[Outcold]

This question is for people who have a good grasp of the physiological disease-process of diabetes. It is well-known that Metformin helps diabetics who take it lose weight. That's certainly one major reason I am very fond of it myself. The diabetes book I'm reading says that it does this by reducing the appetite, but I certainly haven't experienced any reduction in appetite that I can discern. So I tend to think that the weight-loss effect is likely something related to the main thing the medication does physiologically. And what it does is inhibit the glycogenolysis effect (breaking down stored glycogen into usable glucose in the liver) of glucagon (the yin to insulin's yang).

My understanding is that insulin and glucagon have a negative feedback relationship (glucose-levels going up triggers the release of insulin, which brings glucose-levels down, and this in turn triggers the release of glucagon, which raises glucose-levels, thereby maintaining balance). So as glucagon promotes the release of stored energy (through lipolysis, or the breakdown of stored fat into usable fatty-acids, as well as through glycogenlysis), so also does insulin promote energy storage. (That's why if you have been overweight your entire life, then pre-diabetic insulin-resistance will likely give you a nice, big beachball on your lower-middle front torso to carry around with you!) What really gets me about insulin's promotion of energy storage is that it not only promotes the conversion of fatty acids into stored fat and the conversion of glucose into stored glycogen, it also promotes the conversion of glucose into stored fat when the glycogen capacity of the muscles and the liver is full. GUH! ARGH!

So my educated speculation about why Metformin promotes weight-loss is that the effect of the glucagon is inhibited, so the body produces less insulin because there isn't the need for as much insulin to make muscle-cells able to use glucose as energy. And this is simply because less glucose is being released form storage in the liver. The result of this change in the nature of the balance is that less fat is stored. This is the only thing that really makes sense to me when I think about it, but the problem with my supposition is that the glucose-insulin metabolism is out-of-whack in diabetes, and that could affect things in ways that I'm just not yet understanding. So if I'm all wet here, then definitely give me some schooling in why I'm all wet. Inquiring minds want to know!

ETA: If I'm right about this "less insulin" stuff, then that might possibly mean that Metformin also slows down the wearing out from overuse of the beta-cells in the pancreas that produce insulin, thereby lengthening the period of time that one can produce just enough (though still not enough to be "normal") of one's own insulin provided one does all the right things WRT lifestyle.

 

[Shanny]

Very well thought out and prob'ly pretty much on the mark too (the scientist in this household is NOT me, but it sounds logical

). The pancreas protection properties are well known, and are one basic reason that metformin is much more often prescribed instead of the sulfonylurea class of oral meds which stimulate insulin production & do wear out the beta cells.

Metformin did and does, however, markedly reduce my appetite. It became apparent as soon as I went on it - having at first continued to fill my plate as before (just different foods than before), but found I couldn't eat it all. Later noticed that in eating nuts - my first line of defense against the munchies - I was eating one-at-a-time, not by the handful/mouthful as before. So metformin essentially creates portion control where I previously had NONE.

 

[Outcold]

Metformin did and does, however, markedly reduce my appetite. It became apparent as soon as I went on it - having at first continued to fill my plate as before (just different foods than before), but found I couldn't eat it all. Later noticed that in eating nuts - my first line of defense against the munchies - I was eating one-at-a-time, not by the handful/mouthful as before. So metformin essentially creates portion control where I previously had NONE.

Perhaps the difference in our experiences in appetite reduction is because my appetite is one not easily reduced. Also, it is generally thought that colder, wetter climates such as that of Wisconsin make people want to eat more, and I have heard it said that moving to Wisconsin has caused quite a few people to gain weight. (But that could also be a cultural thing, as we Wisconsin people are fond of our vittles, and I'm sure the effect can be psychologically contagious.)

ETA: I can conceptualize how lowering BG levels could reduce appetite in some people, because it is my understanding that one symptom of diabetic hyperglycemia is that one feels as though one is always at least a little bit hungry. And that's probably because your muscle cells are having problems utilizing the glucose in the bloodstream and somehow sense this situation, so your physiology's solution is to send the "More, more!" signal to your brain WRT food.

 

[onlymep]

Well metformin was a drug I was on for years and I wish I had never been put on it to be honest. Although it's considered the 'safe' drug of choice by the docs... what they don't tell you is the side effects and damage to your stomach it can cause. I was recently diagnosed with functional dyspepsia and my stomach problems started when I was placed on metformin (I didn't have upset stomach prior to this). It probably did decrease my appetite because it made me so sick all the time. I'm sure for most people it's a drug that works for them... but for a few of us it just doesn't work. My view of it when I look back now is even worse than it used to be when I tolerated the side effects. I'm now stuck with a chronic stomach disorder which they have put me on 3x drugs to treat... when I looked up medications that cause dyspepsia... metformin is one of them. I certainly had a number of factors that possibly lead to dyspepsia... but it all started with metformin.

 

[Outcold]

Well metformin was a drug I was on for years and I wish I had never been put on it to be honest. Although it's considered the 'safe' drug of choice by the docs... what they don't tell you is the side effects and damage to your stomach it can cause. I was recently diagnosed with functional dyspepsia and my stomach problems started when I was placed on metformin (I didn't have upset stomach prior to this). It probably did decrease my appetite because it made me so sick all the time. I'm sure for most people it's a drug that works for them... but for a few of us it just doesn't work. My view of it when I look back now is even worse than it used to be when I tolerated the side effects. I'm now stuck with a chronic stomach disorder which they have put me on 3x drugs to treat... when I looked up medications that cause dyspepsia... metformin is one of them. I certainly had a number of factors that possibly lead to dyspepsia... but it all started with metformin.

{/puts on county-fair psychic-reader turban} And let me guess, when you tried to tell your doctor you were experiencing a terrible side-effect, they refused to believe you, right?

 

[onlymep]

{/puts on county-fair psychic-reader turban} And let me guess, when you tried to tell your doctor you were experiencing a terrible side-effect, they refused to believe you, right?

yes, you hit the nail on the head... I lost count of how many times I heard "this is the best drug for you to be on".... and "let's just change the dosage and see if it works better for you"... or "let's just try the slow release version and see if you feel better".... it went on like that and then it was "let's introduce another drug with the metformin to see if that works better"... and you get the picture. I was trialled on so many drugs. In reality I think I should have been placed on insulin a lot sooner than I was as the oral meds were just not working for quite a few years on me. I think my endo and doc thought that I should just carry on 'tolerating' the side effects. But I think they have this thing where they trial all the drugs first before placing you on insulin. They certainly try and keep you on metformin... I was on it for 5+ years. My view is that it weakened my stomach.... I've never had so many infections since being on that drug and I had all day sickness and diarrhea on it... no matter what the dosage or version.

 

[Outcold]

yes, you hit the nail on the head... I lost count of how many times I heard "this is the best drug for you to be on".... and "let's just change the dosage and see if it works better for you"... or "let's just try the slow release version and see if you feel better".... it went on like that and then it was "let's introduce another drug with the metformin to see if that works better"... and you get the picture. I was trialled on so many drugs. In reality I think I should have been placed on insulin a lot sooner than I was as the oral meds were just not working for quite a few years on me. I think my endo and doc thought that I should just carry on 'tolerating' the side effects. But I think they have this thing where they trial all the drugs first before placing you on insulin. They certainly try and keep you on metformin... I was on it for 5+ years. My view is that it weakened my stomach.... I've never had so many infections since being on that drug and I had all day sickness and diarrhea on it... no matter what the dosage or version.

I really need to start my own psychic 900 line. All I need to do yet is master a bad ethnic accent of one kind or another! Seriously though, this is probably the oldest and most well-known song in the doctor-patient-relationship book in this country.

I was put on Lisinopril for my blood pressure, and it was well and truly a gondola-boat-ride through Hell. I wasn't surprised to learn that the chemical basis for it was derived from the venom of a South American pit-viper. That must have been what it would feel like to have somebody sneak up behind you and clock you over the head with a baseball-bat. The worst freaking hell I had ever been through as a result of an ingested substance (apart from that one time in my teenage years when I... nevermind) and my doctor refused to believe that stuff was vile poison to my system. However, my mother takes it and has no problem with it. Even the persistent dry cough went away eventually.

I flat-out told my doctor that I would literally rather die than take anymore ACE inhibitors. Now I'm on an ARB (Cozaar AKA Losartan), and it's much better. I really wish more people would stand up for themselves in exactly this manner. It's your life, and your choice, after all. Even if they didn't want to put you on insulin right away, I know from the book I'm reading that there are other drugs. This same book states that some people just can't tolerate Metformin at all. You are obviously one of them. For me, I am amazed at how well I tolerate it.

 

[jwags]

I've been on metformin (2550) for almost 4 years. I can't say it has decreased my appetite, but I have lost ove 30 pounds on it. I am not at my college weight. I'm not sure if this was from the metformin , alone or the low carb diet. In fact last Fall I had to up my carbs becaue I lost too much weight and looked like walking death. Metformin works in the liver primarily and in the gut to block some carb absorption ( thus the GI effect lots of D's get). In the liver it inhibits some of the changing of glycogen into glucose. That is why our bgs are lower. Not because we produce more insulin but because we have less liver dumps. But metformin does make us more sensitive to the insulin we normally make. I do think when you pair it with a low carb diet and exercise you do increase your insulin sensitivity. Actually the drugs like sulfyureas that force our pancreas to overproduce insulin actually accelerate beta cell loss. So used correctly Metformin will help with weight loss. Personally I think it is the lower carb diet that I use that has allowed my pancreas to rest a little.

 

[onlymep]

I really need to start my own psychic 900 line. All I need to do yet is master a bad ethnic accent of one kind or another! Seriously though, this is probably the oldest and most well-known song in the doctor-patient-relationship book in this country.

I was put on Lisinopril for my blood pressure, and it was well and truly a gondola-boat-ride through Hell. I wasn't surprised to learn that the chemical basis for it was derived from the venom of a South American pit-viper. That must have been what it would feel like to have somebody sneak up behind you and clock you over the head with a baseball-bat. The worst freaking hell I had ever been through as a result of an ingested substance (apart from that one time in my teenage years when I... nevermind) and my doctor refused to believe that stuff was vile poison to my system. However, my mother takes it and has no problem with it. Even the persistent dry cough went away eventually.

I flat-out told my doctor that I would literally rather die than take anymore ACE inhibitors. Now I'm on an ARB (Cozaar AKA Losartan), and it's much better. I really wish more people would stand up for themselves in exactly this manner. It's your life, and your choice, after all. Even if they didn't want to put you on insulin right away, I know from the book I'm reading that there are other drugs. This same book states that some people just can't tolerate Metformin at all. You are obviously one of them. For me, I am amazed at how well I tolerate it.

interestingly I was just quickly taken off a drug called sertraline because I had adverse side effects... I was told to rest and stay away from work for the week. Now apparently because that drug works on the brain, they don't risk leaving you on it. I'm not sure what the difference is supposed to be here? If a drug gives you side effects full stop... they should take you off it I think. The sertraline is one of the drugs I was put on for my stomach... I'm now on another brand name for the same drug.... so far so good. But if I get the slightest side effect... I'm not staying on it and I'll definitely be telling my doc that. The other choice drug is cisapride which is a banned drug.... apparently they need special permission to use it and you have to have regular ECG's if you get put on that one as it apparently slows your heart rate... that's a big "no thanks" from me.

 

[Shanny]

The other choice drug is cisapride which is a banned drug.... apparently they need special permission to use it and you have to have regular ECG's if you get put on that one as it apparently slows your heart rate... that's a big "no thanks" from me.

I'm on a beta blocker for my hypertension, and it slows my heart rate, but I haven't found any downside to that since the numbers are stable around 65 bpm. And my b/p numbers are ideal, which is exactly where I wanna be. Now if my glucometer would only have a chat with my b/p monitor!

(Oh! And I think I should mention that Jeanne (jwags) means she is NOW at her college weight - instead of "not" )

I am not at my college weight.

 

[onlymep]

I'm on a beta blocker for my hypertension, and it slows my heart rate, but I haven't found any downside to that since the numbers are stable around 65 bpm. And my b/p numbers are ideal, which is exactly where I wanna be. Now if my glucometer would only have a chat with my b/p monitor!

(Oh! And I think I should mention that Jeanne (jwags) means she is NOW at her college weight - instead of "not" )

LOL Shanny... wouldn't that be nice to have everything working in harmony! Do you have to have regular ECGs on that drug you're taking? The drug I mentioned above is banned in the USA apparently as it causes heart problems. Here in Oz the docs need special permission to use it. I'm definitely against any drug that causes such a thing... and the thought of having to go for regular ECG's would be an absolute pain too... makes me wonder if it would interfer with my diabetes? I think I've had my fair share of side effects for now without them scaring me with this stuff that just sounds ghastly... I don't need heart troubles created by drugs. With a heart beat of 65 bpm... that's a lovely number! You're supposed to be between 60-70 bpm for a healthy person as I've always been told by doc.

 

[Shanny]

Nope, no tests to monitor the atenolol, and there's nothing about the EKG that does anything with or to diabetes. But it seems like at my age, every time I turn around somebody wants to hook up the EKG. No big deal in my book - I don't have any cardiac issues, but it takes all of 30 seconds & the most time-consuming part is about five minutes spent positioning the sensors. Now when they come around with 35-40 goopy sensors to attach to my scalp for sleep study - that's the one that's a pain in the prat!

 

[suzette11]

My doc has been considering putting me on it and since i have gained weight back, being more active and watching my diet, I will ask her to put me on it and see if it helps me..she is awesome and i feel really comfortable with her..

Cathy

 

[beefy]

My doc has been considering putting me on it and since i have gained weight back, being more active and watching my diet, I will ask her to put me on it and see if it helps me..she is awesome and i feel really comfortable with her..

Cathy

With the exception of some gastro-intestinal problems that some people experience (which is usually temporary), Metformin has very little, if any, negative effects.

One of the biggest reasons it helps with appetite is that it does help insulin-resistance. By doing so, it decreases the release of excess insulin that some of us experience. Since excess insulin causes both fat storage and hunger, the reduction of it will dramatically help with weight loss.

 

[suzette11]

so much to learn.. I am only about 6 months in so any and all suggestions are welcome !

Cathy

 

[beaner293]

I don't know about the decreased appetite, mine is still good on 1700 mg/day of Metformin. My weight loss (~65 lbs) is more likely attributed to cutting out the daily intake of Coke (100+ oz /day).

I've had zero side effects from the Metformin, so I guess it affects everyone differently.

 

[beefy]

...the daily intake of Coke (100+ oz /day).

I've always been a diet coke guy... Used to drink up to 8L a day (4 gallons per day) Now I have at most ONE diet soda in a day, always with a meal.

I've had zero side effects from the Metformin, so I guess it affects everyone differently.

You are SOOO lucky. I lived in the Loo for 6 weeks until I got on the extended-release version...

 

[beaner293]

Unsweetened tea has become my new coke. Unfortunatlely, because I live in the US-South, sweet tea is the preferred drink. Often when I get my morning tea, the drive-thru screws-up my order and I end up with Sweet tea. The lawn at work seems to enjoy the added nutrients. If you've not had it before, imagine 1 gallon of tea with 5 lbs of sugar. (Yes, that's a slight exaggeration)

Alternatively, you can just eat the sugar out of the bag, same effect on your BGLs

 

[beefy]

...The lawn at work seems to enjoy the added nutrients.

:lol:

If you've not had it before, imagine 1 gallon of tea with 5 lbs of sugar. (Yes, that's a slight exaggeration)

Alternatively, you can just eat the sugar out of the bag, same effect on your BGLs

Ewww.... I can't imagine eating straight sugar. Donuts I can imagine, but not straight sugar.

Dangit, now I'm thinking of donuts. :dizzy: