DOES ANYONE HAVE EXPERIENCE TAKING METFORMIN AS A PREVENTIVE MEASURE

[CroquetGirl]

I AM A 66-year old female who was in top condition 18 months ago. It was a year before I received the PMR diagnosis and it's been 12 weeks since I've been on prednisone. I've tried to have a good attitude about the pred and to throw all my energy into my health and minimizing its side effects. I've read that some people take metformin right off the bat to minimize the possibility of diabetes. Your experience or insight about this drug and/or this approach would be most welcome.

[piglette]

Metformin can be used as a preventative against diabetes. Has your doctor suggested it?

[Logic in reply to piglette]

I was prescribed Metformin when I began to take prednisone in 2018 for PMR and suspected GCA. I started on 50 mg so it was a high dose and my primary care said it was a precaution. It was a low dose, 500 mg, and I took it until I tapered off in November 2020. When I had pain again I October 2021, I began to take it immediately after starting prednisone again and it has kept my A1C tests all good.I had one high result in 2018 which is why my doc advised taking it.

It's a pain in the neck taking all this stuff but better to avoid problems.

I am now down to 3 mg and will stop Metformin when I stop the prednisone.

I normally don't even take an aspirin unless I'm dying, but here I am taking alendronate and Metformin. You do what you have to do.

[Kendrew]

Hi CroquetGirl,

Others with more knowledge will be along.

I've had PMR for 3yrs now and been taking advice from this forum for over two of them.

I have to admit to never having been aware of any discussions regarding the automatic prescribing of metformin as soon as prednisolone is required. (I may of course have simply & unknowingly 'overlooked' any there may have been)

I personally would not take any kind of medication without strong evidence to support it's use and over the past 3yrs my blood sugar levels have remained well within normal parameters.

It's important to say that I am very careful with my diet and stick to very low carb. I also engage in regular, daily exercise (within my capabilities) and together this has so far enabled me to avoid developing diabetes.

I'm fully aware this might change but until it does I'll not be adding yet another medication to the list I already take.

Similarly, my rheumatologist wanted to automatically put me on omeprazole when I started prednisolone. I refused and said I would only take it if symptoms or problems arose. So far, I've not required it.

Had I taken his advice again, I would also now be on amitriptyline and gabapentin....neither of which I have actually needed!

Obviously, we're all individuals and your PMR/GCA health history will not be the same as mine. All I'd say is, just make sure there's real evidence to support a need for the metformin before you agree to start taking another medication.

[SnazzyD]

Hello, personally unless there was a compelling reason I’d just go for eating a very low carb diet and I mean very low. This means not just cutting back but cutting out bread, pasta, rice, flours, sugar and maize etc. The reason one does this is to stop adding to the spikes in blood sugar induced by the Pred whereby it makes the liver break down glucagon into glucose. If you then start adding high glucose forming foods you add to the burden of the body having to keep putting out lots of insulin. Two things can happen, your body stops reacting to insulin that is there to clear the blood of the excess glucose and/or your pancreas stops being able to keep making insulin. I did this diet (as have others) with good effect even on high doses for GCA. For some unknown reason low carb diet is not considered by doctors because they don’t seem to know about it and regard diabetes and weight gain as an inevitability. I haven’t noticed on this forum that many people are given Metformin prophylactically routinely. The happy side effect of this is reducing the weight gain associated with Pred because with less insulin floating about, there is less conversion of glucose into fat. Perhaps suggest you try this and see if your HbA1c test in 3 months or so is ok.

[PMRpro Ambassador]

Cutting your carbs seems to me to be a far preferable approach to me - too much reliance on a pill to cure every ill.

We are pushed on to too many "just in case" medications and the more you take, the higher the likelihood of interactions and adverse effects. I have been on pred for 13 years - and have absolutely no sign of even pre-diabetes, my Hba1c is 37! Nor any significant loss of bone density. I already need 4 medications for PMR and atrial fibrillation - there would have been at least another 4 or 5 had I taken the "just in case" offers which it turns out, I have not needed.

According to this the effect is less in older subjects - and greater in men:

ncbi.nlm.nih.gov/pmc/articl....

And it isn't approved by the FDA or any other drugs authority for this use.

[SheffieldJane]

My blood sugars show borderline diabetes that hovers around high normal. I was prescribed Metformin. As I recall, it made me feel ill and I didn’t persevere. I have since read that it is being used as a weight loss drug in the US. This gave me pause for thought. I was wondering about trying again with a better attitude?Like everybody though, I really resent the raft of “ just in case” drugs foisted upon our age group, each with a set of side effects.

[Koalajane]

I was diagnosed type 2 diabetic a few months after my PMR diagnosis. I was put on gliclazide. This was a kick in the butt for me as I had been eating badly. I went on a low carb high fat diet and 6 months later was taken off the gliclazide as my hba1c had gone into normal range.My feeling here is that rather than put people on metformin, which can cause unpleasant diarrhoea, it would be far better to warn about the possibility of type 2 and to change their diet!

[PMRpro Ambassador in reply to Koalajane]

I suspect some of it is the mistaken idea that if you take the pill, you can eat what you like!

[Koalajane in reply to PMRpro]

It is a very mistaken idea!My husband is on metformin for his type 2 and eats biscuits, chocolate etc and it hasn’t reduced his hba1c as much as mine has on my low carb diet! He isn’t on steroids either! The low carb diet put me into remission within 6 months

[PMRpro Ambassador in reply to Koalajane]

People think the same with statins apparently. A lot of men do seem to struggle with accepting that there has to be a change in diet too.