How I Crushed Type 2 Diabetes in Only Weeks and Completely Changed My Outlook on Life

Editor’s note: We found Rey’s remarkable story in the diabetes online community, and asked him if he would share it with us. Rey experienced extraordinary rapid success by following a precise diet and medication regimen immediately after diagnosis with type 2 diabetes. His improvement was incredible, but others making the same changes may not experience the same success. Please speak to your doctor or caregiver before enacting any major health changes of your own.

I’m Rey, and I’m a 44-year old male with a history of high blood pressure and being overweight, but until recently I had no major health issues. Only this past summer I learned that I had dangerously uncontrolled diabetes. Within the span of just a couple of months, I completely changed my diet, started and then stopped glucose-lowering medications, and got my blood sugar back into the normal, healthy range. Here’s my story.

My First Health Scare

My story is ultimately a diabetes story, but there were some bumps along the way that I think are worth including before I jump into the diabetes.

My adventure really began in the summer of 2020. After some stressful life events, I developed a rather constant state of anxiety, which seemed to be preventing me from getting good sleep. Even while using a sedative, I was up at least 4-5 times during the night, every night. I didn’t have a previous history of mental health problems, so this was all new to me. The especially challenging part was that as time passed, lying in bed became a trigger for the anxiety, which made the sleep even harder to come by. I felt like I was just going through the motions to get through life.

Fortunately, after months of stubbornness and sucking it up the best I could, I finally got to the bottom of things. I discovered it was sleep apnea, and started CPAP treatment. The result was truly life-changing, sleep returned to normal, and my anxiety went away 100%.

Life was great and I’d survived and handled my major mid-life health crisis…. or so I thought! Little did I know, but that relief would prove to be short-lived as in the coming months I started to experience a new set of symptoms.

I was at my highest weight yet and my BMI was creeping towards 30. Some reading this will scoff and think “30 is nothing, I’m well above that,” but everyone’s body is a little different and apparently 30 was my personal breaking point.

My fasting blood sugar was over 100 mg/dL, and my doctor said something about pre-diabetes, but she didn’t sound too concerned about it.

The Symptoms

I was again experiencing sleeplessness. Now I was finding that instead of sleep apnea waking me up during the night, my bladder was sure filling up and I was getting up to pee several times a night. Also, I was quite thirsty when this would happen. I did notice it was nights that I’d eat pizza or pasta for dinner that were the worst. Some combination of stubbornness and perhaps denial kept me from taking this too seriously, so I just kept on with things. Besides, this was March 2021 and you didn’t dare go into a medical clinic unless you were on your covid deathbed. Surely, this was no big deal, and getting checked out could wait.

Still, I sensed something was wrong and I reduced the amount of pizza and pasta I was eating for dinner (maybe twice a week instead of five nights a week), eating beans with rice and veggies for dinner instead. In hindsight, not great, but a minor improvement.

The next major symptom arrived in April: blurry vision. At first, I wasn’t worried. I’d gotten LASIK eye surgery done 12 years earlier, and this change seemed like a mild return of my nearsightedness. I was also in my mid-40s, which I’m told is a time where focusing becomes harder and your vision changes.

Then it got really bad: I was on a trip to Florida when I couldn’t read a menu board that was 8 feet in front of me. I had to resort to taking a picture of it with my phone and then looking at that picture to read the menu. Something was majorly wrong!

When I got back from Florida (after some real nerve-wracking and likely dangerous driving), I went in to get my vision checked and received a -2.0 diopters prescription. The optometrist was shocked that I had let my vision get that bad before getting glasses and made a comment about diabetes, but was also of the impression that my vision would change throughout the day as my blood sugar changed. That clearly wasn’t happening to me (turns out it’s more complicated than that).

The last major symptom was that I had been losing weight at a pretty decent clip (5-10 pounds a month). Obviously, this must have been due to cutting back on pizza and pasta, right? Curiously, past attempts at eating better had never been quite this effective, but why question such great progress when you’re on a roll! At this point, it was late April and the earliest I could get in for a check-up was mid-June, so why not ride out another month of weight loss and see how great my labs come back then?

My Diagnosis

A little over a week before the appointment I started researching diabetes online, since I was starting to wonder about what my doctor and optometrist had said. But surely that takes years to develop, right?

Obviously, my “diet” was working since I had now lost 25 pounds this year and weighed less than I did in my 30s. Who knew eating healthy was so easy!

After a little light reading, I quickly realized how wrong I was, that everything that had happened in the last few months was explained perfectly by diabetes, and that the weight loss might have been diabetes rather than my new diet. This was hard to process.

I picked up a blood sugar meter, and on a Friday night fumbled with the thing enough to figure out how to get a reading. I was shocked when the meter read 567 mg/dL. That can’t possibly be right! My girlfriend tried the meter and her result came in at 77 mg/dL. I tested mine again and this time it registered 596 mg/dL!

At this point, it was 11 PM on a Friday night, and my safest course of action would have been to go to the ER, but I figured if high blood sugar hadn’t killed me in the last 3-4 months, it probably wasn’t going to kill me that weekend. I decided to read more about diabetes, give myself a couple of days to get my wits about me, and go into urgent care on Monday. I also continued to test my blood sugar and it seemed to stay in the 300 to 450 mg/dL range that weekend, regardless of what I ate or whether I was eating.

At urgent care my A1c came in at 13.7%, and my fasting blood sugar was 449 mg/dL. Based on my history, I was more likely to have type 2 diabetes (and additional testing would later confirm that). I was prescribed metformin, and advised to take insulin, advice that I wasn’t ready to take.

Rey kept track of his blood sugar measurements from the moment he began testing, before he was diagnosed with diabetes. You can see his girlfriend’s healthy reading, 77 mg/dL, on the first day.

A New Diet

I now understood that the reason I had lost so much weight so quickly was my uncontrolled diabetes, at least 3 months of it!

I immediately cut most high-carb foods out of my diet and subsisted largely on a diet of full-fat cottage cheese, full-fat plain Greek yogurt, hard cheese, nuts, avocadoes, and canned beans with olive oil. I also kept some fruit and berries in my diet initially. Throughout the day I ate random combinations of these foods. I didn’t really prepare them or fancy them up at all with cooking (other than heating the beans in the microwave so they’d be warm).

I knew I had screwed things up, and if there was going to be any hope of reversing the damage I feared I had done to my body I needed to focus. Maybe I would be able to go back to eating pizza, pasta, and all those delicious carb-filled foods that I loved someday, but it was clear now wasn’t the time for that.

I’d certainly thrown in the towel on diets plenty of times before and gone back to eating like crap, but this time it felt like there was a gun held to my head, and quitting wasn’t an option. Perhaps I’m being overly dramatic about this, and perhaps it wasn’t the healthiest outlook, but it’s how I saw things and it got me through the first weeks where I was at my highest level of motivation.

I wasn’t using a particular diet system I had found on the internet or in a book, it was just me trying to think of all the foods (as a vegetarian) that I normally ate that were lower on the glycemic index, and sticking to those. Frustratingly, there seemed to be a lot of disagreement online in regards to what the “best” diet was for a diabetic, but I’ll come back to that later.

The Right Medications

With this diet and metformin, my blood sugar still ranged from about 250 to 400 mg/dL that first week. My blood sugar really needed to come down since the longer it remained elevated, the greater my risk for diabetes-related complications. Clearly, a week of my new diet and metformin wasn’t enough, and I was more open to exploring what else could be done.

When I saw my primary doctor after that week, she wanted to put me on insulin too, in order to stabilize my blood sugar. Although I knew that insulin would have rapidly brought my blood sugar down to normal levels, using it would have made it difficult for me to gauge if my dietary changes were getting the job done.

Through my research, I had become convinced that SGLT2 inhibitors were the only class of drugs that made any sense for a person with new uncontrolled type 2 diabetes to take (in addition to metformin). Normally in uncontrolled diabetes, your kidneys excrete sugar to your urine as a means of keeping your blood sugar from getting dangerously high, but that effect doesn’t really kick in until your blood sugar levels are way up there. With an SGLT2 inhibitor, your kidneys are just doing that all the time, keeping your blood sugar down in the process. The real beauty of this is instead of insulin, which causes your body to store that excess sugar (only delaying the problem), once you pee out the excess sugar, it’s gone forever.

I asked my doctor for a referral to an endocrinologist and a prescription for an SGLT2 inhibitor instead. She didn’t have much experience with SGLT2s and started talking about other drugs, but she could see I had a pile of notes with me on different drug classes, the research I had done on them. I think she also realized that although she was the one to write the prescription, that I was ready to argue my case.

As soon as I started taking the SGLT2 inhibitor my blood sugar came down almost immediately.

On Farxiga, within days my blood sugar dropped to the 100 to 150 mg/dL range. I had to pee a little more at first too, which suggested the drug was doing exactly what it was supposed to. After a few days, I found I wasn’t peeing any more than normal, which was probably due to my fairly low-carb diet.

[Editor’s note: Rey had an incredibly positive experience with SGLT2 inhibitors, but they are not for everyone, and do carry side effects and risks, especially when combined with low-carbohydrate diets. Please speak to your doctor about changing your medication.]

This was a great improvement over where I was before, but like every newly-minted diabetic I had dreams of reversing my diabetes and getting my blood sugar back to “normal.” I obviously wasn’t there yet and just because you want something doesn’t mean it’s possible or realistic, but I was holding onto that dream.

Remission is a very controversial topic. Most ADA and official-looking literature I found said that diabetes was a progressive disease. As time passes, more drugs are required to maintain the same degree of control, and some pretty awful complications occur as it gets worse and worse. That was a rather depressing outlook. If it all falls apart in the end, why not just go back to enjoying all those carb-rich foods that I love and enjoy whatever time I’ve got left? Fortunately, I didn’t fall into that trap, but I have to imagine many do.

Intermittent Fasting

I was aware of internet doctors out there on the fringes saying type 2 diabetes can be reversed and people can manage through diet alone, without drugs. Are they selling false hope, similar to new-age healers selling energy crystals to cure cancer? Most of them are talking about low-carb and “keto,” which I’d previously assumed to be just another random fad diet. “They’re obviously quacks,” I thought. I figured that American Diabetes Association was most certainly correct about diabetes being progressive, just giving me the cold hard truth. But just for the sake of argument, I decided to hear the quacks out first.

Of the doctors on Youtube, the first to really suck me in was Dr. Jason Fung, a Canadian nephrologist. He had a very intuitive model for explaining type 2 diabetes, and used research on treating the condition with gastric bypass surgery (which has been highly successful) as a starting point. He suggested a low-carb diet combined with fasting in various forms. Hey, I’m already doing the low-carb thing and it seems to be helping. Maybe fasting would be the next nudge I needed.

I started with 3 set meals a day (eating between 7:30 AM and 7:30 PM, and then fasting from 7:30 PM until 7:30 AM the next morning). Around the time I started Farxiga, I moved into the next phase of fasting, which was to skip breakfast and then eat only lunch and dinner (eat at 12 PM and then 8 PM). To my surprise, I no longer felt hunger when I wasn’t eating. I now know that’s a common benefit to the keto diet, but if someone had tried to tell me about that a year earlier, I would have thought they were crazy. Also, I didn’t really know I was doing keto. I was just doing a tighter version of the diet I’d explained earlier, with less fruit and no beans.

I completed my first full-day fast the weekend after starting Farxiga. I didn’t eat anything at all starting Friday after dinner until around 1 PM on Sunday, for a 40+ hour fast. Again, Farxiga had gotten my blood sugar down to under 150 mg/dL on a regular basis, but this was the kick that finally got me back under 100 mg/dL. Throughout Friday it was testing 130 to 150 mg/dL, Saturday morning I was at 144 mg/dL, but as Saturday dragged on and my fast continued I started getting multiple readings under 100 mg/dL. My Sunday morning fasting result was 96 mg/dL and, it got as low as 79 mg/dL on Sunday afternoon before I finally broke my fast. To my surprise, breaking my fast only bumped me to 119 mg/dL and 5 hours later my blood sugar was back down to 82 mg/dL. Seeing this progress felt truly amazing and it was only 16 days after finding out I had diabetes!

Maintenance

Rey’s blood sugars improved rapidly and remarkably with the right combination of diet and medication.

Of course, you don’t eat your way to diabetes in two weeks and you don’t undo your diabetes in two weeks either. I was taking 2,000 mg of metformin a day as well as the SGLT2 inhibitor. The week after my big fast, my fasting blood sugar readings would go back over 100 mg/dL, but I kept plugging away, only eating two larger meals a day during a narrow set of eating hours. I also tested the high-carb waters with a 6-inch Subway sandwich – it spiked my blood sugar to 190 mg/dL, which is much higher than a non-diabetic would likely hit from that meal. That helped knock me back down a peg and remind me that I still had diabetes, after all.

The next weekend I noticed that my blood sugar numbers were starting to come down to under 100 mg/dL without extended fasting. I also noticed that foods that previously spiked my blood sugar a great deal were now spiking it much less. On June 28th (day 24 of knowing I had diabetes and 13 days after starting my SGLT2) I decided to stop taking Farxiga and see what effect it would have. This was not a responsible decision, as you should always consult with your doctor before discontinuing medication, but with my improved blood sugar levels, I questioned if Farxiga was still doing anything for me. It turned out my guess was correct. There was no significant change in fasting or post-meal blood sugar readings in the days that followed, and my type 2 diabetes was now well-controlled via just diet and metformin!

About a week later I started wearing a Freestyle Libre 2 to get a broader picture of my blood sugar trends, and for convenience. My readings were still in the 80-90 mg/dL range throughout the day, with small bumps up over 100 mg/dL after a meal. When I finally was due for my appointment with an endocrinologist to discuss my diabetes treatment, the feel of the visit could best be summed up as “why are you here?” My data showed that my average blood sugar in the previous 10 days had been 95 mg/dL, which would extrapolate to a 4.9% A1C (compared to the 13.7% result when first tested). This is, of course, only an estimate. And my blood sugar had only been well controlled for 2-3 weeks at this point.

Blood sugar wasn’t the only improvement either over last year’s numbers: total cholesterol dropped from 238 mg/dL to 172 mg/dL, with HDL (“good cholesterol”) fairly steady from 64 to 62 mg/dL. LDL (calculated) dropped from 141 to 90 mg/dL. Triglycerides dropped from 165 to 102 mg/dL. The endocrinologist agreed that I no longer needed Farxiga and indicated there really wasn’t a reason for me to see her again, but that I was free to set up another appointment if things changed.

My Best Path Forward

Since then, I’ve done more reading on the keto diet and feel that’s my best path forward to continue to maintain my health, both in terms of diabetes and beyond. I’ve improved enough that I no longer wear a CGM or perform finger sticks to check blood sugar on a regular basis, only checking maybe once a week “just to be sure.” Although I’ve tested out eating some of my old high-carb favorites and been impressed by how much less they spike my blood sugar now, I’m no longer interested in eating them on a regular basis, which is surprising to me. I’ve also found I can sleep through the night just fine without my CPAP machine due to the 35 pounds of weight I have lost from my peak of 215 lbs. The sleep apnea isn’t completely gone, so I still wear the mask most nights, but it appears to be dialed back from severe to mild.

It’s a very weird feeling: when I first found out I had diabetes I wanted nothing more than to continue eating the foods I loved and found comfort in. I felt like something had been stolen from me and feared that my body was permanently broken. Why should other people be able to eat what they want to, and I can’t? It felt very unfair and I really wanted there to be a drug or a treatment that would let me eat how I wanted to. Now that I’ve immersed myself in a better understanding of just how bad those foods were for me, I view things very differently.

I share my story not to lord my results over you if you’ve been less successful with your diabetes. I got really lucky, finding good dietary advice quickly after my diagnosis. Sadly, much of the official guidance out there seems sure to fail. I was also lucky with my uncontrolled diabetes “helping” with the first 25-30 pounds of weight loss.

I no longer have aches and pains when I get up out of bed or have to roll a certain way to avoid them, my memory has improved quite a bit and I’m no longer struggling to recall things I was just told, as I did with high blood sugar levels. I have so much more energy and stamina rather than feeling lethargic or struggling to complete physical activities. It’s like I’m in my 20s all over again (except for a little gray hair)! The downside is I now know if I go back to a lifestyle of enjoying carbohydrate-rich foods, things will go poorly for me, but as long as I don’t, I get to enjoy life so much more than I had before. And there are plenty of delicious foods that aren’t packed with carbs that I’m free to enjoy.

I think diabetes has been a net positive for me, as strange as that sounds. The me of today is very different than the me of a year ago.

Source: diabetesdaily.com

Heart Failure – The Overlooked Diabetes Complication, Part 1: What and Why?

This content originally appeared on diaTribe. Republished with permission.

By Ben Pallant

Learn what heart failure is, what it has to do with diabetes, and how to identify and talk about this complication that’s often less discussed.

Healthcare professionals often discuss diabetes complications such as vision loss (retinopathy), chronic kidney disease (nephropathy), and cardiovascular disease (referred to as atherosclerotic cardiovascular disease by healthcare professionals). However, there is a less talked about heart complication, heart failure. Heart failure refers to a condition where the heart’s ability to pump blood is less than normal, often meaning not enough blood is effectively circulating to the rest of the body.

This is part one of a two-part series on heart failure and diabetes.

What is heart failure?

First, it’s important to differentiate heart failure from other conditions such as cardiovascular disease, a heart attack, or cardiac arrest. There is also the broad term “heart disease,” which can encompass any heart issue. Because the names can get confusing, here are some brief explanations:

  • Cardiovascular disease, or atherosclerotic cardiovascular disease, is related to the process called atherosclerosis, which occurs when a substance called plaque builds up in your arteries making it difficult for blood to flow normally. The plaque buildup can be caused by high blood pressure, high cholesterol or triglycerides, smoking, or a number of other reasons. When it builds up in the arteries that supply blood to heart muscles or the brain, a heart attack or stroke can occur. Read our article on diabetes and heart disease here.
  • In a heart attack, the blood flow (and the oxygen supply, since blood carries oxygen throughout the body) to the heart muscle is blocked, causing damage to the heart muscle.
  • Heart failure happens when the heart isn’t able to pump enough blood to the rest of the body.
  • Cardiac arrest is the sudden loss of heart function. Usually due to an issue with the heart’s electrical system that disrupts a regular heartbeat, cardiac arrest causes the heart to stop pumping blood to the rest of the body.

There are a number of reasons why heart failure can occur, including coronary artery disease, high blood pressure, previous heart attacks, or other conditions and structural issues that damage the heart muscle (like cardiomyopathy or heart valve problems). Your chances of developing heart failure also increase as you get older. The heart’s inability to pump enough blood usually happens in one of two ways:

  1. When the heart muscle becomes stiff, the chambers in the heart cannot relax. This decreases the fill capacity of your heart chambers. Nevertheless, the heart is still able to release more than 50% of the blood in the heart chamber to the rest of the body. This type of heart failure is called “heart failure with preserved ejection fraction,” or HFpEF.
  2. When the heart muscle becomes weaker, not enough blood goes out to the body with each heartbeat. Thus, the percentage of blood that is released to the body is less than 50% of the amount in the heart chamber. This type of heart failure is called “heart failure with reduced ejection fraction,” or HFrEF.

Diabetes and prediabetes have been associated with both types of heart failure. Heart failure overall is a widespread health challenge – over 6 million Americans live with heart failure, and it leads to about 1 million hospitalizations per year in the US.

Heart failure is usually a chronic condition that progresses over time. At first, people may not experience any physical symptoms at all because the body has ways of trying to compensate – the heart may become bigger, it could develop more muscle mass, or it could try to pump faster. Over time though, heart failure worsens leading to shortness of breath, fatigue, inability to exercise, and more. Eventually the heart’s decreased ability to pump blood causes fluid to build up in other parts of the body, including the legs and lungs, which makes ordinary things like breathing and walking difficult. This is called congestive heart failure (CHF).

To learn more about heart failure, check out the American Heart Association’s heart failure resources.

What does heart failure have to do with diabetes?

Heart failure is unfortunately one of the most common and deadly complications of diabetes, especially for people with type 2 diabetes. They are two to four times more likely to develop heart failure than people without diabetes, and having diabetes increases a person’s risk for repeat hospitalizations for heart failure. This is partly because many of the key risk factors for heart failure are common in people with type 2 diabetes, such as a body mass index (BMI) over 25 (click here for a BMI calculator), high blood pressure, coronary artery disease, or a history of a heart attack. Other risk factors for heart failure include heart valve problems, sleep apnea, lung disease, and smoking.

But the shared risk factors alone don’t explain everything – diabetes itself is an independent risk factor for heart failure. According to several research studies, each percentage point increase in A1C is associated with an increased risk (8-36%) of heart failure. Researchers suspect that over time, high blood sugar levels either damage the cells of the heart muscles or force the heart to work harder due to damage to smaller blood vessels throughout the body and in the heart – this may be why high glucose levels are associated with heart failure.

Signs, symptoms, and screening

The Mayo Clinic and the American Heart Association have identified a number of possible symptoms of heart failure. These include:

  • Shortness of breath during activity or when you lie down
  • Tiredness and weakness
  • Swelling in your legs, ankles and feet, and very rapid weight gain (due to fluid retention)
  • Rapid or irregular heartbeat
  • Persistent coughing or wheezing (or coughing that produces pink, foamy mucus)
  • Chest pain if the heart failure is caused by a heart attack
  • Lack of appetite or nausea
  • Confusion or impaired thinking

It is especially important to seek immediate medical attention if you experience chest pain, severe fatigue or weakness, rapid or irregular heartbeats with shortness of breath or fainting, or sudden, severe shortness of breath especially if it is associated with coughing up pink, foamy mucus. For CHF especially, seeking timely medical attention is essential.

Talking to your healthcare team is key to making sure you are staying healthy, and it can help identify an early diagnosis. If you are experiencing any of the above symptoms, ask your healthcare professional if you can be tested for heart failure. Even if you aren’t exhibiting symptoms, start a conversation about what you can do to stay healthy and prevent future complications.

How do healthcare professionals test for heart failure?

Heart failure is most commonly assessed using medical imaging techniques that allow healthcare professionals to “see” the heart and assess its function. The most common test associated with heart failure is echocardiography (often called an “echo”) which is a non-invasive, painless ultrasound image of the heart. The echocardiogram can show how thick the heart muscle is and how much blood is pumped out of the left ventricle (one of the heart’s four chambers) with each beat. This information can be used to determine whether heart failure involves preserved or reduced ejection fraction.

Other imaging tests include an x-ray, an MRI, and a myocardial perfusion scan. An x-ray can see if the heart is enlarged or if there is fluid in the lungs, two signs of CHF. If your healthcare professional is concerned that there may be damage to the heart muscle or blockages of major blood vessels to the heart muscle, they may recommend an MRI. A myocardial perfusion scan uses a tiny amount of a radioactive substance that allows the heart to be imaged. It can show how well the heart muscle is pumping and areas with poor blood flow. This scan is often done with an exercise stress test (explained below).

In addition to these different imaging techniques, healthcare professionals use exercise stress tests (which measure how a person responds to increasingly difficult exercise) as a measure of heart function, blood tests to check for heart failure-associated strain on the kidney and liver, or an electrocardiogram (EKG or ECG) test to look at the heart’s electrical activity for signs of a heart attack and to see if the heart rhythm is abnormal.

Before any of these heart tests are ordered, your healthcare team will usually conduct a physical exam to determine what your symptoms are and what tests are needed. It’s important to be honest – your healthcare team needs to know about your lifestyle, including whether you smoke cigarettes, eat a lot of high-fat foods, and are physically active. Be prepared to answer other questions too:

  • When did symptoms begin?
  • How severe are the symptoms?
  • Does anything make the symptoms better or worse?
  • Do you have a family history of heart disease, diabetes, or high blood pressure?
  • Are you taking any medications, including over-the counter-drugs, vitamins, supplements, or prescriptions?

To learn more about heart failure, including prevention, medication options, and management tips, read “Heart Failure – The Overlooked Diabetes Complication, Part 2: Prevention and Management,” which our team will be updating this summer. You can also check out the Know Diabetes By Heart resources on heart failure.

This article was originally published on June 15, 2018. It was updated in May 2021 by Matthew Garza as part of a series to help people with diabetes learn how to support heart health, made possible in part by the American Heart Association and American Diabetes Association’s Know Diabetes by Heart initiative.

Source: diabetesdaily.com

Everything You Always Wanted to Know About Metformin, But Were Afraid to Ask

This content originally appeared on diaTribe. Republished with permission.

By Marcia Kadanoff and Timothy Hay

Starting on metformin? My journey as a type 2 of learning how to deal with side effects, “faux lows,” and learning more about this therapy. 

Editor’s note: this article is in Marcia’s perspective of living with type 2 diabetes, as written by Timothy Hay in January 2019. It was updated in March 2021.

When I was first diagnosed with type 2 diabetes at the age of 58, my doctor immediately put me on metformin, a medication I didn’t know much about.

I soon learned why metformin is considered the first line of defense for people with the condition, as it is safe, effective, and affordable. It’s not linked to weight gain and it puts very little stress on the internal organs. I also read that metformin has side effects for some people.

I expected it to work like insulin in pill form and drop my blood sugar (around 180 mg/dl at the time) right away. But metformin doesn’t work like that. Not at all.

I learned – as millions of people with type 2 diabetes have – that metformin doesn’t immediately lower your blood sugar. It can take four or five days to experience the full benefit, depending on your dosage.

It might not solve all your problems in the blink of an eye. But it is an effective medicine, and its interaction with the body is complex and interesting.

Want more information like this?

What We Know About Metformin

Metformin, which is also sold under the trade names Glucophage, Fortamet, Glumetza, and Riomet, is of the class of drugs called biguanides, which inhibit the production of glucose in the liver.

How does metformin work?

The medicine does not increase insulin levels in the body, but instead lessens the amount of sugar the body produces and absorbs. As it lowers glucose production in the liver, metformin also lowers blood sugar by increasing the body’s sensitivity to insulin. It also decreases the amount of glucose that our bodies absorb from the foods we eat.

What is metformin used for?

Metformin is commonly used to help people with type 2 diabetes manage their blood sugar levels. For most, metformin works to bring down blood sugar gradually when combined with a healthy diet and exercise (I found Adam Brown’s book, Bright Spots & Landmines: The Diabetes Guide I Wish Someone Had Handed Me to be helpful, particularly in deciding what to eat and not to eat). It’s not so much a quick fix with overnight results as it is an important component of a larger health regimen that keeps the condition manageable.

Is metformin safe?

Metformin is considered a safe, cheap, and effective medication worldwide, and is widely accessible in most countries.

What are the most common side effects of metformin?

Metformin does cause side effects in some people, but many of these are mild, and are associated with taking the medicine for the first time. Nausea and gastric distress such as stomach pain, gas, bloating, and diarrhea are somewhat common among people starting up on metformin.

For some people, taking large doses of metformin right away causes gastric distress, so it’s common for doctors to start small and build the dosage up over time. Many people start with a small metformin dose – 500 milligrams once a day – and build up over a few weeks until the dosage reaches least 1,500 milligrams daily. This means there’s less chance of getting an upset stomach from the medicine, but also means it may take a bit longer to experience the full benefit when getting started on metformin.

I experienced some mild side effects when I started taking metformin, and I found that the symptoms correlated with how many carbs I had in my diet. Once I dropped my carbs to 30-50 grams per day – something that took me weeks to do – any symptoms of gastric upset went away.

Asking your doctor for the extended-release version of metformin can keep these symptoms at bay, and so can tracking your diet.

What is the best time to take metformin?

Standard metformin is taken two or three times per day. Be sure to take it with meals to reduce the stomach and bowel side effects that can occur – most people take metformin with breakfast and dinner.

Extended-release metformin is taken once a day and should be taken at night, with dinner. This can help to treat high glucose levels overnight.

What are less common side effects of metformin?

The medication can cause more serious side effects, though these are rare. The most serious of these is lactic acidosis, a condition caused by buildup of lactic acid in the blood.  This can occur if too much metformin accumulates in the blood due to chronic or acute (e.g. dehydration) kidney problems. Severe acute heart failure, or severe liver problems can also result in a lactate imbalance.

Metformin can also increase the risk of hypoglycemia (low blood sugar), particularly for those who take insulin and drugs which increase insulin secretion (such as sulfonylureas), but also when combined with excessive alcohol intake. Even though I’m not on insulin, I started on continuous glucose monitoring (CGM) to be able to keep a closer eye on my blood sugar levels. Of course, regular checking with a blood glucose meter is also helpful in preventing low blood sugar episodes.

Because long-term use of metformin can block absorption of vitamin B12, causing anemia, sometimes people need to supplement vitamin B12 through their diet as well.

For most people who take metformin, side effects are mild and relatively short in duration.

Metformin

Image source: diaTribe

The “Faux Low”

There is another common side effect often experienced by people taking metformin for the first time. It’s something called a “faux low.”

A faux low happens when you drop your blood sugars to a “normal” range after running consistently high (i.e. above 180 mg/dl), whether by starting on a therapy like metformin or going on a low-carb diet, or both! Your body responds to this change as if it’s in real hypoglycemia (below 70 mg/dl).

Although every person with diabetes has a different blood-sugar threshold and different symptoms, people often feel irritable, tired, shaky, and dizzy when their blood sugar is 70 mg/dl or lower. When I experienced faux lows, I felt similarly dizzy, lightheaded, nauseous, and extremely hungry.

Tool

Image source: diaTribe

If you experience symptoms like these and have confirmed with a glucose meter the low you are feeling is indeed false (i.e. your meter says you’re at 96 mg/dl), keep taking your metformin as directed. Don’t start carb-loading (eating carb-rich foods like orange juice to bring sugars back up).

If I’m indeed having a faux low and not a real one, I found that drinking water and taking a high-sodium, non-carbohydrate snack (nuts are great for this, especially macadamia nuts which are high in fat) nips the symptoms in the bud, allowing me to move on with my life.

Note that especially for type 2 folks out there on metformin and insulin or sulfonylureas, hypoglycemia is a real risk. If you’re feeling low, check your blood sugar – there will be times when you do need to treat hypoglycemia with glucose tablets or orange juice or the like.

Metformin interactions: what should I avoid while taking metformin?

When taken at the same time, some drugs may interfere with metformin. Make sure your healthcare team is aware of any medications that you take before you start on metformin, especially certain types of diuretics and antibiotics. Remember, insulin and insulin releasing medications can increase your risk of hypoglycemia, so it is particularly important to carefully monitor your glucose levels.

You should also avoid drinking excessive amounts of alcohol while taking metformin – aim for no more than one glass per day for women, and two per day for men. Alcohol can contribute to lactic acidosis.

Does metformin cause cancer?

In 2019 the FDA investigated whether some forms of metformin contain high levels of a carcinogenic (cancer-causing) chemical called N-nitrosodimethylamine (NDMA). In 2020, the FDA recommended the recall of several versions of extended-release metformin, and more than a dozen companies have since voluntarily recalled certain lots of the medication. While low levels of NDMA are commonly found in foods and drinking water, high levels of the substance are toxic and can cause cancer.

You can check to see if your metformin has been recalled here. For people taking extended-release metformin, the FDA recommends that you continue to take your medication until you talk to your healthcare professional.

Other Possible Metformin Benefits

Most people with type 2 diabetes tolerate metformin well and are glad it’s available in generic form, which keeps the price low. The medication is so effective as a first-line therapy the American Diabetes Association includes it in its diabetes Standards of Care.

But metformin could have additional uses and benefits outside of treating type 2 diabetes.

Researchers are currently studying whether the medicine can help in the fight against cancer, neurodegenerative conditions, vision problems like macular degeneration, and even aging. It will be a while, however, before uses other than blood-glucose lowering are proven to be effective.

At the same time, metformin is also used in the treatment of gestational diabetes and polycystic ovary syndrome.

The American Diabetes Association has said more doctors should be prescribing metformin to treat prediabetes (a state of higher-than-normal blood glucose levels that doesn’t meet the diagnostic criteria for diabetes), especially for people under the age of 60, although the FDA has yet to bless metformin’s use for the condition.

Can metformin cause weight loss?

The FDA has also not officially approved metformin as an aid in losing weight. Many people with type 2 diabetes have lost weight after taking the drug, as researchers are still torn over exactly how metformin affects the weight. Some believe it decreases appetite, while others say it affects the way the body stores and uses fat.

Scientists are also examining metformin’s potential to protect against heart disease in people with type 2 diabetes – some older data supports this. While robust heart outcome trials with metformin are yet to be conducted, more attention is being paid to this research area.

Metformin and type 1 diabetes

It will be an exciting development if metformin is helpful in the treatment of cancer or neurodegenerative conditions like Huntington’s. But what if it is found to help people managing type 1 diabetes?

Metformin is not currently approved by US or European regulatory agencies for use in type 1s, but people have been known to take the medication anyway, and many doctors prescribe it if someone with type 1 diabetes is overweight. There are actually several reasons metformin is an attractive option for many type 1s. One, metformin has been found to help reduce glucose production in the liver, which is a problem in type 1 diabetes. Two, people often form resistance to the insulin they take, and metformin can help improve insulin sensitivity.

And, metformin may support weight loss and protection against heart disease. A study published in the Lancet following type 1 participants for three years found that compared to placebo, participants taking metformin lost weight. Particularly because insulin often causes weight gain, healthcare providers prescribe metformin “off-label” (not for intended use approved by regulatory agencies) to their type 1 patients. While the study didn’t find that metformin definitively protects against heart disease, based on observed trends in the data, the authors concluded that it may have a role in heart disease risk management.

The Bottom Line?

Metformin

Image source: diaTribe

If you are a person with type 2 diabetes, there are plenty of benefits to taking metformin for its original, intended purpose.

Its side effects are minimal for most people. It’s affordable and covered by Medicare and most insurance plans. Speaking for myself: metformin doesn’t have to cure aging or cancer to be immensely valuable. It helps me process insulin and go on with my life. For me, that’s enough.

About Marcia Kadanoff

Marcia Kadanoff is an advisor to The diaTribe Foundation. She was diagnosed with type 2 diabetes in June 2017 at the age of 50-something, and both her parents and grandparents died of diabetes-related complications. With the help of diaTribe and Adam Brown’s book, Bright Spot & Landmines, Marcia discovered that type 2 diabetes can be put into remission with lifestyle changes. Over the next 7 months, Marcia worked to reverse her diabetes through a LCHF (low-carb, healthy fat) way of eating and regular exercise. Along the way, she lost 45 lbs (!) and found that she no longer suffered from sleep apnea and fibromyalgia. Marcia has maintained her weight loss for a year and had a 4.9% A1C at her last checkup. She wants other people with type 2 to know that they too can put their diabetes into remission.

Source: diabetesdaily.com

Review: Wellue 02Ring-Ring Oxygen Meter

It’s the year 2020 and unfortunately, due to the COVID-19 pandemic, many people are rethinking how to monitor and manage both their family’s and their own health. With so many doctors moving to telehealth, many are purchasing important health products so they can better assess and monitor their health conditions from their own homes.

The COVID-19 virus is leaving many patients with dangerously low levels of oxygen even when they are feeling well. An oximeter was one of the most coveted devices that people were searching for when COVID-19 began per many healthcare workers’ suggestion.  The Wellue O2Ring is a ring oxygen meter that tracks you and your loved one’s oxygen levels so that you can pick up this warning sign and get medical attention before the patient’s condition worsens.

Who Are They?

Wellue is a brand belonging to Viatom Technology that creates medical and wellness products that are consumer-friendly and help people to better detect and manage their health conditions. Wellue has many other medical devices available with medical-grade accuracy.

What Is It?

Wellue O2Ring is a patented smart device that allows the patient to monitor their oxygen levels and heart rate for long periods of time and is designed to be comfortably worn overnight. The many features allow the patient to be notified of low oxygen and heart rate levels, collect data and send reports to their healthcare team. It also comes with a companion app that shows both data analysis and trends allowing the patient to feel empowered with information about their health.

Photo credit: Wellue

Some of the key features of the O2Ring are:

  • Overnight tracking: The device continuously tracks your oxygen level and heart rate.
  • Adjustable vibration and intensity alarm alerting you of low oxygen or abnormal heart rate.
  • Free PC software and Mac app which allows you to print and share all data with your healthcare provider.
  • The O2Ring is rechargeable and lasts 12-16 hours with stand-alone memory, meaning a smartphone is not even needed.

Where Can I Purchase and How Much Does It Cost?

Wellue sells its products on its website and it is also available at Walmart and Amazon. I found the lowest price to be on their website which was $170. Wellue is currently offering Diabetes Daily readers a 10% discount. You can purchase on their site using this discount code: BLDIABETES10.

Photo credit: Wellue

My Review

At a time where many are neglecting routine visits, settling for virtual care, and wondering what the future of healthcare looks like, this is the perfect time to invest in your health. Having medical products at home can help you stay ahead of your health conditions. Wellue also makes many other medical devices such as pediatric oxygen masks, blood pressure monitors with oximeters, forehead and ear infrared thermometers, and Babytone Fetal Heart Monitors, to name a few. All these products can help give you peace of mind about you and your family’s health.

Whether you struggle with chronic obstructed pulmonary disease (COPD), sleep apnea, asthma, pneumonia, or any other health conditions affecting your oxygen levels and heart rate, I highly recommend the O2Ring oxygen meter. It is comfortable to wear and it alerts the patient without disrupting their partner’s sleep, lessening the burden on our loved ones, which many of us stress over.

Being proactive with my health makes me feel empowered to manage my type 1 diabetes and my overall wellbeing to the best of my ability. Having technology like this at your fingertips (in this case, literally) can make taking care of your health a lot easier and add years on to your life. Wellue uses the same type of technology that hospitals do, which makes me feel extra confident that their products are of the utmost quality and accuracy. In summary, I highly recommend their products.

Source: diabetesdaily.com

The Rise of Childhood Obesity in the United States

September is National Childhood Obesity Month in the United States, according to the Centers for Disease Control and Prevention. Currently, about 1 in 5 American children (19%) is obese, and the numbers are startlingly and steadily rising. Bringing awareness to this health crisis can help educate parents and caregivers about warning signs for childhood obesity, and how to prevent it for their children and loved ones.

Childhood Obesity is a Major Public Health Concern

It’s important to know that childhood obesity is not about vanity or looks. Childhood obesity is a serious public health issue that has serious and devastating consequences for children and families. Children who are obese have a body mass index (BMI) at or above the 95% percentile (a pediatrician can perform this measurement for you). Children experiencing obesity are at higher risk for other chronic health conditions, including asthma, sleep apnea, hypertension, type 2 diabetes, cardiovascular disease, and even many types of cancers. Additionally, children who are obese are more likely to be bullied in school, and can face mental health issues such as depression, anxiety, and suicidal ideation as they age.

Causes of Childhood Obesity

Childhood obesity can have many causes, most of which are behavioral in nature, although metabolism and genetics do play a strong role. Lack of physical activity and unhealthy eating patterns are some of the highest risk factors for developing obesity, as is a lack of sleep, and simply not having access to a safe place to exercise or the ability to buy healthy foods (living in a food desert, for example). Many social determinants of health play a role here. Children of lower socioeconomic status are at higher risk of developing obesity than children of higher socioeconomic status, who may have better access to parks and recreation and healthy foods.

Preventing Childhood Obesity at Home

There is a lot that family and friends can do to help to prevent obesity from affecting a child’s life.

  • Tracking a child’s weight and Body Mass Index (BMI) regularly can keep a child on track; if you see rapid weight gain, you can catch it more quickly and reach out to your doctor for a check-up.
  • Focusing meals on fresh fruits and vegetables, and eating foods in their most natural state prevents eating additional additives, preservatives and chemicals that won’t fill a child up, but are loaded with empty calories.
  • Make sure your child is active every day. Aim for 60 minutes of physical activity. This need not be a formal activity, like a soccer game. Walking the dog, helping to clean the house, and even walking around the shopping mall are all great forms of physical activity that gets a child moving and don’t cost any money.
  • Limit screen time. In 2019, the World Health Organization released new guidelines for the recommended amount of screen time by age, for children.
  • Make sure children are drinking water and not soda. About 40% of the calories consumed by 2-18 year olds comes in the form of these empty calories. Swapping soda out for water will save a ton of calories and will ensure that your child is filling up on wholesome, nutrient-dense calories instead.
  • Make sure your child has a healthy HbA1c. Keeping tight control on blood sugars and HbA1c can prevent overtreating lows and overeating, both of which can contribute to weight gain.
  • Eat healthy meals as a family. Children do what you model, not necessarily what you tell them to do. If you act as a role model with healthy meals, they will naturally follow.
  • Make sure your child is getting adequate sleep. When sleep patterns and circadian rhythms are off, children’s hormone levels become out of range, and they are more likely to overeat and not be physically active. They may also fall behind in school and suffer low self-confidence, resulting in overeating as a coping mechanism. Make sure your child is getting good sleep every night of the week.

Community and Societal Support

Preventing obesity may start at home, but it takes a village to raise a healthy child. Communities should provide safe and healthy playgrounds and parks accessible to all children, and local schools should provide free, clean, and safe drinking water and lunchroom cafeterias should provide balanced, healthy meals. Schools should also encourage physical activity, and provide robust physical education classes and electives for children and teens.

Additionally, your child’s health care provider should be conducting regular physical and mental health checks, to make sure your child is on track to enter adolescence and adulthood in a healthy mindset and at a healthy weight, especially if they are living with diabetes, which can make them more prone to disordered eating.

Together, with cooperation from parents, caregivers, schools, communities and engaged pediatricians and care teams, we can work to prevent childhood obesity and set the stage for healthy children and the future (healthy) adults we hope they will become.

Source: diabetesdaily.com

Unusual Type 2 Diabetes Symptoms Not to Ignore

Approximately 463 million people globally are living with type 2 diabetes and by 2045, this is supposed to rise to 700 million. Type 2 diabetes is largely caused by insulin resistance (IR) while the cause of IR can range from any number of genetic deficiencies to environmental causes. It’s important to look at both of these factors when considering a type 2 diagnosis.

Symptoms may be similar to those of type 1 diabetes but are often less pronounced since the condition progresses gradually over time. A startling statistic is that 1 out of 2 people will be misdiagnosed, leaving them susceptible to years of elevated blood sugars and the risk of complications that come along with the disease before being properly diagnosed and treated.

It is more important than ever to know the signs of type 2 diabetes so that a person can properly educate themselves in order to make better choices to improve their blood sugars and overall health. Routine blood tests at your yearly physical should help determine if you are experiencing issues that need medical attention.

Many of us are aware of the common symptoms associated with type 2 diabetes. But since it may take years before a correct diagnosis, many say they were unable to detect the slow changes to their health. It is important to pay attention to these signs especially if you are at an increased risk for type 2 diabetes.

Common Symptoms of Type 2 Diabetes

Some common symptoms to look out for are:

  • Increased thirst and frequent urination. As sugar build-ups up in your blood, it forces your body to try to flush it out through increased urination.
  • Increased hunger. Because your body is not absorbing sugar properly, it thinks it needs more creating you to become hungrier than normal.
  • Weight loss. As your body can’t utilize sugar, it turns to muscle and fat for fuel, which can result in significant weight loss.
  • Fatigue. Your body loses access to sugar which has been your main source of energy, therefore, leaving you feeling exhausted.
  • Blurred vision. High blood sugars can cause swelling of your lens and damage blood vessels which can create vision issues.
  • Slow to heal sores. High blood sugar can make your immune system not function as well as normally, causes wounds to heal more slowly.
blurred vision diabetes sign

Blurred vision is a classic symptom of type 2 diabetes. Photo credit: Adobe Stock

Unusual Symptoms of Type 2 Diabetes

While many will have classic symptoms leading up to a type 2 diagnosis, some people have rare and unusual symptoms that occur. Here are some of the less common symptoms to look out for, as being vigilant can help add years to your life.

  • Dark patches of skin. This condition is known as acanthosis nigricans (AN) and seems to occur mostly around the neck area or other areas where there are creases of skin such as the armpit or groin area. It is more common for people with darker skin and is a result of skin cells reproducing too quickly because of the excess of insulin in the blood.
  • Yeast infections and jock itch. High levels of sugar in your blood can cause an overgrowth of yeast in the genital area, resulting in a fungal infection. Other fungal infections such as bladder infections and skin infections can also be indicators of diabetes.
  • Itchy, bumpy, discolored skin. Eruptive xanthomatosis is a condition that can occur in people with poorly-managed blood sugars who have very high triglycerides and high cholesterol. It creates itchy, yellowish-colored bumps on the backs of the appendages and buttocks when blood sugars are elevated for a long period of time.
  • Sexual dysfunction. This is seen mostly among men with type 2 diabetes who frequently have high blood sugars. Elevated blood sugar levels can lead to nerve and blood vessel damage making it harder to achieve an erection. Women can also experience sexual issues related to high blood sugars, including arousal problems and less lubrication.
  • Lightheadedness. We often assume that when we feel this way it must be because we are hungry or fatigued but this can also be a result of diabetes. Dizziness will often be a sign of low blood sugar, but long bouts of high blood sugar will lead to dehydration, affecting sodium and electrolyte levels, resulting in cognitive changes.
  • Lack of sleep. There are quite a  few reasons a looming type 2 diagnosis could cause you issues when it comes to getting sleep. If you have undetected high blood sugars, you are likely to get up a few times to urinate disrupting your rest. Additionally, being obese isn’t only a risk factor for diabetes, it increases your risk of sleep apnea as well. If you notice your sleep patterns are changing, it is important to talk to your doctor.

It isn’t always easy or possible to be attuned to all the changes in your health but being aware of the symptoms, both common and uncommon, can help you to detect any issues if they arise. The good news is that once a proper diagnosis is given, you can take control of your health and normalize your blood sugars which will make many of these symptoms disappear. Acting fast is key to ensuring no long term complications.

If you were diagnosed with type 2 diabetes, what symptoms did you have? And if you haven’t been diagnosed, but have reason to think you may, what symptoms are you experiencing? Share and comment below!

Source: diabetesdaily.com

I Thrive: Being the Architect of Your Future

While Basil’s story might not be about epic adventures of climbing mountains or sailing around the world, his story is real and unapologetically his. He’s a husband, father, uncle, son, and entrepreneur. His story deeply resonates. During the years when his body was in a pre-diabetic state, he actually wasn’t aware it existed and ultimately […]
Source: diabetesdaily.com

Search

+