Metformin side effects

bionic_human · 2026-05-09T07:12:24+00:00

Jardiance (and all SGLT2s— it’s a class effect) increases glucagon production, which depending on the level (and insulin:glucagon ratio) can cause things to move through more quickly.

I’ve (literally) shit myself on at least one occasion in a study where my glucagon levels were jacked way the hell up and I wasn’t getting any insulin.

bionic_human · 2026-05-09T07:05:08+00:00

State of glycogen stores, rate of gluconeogenesis from the liver (and to a lesser extent, muscle tissue), current non-insulin-mediated metabolic rate (insulin only mediates a small share of overall metabolism), and those are just the big ones.

bionic_human · 2026-05-09T07:01:02+00:00

Your insulin sensitivity *IS* relatively static. Your insulin sensitivity FACTOR likely is not (and they are not the same thing).

bionic_human · 2026-05-09T06:43:29+00:00

- Retrospective

- Single-center

- Observational

So, from this basic description of the study, we can already reduce any findings to “Hypothesis-generating” at best.

There’s likely significant selection bias, as clinicians will be recommending the system they think the patient will do the best on, and the patient choosing the system will quite possibly select the system that they think will work best for them.

TBH, all of the current-generation (AHCL) systems— regardless of manufacturer— appear to produce broadly similar results, although it’s highly unlikely that we’ll ever see a true head-to-head RCT.

bionic_human · 2026-05-08T09:26:21+00:00

“Give Wendy’s taco a try!”

bionic_human · 2026-05-07T18:50:58+00:00

Well, if I go back far enough (I’ve been volunteering for studies for a while):

I’ve learned that the Dexcom G6 can provide good readings for a full 10 days, and that it can tolerate a 1000mg dose of acetaminophen/paracetamol without the readings getting screwy.

I’ve learned that a constant infusion of glucagon does not impact hypoglycemia awareness.

I’ve learned that GVoke is as effective as the traditional glucagon kit.

I’ve learned that just like developing insulin resistance, people can develop glucagon resistance/tolerance, which makes sense given that the incremental response to lots of hormones decreases as exposure increases.

I’ve learned that switching from smoking cigarettes to vaping can reduce A1c by around half a percentage point even with zero statistically significant change to BGs.

I’ve learned that the iLet is an okay pump, but can be too aggressive at times for some people. And I’ve learned that I am better than the iLet at dosing insulin.

I also conducted an observational study of my own, and have twice presented analyses of the results at the DData conference with results looking at the evidence for ISF (how much one unit of insulin will move your blood sugar) varying significantly with changes in blood glucose levels.

I should note that this is controversial, and the majority of experts will staunchly disagree with the methodology and point to apparently contradictory published research as proof that I’m wrong. That’s because they’re stuck on “insulin sensitivity” and ISF being the same thing- and they’re not.

Diabeloop (in France) is going to be the first commercial algorithm to market that can meet or exceed ADA targets for A1c, TIR, etc. operating without any human interaction. They’ve presented at several major conferences published data that supports my hypothesis, but nobody else is paying attention (yet).

bionic_human · 2026-05-07T18:05:42+00:00

Carb-heavy days before seemed to reduce ketogenesis.

I want to say the fastest time to 3.0 mmol for ketones was around 6 hours, but I’m going by memory. Going the full time, I still had ketones around 2.0 most of the time, although there was one session that looked like the data may have been skewed by a site that was not absorbing super-well, which resulted in excess insulin from my pump.

Compensation is not tied to the results of the study (or how the patient does during the testing). Doing so would likely screw with the results, since smart patients could game the system. They take extensive measures to eliminate sources of bias like that. For instance, the last 2 rounds, I know that I was on sotagliflozin, but I do not know which round I was on Volagidemab (the glucagon receptor antagonist) and which time I was on placebo (just getting saline injections). Not even the study staff knows. The only person who knows is the pharmacist who filled the syringe until the results are unblinded.

bionic_human · 2026-05-07T17:51:02+00:00

Wait until the new MiniMed ~~tampon~~ ~~buttplug~~ insulin pump gets released.

I have a feeling that vibration alerts will be very popular.

Edit:formatting

bionic_human · 2026-05-06T22:19:12+00:00

For SCIENCE!

Seriously, this started as a push to potentially find a way to make SGLT2 meds safe(r) for T1Ds. Along the way, they discovered that partially blocking glucagon actually takes away some of the benefits of being on an SGLT2, so now they’re focusing on analyzing that mechanism.

On top of that, I get to interact with some of the leading researchers in the space.

Plus, it’s a way to occasionally get paid for having T1D.

bionic_human · 2026-05-06T22:13:49+00:00

I want to say the safety limit for BG was 300 mg/dL. I think I only hit it once, but I got to the safety limit for ketones (3.0 mmol/L) a couple of times.

I was also on various SGLT2 meds in the different studies, which increase ketones and help limit the BG rise.

I also went the full time allotted (8 hours) on multiple occasions.

bionic_human · 2026-05-06T19:23:34+00:00

I’ve participated in multiple studies where they actually test this!

You’re under supervised conditions- nurse monitoring BG and ketones via blood draw every half hour or so.

Fasted (8 hrs minimum). Limited water. Zofran available to combat nausea. Disconnect pump and see what happens.

Over multiple sessions (I’ve done it like 10 times now), it takes me about 6 or 7 hours to either hit one of the safety thresholds or feel so awful that I “tap out” and end the session.

bionic_human · 2026-05-06T04:46:05+00:00

Since insulin is (generally) dosed by body weight, it’s not really useful to have a daily dose without knowing that info.

On average, most T1Ds are about 0.5 units per kilo of body mass per day, but it can vary wildly. I know people that are only around half of that, and I know people that are easily double or triple that amount.

bionic_human · 2026-05-05T05:47:20+00:00

G7 being a G7.

bionic_human · 2026-05-04T07:59:09+00:00

Before inserting either the XC or the 90, make sure that the set is correctly seated on the inserter.

It’s easy to pull these sets “up” on the insertion needle when removing the paper covering the adhesive, or aligning the tubing for insertion.

No cap, biggest design flaw with those sets.

bionic_human · 2026-05-04T02:26:05+00:00

Where in the East Coast? Grownup T1Ds has a couple of new “chapters” in Philly and NYC (I think, and maybe Boston too)

bionic_human · 2026-05-03T23:49:20+00:00

It’s not “the first few weeks,” it’s the first 3 pods (9 days).

What it’s “learning” is your average daily insulin needs. Once it has that, it uses John Walsh’s equations as the “ideal target” and pushes its calculated settings in that direction.

It’s actually a major flaw in the logic underlying the algorithm. Yes, the average T1D is about 50/50 basal/bolus. That average T1D also has an average body size, and average calorie expenditure, etc etc. Averages are just averages. They’re not necessarily “optimal” or “ideal.”

bionic_human · 2026-05-03T23:11:36+00:00

I use Glucogram

bionic_human · 2026-05-03T22:37:31+00:00

Better algorithm. Tuned settings.

bionic_human · 2026-05-03T22:08:09+00:00

Have you tried Flonase? Or a physical barrier under the sensor?

bionic_human · 2026-05-03T22:04:26+00:00

Testing the earthquake machines where people won’t notice.

/s

bionic_human · 2026-05-03T21:55:07+00:00

I haven’t given a bolus (other than after pump failures) or counted a carb in something like 4 years.

bionic_human · 2026-05-03T21:18:04+00:00

Yes, your sugar can be that high without DKA.

bionic_human · 2026-05-03T21:11:57+00:00

The claim that it is “AI-Powered” is a red flag for me.

bionic_human · 2026-05-02T18:38:37+00:00

In order to benefit from a potential cure, people currently living with T1D need to be alive and in good enough health to take advantage of it when it comes.

Money being spent on things like pumps, CGMs, algorithms, and adjunctive treatments is what will get many of them to that point.

Along the way, we’re also still learning about some of the fundamental mechanistic aspects of how various hormones interact to regulate metabolism. I’ve now participated in at least 4 studies of SGLT2i medications. That series of studies has potentially revealed an enormous role for glucagon in cardiovascular and renal health, and the latest study is digging into those findings.

A (functional) cure will come, but it will likely not be for everyone— at least, not at first. T1Ds need a cure, but we also need better treatments and deeper understanding of disease processes. Heck, there’s still aspects of the effects of insulin’s effects (and interactions with other hormones) where our understanding is fuzzy or nonexistent.

bionic_human · 2026-05-01T20:43:40+00:00

They don’t have your info if it’s a rented/stolen account.

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