Since the launch of Symlin in 2005, it's not uncommon for people to treat their type 1 diabetes with a supplemental injectable medication. But hang around long enough, and you too might get to know someone with type 1 who takes insulin and oral meds, those formerly known as "type 2 only" drugs.
Really? Type 1's taking oral meds alongside insulin? To clarify this, I just had to query some experts.
Just like in type 2 diabetes, people with type 1 diabetes can sometimes suffer from insulin resistance (when the insulin that's present can't perform it's work properly), and Metformin can lower your insulin requirements by helping the body make better use of the stuff — in this case coming from an injection or insulin pump.
Gary Scheiner, CDE, author, and head of Integrated Diabetes Services in Wynnewood, PA, explained it this way: "Some of the more creative and aggressive endos are prescribing Metformin for type 1's, particularly if they are overweight or requiring very large basal insulin doses. In addition to having some mild appetite-suppression effects, it will enhance insulin sensitivity by hepatic cells (in the liver) and limit the amount of glucose secreted by the liver. Personally, I think it can be helpful during adolescence as well. As long as the patient has good liver and kidney function, the side effects and risks are negligible."
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I also learned this: a couple of other uses of Metformin for women to consider are PCOS (ovary disease) and pregnancy.
Kelley Champ Crumpler, RN, who is a diabetes nurse educator and a type 1 diabetic married to an endocrinologist with type 1 diabetes (how's that for keeping it in the family?), explained that, although PCOS is a cousin of type 2 diabetes, it can occur in women with type 1 diabetes.
She explains the science behind it: "High levels of insulin antagonize the production of hormones in the pituitary gland, which then signal for the ovaries to release higher amounts of testosterone. This extra testosterone then causes developing ovarian follicles to clump together and become sticky, which results in a cystic appearance. This can prevent ovulation from occurring, and also cause irregular menstrual cycles. In fact, PCOS is the No. 1 cause of infertility in American women. One in four of us has it."
Using Metformin to treat PCOS helps decrease insulin levels. Who knew?!
In pregnancy, insulin resistance increases a ton during the second and third trimesters. As the pregnant diabetic increases insulin intake to keep blood sugar as close to normal as possible, the risk for preeclampsia and pregnancy induced hypertension also increase. Both are very dangerous for the mother and the baby.
"We began prescribing Metformin to these women, and suddenly, their insulin needs were going down. We have, at this time, had 20 successful deliveries of healthy infants to mother's of type 1 diabetics who used Metformin during the pregnancy," Kelley says.
And guess what else? Kelley is currently pregnant herself! She shares her experiences: "I, personally, have taken brand-name extended-release Metformin for two years. I also suffer from PCOS. It has allowed me to use less insulin during my current pregnancy, and I plan on continuing the use of Metformin throughout the remainder of the pregnancy, and into the postpartum state."
Sam (a patient who refrained from sharing his last name) is a 30-year-old with type 1 diabetes. He also used Metformin to lower his insulin requirements. His doctor recommended it to him after Sam explained that he wanted to lose weight.
"My doctor suggested that Metformin could help both with reducing the amount of insulin I need (and therefore helping me to stop gaining fat), as well as reducing my appetite," Sam explains.
Starting out was bumpy, with nausea and vomiting occurring a few times in the first two weeks, but Sam says he pushed through and the side effects went away. Although Sam isn't using Metformin anymore, he was able to lose 42 pounds and reduce his insulin dosage by nearly half, which he says helped with the weight loss. (After the weight loss, Sam naturally doesn't require as much insulin as before and has thus taken himself off the Metformin.)
Hmm, help with weight loss is always good, but those side effects don't sound pleasant. Both Gary and Kelley say the instance of side effects is relatively low, yet Kelley adds: "Most often, we hear complaints of gastrointestinal side effects, most often diarrhea, cramping, nausea and flatulence. For many, this will go away with continued use, for others, they are just unable to tolerate the drug."
So what if you don't suffer from insulin resistance or PCOS? Is it still worth considering Metformin?
"We've seen about a 50/50 split, as to some receiving the benefit of decreased insulin use, and sometimes resulting weight loss — which then makes you question if there wasn't SOME degree of insulin resistance to begin with — and others who receive no benefit at all," Kelley says.
In short, this is completely new territory for me, because I've always considered oral diabetes drugs completely off the map for type 1s. So... do you or someone you know use Metformin to treat type 1 diabetes? What have your experiences been? Would you could considering going on Metformin if your doctor suggested it?
(Editor's note: Kelley and her husband are located near College Station, TX. If you're in the area, you can contact their office by email.)