December 26, 2009
A1c (Glycohemoglobin, HgbA1c), Pills for Diabetes
Question from Norwalk, California, USA:
For the last few years, my daughter’s A1c and blood sugars have been high. Her A1c has been around 9.0 and her blood sugar has averaged 200 mg/dl [11.1 mmol/L] most of the time. She is on a high dose of insulin, has insulin resistance and irregular periods and is a little overweight. Her endocrinologist did some test and said she does not have PCOS. They recommended more exercise to help with blood sugars levels and to lower her A1c. She had a very good diabetes team and endocrinologist through the years, but she is now 18 and had to change doctors. Her new endocrinologist has decided to put my daughter on metformin Hcl 500 mg then will increase to 1000 mg. I am very scared of this drug for my daughter. The manufacturer states that this is not for type 1 diabetics. Her endocrinologist said she is not giving it to her for her diabetes but for PCOS. She just started back on an insulin pump.
I think that with proper exercise, my daughter can get a better A1c and blood sugar levels. Are there a lot of type 1 diabetics on metformin? I know there are a lot of people with type 2 taking this drug. I would think that her first endocrinologist would have put her on it if she needed it. The pediatric endocrinologist has been practicing for over twenty years; her new one for only eight years.
Answer:
The problem of type 1 diabetes and insulin resistance is a difficult one. You have to increase the insulin dose to such high levels that it is difficult to lose weight. Although you have stated that her physician has previously done tests to rule out polycystic ovarian syndrome, it is not that simple. There may still be some components of insulin resistance that overlay the type 1 diabetes. The metformin is an attempt to address the insulin resistance. This has some benefit in patients who have had polycystic ovarian syndrome, as well as those with generalized insulin resistance. It is commonly used in young people. It is generally safe. I would have little hesitation using it my population of patients with similar findings. You can talk with her endocrinologist more, but I would see this as a trial of therapy meant to see if there may be some benefit gained. If not, it can be stopped. I encourage you to have your daughter talk with her endocrinologist in more detail about this.
JTL
