## Missed Metformin Dose

I forgot to take my metformin this morning at 7am! OMG! What shall I do?

Well, according to Wikipedia, the half life is between 4 to 8.7 hours. I assumed 6 hours. Thanks to a little googling, the formula to use is below. I modelled it based on taking my morning pill at 5pm when I got home and skipping my evening pill (which is not at 7pm, but usually around 9pm to 11pm), and:

The formula:

I like useful math

## Calories In Minus Calories Out

There was a conversation at work. Simplified:

VP (Visiting Person): “What Kind of Cookies do you have here?”
Me: “I don’t know, I haven’t checked. I’m not eating Wheat right now, and that shelf is all wheat.”
VP: “How’s that going? I’ve heard about that.”
Me: “Pretty good. I’ve lost a few pounds even without exercising.”
VP: “Yep, calories in and calories out.”

My brain took off on that conversation. Hence, this blog post.

### Normal

The assumption is that people simply control the calories out. “Just work out harder”.

```# Powershell
"Normal Situation: "
"Calories In : {0}" -f (\$caloriesIn = 2000)
"Calories Out: {0}" -f (\$caloriesOut = 2000)
"Net Calories: {0}" -f (\$netCalories = \$caloriesIn - \$caloriesOut)
"Gain/Loose {0} lbs per week" -f (\$netlbsperweek = \$netCalories * 7/3500)

Normal Situation:
Calories In : 2000
Calories Out: 2000
Net Calories: 0
Gain/Loose 0 lbs per week```

True, but there’s a twist that I found out, due to my type two.

### Conjecture for DM2

This is only my understanding of it. It is not proven or fact.

The hidden factor for me was insulin release, and and insulin resistance.

Lets say that for the calories I was taking in, my blood sugars bumped up to the 140+ range. Lets assume that I’m not working out actively at the moment. (when engaged in physical activity, some other form of transport happens, and sensitivity to insulin goes up).

My body is desperately trying to shove this energy into my cells, and is pumping out insulin (all that it has). The insulin has the effect of transmuting some of these calories to stored fat – almost immediately – before I have a chance to use it.

```# Powershell
"Actual Situation: (not on drugs)"
"Calories In:  {0}" -f (\$caloriesIn = 2000)
"Converted to fat due to high insulin levels: {0}" -f (\$insulinToFat = \$caloriesIn * 0.15 )   # total guess
"Fat gained per week: {0} lbs" -f (\$fatperweek = \$insulinToFat * 7 / 3500)
"Body must make do with {0}" -f (\$bodyAvailable = \$caloriesIn - \$insulinToFat)
"Feeling as though only consuming {0} calories - ie, starving" -f \$bodyAvailable

Actual Situation:
Calories In:  2000
Converted to fat due to high insulin levels: 300
Fat gained per week: 0.6 lbs
Body must make do with 1700
Feeling as though only consuming 1700 calories - ie, starving```

### My evidence for myself:

There were 2-3 months that I went off my medication, but was watching and logging what I ate.
During that time, I ate 1800-2100 calories a day. Yet, I gained 5 pounds in about 4 weeks.

My deduction:
By storing those 5 pounds => that would mean 17500 calories over 28 days = 625 calories a day.
Which meant that I lived on around 1200-1400 calories a day.
And yes, I felt starved the whole time. (not really starved, but you know, the feeling? I have never really starved, except perhaps once)

### So what the heck does my medication (Metformin) do?

Everything says “it limits the production of hepatic (liver) sugar”.
What does that have to do with anything?

My understanding (only my understanding) is:
The body MUST MUST MUST not get into a hypoglycemic situation – because the brain dies. Therefore, it monitors it very seriously.

As blood sugar gets too low, it tells the liver to go make some more. Its not an all or nothing – its a gradual release type thing. However, its tuned based on “relative” levels of blood sugar, not absolute levels.

Being diabetic, and having repeated elevated blood sugar levels “reset” what my body thinks normal is. So my body is churning out sugar even when I’m at a comfortable spot, like 110. It thinks 110 is low.

By jumping in and cutting that link (or reducing it, anyway), Metformin allows my “average” sugar levels to come back down to what they are now.. a fasting number of 80 or so.

And once I get down to 80.. and if I watch what I eat, such that any meal, 2 hours after, I’m back under 140 (these are numbers I’ve chosen for myself), my body leaves the second equation, and goes back to the first equation. Or maybe, the 0.15 goes down and becomes a 0.5. I don’t know exactly.

What I do know is: If I stay off Metformin, my weight goes up, and my fasting blood sugar levels go up. If I stay on it, and I eat wisely, they come back down to normal levels.

### In Conclusion

All of the above is my explanation to myself.
Its probably wrong. The reality probably has something to do with aliens, monkeys, ninjas, and a turtle.
If you have a better explanation, grand unifying theory of blood sugar, please do post it and point me at it.