Pred and Metformin?

[Cross-stitcher]

After 6 months on Pred for PMR, tapering without problems from 15mg to 7 mg, I have had an HbA1c test and the score is 72. For the previous 4 years, my Type 2 Diabetes was being managed solely by diet and exercise and my HbA1c never rose above 45. I have not put on any weight from the Pred, my eyesight has been checked and is good, and am otherwise well. My GP has now put me on Metformin. Does anyone have any advice? I really didn't want to have to take another drug. I will have another HbA1c test in 3 months.

[Koalajane]

Hi, sorry to hear you have been put on metformin but it is not a terrible thing. Is this your first hba1c since your diagnosis of PMR?

I am on 5 mg and my type 2 is in remission. You say you control your diabetes with diet and exercise. Are you on a LCHF diet. It was the LCHF diet and walking that put my diabetes into remission.

Good luck with it all

[Cross-stitcher in reply to Koalajane]

Thank you for your comments. Yes, I had an HbA1c test before I started on Pred and it was only 42, now 72. And yes, my diet is (and always has been) high fibre, high fat and low in carbs, but not "No Carbs" - I do eat two slices of home-made wholemeal bread a day. I have gained no weight while on Pred - no buffalo hump, no hamster-face. I can only blame the high blood glucose on Pred, as nothing else in my life has changed.

[Koalajane in reply to Cross-stitcher]

Hi, I am not a no carber . I may have my type 2 in remission but I have diabetic macular oedema. My opthamologist tells me it is due to the sugar spikes from the steroids. I tried cutting the steroids down to 4 and had a flare and my inflammation levels went high and I had signs of anaemia so went back to 5mg. The only other thing I could do was miss out on lunch which is when my sugars spike from the steroids and hopefully it will help my eyes as it has helped my hba1c, 35 at last test 2 weeks ago. I eat a slice of Hilo bread for breakfast and some cheese and then have dinner at 5 pm.

[PMRpro Ambassador]

A crucial contribution to keeping the Hba1c in the acceptable range when on pred is to cut carbohydrate in your diet. Some have been able to reverse the upward trend by adopting a low carbohydrate diet and have got back to normal range. It also helps manage weight on pred.

[Cross-stitcher in reply to PMRpro]

Thank you PMRpro, but I'm really not sure how I can adapt my diet much further - see my reply to Koalajane above.

[PMRpro Ambassador in reply to Cross-stitcher]

Two slices of bread is probably well over 20g of carbs before you add anything else at all - it really is scary how it mounts up and where carbs hide that you just don't think of.

[Hidden]

The only other option is low carb high fat but sometimes you have to med your way out of a corner until it drops. Just thing how sticky your blood is at 72 and everything is at long term risk. I have taken metformin for years with no ill effects. I was reading on diabetes UK website that metformin helps with inflammation too. Give yourself 3 months on low carb high fat diet and if no downward trend then make your decision.

[Cross-stitcher in reply to Hidden]

Hi Poopadoops, it is reassuring that you have taken metformin for so long without problems. As I have said above, I changed my diet when first diagnosed with type 2 diabetes 4 years ago, and there's not much scope for any further changes that I can see. But I may treat myself to a couple of new recipe books...…….. and then just put a few chips of a baked potato on my husband's plate at dinner. My GP warned me about "loose bowels". Is this a common side-effect of metformin? I tend that way already - 3 times a day is normal for me - and it will be a bit of a pain if that gets even more frequent or urgent.

[Hidden in reply to Cross-stitcher]

I haven't had that problem but I take pain killers too so historically have had the opposite problem! I know some have bad tummy but I have found that if I sandwich metformin in the middle of my meal it presents no problem. I have had to start tKing insulin since first year of pred as nothing was taking it down... Was 114. I am now down to 45 on insulin, metformin and a weekly injection of duglatide/trulicity. I have gradually reduced inulin as pred reduced. I started on 39units twice a day and am on under half that now so fingers crossed I will one day be back on metformin and diet, or just diet. I felt so much better as my blood glucose came down. I have been on metformin since 2001 so it is a long time. It and diet kept me in the 30s for years.

[Cross-stitcher in reply to Hidden]

I've never been in the 30's that I know of. My previous GP just used to rely on the fasting glucose dip-stick test. It was only when we moved house and the new GP wanted to do a full "new patient" health check, including HbA1c, that my borderline Type 2 was spotted.

[Hidden in reply to Cross-stitcher]

Hopefully you will be able to manage it now you know. Get some butter on that bread to slow down the release of energy from the bread. 😉