Type 2 Diabetes, a Dietary Disease #352: If you’re a Type 2, DON’T READ THIS.

Metformin* is designed for cheaters, like me! By that I mean Metformin is designed to work, or works best, with a “load” or “carbohydrate challenge.” That is my hypothesis, which recently came to mind after a “test” or “experiment,” as a friend jokingly refers to it, in which I consumed a large quantity of carbs in a short time.

I have to admit my judgment was impaired. We’d been indulging all afternoon with friends, and I’d had more than a little red wine. Then, after a light supper that my wife prepared, she “raided” the freezer, and while her back was turned, I snuck a taste of her ice cream. And then – she is so noble – to be sure that I ate no more, she finished the container. Later, when I snuck back to the kitchen, opened the freezer and discovered this, I found a new pint of Talenti Gelato (Hazel Nut Chocolate Chip) and ate half of it, about 50g of carbs.

And if that wasn’t bad enough, the next day was Sunday, my weekly comeuppance day. It’s the day my Excel program averages the previous week’s seven Fasting Blood Glucoses and records my week’s weight loss. But, lo and behold my FBG was only 98, up from 91mg/dl the day before. And the weekly average was 96, up from 94 the week before. Thus, my hypothesis: Metformin works best with a carbohydrate challenge.

So, if Metformin is so effective at improving glucose uptake when presented with a big carb load, like a 50g slug, what incentive is there to not indulge now and then? I mean, we all do it from time to time, right?

Well, I didn’t test my blood sugar post gelato, but considering it’s been more than 30 years since I first developed Insulin Resistance (IR), I can only imagine the rise that my blood sugar and blood insulin levels took in the immediate aftermath of that slug of sugar. It had to be precipitous, taking me well into the over 140mg/dl zone where damage is done to my organs. And it certainly took me out of a mild state of ketosis.

My weight the next morning was only a pound more than the day before, but how long, I wondered, would it be before the new glycogen stores were used up and my water weight dropped again. And how long would it be before my blood insulin level dropped, the bloat was gone, and I had that lean, high-energy feeling again.

Was it worth it? Probably not. But was it avoidable? For some, the answer apparently is “yes,”, or so I’m told by readers who profess not to be tempted. But then they may be people to whom temptation is not often presented – people who either live alone or with someone who is also attempting to eat Very Low Carb. In these households there IS no ice cream in the freezer. I am also definitely tempted by visual stimuli, or a lack of will to resist a visual stimulus. Or maybe it’s just a case of “arrested development” from a dysfunctional adolescence. Who knows? We are all, as we non-compliant folks rationalize, different. Indeed.

*  My current Metformin regimen (recently up from 500mg/d), is 1500mg/d, divided between AM and PM. That’s the only anti-diabetic medication that I have taken since I started to eat Very Low Carb (…most of the time, lol) in 2002. I am experimenting (there I go again) with the larger dose since recently reading that Metformin is really effective only at higher doses. I wish I could find that reference to link to.

I had also observed at a Metabolic Therapeutics conference that I attended earlier this year that a large cohort of normoglycemic men, specifically fitness experts and body builders, were taking maximum doses of metformin (2000mg/day) to enhance glucose uptake and suppress gluconeogenesis. They want to facilitate ketogenesis to break down body fat, enabling them to reduce stored body fat and, by rigorous exercise, to build muscle. Metformin has several known mechanisms of action and, in general, is very well tolerated.