Metformin and Fasting

One of the penalties for indulging in junk food and not exercising, besides obesity, is metabolic problems, like (pre)diabetes.  As I've confessed in previous blog entries, I haven't been taking dieting seriously, and now I've crossed into the (pre)diabetes zone.

Currently, I'm faced with the dilemma of whether or not to take the medication prescribed to me for glucose intolerance.  I tried it for a day and a half, had some strange symptoms (pain in my right side, feeling very fatigued), and decided to stop taking it.  My doctor wants me to take the medicine for a couple months and then test my blood levels again, at which point he'll decide if I've done well enough in my diet to be able to cut the dose in half, or if, according to his attitude, a miracle occurs and I don't need to take it anymore.

One option is to skip the pills and go balls to the wall on eating clean, exercising, and fasting to shed my weight and naturally get my metabolism back in the healthy zone.

The other option is to take the medication while doing the same.  I'm not sure how to manage intermittent fasting (IF) with the medicine.  A google search pops up all sorts of opinions, typically the scaredy cat admonition that diabetics must never skip meals and probably should be eating at least a few bites every 20 minutes.  A few people not terrified of IF offer different advice: take the pill, skip the pill.  But I haven't seen any solid information, either from someone who was taking the medication while doing the primal/paleo thing with IF, or from someone with more than a few half-informed notions of what's what.

If I send a message to my doctor's nurse, I'll get an answer in anywhere between 4 hours and 2 weeks.  Asking him, or the nurse, about whether to take the pills when I fast, there is a good chance he or she will say that skipping meals is baaaaad and not be helpful one bit.

OK, for the nitty-gritty:

Lab Results

Feb 13, 2014:

weight	(lbs.)	~240	(165-175 is my goal)
fasting blood glucose	(mg/dL)	122	(70-105 is normal)
cholesterol	(mg/dL)	197	(≤ 200 is "good" *)
HDL	(mg/dL)	43	(40-59 is "OK", ≥ 60 is "good" *)
LDL-calculated	(mg/dL)	139	(≤ 100 is "optimal" *, 100-129 is "OK" *, 130-159 is "borderline high" *)
triglycerides	(mg/dL)	76	(≤ 150 is "normal" *)

Jun 12, 2014:

weight	(lbs.)	~222	(165-175 is my goal)
fasting blood glucose	(mg/dL)	86	(70-105 is normal)
hemoglobin A1c	(DCCT %)	7.0	(4.0-6.0 is optimal for non-diabetic, ≥ 6.5 is a criterion for the diagnosis of diabetes)

* Some of the comments on the evaluation of given ranges are surrounded by scare quotes, due to the common wisdom of medical providers having a tendency towards being wrong, particularly on the subject of lipids.

The A1c glycated hemoglobin is a marker they use to estimate the average blood glucose level over the previous three months.  I've searched for the meaning of the number and gotten a variety of different interpretations for a 7.0%.  According to Wikipedia, that indicates a mean glucose level (mg/dL) of 154±31 (123-185).  My doctor said the cutoff for diabetes type 2 is 6.5%, but then he wrote on my chart a diagnosis of ICD-9 277.7, which is commonly called "prediabetes", but more formally called "metabolic syndrome X" or "insulin resistance syndrome".  So, I'm not sure if he thinks I am actually diabetic, or just flirting with it.

Prescription

Glucophage (Metformin) 500 mg pill, twice a day with meals.

I took it three times, starting in the evening of my doctor visit.  I admit I was shaken up by his words and his attitude, and worried that if I didn't take the medicine, all sorts of damage would be continuing to wreak permanent havoc.  But when I did take it, I developed a pain on my right side, below the ribcage.  It wasn't the liver or kidney area, so I'm thinking it was general intestinal distress.  I mentioned the dosage to someone who currently takes it and she was shocked that the doctor didn't start me off slowly, taking one pill every other day and working up to the twice a day level, to avoid the intestinal problems.  I also felt very fatigued, which I'm guessing was the medication artificially dropping my glucose.

So, if you have taken Metformin and fasted intermittently (whether it was just skipping a meal or a full 24-36 hour fast), I would appreciate any insight you might have on whether to take the pill during a fast.  Or, if you have expertise on the subject and can provide me with explanations for why I should or shouldn't take the pill, your advice will be welcome.  Otherwise, I'm not looking for guesses or notions.  Only experience or expertise are of interest to me.

Thank you.

Paleo/primal success and failure

Since February 2006, I successfully lost 45 pounds or more three times. Except for the first time, I lost the weight using paleo/primal eating habits. The second time, I used intermittent fasting (IF) twice a week, for 18-36 hours, depending upon how long I could hold out. I exercised towards the end of the fast to maximize fat burning. My workouts were about 20 minutes of interval strength training. The third time, I lost the weight mostly by diet, without a serious exercise program.
The first time, I lost 50 pounds via diet and exercise (mostly walking). Between 1994 and 1999, I had done a lot of weight lifting and swimming. I was under 200 lbs. at the time, and added quite a bit of muscle, so weight loss was not much of a concern to me at the time. The whole diet yo-yo has frustrated me, but I keep trying to reset and try to achieve lasting success.
The reasons for failure: fast food, ice cream, and lack of exercise. The mindset that I'll eventually get around to losing my weight again, just not today, is a denial of reality which can only go on for so long. As Ayn Rand said, "You can avoid reality, but you cannot avoid the consequences of avoiding reality."
Now, the consequence is that I'm facing type 2 diabetes, so the stakes have been significantly raised. I've seen quite a number of success stories of people using a paleo/primal diet and exercise approach, who were able to reverse diabetes and return to normal levels. I prefer to do that than to depend on medication in the long term.

Updated the first couple of paragraphs to more clearly describe previous successes.