Letters to the Editor
Musing About Metformin
I'd like to share a story from my local newspaper about a woman who was helped by metformin.
This woman's blood sugar was consistently in the high 200s and she often experienced dizziness from the effects of insulin, requiring her to eat often to avoid passing out. She was finding it difficult to lose the 20 lbs. her doctor advised her to drop.
After her doctor switched her from insulin to metformin, a new pill that helps control BG levels by boosting the body's ability to use the small amount of insulin some diabetics create naturally, the woman's lightheadedness ceased (this is because metformin cannot cause dangerously low BGs). Her BGs now average 132, and she has lost 5 lbs.
Metformin, a Bristol-Myers-Squibb product sold under the brand name Glucophage, is the first of several new oral diabetes medications on the way. Another similar drug is awaiting FDA approval, and two more are under study.
Researchers are also participating in at least two other national studies looking at medications that might help prevent or repair damage caused by diabetes, such as loss of vision or loss of feeling in extremities.
I hope everyone enjoys this bit of news. I know my husband and I have.
Did the stomach side effects make it impossible to work? Was it just pain, or gas and frequent trips to the bathroom? I want to know all the possibilities before I start. I am also finally in the habit of swimming three times weekly, and fear that stomach distress may break the momentum.
I was diagnosed with diabetes in 1989, just before my 23rd birthday. I showed some signs of type I and some of type II-it's never really been entirely one or the other. I was put on Micronase (a sulfonylurea) for a few months, but it didn't work well enough. I took insulin for about four years, then participated in the metformin study, taking a combination of 2500 mg metformin and 20 mg glyburide for a couple of years.
My blood sugars were always highest in the morning (as was the case when I was on Ultralente for those four years), around 150-160 (compared to before-lunch readings of around 90-110 and before dinner of around 100-120).
Two weeks ago, my new doctor told me that my two-year vacation from injections had to come to an end-160 just didn't cut it. So now I'm back on insulin (and still on glyburide, but no longer metformin). This time, it's one shot a day, 15 units NPH, until my blood sugars stabilize. Right now, I'm about 180 in the morning and 160 in the afternoon, and my NPH dosage will go up to 20 units this week. If I can't get to around 120 (or less) all day long, I will end up having to take two shots a day (as was the case with the Ultralente two years ago).
In any case, my two years on metformin were very pleasant_the gastro problems lasted only a couple of days each time the dosage was increased (from 500 to 1000, then a week later to 2000, then finally to 2500), and I ended up losing about five pounds in the process (and, fortunately, did not gain them back after stopping the metformin). And it did not adversely affect my long-term blood sugars as measured by routine A1c tests (around 7.7-8.4 typical, where 3-7 is "normal" for a non-diabetic). Nor did my eyes deteriorate in the last year and a half. However, my new doctor is very concerned with even stronger control, so back to insulin I go.
The only complaint I had about metformin was the price (since I didn't have a prescription plan at the time, I had to buy it myself, around $0.45 per pill, five pills a day-adds up quickly when you're on a student's budget) and the general lack of availability in local pharmacies. But now that it's readily available, that would no longer be a problem.
I have a question about the cost of metformin. Here in Northern B.C. my monthly cost is $12.90 for 90 tablets, plus a dispensing fee of $8.25. I also take glyburide which, with the dispensing fee, costs $17.32. It would be interesting to find out what others have to pay for their meds.Dave T.
I take several drugs for various ailments and metformin is by far the least expensive. $38 for 60 500mg tabs. It costs over $200 for some of my blood pressure meds. I have been on metformin for more than three months now-I had to plead my case with my doctor before I could do it. After I showed him I was carefully monitoring my BGs he agreed to start me.
Overall, I've had a 20% drop in my average BG levels, and that's on the lowest starting dosages. I am now on 500 mg morning and 850 mg evenings. I'm pretty much over the gastrointestinal problems I initially had. So far so good. I am still awaiting the verdict on metformin, but it looks promising.Mark C. Campbell-Adams
I am taking metformin. My doctor started me on it the first of August. It is working very well for me. Sometimes my schedule makes it hard to keep up with my exercise routine. When this happens I would have readings near 200 for several days. On the metformin I take less insulin; when I exercise my sugars are near 100, and when I don't they are near 130.
I did suffer greatly with the gastrointestinal problems. With the last dosage I was almost ready to quit. I'm glad I didn't. My body adjusted to the medication and I have never had such control-especially when I can't stay on my schedule. The only tip I have: eat the next meal when it hurts. With metformin, avoiding eating doesn't relieve problems, it increases them. If the next meal was too far away I ate part of it right away. It usually helped.
Loi Claire Latscha
My diagnosis of diabetes is about two and a half years old, my physician having told me, "Well, we've been watching this develop for years." Of course, that was news to me. I have a new doctor now.
Anyway, I spent months on Diabeta with initial positive results for about two to three months, then back to the old levels. Was switched to and weaned onto insulin which proved ineffective and ultimately allergenic. Attempted control (without enthusiasm or much rigor) by diet and exercise. The diet was effective only when carried to absurd lengths: one small meal every two to three days.
This summer I went onto Glucophage (metformin), now 1000 mg twice a day. So far, the only GI effect is persistent gas, which can be both painful and embarrassing. I have just passed my 60th birthday and have been told that "old folks" are gassy anyway. The Glucophage is working. My blood glucose is usually in or close to the normal range, with an occasional spike. I check daily before breakfast and before dinner. I have even been able to eat some fruit.
Regards, David Atkins
I've been taking metformin for one and a half years. Up to this point I have had no problems with it. I expected to have side effects. My DM physician said something about diarrhea so I stayed home for a few days after I started the drug so I wouldn't have an "accident", but nothing happened. No side effects.
I am a long-time metformin user-I went to Canada to get the drug a few years ago. Like many people, I experienced gastrointestinal problems at first. I now take a half-cup of plain yogurt with my metformin and have no more discomfort.
Does anybody ever read the literature about the effects of metformin on glucose transport in vascular smooth muscle and endothelial cells? Any language? Any information is highly appreciated.
Dept. of Anatomy, University of Iowa
Phone:319-335-7749, fax: 319-335-7198
The following are part of a continuing discussion about Loran Medical Systems' $20,000 experimental trials involving fetal pancreatic tissue injections, reported in our October '95 issue.
I think I would rather die of diabetes than treat it at the cost of a child's life. We will die some time, but what kind of world will we leave behind? I choose not to bequeath a world in which human beings are nothing more than parts factories for the powerful.
The really interesting thing about this article is that the "miracle cure" is from Russia. I read an article recently about an American who visited a hospital for diabetes patients in Russia The description of the treatment sounded like what Americans were using in the early twenties. They weren't even using insulin used to control BG. If you want to check this, it might be in "Diabetes Forecast" sometime in the last year.
I have been receiving your publication for several months now and would like to commend you on a very up-to-date and educational publication. In your Sept. 95 issue I read about your interest in support groups, and would like to tell you about mine.
I was diagnosed with Type II diabetes in 1981. It wasn't long before I realized I needed to talk to someone else with diabetes because my family and friends just didn't understand my problems. My internist told me I didn't need a support group. I eventually discovered there were no support groups in Southern California, so I decided to start one.
The group became so large I started another one, and then another. I still have these three groups, each of which meets once a month. Initially, I thought I was doing something wrong. It took me a few years to realize people often come only until they have received what they want. But there are always new members who need support as much as I did originally.
Thirteen years have gone by since my first meeting and words cannot express how much my groups have helped me through my problems. After this many years, my bottom line is support and education. The more people learn about their illness, the better off they are. I often have speakers from the medical community come speak with us.
The Sweet Peas Diabetes Support Groups is our name. We meet in Fullerton, Anaheim, and Fountain Valley. Besides Diabetes Health, I read many other diabetes publications each month and review articles of interest with the group. I find Diabetes Health to be a wonderful tool in my efforts with the Sweet Peas.
Joan B. Taylor
Human vs. Beef
I received samples of the March and April issues of Diabetes Health, and am sending in my subscription after reading your article about the differences between animal insulin and human insulin in some people.
I've been on animal insulin for 45 years, and only changed to Humulin since Humulin was used in the hospital during my stay for quadruple bypass heart surgery. And I thought, why not? Human is the standard insulin used in hospitals for new patients.
Now, I realize this must be the cause of my erratic and unpredictable blood sugars. I had thought it was due to my medications.
Thank you for the information in your columns. Now I'll read the rest of the newsletters. I have not found information like this in the other two diabetes magazines I subscribe to.
Alice E. Mason, type I diabetes