Need tips on taking metformin

[Sassysmom]

Hi everyone. I'm on metformin at 250mg twice a day. The doc plans to increase it at my next appointment. My problem is the GI side effects. The gas I can handle but not the diarrhea. I've tried taking it before meals, after meals and during meals. I still get hit and barely make it to the bathroom. If I have to be gone all day I don't take the a.m. dose until I'm home.

The pharmacist said this should resolve after a few days but so far it hasn't. I took a dicyclomine this morning to slow down the GI tract. The pharmacist said if this doesn't work to try metamucil. I know there is a trick to taking metformin because I used it before but I can't remember what it is. Does anyone have any suggestions on how to reduce the side effects?

[Hidden]

I had been on Metformin and Glipizide when I was diagnosed with CKD, 28 months ago. I was told that as far as the T2D I had it under control with diet and exercise and no longer had to take the medications. I stopped. I was told later that day that I had CKD. Back in August of this year, I was told that I was going to need surgery to remove my gallbladder. My PCP had also seen an increase in my blood glucose reading and suggested a short maintenance dose of a combination of Glipizide-Metformin until after the surgery. The surgery was just over three weeks ago and I still have one week of the combo until it expires. When it does run out I will stop taking it.

While medications like that have proven to be effective for T2D they aren't the best choice for CKD patients. When I okayed the short term use of it my pharmacist asked me about it and I explained that it was to help me get through the surgery and recovery. She then said that since my GFR has averaged out to 49 the short term use would not affect my kidneys. So far that has proven to be the case.

If my GFR would have been lower, say in the 30's the pharmacist would have advised against it. When I brought all of this up with my nephrologist, he agreed with the pharmacist and so I went along with the temporary use of the combination. By the way, my A1c taken at the end of last week was 5.2

[Bet117 NKF Ambassador in reply to Hidden]

Excellent A1C ! So happy to hear!

Feel Good!

In my thoughts!

B...

[Sassysmom in reply to Hidden]

I have about 3 weeks before I see the nephrologist. So I'm only on it until I see him and see what he recommends. I have a severe sulfa allergy so that is a concern with some meds

Your A1c is great. Mine have been right at 5.9 but my individual readings have been all over from 66-250 over the past several months. I want to get all the info I can from the renal doctor, I have a f/u appointment with cardiologist in December. And then I'm taking all of the information to a new doctor and let him go through everything and make a plan.

It's strange that the A1c is the most used test to diagnose diabetes. When taking my readings to my last doctor he always said I'm not a diabetic because my A1c was always normal. I'm losing a lot of faith in healthcare.

[Hidden in reply to Sassysmom]

I understand your frustration completely. The solution is to learn all you can. BE PROACTIVE. As you put together your Care Team, be sure to "interview" the doctors and let them know you expect their best advice and then they will support your decision.

I've been through a lot of physicians but I have put together a group of doctors that accept that and it makes all the difference.

You have to do your research and stay active, be aware of changes with your health issues, new medications, and don't be afraid to ask questions.

Before my CKD diagnosis I just did what the doctors said without question. Now, I know what to ask.

[Bassetmommer NKF Ambassador]

Hi Sassysmom,

My husband takes a lot of diabetic meds and they all have the same effect on him. I call him a food tube like my doggies because what goes in goes right out. He has been on the drugs for a long while and it did calm down after a while. Now he has less OMG moments.

I too was concerned about the metformin and his kidneys. He stopped it for a while and his sugar went out of control. He went back on it and has much better control. His GFR actually went up because his sugars were more normal. He is stage 3a.

[Sassysmom in reply to Bassetmommer]

I didn't start the metformin until last after my glucose tolerance test. I keep hoping my gut will settle down soon. I've tried the bentyl for two days now with no relief so I'm going to check with pharmacist about immodium prn. The pharmacist didn't think the bentyl would be effective and it wasn't. So it's either metamucil and/or immodium. At least for those days I have to be out and about. I don't know if I'm 3A or 3B. I was 55 and then 37. He stopped several meds and I put myself on an NAS diet. I know I'm not supposed to skip a dose but it's a 20 minute drive to town and another 20 to a Walmart. So anything that's rumbling means a disaster for me. I'm going to hold on see if this settles down.

I also have a change in meds for my bipolar disorder. Bless the NP at the new doctors office for doing it. Seroquel ramped up my appetite and I'm not having the carb cravings and no more binge eating. l also start a diabetes education class on Tuesday along with diabetes cooking class.

[KidneyCoach NKF Ambassador]

Metformin is not recommended for those with CKD. Does your doctor know about any limited or reduced kidney function you have? Please talk with your doctor about this. Surely there are other meds out there more compatible to you as an individual with your medical issues. Ask your doctor, inform them of all your conditions and side effects of Metformin. Suffering from this med is unnecessary and meds can be changed. Blessings

[Sassysmom in reply to KidneyCoach]

My cardiologist is the one who diagnosed the acute exacerbation of CKD. And ordered the renal ultrasound, bmp and glucose tolerance test. I'm stopping by his office tomorrow for the test results and will ask him about the metformin. Especially with the side effects I'm having. My appointment with the nephrologist is the day before Thanksgiving.

[Bassetmommer NKF Ambassador]

Hi Sassy,

It is imperative that all your doctors know what is going on for you. I did not realize that your GFR is 37 and dropped from 55. How long ago was it 55?

Just for your information, I was never put on metformin because of kidney issues, even at stage 3. They put me on Lantus and Januvia when the diabetes got really bad. Then my EX-PCP put me on Tragenta thinking it was better for my renal function and my A1c went completely out of control again. I put myself back on the Januvia, and have had steady below 5.9 A1c's since.

So it is trial and error. If the met is making you sick, then get something else. They go with metformin because it is dirt cheap and been around forever. Advocate for something that does not make you sick.

Oh, and I so understand what you are going through. I had the same reaction to a couple of biologics I was on. I could not go anywhere without fear. My drive to work was over 20 minutes. One time I had to stop and find a rock in a park to relieve myself. Oh... it was horrible. Don't suffer and tell your doctor now. Do not let him tell you that "you will get used to it." You are having a life altering side effect and since there are so many other drugs out there, it does not make sense for you to be on it.

Also, good for you for taking classes and cooking classes. Both my husband and I take all sorts of cooking classes and I just helped write the recipes for the NKF kidney cooking class we have here. Way to go being proactive.

[Sassysmom]

I'm looking forward to the cooking classes. I hate to cook. I loved it when my kids were home and they'd be there talking and excited. Now it's just a chore.

I was not actually diagnosed until about 5 weeks ago. After looking at my labs I freaked out when the gfr was 55 3 months before I saw it. No one said anything. So I went back in and brought it up. They ran it again and it had dropped to 37. My visit 5 weeks earlier was for edema and shortness of breath. The N.P. put me on HCTZ for that.

I called my cardiologist and moved my yearly appointment up. He was upset my regular provider ignored it. He diagnosed me with acute CKD and prediabete with the caveat that he believes it's full blown diabetes. He ordered the gtt test BMP and renal ultrasound. I missed his office hours last week so I'm going this week for results. It's been a nerve-racking October for sure.