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Re: [IPk] Definition of a hypo and Metformin

 I have been on Metformin for a few years as a treatment for Polycystic ovaries
and completely irregular periods. I was only ever regular on the pill, so when I
came off it to get pregnant and put on weight and had irregular periods again
and couldn't get pregnant, I was put on Metformin. I don't know if the Metformin
made me more fertile as I have a 6 year gap between children - so probably not.
When I was told I probably shouldn't go back on the pill after child number 2, I
went back on Metformin to avoid the complete randomness of my hormones. In my
forties now I am annoyingly regular every 23-28 days as opposed to every 8-26
weeks. I am sure this has helped my diabetes control as I now can see the
patterns my hormones cause. And I suppose Metformin does make me more insulin
sensitive too.
 It's probably not at all relevant to this trial, but I thought you might like
to know the other reasons people take it.
 Did your wife experience a slightly upset stomach at the beginning? As that is
a side effect of Metformin that you quickly get used to.

Sent from Helene's iPad

 > On 6 Dec 2013, at 07:41, "Belinda Washington" <email @ redacted>
> Good Morning Gareth,
 > If she wakes up hypo, because her alarm clock goes off & it's time for her
> to start there 2 big problems. I know you know them, but when you are working
> with clueless clinicians, it helps to break them down:
> 1) she must have become hypo whilst asleep.
> 2) the hypo did not wake her, which suggests nocturnal hypo-unawareness.
> That combination is, without scaring you, dangerous.
> Have you got "Think Like a Pancreas"? It gives you tips for basal reduction.
> By the way, blood sugars varying widely because of hypos & treatment, is
 > reported to be associated with less than ideal HbA1Cs. I have read the
> but I am not really awake enough to find them again yet.'m
>> On 6 Dec 2013, at 06:51, Gareth <email @ redacted> wrote:
>> Thank you Belinda, Rhoda & Jackie for your input.
>> My initial query was made partly out of curiosity as to what the consensus
>> might be amongst listers as to what level of hypos we tolerate in practice,
>> whatever 'the rules' say
>> The Wikipedia article is quite useful for an overview
>> http://en.wikipedia.org/wiki/Hypoglycemia
>> In my wife's case, a study of the various care link reports indicates to me
 >> that whether on "live" metformin or not there has been a sea change in her
 >> levels in general - a downward shift of the 'plateau' if you will.
>> that insulin is more effective, probably because of the metformin which she
> may
>> or may not be taking..........
>> There is no single pattern of low Bgs although the first one in the morning
> is
>> a regular.
>> We today intend decreasing all basal rates by a common percentage which
> equates
>> with lifting that plateau up in stages to the point where average lows are
>> around 4.
>> That will inevitably increase her HbA1c, it will be interesting to see where
>> that ends up.
>> It's still rather early here in the Uk so will leave the actual calculation
>> until fully awake!
>> For the sake of saying it, we report key data monthly to our Remove trial
>> contact person, plus less frequent actual review meetings .
>> Speaking generally, we don't feel that we are 'on our own' in any sense
 >> although we do seem to know more about pumping than some of the
> we
>> deal with across the whole piece. Which isn't saying very much !
>> Gareth
>> On 5 Dec 2013, at 23:15, "Jackie Jacombs" <email @ redacted> wrote:
 >> While it's great to take part in trails I do have concerns that your wife
>> not have been informed if she is on a medication which can affect the blood
>> glucose levels. Well of course she would have know she was or might not be
> but
>> I would have thought that she would have someone on the trials who can give
>> advice. Also another thing to remember that if the BG levels are running
> lower
>> for longer periods that there will be greater insulin sensitivity and
> therefore
>> with really good tight control your wife may need to review both bolus and
>> basal
>> ratios.
>> Jackie
>> -----Original Message-----
>> From: email @ redacted [mailto:email @ redacted] On Behalf
> Of
>> Gareth Hicks
>> Sent: 05 December 2013 22:05
>> To: email @ redacted
>> Subject: [IPk] Definition of a hypo
>> My wife Jean is the T1 in our house, it's now been 48 yrs - and a pumper for
>> last 5yrs.
 >> She's now almost a year into a 3 yr trial (Removal) which I understand is to
>> assess how metformin might be used in T1 treatment (as against T2) to
> mitigate
>> diabetic complications (and make insulin more effective?).
>> It's a blind trial so we don't know for sure whether she's on metformin or
> not,
>> but have a suspicion that she is.
>> That's because we've seen many more 'technical hypos' since she started on
> it,
>> sometimes daily.
>> These are virtually ALL between 2 and 3, her hypo setting is 3.3 I said
>> 'technical' because she has no really obvious symptoms these days, not above
> 2
>> anyway.
 >> Aside from the administration of the trial itself, Jean's diabetic
>> and GP are now concerned about hypo frequency and are suggesting some more
>> fasting tests.
>> Whilst this is OK in theory, our experience is that we can fiddle about with
>> basal settings to out heart's delight but historically have eventually ended
> up
>> roughly where we started.
>> That's an over simplification, and we did make some 'trial and error' basal
>> adjustments shortly after the Removal trial started,  but you get my point.
>> I'm not saying we resist fasting per se, just wondering whether the hypo
>> related
>> criteria for doing so is 100% relevant to her.
>> We are in fact already more actively using temporary basal reductions when
> BGs
>> are edging downwards, especially last thing at night.
>> And using longer acting carbs when sorting out a hypo, something we haven't
>> been
>> too good at admittedly.
>> Her latest HbA1c is 6.3 compared with 7.5 - 8 in pre pump days.
>> Considering Jean's age, the advice we have received from our consultant in
> the
>> past, and listened to,  is not to consider a  much lower HbA1c than say
>> 7 as
>> a target in any sense.
>> Implying that avoiding hypos is now more relevant for her.
>> We have, about 6 months ago, adjusted the bolus settings and the insulin
>> sensitivity factor  and I am (fairly) happy they are Ok where they are.
 >> I have no idea now where the 'under 3.3 qualifying line' for hypos came
>> perhaps set by the DSN when Jean first had a pump.
 >> My question, do other pumpers use a different definition of a hypo, and if
>> does anyone know how these are worked out?
>> Or is a standardised  definition being used?
>> My growing and uninformed, concern, despite there being no obvious symptoms,
> is
 >> that frequent hypos (as currently defined) are causing longer term
>> harm, unnecessarily.
>> Gareth Hicks 
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