Metformin? Or Just Diet/Exercise for the Newly Diagnosed . . .

I've been diagnosed with Type 2 diabetes about a month ago. I am 33 years old, with a BMI of 20, total cholesterol 174, triglycerides 77, HDL 60 & LDL 99. All my life, I have eaten lots of vegetables, fruits, grains, and have been taking vitamins for the past 3 years. Granted, I love carbs (grains, bread, fruits, vegetables), so I am practically a vegan, as I've always hated red meat. My father was diagnosed with diabetes at 45. He was severely underweight (BMI 19). So I guess I've been genetically predisposed, combined with low physical activity (I usually only exercise 1-2x a week). However, I've never considered myself obese or out of shape, so you can imagine my shock.

My doctor told me since I was "skinny" and was eating healthy, there was nothing she could do for my blood glucose than to prescribe Metformin (500 mg 2x a day).

Now my question is, should I exercise more & diet more (low carbs) to get my blood glucose back in the normal range (Fasting BG was 128 mg/dl when I was diagnosed) or should I be using Metformin additionally? I do not want to develop any dependence on Metformin or any other drugs, I have been trying to lose an extra 10 or 15 pounds to become 110 lbs (I am 5'6") and exercise on a daily basis for 30-45 minutes. So far my fasting blood glucose has come down to 110-120, but still not in the normal range. If I eat only 12 grams of carbs per meal, my blood glucose stays in the under 140 mg/dl range after 2 hours but if I add any more carbs, it jumps up to 168 mg/dl, 150 mg/dl, sometimes up to 180 mg/dl, sigh.

Does anyone have encountered this problem and would you advise on following the doctor's orders and taking Metformin + diet + exercise or just diet + exercise for now? Any feedback would be appreciated, thanks!

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Comment by 123 on November 19, 2008 at 6:16pm: Kat, I was in your shoes a year and a half ago and was also diagnosed as a type-2 and placed on Metformin by my family physician. Within a month I had seen another family physician because my blood glucose was not under control and that physician told me I was too concerned. That was I needed to hear, I immediately made an appointment with an Endocrinoligist who properly diagnosed me as type-1. This may not be the case with you, but I would investigate this matter further if I was in your shoes.

You sound like you are very aware of the range you want your BG(blood glucose) readings to be, and that is a good thing. Personally I set my BG goal as close as I can to what a normal persons BG level would be before and after meals.

I remained on Metformin for over a year because it allowed me to better control my BG range, but after reading more about the drug I decided that it would be best to discontinue its use.

Comment by Judith on November 19, 2008 at 6:33pm: I can't advise you on the metformin, but you will find many here with experience and much willingness to help. I am currently doing it with diet and exercise---lo-carb and lots of exercise----probably more than you need since I am a middlle-aged woman and weight maintenance is harder for me than you. You might also read David Mendosa's blogs. He got off meds after a number of years, so it is possible to do so. What were your Dad's numbers? Is that part of the legacy--that perhaps what is "normal" for your gene pool is not normal for others. And I would definitely research being underweight and it's impact on blood glucose #s. Hang in there. Many folks here wil be able to advise you.....Take care

Comment by Joe Dennis on November 20, 2008 at 9:58am: Hi kat, I went through the very same thing. I didn't fit type 2 . The old standard was you had to be under 18 to be type 1 and if you were older it was type 2. Check out the forum for type1.5 . I'm betting your in this group. Insist on a GAD test for antibodies .If you type 2 there shouldn't be any .But if there is your LADA . I which case you may want to look into a low dose basal insulin to keep from burning your remaining Beta cells out.

Comment by Kristin on November 20, 2008 at 11:38am: I agree with the others that you should be tested to see if you are actually type 1.5/LADA. It doesn't sound like you need to lose any weight!! I don't think that your blood sugars will be better if you become even skinnier!

I hope that you are able to get some more answers!

Comment by Kat on November 21, 2008 at 6:24am: Thanks everyone for the wonderful feedback. I am in the process of scheduling another blood test with my primary doctor. Perhaps I should go to an endocrinologist to determine if I"m indeed Type 1.5/LADA. Knowing for sure which type I am will help. I am afraid of taking insulin shots though . . .

Comment by Kristin on November 21, 2008 at 6:26am: Hi Kat!

It's better to know. And I know many people are afriad of insulin shots, but I can tell you from my experience, the shots are the easiest part of diabetes! It's carb counting, frequent blood sugar testing, and controlling my diet that take more work!

Either way, we are here for you to help!!

Comment by Megan Skelly on November 21, 2008 at 6:48am: Hi Kat

I was initially diagnosed as a Type 1 in April this year, and put on insulin. I was really scared to give myself my first shot, but the educator forced me to and it wasn't nearly as bad as I thought it would be. The idea of giving yourself an injection is FAR worse than actually doing it. Also, you can't compare giving yourself an insulin shot with the other kinds of shots you have been given. Firstly, you're doing it yourself so you can feel to avoid nerves and muscles and blood vessels etc. Secondly, the needles are a lot shorter than most regular injections. Don't be afraid of insulin - it is your friend! You will much better taking it than not taking it.

Comment by tmana on December 2, 2008 at 3:59pm: Kat, was your father put on either oral medications or insulin? What (if anything) is he using now? If he is underweight and has always controlled his diabetes by oral medications, then I would also consider having genetic tests done for MODY, which is a collection of even rarer forms of diabetes than LADA. Some forms of MODY can be controlled by diet and exercise, others need insulin, and others can be controlled by oral medications (I think it's MODY6 that responds to microdoses of sulfonylureas).

Comment by Kat on December 3, 2008 at 2:35pm: Tmana thanks for your reply -- my dad is on Metformin 500 mg 2x a day and some other diabetes drugs (I do not know which ones) as well as something to control his cholesterol. He does not take any insulin. He has never been overweight in his life, but he did smoke & had a craving for sweets. My sister has a BMI of 20 and she's also glucose-intolerant with elevated fasting blood glucose in the mornings in the mid to high 90's.

I did not know 80-90% of T2's had higher BMI's, but most Korean T2 diabetics I know are average or thin and I have never met a T1 Korean diabetic, it appears to be very uncommon. I'm not sure if my insurance would cover a genetic testing for MODY, but if it does, it would be great to find out for my own sake. Most of the times I feel like my doctor doesn't care to "categorize" me into any types, she just thinks the treatment for all diabetics is the same. I cut back on carbs in November, with diet & exercise, my FSB was in the 90s-110's, so for December, I've started to take Metformin to normalize it.

Renee - 2000 mg a day sounds like a lot. How old is your son? I have no idea if Metformin causes a person to become "dependent" on it or makes your body need it more & more as time goes on, that is one of my main concerns. My doc said it was a very safe drug, but I don't know if I can trust her 100%, she's no endo.

I hope you can inform me once your son goes in for a diagnosis about any "dependencies" that might be caused by Metformin?