Taking a Drug Holiday

Every year I go off my metformin for a week or two, usually because my digestive system gets upset enough that it makes sense to cut out a drug notorious for causing stomach issues.

Since I am using insulin at mealtime now, going off metformin does not pose a danger to my health as long as I adjust my insulin dose to match the higher blood sugars I get without metformin in my system.

This past week, off the metformin, has been very interesting. As expected, my digestive system got a lot happier very quickly. No heartburn or weird feelings in the heart region that turn out to be signals from the esophagus or top of the stomach. (If you take Metformin, you probably know what I'm talking about.)

But after stopping, I was surprised at how much more energy I got. I'd been very sleepy in the evenings the last couple months but now, after almost a week without met, I'm bright and alert at 10 PM. My mind feels clearer during the day, too. Interesting!

My insulin needs have gone up, though my carb/insulin ratio is still that of a non-insulin resistant person--1 unit to 11 or 12 grams rather than 1 unit to 15. It took me a few days to adjust my dosage up, very carefully, a half unit at a time. Now I'm using 4.5 or 5 units, instead of 2.5 or 3 per 40-50 gram meal.

I do find it easier to go low with the higher amount of insulin, hence the higher carb intake. I'm not eating those 50 grams all at once, but instead eating a some at 2 or 3 hours to prevent lows. I'm using R, which hits hardest between 2-3 hours. Novolog would require a different approach, but I haven't had the time to work it out.

I'm also hungrier--which is one reason I started taking metformin, because without it I can be hungry and that pushes up my intake and weight. I consider hunger a symptom, not a moral failing, and for years metformin has been helpful in giving me normal hunger patterns. That's one reason I might go back to taking it.

Metformin also lowers my triglycerides dramatically, and since they are one of the more predictive elements in the lipid profile, I see that as good reason to take it. I'm sure my triglycerides are nastier now as I'm eating a bit more carb than usual, reworking the insulin dosing.

Finally, for some reason, taking metformin also lowers my blood pressure enough that when I take a blood pressure pill along with metformin, I can have serious problems with BP going very low. Now that I'm off the Met, I'm taking my blood pressure pills more frequently. I can't take the Diovan every day, never could. For years one Diovan would last me 2 days, and when I'm on Metformin it often controls my blood pressure very well for four! Any more Diovan and I'm likely to find myself flat on my back in the garden seeing stars if I bend over to pick a weed.

But I'm wondering, now that I feel so much more alert and awake without metformin, what this tells me about potential side effects. Is it subtly poisoning me in ways I didn't know about? We know it acts on the liver, and, well, I'm fond of my liver and would really like to keep it around for years to come. Metformin has been used for decades, so it has a pretty good safety record, but even so, the old "listen to your body" thing is telling me that maybe a little less Metformin might be in order.

I'm going to stay off the Metformin for a while longer and then go back on it and see if the sleepiness comes back. This kind of "challenge test" is what my endo instructed me to do years ago when I expressed other concerns about metformin side effects.

All in all, I think it probably is a very good idea to go off any drug we are taking day in and day out after we've taken it for years, to see if 1) it is still actually doing anything--many drugs don't after a while and 2) whether the drug has been causing side effects we haven't connected with it.

Obviously, if you stop a drug you need to closely monitor the area it impacts. You don't stop a blood pressure medicine without testing your blood pressure several times a day. Ditto blood sugar meds and blood sugar.

A Word of CAUTION

For many meds you can't stop cold turkey, because, although doctors often fail to mention this, the drugs are physiologically addictive and you'll have very nasty rebound symptoms or even, in the case of beta blocker blood pressure meds, a heightened risk of heart attack. If you feel a drug vacation is in order discuss your particular drug with your doctor before you stop taking it.

But it is well worth reviewing the rationale behind any drug you've been taking for a few years or more. Your condition changes, other drugs you have added since starting a drug may be duplicating the effect of that older drug, or the drug you have been taking may have become ineffective over time. A good doctor will take these concerns seriously and help you understand how to audit what you are taking and decide if it's time for you to try a drug holiday.