message
<1129495384.071981.160690@o13g2000cwo.googlegroups.com>...

>Hi all,
>
[quoted text clipped - 9 lines]
>Thanks,
>Avi

As mentioned by other posters, you are describing the famed (notorious? ?
?) Morning Effect. Your body releases hormones in the dawn and morning
hours which send bG upwards. Mine is absolutely fierce; some folks
hardly notice theirs. YMMV

The U.S. PDR recommends 1500 mg/day metformin as a more or less "standard"
clinically effective dose and about 2500 mg/day as the maximum recommended.
"A week ago I doubled the dose. . ." may not have given the metformin enough
time to work, or you need more..

http://www.pdrhealth.com/drug_info/rxdrugprofiles/drugs/glu1188.shtml

More thoughts:

There are some evening snack tricks which help many. Snacking on a very
slowly digesting carb before bed helps some folks. Some Ob-Gyn have
their Gestational Diabetes mothers snack on nuts at 3 a.m. or so. That's a
bit extreme but for them it's only short term need.

High FbG is one of the prompts for a single shot of long-lasting insulin at
bedtime. Another seemingly extreme solution but it can always be made to
work and eases the evening snack conundrum.

Regards
Old Al

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Jenny - 17 Oct 2005 14:16 GMT

> The U.S. PDR recommends 1500 mg/day metformin as a more or less "standard"
> clinically effective dose and about 2500 mg/day as the maximum recommended.
> "A week ago I doubled the dose. . ." may not have given the metformin enough
> time to work, or you need more..
>
> http://www.pdrhealth.com/drug_info/rxdrugprofiles/drugs/glu1188.shtml

Al,

I've seen that 2500 maximum dose for Metformin number posted here a lot,
and it got me into trouble!

The maximum dose for REGULAR metformin is 2500 mg. However, the maximum
dose for ER (extended release) metformin is 2000 mg. My doctor got
confused and prescribed 2250 mg of ER metformin and it was a few days
until I went back and looked at the prescribing info and discovered the
mistake. The pharmacy that filled the prescription did not flag it as
over the top dose.

The overdose made me feel poisoned, which is why I went back to the
prescribing info.

So remember, 2500 for Regular. 2000 for ER!
--Jenny

http://www.geocities.com/lottadata4u/ Type 2 Diabetes info
http://www.geocities.com/jenny_the_bean/ Low Carb info

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Andrew B. Chung, MD/PhD - 23 Oct 2005 18:31 GMT

> Hi all,
>
[quoted text clipped - 6 lines]
> insulin response before and after meals. I'm looking for an idea what
> is the cause for the high FBG and why the med doesn't do it.

Would wonder about your height and weight (visceral adiposity) and IR
(insulin resistance).

> Thanks,

You are welcome, Avi :-)

In Christ's love and service forevermore,

Andrew

--
Andrew B. Chung, MD/PhD
Board-Certified Cardiologist

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