[SerotoninSurfer]

Before metformin, I could keep predictable (though a bit high) levels by eating 30g carbs per meal (3x/day) with 15g carb snacks in beteeen and before bed. Lows about 100, highs (2hrs post meal) at 130-145. Not great, but predictable.

On metformin, I have 1-hr post meals highs of 120-125 or so and 2hr levels around 110. When I drop to the 90's however I get the sweats & shakes from a hypo and rebound up 30+ points. If I eat carbs (30g or so) on a rebound my level DROPS back down at least 20 points. If I eat many fewer carbs for meals, I drop and rebound quicker... so I seem to need more carbs on metformin than without.

This is leading to constant overcorrection/eating I cannot afford. On top of the calories I get mentally foggy and can't focus. The metformin is definitely helping meal digestion, but the bounce at 100 is driving me nuts. And what's with the drop in bg after eating a bunch of carbs to compensate? Is the metformin not enough or too much?

I wish I could reprogram my liver.
Surfer

 

[Shanny]

The problem is not metformin, it is too many carbs. If your diet came from a medical professional, you're going to have to reject their advice, because 120g to 135g of carbs day is way over-the-top too much. Metformin works very well with a low-carb diet. It can't cover all those carbs. Just drop your daily carb level to less than 50g and see if you don't see more stability.

 

[SerotoninSurfer]

Carbs already 1/2 of what they recommended

My 120 carbs/day is about 1/2 of what the dietician wants. When I have tried less than 30 for a meal, I will drop to normal in 60-90 minutes and rebound a little over 2 hours. It continues to climb past 150 if I don't eat more carbs.

I understand and agree with the low carbs approach and it was doing pretty well before metformin. Since I've started it though I am having hypo symptoms and rebounds when I drop below 100. My bg keeps going up on its own until I do finally eat more carbs.

If I drop even lower can I hope it will straighten out within a few days? I will have to leave work because I get so foggy during the "hypos". I'm a programmer and just can't function in that state.

 

[Shanny]

I've forgotten when you started the metformin, SS . . . have you been on it several weeks? It DOES need time to reach optimum blood levels. And what is your dosage, if you don't mind me asking?

 

[SerotoninSurfer]

Started it about 2 weeks ago, 500mg x2. After 4 days or so I noticed my post-meal levels dropped nicely, and not long after this whole false-hypo stuff started up. I have an appt with the new nutriionist Friday, I think I'll drop to <50 carbs the rest of the week and see what happens. My concern is that it goes >140 if I let it keep going, but maybe I need to let it do that a few days without feeding it extra carbs so my bg "thermostat" can reset itself.

 

[tony0611]

Just a random thought - While keeping yourself at low carb in a day (like 50 gm a day) have you thought about giving your body a 4-5 gm carb boost every 2 hours between your meals (like a small peice of candy or a small biscuit) ?

Since you are experimenting you can try this approach as well.

As you know 90 is not a hypo. Eventually your body will realize that as well and get adjusted.


Tony


.

 

[Shanny]

Started it about 2 weeks ago, 500mg x2. After 4 days or so I noticed my post-meal levels dropped nicely, and not long after this whole false-hypo stuff started up. I have an appt with the new nutriionist Friday, I think I'll drop to <50 carbs the rest of the week and see what happens. My concern is that it goes >140 if I let it keep going, but maybe I need to let it do that a few days without feeding it extra carbs so my bg "thermostat" can reset itself.

That's a good dosage of met to start out with, and a couple more weeks will prob'ly give it time to fully kick in.

I don't think you should just let your levels continue rising, but I think you shouldn't have to eat CARBS to stop it. For me at least, anything like nuts or cheese or a beef stick, hard-cooked egg, etc., will arrest the upward movement. Go ahead & drop down to <50g per day, but use low or zero carb foods to correct the rising levels.

 

[jwags]

First of all metformin may take a full month or so to start working fully. It also works much better on a lower carb diet. The problem a lot of us have is that we are Insulin Resistant. We each have a carb tolerance. If we go over that tolerance our pancreas has to crank out way too much insulin. One thing Metformin does is make you more sensitive to your own insulin. As it builds up in your system it will also limit those liver dumps. It is not only the carbs at a meal but also the balance of fat and protein. You need to find the balance that gives you the smallest spike. With me I rarely eat more than 15 carbs usually less but I make sure I eat at least 20 grams of fat at each meal. The other thing to consider in Liver Dumps is the amount of Glycogen your liver stores. The more carbs you eat at meals and snacks the more glycogen your liver stores. Unless you are very athletic and workout tons to burn it off, it will be available for liver dump bg surges. When I was first dx'd those liver dumps drove me nuts. I would get them late morning and late afternoon. At first I thought it was because I wasn't eating enough carbs but it was because I was storing too much glycogen. The only way to deal with the liver dumps is to increase metformin and go lower carb.

 

[SerotoninSurfer]

Tony -
that's what I'm going to try. I'm going to play chicken with my rebounds and see whether they back off or I do because they get crazy high. I'll shoot for 10g meals with 5g snack. I need to make sure I eat plenty of protein and fat calories though to make sure its not a starvation-reaction.

Chaaaarge!!!

Correction: I crossed posting times with some replies. I'll add more non-carbs to my snacks. Thanks Shanny.

 

[tony0611]

Tony -
that's what I'm going to try. I'm going to play chicken with my rebounds and see whether they back off or I do because they get crazy high. I'll shoot for 10g meals with 5g snack. I need to make sure I eat plenty of protein and fat calories though to make sure its not a starvation-reaction.

Chaaaarge!!!

Correction: I crossed posting times with some replies. I'll add more non-carbs to my snacks. Thanks Shanny.

Be careful with the protein. Fat can be taken liberally. Also keep in mind that you do not go over board with your overall portions and calorie requirements

 

[Patdart]

I'm with Shanny and Tony about this. It does take a few days to get used to low carb, but that should straighten things out.

 

[d33na]

By dropping the carbs (it may still take a couple of weeks with metformin) you will attain mental clarity and more energy...I was also a programmer and I know how hard it is to do complex problem solving with a brain that would rather float around in the ether...

Ive found that nuts work really well with me..I keep little zip lock plastic bags with 20 almonds inside on me at all times...it stops me over eating when I 'feel' low and shakey...it heads off feeling really bad (especially at work) and stops the carbs/low/high rebounding...

It is not an easy balance to achieve...but I thinking the key is (as all those clever ppl above have said) no more than 15 carbs per meal and eat protein for snacks maybe with fat (nuts have both) and keep the metformin for a month...

Stay calm lol and trust that we have all been there...just know it will settle if you eat less carbs take the metformin and plan your snacks...

 

[SerotoninSurfer]

Thanks to everyone for the support and advice. You all are an invaluable resource; there is no substitute for personal experience and I count myself lucky to benefit from yours. I'll let you know how it goes over the next week.
Surfer

 

[SerotoninSurfer]

Update: dropped to about 50 carbs/day since Monday night and have levels between 95-120 round the clock (checking every waking hour actually). As expected, the highs are 1hr after meal. I never go below 95 anyway so these are great numbers for me. Instead of rebounding up into the 140's, it seems the lack of carb ammo for my liver is keeping my rebounds in the 110 range. I see the nutritionist tomorrow AM so I am glad to have the hard numbers from my own personal experience to rely on.

I am still fighting hunger pangs a lot but the hypo sweats & shakes aren't as bad. Snacking every 1.5-2hrs is helping.

Thanks to all for the continued support.

 

[Patdart]

Fabulous news! Do keep us posted on the results you get tomorrow!

Good luck,

 

[d33na]

the lower your carbs the less your liver can dump so less rebounding...I'm still learning too...

 

[SerotoninSurfer]

Saw the Nutritionist...

Saw the nutritionist this morning. She was a lot smarter. She had the usual ADA diet plan, but agreed that what I was doing was definitely working for me. My BG, cholesterol, tri-G, kidney functions, blood pressure are all great and my A1c is dropping. My meter was the proof that I simply could not handle carb loads over about 10-15g at a time.

I think she realized just like she had solid research on diet for "normal" people, I had solid research on diet for myself as a diabetic. That's all I ever wanted; an intelligent conversation with someone who knows a lot about nutrition but is also realistic enough to accept hard data showing their approach was not 1-size-fits-all.

I don't need to see her again, I can tell my doc she was OK with my diet (getting him off my back), and I can keep on losing weight and having controlled BG.

I'll call that a win-win-win scenario.

 

[SerotoninSurfer]

the lower your carbs the less your liver can dump so less rebounding...I'm still learning too...

The nutrionist I just saw said the same thing. She's not totally convinced so few carbs are ok for the long run but she definitely agreed it would stop my liver dumps and was working for overall control.

 

[Shanny]

Such good news, Surfer - a dietitian with an open mind! Now just add enough fat to your way-of-eating so that you aren't suffering the hunger pangs. You are definitely on the right track!

 

[SerotoninSurfer]

Such good news, Surfer - a dietitian with an open mind! Now just add enough fat to your way-of-eating so that you aren't suffering the hunger pangs. You are definitely on the right track!

Fortunately, I'm a peanut butter junkie!