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Ask Dr. Gott 8/13
Curious about high dose of metformin
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    DEAR DR. GOTT: I am a 74-year-old diabetic female and take 1,000 mg of metformin twice a day. My morning blood sugars are around 160, and they drop to the 129-140 range at night. A snack of graham crackers and peanut butter doesn't help. I've started 1,000 mg of cinnamon daily, but haven't noticed any change yet.
    My feet are now showing some nerve damage. Any help would be appreciated.
    DEAR READER: Metformin is an oral medication prescribed for people with type 2 (non-insulin dependent) diabetes. The normal dosing for oral medication is 500 mg taken twice daily, while the extended release form is taken once daily in a 500 mg tablet. Therefore, I am rather surprised you are on 2,000 mg daily. This appears to be a hefty dose with less-than-perfect results. Normal blood sugars run in the 70-150 range, with lower readings in the morning and higher readings in the evening and after meals. To have a morning reading of 160 on this elevated dose is somewhat disturbing.
    The nerve damage in your feet sounds like peripheral neuropathy to me, a condition that causes pain and numbness of the extremities. It can result from infection or traumatic injuries and is seen commonly in poorly controlled diabetics. Symptoms often improve over time once the underlying condition is treated.
    Lactic acidosis has been reported in some people on metformin. The condition presents as muscle or abdominal pain, lightheadedness, shortness of breath, weakness, sleepiness and a slowed heart rate. Individuals should avoid alcohol while taking this drug, as it lowers blood sugar readings and can increase the risk of lactic acidosis. As with so many other drugs, several medications can interact with metformin, so advise your physician of anything else you might be taking, including herbal supplements and over-the-counter medications. He or she will then be able to determine if the drug is right for you.
    In response to your cinnamon regimen: This product has been used for many conditions, including stomach disorders, nausea, vomiting, diarrhea, gas and bloating. Most recently, scientists have discovered as little as half-teaspoon daily added to the diet may reduce blood glucose levels. Cinnamon can be added to your toast or sprinkled over cereal, or a stick can be swirled into coffee or tea. Having reported this, I should add that this therapy does not work for everyone. In fact, I often feel that if an individual concentrates on adding a supplement for a specific purpose, he or she rapidly becomes aware of everything consumed. This is likely to lead to better dietary choices that result in better readings.
    Review your concerns with your primary care physician. He or she might choose to switch you to another drug in the same class, but in a lower dosage that will provide better results. You might also consider asking for a referral to an endocrinologist who specializes in diabetes. Such a physician will be armed with the newest drugs and research results available. Perhaps one such drug will be right for you.
    To give you related information, I am sending you a copy of my Health Report "Diabetes Mellitus."
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