Diabetes Talking

Question:

Thanks for more info. My daughter got her NPH switched to Lente last weekend. The result was I have had to reduce her night dose & battle with night lows for the first 3 nights and a couple of day time lows as well.   The unpredictable high bg spikes started again Wed afternoon. Her Endo’s office called & her pump start appointments have been moved up by 5 weeks so she will be pumping in just over 2 weeks and then we’ll see if that works. Heather http://www.execulink.com/~craig/diabetictag.html http://www.execulink.com/~craig/creations.html

– Hide quoted text — Show quoted text – I’ve done a moderate amount of looking into the above topic, since my Type 1 college age daughter was able to reduce her insulin first from 36 total units per day to about 26 (after three months using inositol) and then further making some other diet type changes to about 20 units per day.  It is really easy for a Type 1 to get on the insulin resistance merry go round– I call it a merry go round rather than a path because insulin resistance tends to beget more insulin resistance.  Anyway, PubMed is full of abstracts on the use of Metformin in Type 1 diabetes, as well as insulin resistance in Type 1 diabetes.  And using more insulin to cover this problem helps only half of the cause of insulin resistance– the high blood sugar half.  It actually mediates another cause–hyperinsulinemia.  It is pretty easy to see why these things are progressive.  Here is the latest abstract, suggesting that Metformin has beneficial effects in  certain Type 1 diabetes, for adolescents. (I will say this– anyone taking more than 1 unit of insulin per kg of weight has a serious problem with insulin resistance.  My daughter was at about .67 units of insulin per kg of weight and had a problem.  There are various ways to figure out if there is a problem with this– triglyceride level, waist hip ratio, cholesterol profile, etc.) Diabetes Care 2003 Jan;26(1):138-43 Metformin as an Adjunct Therapy in Adolescents With Type 1 Diabetes and Insulin Resistance: A randomized controlled trial. Hamilton J, Cummings E, Zdravkovic V, Finegood D, Daneman D. Division of Endocrinology, Hospital for Sick Children, Toronto, Ontario. Department of Pediatrics, Izaak Walton Killam Health Centre, Halifax, Nova Scotia, Canada. School of Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada. OBJECTIVE-To evaluate whether, in adolescents with type 1 diabetes, the addition of metformin to insulin and standard diabetes management results in 1) higher insulin sensitivity and 2) lower HbA(1c), fasting glucose, insulin dosage (units per kilogram per day) and BMI. RESEARCH DESIGN AND METHODS-This was a randomized, placebo-controlled 3-month trial of metformin therapy in 27 adolescents with type 1 diabetes, high insulin dosage (1 unit. kg(-)(1). day(-)(1)), and HbA(1c) 8%, with measurements of insulin sensitivity (by frequently sampled intravenous glucose tolerance test [FSIGT]), HbA(1c), insulin dosage, and BMI at the onset and end of treatment. RESULTS-At t = 0, HbA(1c) was 9.2 +/- 0.9%, insulin dosage was 1.2 +/- 0.2 units. kg(-)(1). day(-)(1), fasting glucose was 10.6 +/- 2.4 mmol/l, and BMI was 24.2 +/- 3.9 kg/m(2) (means +/- SD), with no difference between the metformin and placebo groups. At the end of the study, HbA(1c) was 0.6% lower in the metformin group than in the placebo group (P < 0.05). This was achieved at lower daily insulin dosages (metformin group -0.14 +/- 0.1 vs. placebo group 0.02 +/- 0.2 units. kg(-)(1). day(-)(1); P < 0.05), with no significant change in BMI. Fasting glucose levels improved significantly in the metformin group (P < 0.05). Change in insulin sensitivity, measured by FSIGT, was not significantly different between the two groups at study end. Mild hypoglycemia occurred more frequently in the metformin-treated than in the placebo subjects (1.75 +/- 0.8 vs. 0.9 +/- 0.4 events. patient(-)(1). week(-)(1); P = 0.03). There were no differences in frequency of severe hypoglycemic episodes or gastrointestinal complaints between the two groups. CONCLUSIONS-Metformin treatment lowered HbA(1c) and decreased insulin dosage with no weight gain in teens with type 1 diabetes in poor metabolic control. Changes in insulin sensitivity were not documented in this study using the FSIGT. Long-term studies will determine whether these improvements are sustained and whether certain subgroups accrue greater benefit from this therapy. PMID: 12502670 BL

Response:

I’ve done a moderate amount of looking into the above topic, since my Type 1 college age daughter was able to reduce her insulin first from 36 total units per day to about 26 (after three months using inositol) and then further making some other diet type changes to about 20 units per day.  It is really easy for a Type 1 to get on the insulin resistance merry go round– I call it a merry go round rather than a path because insulin resistance tends to beget more insulin resistance.  Anyway, PubMed is full of abstracts on the use of Metformin in Type 1 diabetes, as well as insulin resistance in Type 1 diabetes.  And using more insulin to cover this problem helps only half of the cause of insulin resistance– the high blood sugar half.  It actually mediates another cause–hyperinsulinemia.  It is pretty easy to see why these things are progressive.  Here is the latest abstract, suggesting that Metformin has beneficial effects in  certain Type 1 diabetes, for adolescents.   (I will say this– anyone taking more than 1 unit of insulin per kg of weight has a serious problem with insulin resistance.  My daughter was at about .67 units of insulin per kg of weight and had a problem.  There are various ways to figure out if there is a problem with this– triglyceride level, waist hip ratio, cholesterol profile, etc.) Diabetes Care 2003 Jan;26(1):138-43 Metformin as an Adjunct Therapy in Adolescents With Type 1 Diabetes and Insulin Resistance: A randomized controlled trial. Hamilton J, Cummings E, Zdravkovic V, Finegood D, Daneman D. Division of Endocrinology, Hospital for Sick Children, Toronto, Ontario. Department of Pediatrics, Izaak Walton Killam Health Centre, Halifax, Nova Scotia, Canada. School of Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada. OBJECTIVE-To evaluate whether, in adolescents with type 1 diabetes, the addition of metformin to insulin and standard diabetes management results in 1) higher insulin sensitivity and 2) lower HbA(1c), fasting glucose, insulin dosage (units per kilogram per day) and BMI. RESEARCH DESIGN AND METHODS-This was a randomized, placebo-controlled 3-month trial of metformin therapy in 27 adolescents with type 1 diabetes, high insulin dosage (1 unit. kg(-)(1). day(-)(1)), and HbA(1c) 8%, with measurements of insulin sensitivity (by frequently sampled intravenous glucose tolerance test [FSIGT]), HbA(1c), insulin dosage, and BMI at the onset and end of treatment. RESULTS-At t = 0, HbA(1c) was 9.2 +/- 0.9%, insulin dosage was 1.2 +/- 0.2 units. kg(-)(1). day(-)(1), fasting glucose was 10.6 +/- 2.4 mmol/l, and BMI was 24.2 +/- 3.9 kg/m(2) (means +/- SD), with no difference between the metformin and placebo groups. At the end of the study, HbA(1c) was 0.6% lower in the metformin group than in the placebo group (P < 0.05). This was achieved at lower daily insulin dosages (metformin group -0.14 +/- 0.1 vs. placebo group 0.02 +/- 0.2 units. kg(-)(1). day(-)(1); P < 0.05), with no significant change in BMI. Fasting glucose levels improved significantly in the metformin group (P < 0.05). Change in insulin sensitivity, measured by FSIGT, was not significantly different between the two groups at study end. Mild hypoglycemia occurred more frequently in the metformin-treated than in the placebo subjects (1.75 +/- 0.8 vs. 0.9 +/- 0.4 events. patient(-)(1). week(-)(1); P = 0.03). There were no differences in frequency of severe hypoglycemic episodes or gastrointestinal complaints between the two groups. CONCLUSIONS-Metformin treatment lowered HbA(1c) and decreased insulin dosage with no weight gain in teens with type 1 diabetes in poor metabolic control. Changes in insulin sensitivity were not documented in this study using the FSIGT. Long-term studies will determine whether these improvements are sustained and whether certain subgroups accrue greater benefit from this therapy. PMID: 12502670 BL

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