Normal A1c levels can be difficult to achieve in long-standing diabetes. But using the HbA1c is not always the best way to measure success or failure of diabetic treatments.
The hemoglobin A1c test is a blood test used to diagnose diabetes mellitus. You can also use it to monitor the progress and success of treatment.
It gives an average of your blood sugar levels over the past 3 to 4 months.
What is hemoglobin (haemoglobin)
Hemoglobin is a protein found in your red blood cells. It carries oxygen from the lungs to the cells. It also takes carbon dioxide from the cells to the lungs to be breathed out into the atmosphere.
Sugar in the blood attaches to hemoglobin to form glycated hemoglobin, which is commonly known as HbA1c.
The higher the sugar levels in the blood, the more of it binds to the hemoglobin, the higher the HbA1c levels.
Once sugar attaches to the hemoglobin, you cannot remove it.
The only way to get rid of this sugar is to destroy the red blood cell. The average lifespan of a red blood cell is 3 to 4 months. So once it is formed, the a1c (glycated hemoglobin) will remain in the blood to be measured for 3 to 4 months.
The HbA1c is often described as a percentage:
glycated haemoglobin/ total haemoglobin x 100.
How is the HbA1c test done?
You must have a blood sample to check the HbA1c levels. You don’t need any special preparation. That means you can have your blood drawn any time, day or night.
Everybody has some a1c (glycated haemoglobin) circulating in their blood. Your blood sugar cannot be zero or else you’d be dead! In the same way, your HbA1c cannot be zero because you must always have some sugar circulating in your blood.
Normal A1c Levels
less than 5.7% is normal
5.7 – 6.5 is the prediabetic level
more than 6.5 suggests a diagnosis of diabetes.
Estimated average glucose level (EAG) and abnormal A1c levels
Below is a table that gives the HbA1c equivalents in units you will be more familiar with.
A1c
EAG (mg/dl)
EAG (mmol/l)
6
126
7
6.5
140
7.8
7
154
8.6
7.5
169
9.4
8
183
10.1
8.5
197
10.9
9
212
11.8
9.5
226
12.6
10
240
13.4
The relationship between A1c and EAG (estimated average glucose levels)
eAG (estimated average glucose levels) = 28.7 X A1C – 46.7
Generally speaking, the treatment goal in diabetes is an HbA1c below 7%. However, this depends on age and other coexisting health conditions. Younger people have lower goals, to help them avoid the complications of having high blood sugar over time.
less than 6.5% – young patients
less than 7% – general population
less than 7.5%-patients
less than 8.0%-very sick, elderly or frail patients.
For every drop of 1% in the HbA1c, the risk of diabetic complications reduces by about 30%.
Your aim should be to keep your HbA1c level as low as possible without having frequent blood sugar crashes (hypos). Hypos have their own set of complications and can lead to death. You must avoid very aggressive treatment of diabetes to bring the HbA1c level down to a particular number.
How accurate is the A1c test?
The HbA1c test is not a perfect one. Many things can affect the accuracy of this test one way or another.
Blood disorders:
Blood disorders like sickle-cell anaemia and haemolytic anaemia can lead to a very low HbA1c. They are conditions in which the blood cells are destroyed prematurely, so they don’t survive for up to 3 to 4 months. These result in an abnormally low A1c number.
Iron deficiency anaemia – In this kind of anaemia, the blood cells live for longer than 3 to 4 months which means that there are more blood cells in circulation at any given time. This leads to a markedly increased HbA1c. The same can be said for any condition where red blood cells live longer than 3 to 4 months.
Diseases of the major organs:
Kidney disease can affect HbA1c.
Advanced liver disease can also influence the A1c.
Recent blood loss and recent blood transfusions can also skew the estimated A1c levels.
Disadvantages of the HbA1c test to monitor progression and treatment of diabetes
Measured HbA1c levels can vary from lab to lab, even using the same blood sample. To make sure you have consistent results, you should get your HbA1c test done at the same lab each time.
Another problem is that anything that tampers with the haemoglobin in the red blood cells over the red blood cells themselves can affect the accuracy of the test.
Why is my blood sugar high in the morning even when I haven’t eaten anything? This is a question you may be asking yourself. Believe me, you are not alone. In diabetes or pre-diabetes it is common to wake up with blood sugar levels higher than the night before.
Fasting blood sugar
The fasting blood sugar (blood glucose) is the most common test used to assess the blood sugar levels. You would usually do this in the morning before breakfast. It is easy to do at home with a personal blood glucose monitor which most people with diabetes have.
You usually check your fasting blood sugar after fasting over night. This means you don’t eat or drink anything except water for at least 8 hours before you do the test.
Naturally you would expect the following pattern. You eat dinner, perhaps you check your blood sugar an hour or two after eating. Then you would fast overnight and check your blood sugar before breakfast.
You would expect your morning fasting blood sugar number to be lower than what you had before you slept.
It doesn’t always work that way!
Much to your frustration, you find that your blood sugar isn’t lower! In fact, it’s even higher. There are a couple of reasons why you may be having this problem. I’ll go through them all and explain what’s happening and what you can do about it.
If you have diabetes, you’ll find it more difficult to regulate the levels of sugar in your blood. In type 1 diabetes the body is not able to produce enough insulin. There is an absolute lack of insulin in the body.
In type 2 diabetes the body produces insulin and initially very large amounts. But the body cannot use the insulin effectively. This is insulin resistance. Insulin is the hormone that helps the body cells to take up sugar from the blood. The cells use this sugar for energy.
Normal blood sugar levels
The main symptom of all types of diabetes mellitus is high blood sugar. Diabetes is diagnosed with a fasting blood sugar over 125mg/dl or a random blood sugar above 200mg/dl. The aim of most diabetic treatment in non-pregnant adults is to maintain a fasting blood sugar within certain levels:
between 70 and 130 mg/dl and
2-hour postprandial (2 hours after eating) blood sugar level under 180mg/dl.
In pregnant diabetic women:
the fasting blood sugar should not be above 90 mg/dl,
the 1 hour postprandial blood sugar should not be above 140mg/dl
the 2-hour postprandial blood sugar should be less than 120mg/dl.
The dawn phenomenon (and extended dawn phenomenon)
By far, the most common cause of very high morning fasting blood sugar levels is the dawn phenomenon.
The dawn phenomenon refers to recurring high blood sugar occurring in the early morning before breakfast. Sometimes it may extend into the late morning after breakfast. This is an extended dawn phenomenon.
The body has a circadian rhythm. During this daily cycle the body is programmed to do certain things at certain times of the day. For example in the evening your body starts to wind down. This prepares you to gradually become less active and eventually to go to sleep.
In the early morning, changes take place in your body. These changes prepare you to tackle a day of activity and challenges. This happens in every normal human being.
Insulin secretion goes down in the early hours of the morning. This allows for secretion of insulin antagonist hormones which raise the blood sugar.
Hormones that work to raise the blood sugar
From around 4 a.m. to 8 a.m. the body starts to release certain hormones. They tell it to wake up and be alert. These are the hormones that help you to get out of bed in the morning.
Hormones are chemicals which travel around the body telling different cells and organs what to do. These hormones that are released in the morning include;
cortisol which is a stress hormone
growth hormone
glucagon
thyroid hormone
adrenaline or epinephrine
Under the influence of these hormones, in the early morning hours the liver starts to break down stored glycogen. This releases glucose into the blood. The liver also increases production of glucose from other sources like stored fat.
This leads to a rise in blood sugar. If you don’t have diabetes the body responds by producing more insulin. So as the blood sugar goes up the insulin levels go up as well. This tells the liver to stop producing and releasing more glucose into the blood. It also tells the cells to take up glucose from the blood.
Some diabetics do not have this response to the early morning rise in blood sugar. The blood sugar continues to go up to abnormal levels. There is no increase in the production of insulin. The liver just keeps producing and dumping in glucose into the blood, even as the blood sugar levels are rising higher and higher.
Who has high blood sugars in the morning?
The dawn phenomenon occurs in both type 1 and type 2 diabetics and can also occur in pre-diabetics.
If you are a type 2 diabetics who have dawn phenomenon you may have problems with your pancreatic beta cells. When the liver is dumping glucose into the blood, the pancreas does not produce insulin. It cannot respond to the high blood sugar levels.
In type 1 diabetics, the dawn phenomenon occurs when the insulin you injected the previous day is not enough to compensate for the early morning rise in blood sugar. This means that:
basal insulin injections are too low or
the intermediate acting insulin dose injected the night before is not high enough to compensate for the morning rise in blood sugar. The effects of the injected insulin start to wear off at about the same time as the release of the hormones. This raises blood sugar and opposes the effects of insulin.
About 50% of people with type 1 and type 2 diabetes may experience the dawn phenomenon. Recurring morning hyperglycemia (very high blood sugar levels) can cause insulin resistance. This can lead to a worsening of glucose tolerance and make the disease worse.
The Extended Dawn Phenomenon
If the morning glucose remains high until mid-morning you may have the Extended Dawn Phenomenon.
Possible causes of the extended dawn phenomenon include:
eating too many carbohydrates for breakfast and
abnormal growth hormone secretion.
Growth hormone is normally released into the blood which raises the blood sugar. The levels gradually come down as the morning progresses. But some people with diabetes have an abnormal pattern of growth hormone production. The growth hormone continues to be produced even when insulin has been secreted which keeps the blood sugar high.
Insulin
Insulin acts as a kind of gatekeeper to many hormones. Hormones produced early in the morning that contribute to the dawn phenomenon cannot be released in the presence of high insulin levels. So the low insulin requirements during the night allows these hormones to be secreted.
When you eat, the insulin level rises and then comes down again. Seeing as you’re not eating during the night, the pancreas does not produce much insulin. During the night when you’re not eating the insulin level drops quite low. This reduction in insulin allows the other hormones like growth hormone, epinephrine, cortisol and thyroid hormone to be released into the blood. These hormones work as antagonist to insulin. They raise the blood sugar while insulin brings down the blood sugar.
Tests for the dawn phenomenon
Both the dawn phenomenon and the Somogyi effect can be a reasons why blood sugar is high in the morning. So you need to be able to tell them apart because the treatment for them is different.
There are two ways to do this:
Test the blood sugar between 3 and 4 a.m. for several days. In the dawn phenomenon the blood sugar should be normal or high at this time. In the presence of the Somogyi effect the blood sugar will be low.
Check the blood sugar levels with a continuous glucose monitor (CGM). This is a small machine that you attach to the skin to detect changes in blood sugar levels throughout the day. A computer processes and interprets the information. This will show whether the blood sugar is low normal or high between 3 and 4 a.m. This helps differentiate between the dawn phenomenon and the Somogyi effect.
Treatment and prevention of the dawn phenomenon
You can bring down high morning blood sugar levels over time in several ways.
Exercise
Engage in some physical activity after your evening meal. Go for a brisk walk or do something you find enjoyable but not too exciting (as this may stop you from falling asleep).
This activates your muscles so that they can take up glucose from the blood. Physical activity after your evening meal actually helps with blood glucose control throughout the whole of the next day. It is something that you should try.
Change what and when you eat
Eat a meal that’s high in protein and low in carbohydrates.
Have more fish, meat, eggs, chicken etc. with your meals.
Eat less starchy foods like pasta and bread. It’s also best to avoid processed and packaged food and to eat natural whole foods as much as possible.
Eat dinner earlier in the day. Instead of eating around 8 p.m., eat your dinner before 6 p.m.. You may find this difficult to pull off depending on how and where you work and how you structure your day. It may also not work for you if you have a family and you like to eat dinner together. But it is definitely something you should consider if you can make it work.
Take a tablespoon of apple cider vinegar in half a glass of water after your evening meal. It helps to reduce the absorption of carbohydrates into the blood from the intestines.
Medication
Increase your morning dose of diabetes medication
Switch to an insulin pump and program it to release more insulin in the morning
Why blood sugar is high in the morning – The Somogyi effect
Another way you can describe this is rebound hyperglycemia. This is another reason why blood sugar is high in the morning. The Somogyi effect is named after the doctor who first put forward the idea.
It occurs in type 1 diabetics and only in type 2 diabetics who are on insulin. The Somogyi effect refers to a situation in which there is very low blood sugar during the night followed by high blood sugar in the morning. This is your body trying to save you from the dangers of having a blood sugar that’s too low. In the body’s attempt to raise the blood sugar and prevent the complications of having a very low blood sugar, the blood sugar levels overshoot and become very high in the morning.
Your body tries to keep you alive by producing hormones that raise the blood sugar. These hormones tell the liver to release glucose into the blood. In a diabetic the system does not work efficiently and the liver releases more sugar than the body needs. This leads to a very high blood sugar in the morning.
Signs that you may be having very low blood sugar during the night
Signs that your blood sugar may be dropping very low during the night include:
waking up with a headache,
sweating profusely during the night,
having nightmares.
Why blood sugar is high in the morning – dawn phenomenon vs Somogyi
In both the dawn phenomenon and the Somogyi effect, the main symptom is very high blood sugar in the morning. So it’s important to be able to tell them apart to make sure the right kind of treatment is given. Once again the blood sugar should be measured between 3 and 4 a.m.. If it is very low repeatedly over several night this suggests that you’re suffering from the Somogyi effect.
How to prevent the Somogyi effect
You can prevent the Somogyi effect by making changes to what you eat. You can also adjust your medication.
Eat more protein and less carbohydrate with your evening meal.
Adjust your insulin regimen with your doctor’s help to make sure that you’re not having too much insulin or to reduce your insulin. Change your dosage to make sure that you don’t have hypoglycemia during the night.
Use an insulin pump to administer your insulin. Program it to give you a higher dose of insulin in the morning.
Eat a carbohydrate snack before going to bed.
If you exercise in the evening do it earlier in the day.
Problems you may have when blood sugar is persistently high in the morning
You may start experiencing the dawn phenomenon early on when you develop diabetes. If it is not treated it can lead to a worsening of diabetes. It can also increase your chances of developing cardiovascular disease (problems with your heart and blood vessels) and problems with your nerves (neuropathy).
Want to know how intermittent fasting can transform your health? How it can help you lose weight fast even without exercising? How it can help you lower you blood sugar and lower your blood pressure? Yes? Then keep reading. This is not hype, it’s not theory, it’s real.
Sooner or later, everything old is new again.
– Stephen King
Fasting is not some new, mind-boggling discovery, it’s been around forever. I’m not sure there is any Nigerian who hasn’t heard about fasting. Most of us know about it in a religious context. In the bible, Jesus fasted for 40 days and 40 nights in the wilderness. Major religions the world over encourage their adherents to fast for spiritual benefits.
But people don’t really think about fasting in terms of health benefits. I have been doing intermittent fasting (IF) for a few years now and it has been wonderful for my health. I’ve lost weight and kept it off. I have more energy, I feel more alert and awake during the day and I sleep better at night. Intermittent fasting has become my default daily setting.
What is intermittent fasting?
Intermittent fasting means choosing not to eat or drink anything containing calories for several hours or days. It is not starvation, it is not a diet but a way of eating (or not eating 😉 ). The main focus of intermittent fasting is on when to eat . For years there’s been mountains of advice about what you should be eating, most of it heavily influenced by big food producers in the United States, but that’s a story for another day!
There hasn’t been much talk about when you should eat. What you eat is also important in intermittent fasting, more so for some people than others. Assuming you eat dinner at 8pm and you don’t eat again until 8am the next day, you have fasted for 12 hours. After all, what is breakfast? It’s the morning meal that breaks your nightly fast. So you can see that (unless you’re a midnight-snacker) most of us fast for a good number of hours every day without even thinking about it.
How does intermittent fasting work for weight (fat) loss?
Every time you eat or drink your body produces a hormone (chemical messenger) called insulin. Insulin’s job is to push the food you have eaten into your cells as fast as possible, to be used as fuel or to be used for other bodily functions. Any food you don’t use immediately is converted to fat and stored.
If you’re not eating, your body does not produce much insulin so there is no fat storage. To survive, your body release 2 other hormones called growth hormone and glucagon. These messengers tell the body to use the fat that is already stored in your body and burn it for energy. Yippee! That’s what we all want isn’t it? Yes it is.
Intermittent fasting for insulin resistance
One of the most damaging states your body can be in is one of insulin resistance. Many of the chronic diseases we suffer from in the modern world have been linked to insulin resistance. This includes:
type 2 diabetes (the end point of insulin resistance)
heart disease
high blood pressure
Alzheimer’s dementia – (Dementia is a general term for a decline in mental ability severe enough to interfere with daily life. Memory loss is an example. Alzheimer’s is the most common type of dementia.)
Each time you eat, especially if it’s sugary, processed or very starchy food, your body releases lots of insulin. The idea is to get the food out of your blood stream as quickly as possible and into your cells.
Seeing as you’re not going to use all that food immediately, your body stores it as fat, ready for when you need it. Your blood sugar crashes and you start feeling irritable and uncomfortable and hungry again. Then you start looking for something else to eat and the cycle starts all over again.
Because you’re eating constantly, your body never gets a chance to use up the energy that’s already stored away as fat. You just keep adding to your fat stores. Intermittent fasting helps you to break that cycle. Not eating allows your body to use the fat that you have stored away for energy.
What are the advantages of intermittent fasting?
Intermittent fasting is FREE.
In fact it may even save you money. If you eat fewer meals you may end up spending less money on food. If you are on a tight budget you may be able to spend the same amount of money on food while increasing the quality of your food.
This may include being able to buy more nutritious food like meat and vegetables. Cutting out the numerous snacks during the day – buns, puff puff, groundnuts, biscuits, sweets, chocolates, soft drinks e.t.c. will definitely save you money. Also you don’t need to buy any special shakes, pills or supplements.
Intermittent fasting is simple
Really. Don’t eat. How much simpler can it get? You can drink water, tea or coffee without sugar or milk. Some people drink bone broth. Technically speaking, bone broth does break a fast, but it can help you initially to adjust to fasting.
Intermittent fasting is flexible
You can start when you want and stop whenever you choose. Fasting can fit into your lifestyle and around your commitments. You can choose not to fast if you’re going for a party or if it’s your child’s birthday or you’re going out with friends.
Fasting is useful if you’re travelling (avoid traveller’s diarrhoea and having to poop in the bushes!).You can fast through the day and then eat with your family in the evening. You can fast and still enjoy your family and have a social life. What works for you will be different from what works for someone else. You choose.
Intermittent fasting saves time
You spend less time planning and thinking about what to eat. You spend less time shopping for food and less time cooking it. The time you spend eating can be put to good use elsewhere. If you’re not cooking and eating then there’s no mess to clear up.
You will be more productive
Pleasurable as it is, food can be a huge distraction. After the initial adjustments, you may find that you get more done in your everyday life when you’re fasting. I have been known to clean the house when I’m fasting. I also get more done on this blog when I’m fasting.
But breakfast is the most important meal of the day!
You don’t have to eat breakfast.
Is it really? I confess. I used to be a breakfast evangelist myself, but not anymore. Personally, I rarely eat breakfast. We’ve become almost brainwashed into thinking that:
We must eat 3 meals a day.
We have to snack throughout the day to keep up our energy levels.
Skipping meals is dangerous.
Says who? You don’t have to start eating the moment you roll out of bed. If you are a breakfast person, I have good news for you. You can still do intermittent fasting. You can choose to have breakfast and skip dinner. See what I mean about intermittent fasting being flexible?
Why not eat less and exercise more?
Let’s be honest. I’ve tried that, you’ve tried that. How did it work out? Not well I’m guessing. Otherwise you probably wouldn’t be reading this. And I would still be drinking fat-free milk (yuck!)… trying to count calories instead of making delicious, full fat yoghurt. And living in tracksuit bottoms…because I was working out for about 2 hours every day!
Trying to eat small low-fat meals and exercise a lot may work for a little while. Then it stops working. Your body adapts to survive. You’re hungry all the time and you don’t have the energy to exercise. You put all the weight back on and a little bit more.
Maybe I’m supposed to be this big, you tell yourself. After all, it’s normal to “have body” (i.e. to be plump) in your 40’s. This is too much stress. And you give up. And dive into a tub of your favourite ice cream or a packet of double chocolate chip cookies (my preferred poison in those days).
Intermittent fasting is a cycle of eating and not eating. The period during which you eat is called your feeding window. There are many different regimens (or protocols) for intermittent fasting. These are 3 of the most popular.
Here you fast for 16 hours of the day. Then you have a feeding window of 8 hours during which you eat. Anything which you eat or drink must be taken during your 8 hour feeding window, apart from permitted fluids like water.
The hours you sleep during the night can also count towards the 16 hours of fasting. Some people still eat 3 meals during the 8 hour eating window but it is more common to eat less food than usual during the feeding window. Time restricted eating is possibly the most popular form of fasting. Many people skip breakfast and start eating around lunch time.
One meal a day (OMAD) intermittent fasting (23:1)
Some people may call this a 24 hour fast. Strictly speaking you fast for less than 24 hours. In OMAD fasting, you basically….eat one meal a day. This means you’re fasting for about 23 hours each day. You have about 1 hour to eat. It is difficult to eat 3 meals in this small eating window. So you would naturally be eating less food.
Alternate day intermittent fasting
Here you eat one day then fast the next day and eat the day after. This usually gives you at least 36 hours of fasting depending on what time of the day you eat.
The great thing about intermittent fasting is that it is very flexible. You can always try different types to see which one gives you the results that you want. Have you heard of intermittent fasting for weight loss and better health? Have you tried it? What has been your experience? Please let me know in the comments.
Millions of people all over the world use metformin. What does it do? What are the advantages and disadvantages of taking this drug?
Metformin is an oral medication, that is a medicine that you take by mouth. It is used to lower blood sugar, particularly in type 2 diabetes. The generic name is metformin but you may know it better by the brand name of Glucophage.
How does it work?
It works in three ways:
In the intestines it reduces the absorption of sugar from the food that you eat.
It stops the liver from breaking down glycogen into glucose and releasing this into the blood.
It makes your body more sensitive to insulin.
All these work together to bring down your blood sugar.
When do you use metformin?
It is used in several conditions:
To treat prediabetes,
To treat type 2 diabetes,
In type 1 diabetics to make injected insulin more effective.
It is also sometimes used in PCOS as well as in infertility.
In type I diabetes the body does not produce insulin in the pancreas. Insulin is a hormone that triggers cells to take up sugar out of the blood. Seeing as the body is not making insulin, type I diabetics have to inject insulin.
Type 2 diabetics have very high insulin, especially in the early stages of the disease.
There is a difference when you’re using metformin in type 1 compared to type 2 diabetes. In type 1, you’re taking it to make the body more sensitive to the insulin you are injecting. In type 2 diabetes, you’re using it to make the cells more sensitive to the insulin that your body is already producing.
How do you take it?
Metformin comes in 500 mg, 850 mg, and 1000 mg tablets. You can take it up to 3 times a day. The maximum dose is about 2500 mg a day. However, this may vary according to the formulation that you are using. It is also available in an extended-release form which you would usually take this only once a day.
It is often combined with other diabetes drugs to enhance their effects.
What should you monitor while you’re taking metformin?
Fasting blood sugar/fasting blood glucose
HbA1c gives a picture of what your average blood sugar has been over the previous three months.
Kidney function is important because metformin should not be used in severe kidney disease.
Complete blood count may show signs of anaemia.
Vitamin B12 and folic acid levels – long-term use of metformin can lead to a deficiency of vitamin B12 and folic acid, which can also be detected in the complete blood count if it is severe enough.
Advantages of metformin
It is affordable.
It is available all over the world.
It’s an oral drug. There is no need for needles and other things that go with injecting medication.
It does not cause weight gain which other diabetic medications may cause. On the contrary, many people lose a little bit of weight when they start taking metformin.
It is not likely to cause hypoglycaemia which is common with other diabetes drugs.
Disadvantages of using metformin
Ithas some serious side effects. These may be so bad that some people stop taking it altogether.
If you have severe kidney disease you should not use metformin.
You must limit your alcohol intake to avoid dangerous side effects.
While the regular version is very affordable, the extended-release version is quite expensive.
Interactions of metformin
There are some drugs that you have to use with care when you’re taking metformin. The most common ones include:
Beta-blockers-These are used to treat high blood pressure and other problems of the heart and blood vessels. One example is propranolol. They may cause a lowering of blood sugar which can be dangerous. This is even worse when you combine it with the loweringof the blood sugar that metformin causes.
Cimetidine – this is used to treat peptic ulcers. Taking cimetidine can increase the amount of metformin in the system.
Cephalexin – this is an antibiotic that can increase metformin levels
Quinolone antibiotics – these includes drugs like ciprofloxacin. These can cause an increase in blood sugar.
If you need these drugs to treat related medical problems while taking metformin you can still take them. However to your healthcare provider would be aware of the possible interactions and would need to monitor you very closely.
Metformin side effects
Metformin is a drug used by millions of people all over the world. It is the first-line drug in treating type 2 diabetes which is now at epidemic levels worldwide. And yet, many people are placed on this drug without any formal guidance or advice. Get ready to learn everything you need to know about metformin, its side effects and how you can avoid them.
All drugs have side effects, without exception. When a doctor prescribes any form of medication, she weighs the benefits of that drug against the potential side effects. For example, daily aspirin tablets are often prescribed for people with heart disease even though they can cause bleeding. So you would need to weigh the benefits of aspirin in preventing blood clots against the risk of uncontrolled bleeding. If the benefits are more than the risks, you go ahead and use the drug. If the risks appear to be higher than the potential benefits, you need to find an alternative.
Metformin has many side effects. Some of these are very common, while others are rare.
Commonest metformin side effects
These include general side-effects like:
weakness
dizziness which may lead to falls
low blood sugar-especially if metformin is used together with insulin
muscle pain
chills
lactic acidosis
low vitamin B12 levels
lowered folic acid levels
low calcium levels
Gastrointestinal side effects
These include:
unusual taste in the mouth,
loss of appetite,
gas,
diarrhoea,
abdominal pain,
nausea,
vomiting,
bloating with abdominal distension
heartburn and
constipation.
Respiratory side effects
Chest pain
upper respiratory tract infection
persistent cough
Out of these side-effects, the most common are:
weakness
dizziness
gastrointestinal side effects like nausea and vomitin
Virtually any drug that you take by mouth has the potential to cause problems in the stomach and intestines. As usual, side effects vary from one person to another. Just because there are so many adverse effects, it doesn’t mean that you will have all of them. You may not have any at all. In some people, the side effects are so severe that they have to stop taking metformin altogether.
How do you avoid the side effects of metformin?
The best way to avoid metformin side effects is to ease into taking it. You should start on 500 mg once a day, preferably at night (so you can see through any discomfort you may experience).
You should take this for a week or two. If you’re not experiencing huge problems, then you can start taking 500 mg in the morning. Then you can add 500 mg in the evening for another week or two. If you need more metformin to control your blood sugar, then you can add 500 mg every one or two weeks. You can do this until you reach the maximum recommended dosage.
Another option for reducing the side effects of metformin is to use a different form of metformin. Once you’ve swallowed it, the regular metformin starts being released immediately into the stomach. There is another form of metformin known as extended-release metformin. With this preparation, metformin is released gradually throughout the day. It minimises the side effects, especially the gastrointestinal ones. Usually, you would take this once a day in the evening.
A simple way to avoid metformin side effects is never to take metformin on an empty stomach. Wait for about 15 minutes after you eat, then take the metformin. That will make a huge difference, especially in preventing gastrointestinal side effects like nausea, vomiting, heartburn et cetera.
Metformin decreases the absorption of vitamin B12 and folate from the intestines, which can lead to anaemia. Supplementing with vitamin B12 and folic acid helps with this complication.
Lactic acidosis
A rare, but life-threatening side effect of metformin is a condition known as lactic acidosis, which can lead to death. symptoms and signs of lactic acidosis these include:
abdominal pain
nausea, vomiting and diarrhoea
fatigue
muscle pain
altered mental state
shallow breathing
Who is at risk of developing lactic acidosis?
the elderly
using high dose of metformin
If you have decreased kidney function, this increases the risk.
dehydration
If you’re actively taking alcohol while taking metformin, this will increase your chances of developing lactic acidosis.Infection can increase your chances of developing lactic acidosis while you are taking metformin.
Lactic acidosis is a medical emergency that requires immediate medical attention.
Metformin, x-rays and CT scans
Another area where you need to be careful with metformin is when you’re doing some types of radiological tests. Some x-rays and CT scans may require the injection of iodine-containing contrast medium to help highlight particular areas of the body. If you have decreased kidney function (with an estimated GFR of less than 30 ml per minute), you need to stop taking metformin before doing the test. Remember that this problem with metformin also applies to drug combinations that include metformin.
The combination of decreased kidney function and the contrast medium used to do the test plus the metformin greatly increases the risk of lactic acidosis.
After 48 hours, if the doctor has assessed your kidney function and found it to be okay, then you would be able to start the metformin again.
I’ve talked about the fact that many people all over the world take metformin to bring down their blood sugar in type II diabetes. It has lots of side effects, the commonest ones being the gastrointestinal side effects. Also, remember that you can greatly reduce the side effects of metformin by starting with the lowest dose possible. You can increase the dosage gradually. Remember to take metformin with meals.
Have you taken metformin before? Did you have any side effects? If you did, how bad were they? Let me know in the comments.
Vitamin B1 (thiamine) is an essential nutrient for all living things. The human body can’t make thiamine. You have to eat it in your diet. Vitamin B1 is abundant in pork, fish, liver, nuts (macadamia, sesame seeds) and yeast.
Are you diabetic? You need this vitamin! Everyone with diabetes should consider taking vitamin B1. Deficiency of this vitamin is much more common if you have diabetes. These problems arise from persistent high blood sugar.
What causes vitamin B1 deficiency?
Once again, a diet high in processed food is one of the culprits. Processed food is taken from its natural form and transformed into something else, usually less healthy. For example, take a potato that becomes a potato chip. Another example is wheat which is processed to make bread. Often, these steps needed to transform this food remove many of the vitamins and minerals. A diet that is high in processed food can lead to many different deficiencies.
Another cause of thiamine deficiency is eating too much sugar. Yet another is drinking too much alcohol. Some medications like antibiotics and vaccines can cause vitamin B1 deficiency. Bariatric surgery which alters the stomach and intestine in various ways, can also cause vitamin B1 deficiency.
Only about 5% of the vitamin B1 you eat is absorbed, so you’re more likely to develop vitamin B1 deficiency if you’re not eating enough.
Why is vitamin B1 deficiency a problem if you have diabetes?
Like everyone else, if you have diabetes, you may develop vitamin B1 deficiency from not getting enough in your diet. But there are also additional risks:
the kidneys don’t function well in diabetes which can lead to increased loss of vitamin B1 in the urine and
there is decreased reabsorption of vitamin B1 back into the blood so more is lost in the urine.
Symptoms and signs of thiamine deficiency
In the early stages of thiamine deficiency, the signs and symptoms are very non-specific. These may include:
tiredness,
excessive sleeping,
hair loss,
health problems,
nausea and vomiting and
loss of appetite.
You may also have symptoms like:
burning pain and
a feeling of pins and needles in your hands and feet.
That is similar to what you would find in nerve damage due to diabetes. Eventually, these symptoms and signs progress to:
uncontrolled body movements
difficulty in walking
loss of memory and other mental problems.
At this stage, you cannot reverse the damage that has occurred. In diabetes, vitamin B1 deficiency can manifest as elevated blood sugar and persistent mental problems.
What does Vitamin B1 do & why is it so important in diabetes?
Under normal conditions, when glucose levels are normal and all the required nutrients like vitamins and minerals are present, sugar in the diet is converted to energy in the mitochondria.
The byproducts of this process are called Reactive Oxygen Species (ROS). These ROS are very harmful to the cell. There are mechanisms in place to handle them and ensure that they don’t cause harm to the cell.
When you have high sugar levels for long periods, the mitochondria can’t handle the load. So much ROS are produced that the cell can’t cope. The mitochondria try to protect themselves by churning out large amounts of a powerful antioxidant. In small quantities, this is great, but too much for too long is a problem.
Eventually, this leads to damage to the cells lining the blood vessels. It also causes problems with your nerves which leads eventually to the burning and tingling sensation in the hands and feet.
The cells try to find other ways to process all the sugar. These alternative pathways are not as efficient as processes that take place in the mitochondria. They produce unwanted chemicals as they’re trying to use up all the sugar. These chemicals damage the cells, especially the ones that line your small blood vessels and your nerves.
How does thiamine help in the cells?
Your body needs vitamin B1 to break down sugar efficiently. It helps other enzymes to do their work. In its absence, they cannot work efficiently. So, even if you have high blood sugar and high sugar in the cells, having enough thiamine helps limit the damage it causes and offers some protection.
In diabetes, there is a lot of sugar circulating in the blood. There is also a lot of sugar inside the cells. Your nerve cells send signals to the brain carrying information about what’s happening in your body and in your environment. There is so much sugar in the cell that it can’t be turned into fuel.
And that is the purpose of sugar. It’s supposed to turn into energy. When the sugar is too much, it gets shunted into other pathways that eventually lead to complications like burning and tingling of the hands and feet.
What vitamin B1 does is that it prevents this excess sugar from being channelled into reactions that will give rise to complications. So vitamin B1 is required to process glucose efficiently inside the cell. Unfortunately, people with diabetes tend to be deficient in thiamine when they need it so badly.
Treating thiamine deficiency
You can treat thiamine deficiency in several different ways by:
improving your diet and eating more natural food,
limiting your intake of alcohol,
limiting the amount of sugar in your diet,
supplementation (if you have a severe vitamin B1 deficiency you may not be able to get enough vitamin B1 from your diet).
What is benfotiamine?
Thiamine is a water-soluble vitamin. Only about 5% of what you take in your diet passes into the blood. However, there is another form of vitamin B1 that is better absorbed. This form is called benfotiamine. Benfotiamine is fat-soluble and is absorbed much better than regular vitamin B1. So you will achieve higher levels in the blood.
It also gets stored in the nerves because they have a high-fat content. That means that it can work better than regular vitamin B1 to relieve nerve pain and abnormal sensations that you may get from vitamin B1 deficiency.
Taking thiamine can reduce some of the complications of diabetes by up to 50%. If you already have complications, taking benfotiamine can help to slow the progression of these complications and stop them from getting worse.
Even if you’re using benfotiamine with all its benefits, you still need to change your lifestyle by treating your high blood sugar and insulin resistance. That would include changes to your diet and managing your sleep and stress.
As always, anything you do that affect your health should be run by your doctor or healthcare provider first.
Have you used benfotiamine before? Or maybe you have been using the more popular form of vitamin B1 form, thiamine? Let me know in the comments.
Yoghurt has been a staple in our home for years now and we almost always have some in the fridge. The supply has been virtually unlimited since I started making my own at home. It is incredibly simple to do. It is one of the oldest and most popular fermented foods that is eaten in most cultures that keep animals for milk.
What is yoghurt?
Yoghurt is a semi-solid sour food prepared by adding bacteria to milk and allowing it to ferment. The most common bacteria used to make yoghurt are Lactobacillus bulgaricus and Streptococcus thermophilus.
Benefits of eating yoghurt
Why is it good for you?
Yoghurt may improve your gut health
It may help with issues like:
constipation,
diarrhoea,
inflammatory bowel disease and
Helicobacter pylori infection (a common cause of peptic ulcers).
Benefits for colon cancer
It may help to prevent colon cancer by:
changing the balance of the bacteria that are found naturally in your intestines and
decreasing the time it takes for food to travel through the intestines.
More health benefits for chronic disease
It may lower the risk of type 2 diabetes.
It contains calcium and vitamin D which may help to prevent osteoporosis.
Blood pressure and cholesterol levels may be reduced by eating yoghurt.
Yoghurt may help to reduce anxiety and improve mood.
It may help with brain-related disorders like Parkinson’s Disease.
Yoghurt may help increase your immunity by stimulating white blood cells which help you fight disease.
Are you’re lactose intolerant?
About 70-90% of black Africans are lactose intolerant. Milk contains lactose (milk sugar) which is broken down in the body by an enzyme called lactase. If you don’t have this enzyme or can’t produce enough of it, the lactose passes on to your large intestine. This leads to varying degrees of abdominal pain, belching, farting, diarrhoea and vomiting. The lactose in milk is broken down by bacteria in the fermentation process. The longer you leave the milk to ferment, the more lactose is broken down and the more sour the yoghurt will be.
Yoghurt benefits for weight loss and exercise
Yoghurt helps to keep you fuller for longer so you will less tempted to eat unhealthy snacks.
It may help you lose weight and especially help to reduce belly fat.
Yoghurt may soothe muscles and help them recover after exercise.
More advantages from eating yoghurt
It may ease the diarrhoea which can occur after antibiotic therapy.
It may discourage vaginal infections by helping to keep the pH of the vagina low (i.e. increases the acidity).
To get all these benefits from yoghurt, it must have live cultures in it. This means that the bacteria in it must still be alive. Some brands kill the bacteria in the yoghurt so it can last forever on supermarket shelves. With live cultures, it will eventually go bad. Your nose will tell you when that happens.
Why make your own yoghurt?
Now the big question. Why should you take the time and the trouble to make your own?
You’ll know exactly what’s inside it.
Many commercial yoghurt has lots of yummy extras, like thickeners and preservatives added to them. You avoid all that by making your own. Remember the great British horse meat scandal? It became glaringly obvious (if it wasn’t already!) that we don’t actually know what we’re eating a lot of the time. Assuming what you’re using is actually milk, when you make your own, what you get at the end is plain fermented milk and bacteria. To be sure of your milk supply, you could always keep your own cows and/or goats. 😀
Some other great reasons to make your own yoghurt
It’s cheaper than buying it.
My homemade yoghurt typically costs half as much as the one I buy, though recently milk prices have gone up somewhat. This of course depends on the brands of both the milk and the yoghurt you use for your starter.
You can make it just as sour as you want and we like ours cheek-smackingly sour!
As long as you have milk you can make yoghurt. Milk is easy to find and will keep for a long time (eg. UHT, powdered and evaporated). With planning, you will always have a steady supply.
It’s really easy to make. Really.
It takes literally minutes to make. The rest of the time is down time spent waiting for the bacteria to do their thing.
You can make as much as you want. I typically make 4-5 litres at once. You are not restricted by the size of the jars.
This last reason is really important. You get to pat yourself on the back and bask in your thriftiness and ingenuity.
Once I decided I wanted to make my own yoghurt, I went out and bought myself a cute little yoghurt maker. Let’s just say, that experiment didn’t go well!
Some major disadvantages of using a yoghurt maker
It’s expensive when you can find it here in Nigeria. I bought mine before the era of Konga and Jumia and had to cart it back across the waters with the threat of excess luggage hanging over my head. I recently found a listing for a yoghurt maker on Jumia. It had a generous 2.5 star review from an extremely angry shopper who said it was basically a pile of junk.
It takes up space. How many gadgets do you have gathering dust at the back of your cupboards? Do you really need one more?
The jars are usually made of glass. If they break, you’re stuffed. Where are you going to get replacements?
It needs electricity. That’s a biggie. If you don’t live in Nigeria you may not understand what I’m talking about. Electricity. That scarcest of commodities! The yoghurt maker needs about 8 hours of constant electricity. How often do you have power for 8 hours at a stretch? Are you going to burn petrol or diesel in your generator just to make 6-8 teeny, weeny jars of yoghurt?
The main job of this bulky kitchen appliance is to keep the milk mixture at a constant, warm temperature. That’s it. Nothing else. Nada. Zilch. And I’m sure we can come up with a gazillion ways to keep milk warm. 🙂
How to make your own healthy yoghurt at home
Sterilise your containers.
Mix 1 or 2 tablespoons of plain yoghurt with 1 litre of warm milk.
Pour into prepared containers.
Insulate (keep warm) for about 4-6 hours or until the yoghurt sets.
Refrigerate for about 8 hours.
When it’s ready, freeze some and keep it for your next batch. That way you may never have to buy yoghurt again. Is it really that simple? Yes it is. Now let’s look at each step in detail to make sure you get perfect yoghurt every time.
Containers
You need to use clean dry containers to make yoghurt. Let’s make sure you’re encouraging good bacteria to grow and not the ones that will make you sick. If you wish, you can boil your containers in a pot for about 5 minutes and allow to cool. I recycle my tall, glass mayonnaise jars (sooo ecofriendly!). I’ve used plastic ice cream containers. You can use a pot, casserole dish, anything that you can cover. You don’t even have to sterilise, just make sure your container is clean and dry.
Warm the milk
Warm the milk to about 43°C which is supposed to be the best temperature for making yoghurt. I never bother measuring temperatures to be quite honest. I drop a little milk on the inside of my forearm. If it feels comfortably warm without burning, them I add the plain yoghurt. Please don’t burn yourself. You can heat the milk on the stove or in the microwave. Make sure it doesn’t:
boil over, or
burn.
Mix milk with yoghurt culture
Use 1 or 2 tablespoons of plain, unsweetened, full fat yoghurt for each litre of warm milk and mix thoroughly. I use a little whisk. Pour mixture into desired container. I like to recycle glass mayonnaise containers[/caption]
Keeping your milk warm
Finding different ways to keep your milk/yoghurt mixture warm is a fun mental exercise. Here are a couple of ways that have worked for me.
I put my jars in an old microwave. This was a bit limiting because the microwave was small. I like to make big batches.
I put my jars in a pre-warmed gas oven. Forgot to turn off the oven one time and totally cooked the yoghurt. Other than that one mishap, it worked well. Sometimes though, I needed to use the oven for something else (like baking bread) so it was occasionally inconvenient. You can leave off warming the oven and just put a pot of hot water or a rubber hot water bottle in the oven. Once, I forgot the hot water bottle was still in the oven when I lit it. Minutes later, the smell of melting rubber perfumed the evening air.
I’ve put the jars in a cardboard box and covered with blankets. This worked great.
Hot water in plastic containers – I put my jars inside a picnic cooler, put in the containers with hot water and leave for about 18 hours. This is the method I use now.
Here are a couple more ways to keep your milk warm:
An insulated thermos flask,
A cooler with a hot water bottle or heating pad inside,
A slow cooker
How long should yoghurt be cultured?
The experts generally recommend 4-6 hours, or overnight. After 6 hours pick up your container and tilt it slightly to the side. If the mixture stays put, then it’s set and you can decide to stop or leave it a bit longer. We like ours nice and sour so I leave mine for about 18 hours. Also, I no longer warm the milk before hand so some extra time is needed for the mixture to warm up before the process can get started. Some people leave their yoghurt up to 24 hours. It’s up to you to experiment to find out what you like.
Refrigerate
If you leave your yoghurt in the fridge, it will last for days without going bad. Refrigeration slows down the fermentation process and makes it firmer.
Yoghurt has been a staple in our home for years now and we almost always have some in the fridge. The supply has been virtually unlimited since I started making my own at home. It is incredibly simple to do. It is one of the oldest and most popular fermented foods that is eaten in most cultures that keep animals for milk.