Hi TS, Sorry to hear your predicaments. I have similar experience so maybe it can help.

My Diabetes started when I was 40. My doctor prescribed Metformin 850mg x2 daily at first then move to x3 daily. I had similar problems like you. Right after starting it I had to endure diarrhea multiple times daily and the timing would be totally at awkward moments; driving to work or from work, during meetings, when talking to clients, playing with my kids etc. Public transport was totally out of question. I also felt weak and lethargic all the time. Suffice to say that I had to be prepared to shit anytime of the day in my pants. Few months later my social life and work performance went down drastically.

So it happens that I report directly to the directors of my company and since my performance had dropped drastically, the chairman/big boss called me up to talk. Long story short he gave me some direct guidance as he is also diabetic for 30years but totally in control. As he also owns few pharma companies, pharmacy outlets and cares for his staffs, I followed his advice and till today(few years later), my diabetes is under control. Following are his guidelines that I follow till now.

1) Medication dosage: Metformin 850mg 2 or 3 times daily will radically affect your bowel movement. Since its very high dosage at one time go, your bowel movement goes wild. What I did was change to Metformin/Diabetmin Retard (850mg ER-Extended/Slow Release, also Hovid). This helps release the active compounds slowly for 8-10hours (approx.) and significantly reduces adverse bowel movement. At first I did have occasional 'outbursts' but it was reduced few weeks later and took another few months for my bowel to have only small cases/problems occasionally. Metformin is also known to not cause kidney damage unlike other drugs and some studies says it has anti cancer effects.

2) Medication timing: I take one Metformin Retard right after breakfast and one right after dinner (2 tablets daily). I make sure the gap between the breakfast and dinner does not exceed a 10hours gap. You must take a meal before Metformin as taking it on empty stomach gives it a chance to adversely affect your bowel movement. No need to be too strict on meal intake timing but a breakfast is a must. Usually 1 to 3 hours after taking the medication, I will still need to go toilet but I will have ample of 'warning' time from my bowels.

3) Supplements: Your body feels weak because Metformin decreases vitamin B12 absorption so you have to take vitamin B12 supplements. I take Mecobalamin (a form of vitB12) which also helps in preventing peripheral nerve damage, 3 times daily before meal (do not take together with Metformin). This will slowly reduce your fatigue levels. I also take multivitamins but on a occasional basis (don't want to damage kidneys or liver).

4) Food restrictions: This is the hardest part You CANNOT take any forms of sugars or carbohydrates (rice, any form of noodles, roti canai etc). I stopped taking them gradually in a timeframe of few weeks. I now only take brown rice, durum wheat noodles/spaghetti, capati and stevia for teh-o/drinks. I do occasionally indulge in sweet fruits, chocolate, ice cream, potatoes, milo-o etc but on a very small scale and in a big timeframe gap (few weeks once). Vegetables and meats are your new best friends.

5) Exercise: I was already doing walking, cycling and gardening so I just increase my activity time. I lost about 10kg in past few years, not much I know but it did help me getting a more 'lighter' and energetic feel with my body.

6) Self monitoring: I have a simple glucose test/reader for my own monitoring. This can help you in your control. I do a HbA1c test every 6months to monitor my overall control but I did it every 3-4monts when I first started.

So hope my experience helps out. My level is now below 6.0mmol/l consistently (fasting). Please do consult your Dr before changing your medications though. Diabetes is all about control. If you control it, you can live actively until well over 80 like my big boss. Best of luck TS

Hi TS,
Sorry for late reply as I'm always on the move. The feeling of bloated/gassy and nauseated are also some side effects of metformin that I had and still have from time to time. I never had constipation caused by metformin. This could be caused by drastic change in your diet. You should take a little of unprocessed carbohydrate such as brown rice or even better fruits in the morning or afternoon (never at night). Too much meat intake or lack of fibre may also cause constipation. Try your best to take something for breakfast (I sometime take just an apple or pear if I'm busy) and make your medication timing more regular.

Mecobalamin is also known as methylcobalamin, a coenzyme that helps to counter the decrease of VitB12 absorption. You can find few brands in local pharmacy. The brand I use is Live-well because they have done proper studies on their supplements.

Since you're meeting your Dr on Thursday, ask him if you can take Metformin Retard (850 ER). This will really help in reducing side effects caused by Metformin 850.

I understand your feelings when you say you are sad when typing that you have to take meds everyday. I too was very devastated when I first had to take meds and face the side effects everyday. But I had decided that this 'Diabetes' is not going to put me down. I still have many things that I want to do in life and for my family. You too must find something in life that is more important to go on for than your sorrow. Self pity will only make the condition worse. Find a way slowly to counter and control this 'condition' by changing your diet, lifestyle and attitude. Realise that there millions of people with your condition and some are very successful still and live long. I sincerely hope you take care of yourself and take control of your condition than letting it take it control of you.

My very best to you bro.

I'm sincerely glad for you. Better to have minor changes in your life now rather than life long adjustments!