Replies to This Discussion

Permalink Reply by Alan S on November 7, 2011 at 6:45pm

Just a guess, but are you on the extended release version?

That sounds like your capsules, which are designed to dissolve slowly, are not dissolving properly at all when you have those stomach upsets and diarrhea because they are passing through your system too rapidly.

If you only notice them at those times (hopefully infrequently) then I would not be concerned. But if it happens more often I would discuss it with the doctor.

PS As for daring not to take them, I always cease metformin if I have a gastro problem and re-start when I'm better. I suggest you discuss that with the doc too.

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Permalink Reply by wickhamster on November 7, 2011 at 6:54pm

Yes, they are extended release.

I would talk to a doctor, but in this situation where I'm living in a fairly ... um (struggling for polite word here) ... traditional part of Malaysia ... I have a lovely lady doctor, but our language interface is only just there (her English is way better than most) and she seems to have minimal experience with Diabetes. It's not that common here (yet). She will pretty much give me anything I ask for - which is an improvement on how things were at the beginning of this year when I arrived here.

I wonder whether when I don't notice them they are not there, or just - 'embedded' out of sight?

It was such hard work to obtain the Glucophage rather than regular Metformin - standard treatment for the rare cases of diabetes here...

OK, I guess I'll give it a go not taking them until by stomach settles.

Going back to Australia for a short visit soon ... hope I can find a doc who knows.

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Permalink Reply by Alan S on November 8, 2011 at 11:31am

Do you have access to reasonable stocks of test strips? I presume you need the metformin because your blood glucose levels are higher than you like.

The reason I suggest a good supply of test strips is that applying this method may reduce your need for the medication: Test, Review, Adjust. Regardless of your present problem, I suggest you consider applying that technique.

Going back to Australia for a short visit soon ... hope I can find a doc who knows.

What part of Oz are you from? If you are an Aussie citizen and registered with the NDSS, take advantage of your short visit to stock up on any subsidised medications and also on subsidised test strips you may need on return to Malaysia. You may need to tee that up with a doctor back here in advance. When I went on a five-month world trip in 2003 I took five months worth of meds and over 1000 Accu-chek strips on the trip with me, but it took time to get approval from the PBS and NDSS for such a large one-off prescription. That was in my first year after diagnosis and I was testing a LOT back then :)

You may also need prior approval from Malaysian customs to bring the meds in with you. In Australia Glucophage and Metformin are the same thing, you would need to specify extended release.

I wonder whether when I don't notice them they are not there, or just - 'embedded' out of sight?

Is the gastro distress associated with your metformin XR or is it a separate problem caused by local food and water? I doubt the metformin capsules are passing straight through when your system is normal. The more rapid progress of all things through your bowels is likely to be the cause when you have diarrhoea.

Cheers, Alan, T2, Australia

Everything in Moderation - Except Laughter

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Permalink Reply by wickhamster on November 8, 2011 at 4:28pm

Thanks Alan
After a bit of a battle I have managed to get a supply of test strips, 50 per month. I guess I need to rethink everything and get back to some serious testing - just when I thought I had everything sorted! The strips are quite expensive here, (come only in packs of 25, and frequently fail - the climate, they explain!) but my insurance seems willing to give me 50 per month.

I am from Perth, and about to spend a month there visiting kids and grandkids - had been hoping not to spend this precious time in doctor's offices. There is a medical practice near where I'll be staying where they have most of my records (from the odd times when I am back in Aus), but 'my' doctor has gone so I need to start fresh again. I do belong to NDSS, so I will be able to get some strips while I am there.

When I came to Malaysia in January, I brought a whole lot of medication and strips, which lasted long enough to get me organised with the local doctor. (I found the doctors initially just told me to go away and couldn't be bothered to help for the first few months - I can only presume they thought I was just another useless tourist who would ask them to get supplies and then just disappear).

I didn't declare anything when we came here - I don't think I was ever given opportunity. In Aus we can get 2 month's supply at a go and, with special permission, up to six month's worth.

Here they only give a month at a go, and I have actually persuaded the insurance company to let me have 2 month's worth to cover me when I go back to Auz. It seems silly to be taking meds back with me, but I don't want to interrupt the supply stream at this end as I need it to keep going for at least another couple of years!

And lastly, frustratingly, I don't know what caused the stomach upset. In this place there are so many possibilities! I thought it was food poisoning at one stage, and have been carefully watching my husband to see if he was affected. We have both had various upsets ... it's hard to tell. I generally don't eat the food laid out here - it's always lukewarm and sits there for ages - but there is a limit to my ability to be endlessly 'rude' in this culture which values community eating so highly, especially at this time of year when feasting with every group takes up a large part of many days.

Thanks so much Alan - this has been very helpful with my trying to think this thing through.

A couple or three years ago when I was in Saudi Arabia, my (Jordanian) doctor insisted that there was something wrong with my BG meter, told me to throw it away and buy a new one, and would not believe my readings. (He tried to do a check by doing a blood test and at the same time asking me to test with my meter, but the test was 'lost' and I never saw the results...) The issue at that time was basically 'dawn phenomenon' - my sugar was much higher in the morning than at night - which he had never heard of, and the job I had was exceedingly stressful. And now I am wondering whether this was a problem then too and I just didn't notice.

This morning I am feeling much better, but I did notice the presence of a 'pellet' embedded there (!). I am just not game to stop taking them.

There is also this possibility, suggested here by bsc, of gastroparesis. I had never even heard of that until recently - read about it on this site, actually. I guess that's a possibility too. I do have a lot of pain in my stomach. Been on and off various meds for that (somac, omeprosole etc) but presently not taking any. Feel very nervous in that area after my Dad died of stomach cancer. have had endoscopies in the past ...

Don't want to spend my holidays dealing with this - but also don't want to return here to try and deal with it here!

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Permalink Reply by Alan S on November 8, 2011 at 8:00pm

Good luck.

After I showed my doc my records back in '02, which showed that I was using 50 strips a week, he was happy to support my request for more than 20x50 to take on my trip. It may help if you mail a letter to your WA doc in advance advising of your needs and requesting support.

I no longer test as much, but you may need to in the short term to gain control.

On stomach upsets, I travel a LOT :) See my other blog: Born Under a Wandering Star

I have a few basic rules which I break at my peril.

o I never eat raw washed uncooked foods. Therefore I never eat salads or unpeeled fruits in foreign lands.

o I never eat fruit I did not peel myself.

o I never let water in my mouth that did not come from a bottle that I unsealed myself. That is not just for drinking, but for rinsing or cleaning my teeth.

o I never eat "rare" foods. It must be well and truly cooked. I eat street food at times, but only when it resembles overcooked charcoal :)

I realise some of those rules may be tough to follow when you are living in a foreign land long-term.

Despite that, I still get at least one bout of traveller's curse on each long trip. My doc has prescribed Norfloxacin. It works brilliantly for me, but it is strong stuff so I only take it when needed, and only a minimal dose at that time.

Cheers, Alan, T2, Australia

Everything in Moderation - Except Laughter

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Permalink Reply by Lila on November 9, 2011 at 4:20am

Sorry I have to jump in here. Have to disagree that diabetes is 'not that common here [in Malaysia] (yet)'.

There is a huge (Type 2) diabetes epidemic in Asia and this includes Malaysia.

1.2 million Malaysians have diabetes, more than 98% of them Type 2. That's one in seven in the adult population, and there are are probably lots more people who are undiagnosed. Consistent with statistics from other countries with non-white populations, Malaysians get T2 at lower body weights than white people. In one study, I found the statistic that only 50% of T2s in Malaysia are overweight. There is plenty of central adiposity even among otherwise thin people.

Glycaemic control generally is not great. Another study found a mean HBA1C of 8.66±2.09%. Only 11.4% had A1Cs under 6.5%.

(statistics collated from googling 'diabetes malaysia')

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Permalink Reply by wickhamster on November 9, 2011 at 5:17am

Interesting. Well then I feel very concerned for those in THIS part of Malaysia. The state of Terengganu is very 'conventional' and the health care here is not a patch on KL. There is one hospital, and one specialist hospital. Everything else is done through tiny clinics. They told me standard treatment is Metformin- that's basically it unless you can afford specialist treatment, and mostly they can't.

I am not disagreeing with you. A lot of people when they say 'Malaysia' they mean 'KL'. The chemist's mother has diabetes, therefore he actually stocks the strips I use. The heart specialist in the specialist hospital is a diabetic, therefore was willing to take an interest in my case. It took six months, relying on my supply from Australia, to line up a supply of the meds I take - they are ordered in from KL by the chemist for me and cost RM900 ($300) per month. Local people can't afford that nor the insurance I have that covers it.

I love it here, and the local people are just delightful - for all their lack of tubby jolly people! The women are beautiful and so dignified in their top-to-toe sheeny baju kurung - I feel so clunky next to them.

So if I can qualify my statement a little. Although diabetes may be as common here as elsewhere in the world, the chances of someone in the backwaters of Malaysia being diagnosed and receiving quality treatment are rather low. These people live on rice with a little bit of this or that which is generally fried. When I say I have diabetes they understand that to mean that I must not eat sugar.

I'm doing my bit, explaining things a bit at every opportunity. And I appreciate this site which gives me a chance to talk to others who know what it is about. And as this gorgeous peaceful country rushes headlong to keep up with th western world ... I hope they can beat the diabetes epidemic more successfully than some of the more 'advanced' countries have so far.

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Permalink Reply by Lila on November 9, 2011 at 5:51am

I agree with you. Yes, when I read your first post, I did wonder if you were somewhere on the east coast.

I agree 100% with you that the awareness is pretty low and that virtually everybody still thinks diabetes just means no sugar. The local food is delicious but extremely high in carbs, and doing without rice is totally inconceivable. Not to mention all the gorgeous high-carb snacks and the fact that most drinks are sweetened. Imagine your teh tarik without the condensed milk! Impossible.

Am not at all optimistic about the epidemic though. There is a very very strong genetic predisposition for T2, just like in India where more than half of T2s are normal weight. Countries with predominantly Caucasian populations don't have the same genetic triggers for T2. I don't have an answer but I just feel pessimistic.

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Permalink Reply by Alan S on November 9, 2011 at 1:03pm

There is a huge (Type 2) diabetes epidemic in Asia and this includes Malaysia.

Well said. This makes salutary reading to anyone who thinks Type 2 is a western disease:

Country and regional data on diabetes

Western Pacific Region
South-East Asia Region

Extracted from those:

		Country           2000               2030
		Australia      941,000       1,673,000
		China      20,757,000     42,321,000
		India       31,705,000     79,441,000
		Malaysia      942,000      2,479,000

Are you living in Malaysia? I was amazed at the modern affluence and energy of Kuala Lumpur when I visited earlier this year.

Cheers, Alan, T2, Australia.
Everything in Moderation - Except Laughter.

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Permalink Reply by wickhamster on November 9, 2011 at 3:58pm

Hi Alan and Lila

Yes it is very worrying.

I am here as an educator, improving (hopefully!) pedagogy especially in English ... maybe a few health lessons can be learnt along the way.

There is a general belief (seems like the west back in the 60s) encouraged by advertising, that children need lots of sugar. Totally natural fresh sugar cane juice is offered as healthy. All children-specific food (cereals, milks, supplements) are loaded with sugar. The advert says "We all know that children need sugar, but how much is the right amount? ..." I have tried to get soy milk, but it is all sickly sweet.

There is a month of 'fasting' when they eat way more than usual (only during hours of darkness) - after sweating all day and not eating or even drinking water. Then there is another month of blatant feasting from house to house, everything washed down with syrup or teh tarik. I find it really hard to get anything to drink that is not totally sweet.

Veges are rarely offered - despite being readily available in the marketplace - and everything is white rice with something fried, all eaten with the fingers. I have searched and finally found at least wholemeal rice (in very small packets, not the sacks that white rice is sold in.)

On top of that, I am extremely sensitive to chili. It's not that I don't like the taste, my throat closes and I choke. So when I am eating with people (and that is not optional, it's part of life) they run in circles looking for something to offer me. Seeing my size, they presume that I must eat huge quantities, and cannot understand when I say I have actually had plenty. (They probably think I gorge myself when I get home.)

When I was coming to this country, I was a little concerned about how I would cope with my medical needs, but having seen adverts for 'medical tourism' in Malaysia, I presumed everything was modern and well-informed. Most people don't know anything about the east coast! People in Malaysia said to me "go to one of those big poly-clinics, they have them everywhere". Nope, none in this state.

So, I love it here, and I love the people. But it is a bit of a struggle. My little doctor lady is much more experienced than some I've seen, and very cooperative, but I feel that I am her learning curve! She's older, my age, but I think she is now dealing with things she has mostly only read about before. She's happy to look after me because my insurance company pays her good money.

In this very traditional area of the country, it will be even harder to educate people and change things ...

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Permalink Reply by Alan S on November 9, 2011 at 4:10pm

Just one tip.

everything is white rice with something fried, all eaten with the fingers.

Avoid the rice and stop worrying about the fat.

Cheers, Alan, T2, Australia.

Everything in Moderation - Except Laughter.

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Permalink Reply by wickhamster on November 9, 2011 at 4:19pm

Yeah, I'm onto that!

I usually put some rice on my plate to keep them happy, and then leave it.

I look for veges, but it's hard to find any without chili.

I'm generally vegetarian - just don't like meat, especially red - so I'll pick at a bit of chicken if it's not soaked in red. I take a little fish - but usually it's salted fish, so a bare nibble is enough for anyone. Occasionally there are some hard-boiled eggs.

Then I head for the fruit platters and get into the melons and pawpaws (papaya).

When people know I'll be there they try so hard to get it right for me. At the last do they provided sardine sandwiches (white bread with the crusts cut off as they do here). They have heard that westerners like sandwiches! Very sweet of them. Then they pressed me to take all the leftover sandwiches home.

Yeah, every meal is an adventure. :D

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