Prescription drugs holding me back???
 

I've been riding for a while and put in about 60 to 80 miles per week. I have lost weight and feel better but my stamina isn't where it should be. I hydrate well so that is not a problem. I've never completely bonked but it seems that my legs give out much too soon. Spinning is more tiring than mashing and while hills are getting easier, I lose power before the crest. I can't do a hill without breathing heavily but I can still hold a conversation.

I am a 57 yo overweight type 2 diabetic and have had high blood pressure. My weight is dropping so I'm on the right track. I take the following meds: Glucoyhage, Diovan, Zocor, Niaspan and an Aspirin. My blood sugar and blood pressure is under control.

The question is, could one or more of these medicines have an effect on stamina and/or lactate acid build-up or flushing? I asked my doctor and he wasn't sure and is looking into it. Since some of you are in the know, perhaps a quicker answer may happen.

Thank you.

When i first saw the title first thing i thought was this rider must be on a beta-blocker (metoprolol, atenolol, etc). I was wrong. If flushing is a problem, it's definitely the Niacin. Although if you are taking the Niacin in the evening and riding in the morning, that should not be a factor.

Both Niacin and Zocor taken together (even taken seperately) can cause a condition known as rhabdomyolysis (sp?)--breakdown of the muscle--general muscle soreness. Have your LFT's(liver function tests) checked. Talk with your doctor about holding one of the two above medications for a few weeks and see if it has any effect on your well being.

Also, how much weight have you lost and in what amount of time? Too quick ofa loss may result in fatigue.

Cholesterol drugs are known to cause muscle pain and weakness. Is your cholesterol even high? Glad to hear you are losing weight. You may want to try some natural supplements-they really work. All those drugs may not be good for you long term.

i dont know of your specific drugs can affect stamina but i know that some do. i was on topamax for epilepsy and it made me a lump. absolutely tore me apart.

good luck

Lipitor and other cholesterol drugs are known to cause cramping, especially in the calves. Levoquin, Cefaclor, and other flouroquinine based antibiotics are known to cause tendonitis, especially in the achille's tendon.

Az

Thank you for the responses. Regarding the weight loss, it has been reasonable and gradual so that shouldn't be a problem. I don't experience unreasonable muscle soreness, just a lack of stamina. I do occasionally have evening cramps but never during cycling. (Wow, a cramp while clipped in is a frightening thought.)

I tend to trust doctors but I will discuss some of your comments next visit.

Thank you.

Terribly sorry i missed this on the first read but you stated you are taking Glucophage. Lactic acidosis is a condition that can be caused by metformin. If your hydration status is off, as such can happen during long intense exercise, that may worsen the situation. Seeing that you are approaching 60, your kidney function naturally declines with age and may also be a factor. We generally dose metformin on the lower end depending upon kidney function as the drug is approximately 90 % excreted in the urine. Bad kidneys or less than optimal kidney function results in drug accumulation therefore resulting in increased side effects.

Lactic acidosis is a very very rare side effect and is very serious if it actually occurred. 50% of cases being fatal. I do not know if mild excessive accumulation can cause a mild case of acidosis that may have lead to your symptoms.

I can speak to the Niaspan and Aspirin - no worries with them. I take 3000 mg of niaspan, plus the 81 mg aspiring with no adverse affect on riding. I've no idea about the others, but some here have addressed them. I would concur that other heart/blood pressure drugs (toprol/metoprolol, altenolol) can definitely do it. Metoprolol held my heart rate way down - 40 resting HR and my initial dosage (50 mg) made me a sleepy sack of coal. Altace doesn't affect me, but it has done the same for a friend, but you don't indicate taking any of these.

The Niaspan is well know for causing flushing, but usually only short-term - a few hours. Take it before bed to minimize issues from it.

It may simply be the need to build up more endurance on climbs - I still can seem to wear out on climbs, but I'm better than I was and am developing better technique (lower gears).

every one of those drugs can mess with your system, so yes

I suspect Metformin is the problem with both of us. I think that though many Quacks urge diabetics to exercise more, they do not really understand the nature of cycling as an exercise, and thus, the effect that Metformin may have on our riding. I now take 1/2 of the recommended dose, and take it AFTER I ride. The combination of insulin pump, Byetta and other drugs have my A1c at 6.0 now for 6 months, but I'd really like to "lose the burn" going uphills - some is expected , but not what I normally get. It is a b*tch getting old!

More than a few clients tell me that getting old is not the golden age. Even with wealth accumulation, they cannot enjoy the things they're "supposed" to . So seize the moment, and enjoy the bicycling as much as you can.

if you are a cyclist you can pretty do what you like long past runners and weight lifters

it is one sport that if you dig it, you can do it for-freakin-ever because it is so kind to the body

You don't have to worry about bonking until you're doing 60-80 miles in a single ride. Even so, make sure your glucose-level doesn't drop too much during a ride, eat steadily to keep it up.

As for stamina, it'll come with more training; you might be expecting too many results too soon. You'll want to put in about 2-months of what's known as "base mileage", which is doing LONG rides at a steady-state speed, say... 16-18mph. Increase your weekly total about +10-15% a week until you're doing about 200-300 miles/week with 50-60 miles on a single ride. This endurance is the 1st step towards building stamina.

The 2nd part comes with doing intervals. These are short 1-5 minute efforts above LT where your heartrate steadily increases to max. It's the last half of these intervals where you feel like you're gonna gag up your lungs and your legs are gonna fall off from the searing pain that really builds up the stamina.

So the short answer is... more training. Have fun! :)

Do you really take Metformin AND use an insulin pump? I've never heard of that before.

And yes...It is a b*tch getting old.

Combining insulin(whether it be pump or injection) and metformin is a common and accepted practice. Metformin's mechanism of action actually has nothing to do with lowering blood glucose levels directly. Metformin works by increasing the sensitivity of your receptors to insulin. This can actually help you lower the amount of insulin needed to achieve your glucose control.

Your situation is too complex to offer an intelligent answer. And your comments are a perfect example of what's wrong with many aspects of modern medicine.

The idea that you come and post comments about drugs, without "owning up" to the types of behavior that have got you into your situation generates the same kind of wrong headed "reactive" diagnoses -- much like the idea of a "drug for every occasion."

Suffice to say, that exercise and calorie restrictive diets make the dosing and timing of medications much more complicated if an individual is to avoid side-effects. You need to inform yourself about the nature and indications of dosing of your drugs as well their side effects.

You should be prepared to offer an accurate summary of your diet and exercise to your pharmacist and doctor if you want any real help. Bull-spitting on the Internet is hardly the best place to start, go read the fine print on your drug prescription instructions etc........

The question wasn't a hope for an excuse but was a simple request for information because things seemed to be a bit slow in the stamina department. I wasn't looking for a diagnosis but simply wanted to know if any of the mentioned medications directly affected stamina. BTW, since three grandparents and one parent had diabetes as well as various aunts, uncles and cousins, I also had the heredity problem to deal with along with the things under my control that I have recognized and dealt with. I have owned up to my past problems and as stated have been losing weight and do have the diabetes under control.

Danno...Your response makes sense. To everyone else, thank you for your comments.

well...yeah but

partly that is the case. metformin main action is a decrease in glucose uptake in the gut. take 2000mg metformin daily for a week...then drink gatorade while doing a serious hard ride. you will end up dehydrated and have the trots from hell after 50 miles. metformin does 3 things...helps prevent glucose hitting the blood in the first place...keeps it in the gut (and that requires water)...punches the liver to slow it's output, and increases insulin sensitivity in the cells. all great things to keep a sedentary person who doesn't wish to micro manage the diet in good bg control, but tough and unpredictable to manage for an endurance athlete. if a person were to eat mostly fats and protein they could cut some of the metformin way back.

everyone gets a different result from metformin. if it was me I would work my butt off to do whatever it takes to get off the meds, plain and simple. insulin is the only thing that is really 'clean'...but of course some type 2's have such insulin resistance they need to take huge TDD...sometimes 3 or 4 times as much as a type 1...so in those cases insulin is paired with meds.

My point wasn't to give the overall pharmacology of metformin but rather to inform MAX that combining the 2 is common practice and that metformin typically decreases the amount of insulin needed. Aside from your personal experience and opinion of Metformin, the MAIN mechanism of action is decreased glucose production from the liver (decreased intestinal absorption is a minor effect although maybe for you personally it may have a more pronounced effect). The biggest benefit of this drug is that it does not cause direct hypoglycemia like the sulfonylureas (glipizide, glyburide). That is of benefit to athletes. The actual bigger concern with Metformin is it's propensity to cause lactic acidosis which can be fatal. One way to reduce this risk is to stay well hydrated. During truly intense exercise, i would consider skipping my dose beforehand.

All in all it is difficult to manage diabetes as it is and intense or endurance activity makes it more difficult to manage.

MAK,
I am 47 years old, Type-2, have HBP, and have a stent in my heart, so I'm on the same meds as you + more. I have lost weight over the past year, and have my HBP and blood-sugar under control, but am still on the meds. My doctors will ween me off of some within the next 6 mos. or so. A few I will be on for years, maybe life. I will be getting off as much as I can, as soon as I can, but not until the time is right ... I'm not pushing it. It will happen.

To your point ... I take metformin (glucopage) twice a day, and glipzide (5 mg.) for my diabetes. Lysinopril for HBP, and Coreg (beta-blocker), aspirin and Plavix for my heart. And, Lipitor for my chloresterol. I was having similar problems with my stamina, and sore aching quads. Not sore muscles after a ride, but I felt like there was an excess of lactic acid in my quads all the time when riding, even on an easy ride. My doctor cut my Glipizide from 10 mg. down to 5 mg. (because I started to have alot of blood-sugar crashes). Now, I don't seam to have the soreness in the quads. I also take it at night now, instead of the morning, so my sugar doesn't crash after my daily rides like it used to. I know the Coreg (beta-blocker) is what is causing my stamina problem as it has lowered my metabolism (losing weight has been slow), and I don't always feel like riding hard. What I do to combat that, is drink either a cup of green tea (caffeine) before I ride, of use a GUE gel with caffeine before I ride. Recently my rides have been MUCH better, and more enjoyable. I'm not sure if the metformine actually affects my riding, since the aches in the quads have seamed to go away since I cut the glipizide dose and changed the time I take it. All I know, is that for me my rides have gotten better.

The next thing to get off of is the Lisinopril for the HBP, since I can't get off the beta-blocker anytime soon. I figure getting off the BP meds will help me get my metabolism back up to speed. At least closer to where it should be. Right now, I haven't been able to reach MHR no matter how hard I try. The Coreg just keeps my heart working so slowly ... my HR is around 60 (when hanging around the house), while my BP has been around 110/60 (even lower after my rides). When I ride hard I can't get my HR above 145, no matter what I do.

I have no problem riding long distances (150+ miles/week), but I do fatigue sooner than I used to before I got fat and sick, and had to come-back from the dead. Now, I pay very close attention to my hydration, and fuel intake. I have recently completed a VERY hilly century and had NO problem with my hydration, or my fueling. My sugar is fine on long rides, but I have to keep up with my sugar levels after the ride to keep from crashing (not as bad lately).

What I have found ... some prescription meds affect your cycling, and some don't. The bottom line, is that by paying attention to your bodies signals, and being aware of what meds you are on, you can keep the problems to a minimum.

By asking your question, you have taken the correct first steps. Good luck.

skipping a dose of met beforehand won't do a whole lot. if you plan to adjust for riding you need to plan days in advance

steady state plasma concentrations of metformin are reached within 24 to 48 hours

skipping once won't really do much as the half-life is around 8 hours


anyhow only an endo with experience specifically regarding 'sport and athletes with diabetes' can give proper advice
to any individual...that and a phlebotomist in the side pocket


if you are very lucky and just a type 1 like me it is easy. just take insulin, test, and hammer. I have a slight
advantage (maybe...but certainly no disadvantage) over a normal person (but it takes time away from me to
manage and yeah I have a monkey on my back that if I ignore will kill me in 36 hours or less)


if type 2, get to 10% body fat, then recompute med needs. if you are not getting to 10% body fat
then you need to get there by eating less, plain and simple no excuses no magic trick... do it

if you have complications, other issues, immunosuppression therapy ...then just being able to ride
at all is a bonus...find a doctor willing to test you in a human endurance lab along with your meds
and try to dial them in for optimal performance without sacrificing what the meds are for


no one on the internets can offer better advice than: find a doc who makes it his/her hobby to
work specifically with athletes and increase performance.

"skipping once won't really do much as the half-life is around 8 hours"

Actually, if you are taking metformin every 12 hours (some take it every 8 hours), skipping one dose will lower your level of metformin by about 35% so that is a significant drop. The elimination half-life of metformin is approximately 17 hours after reaching steady state. Skipping 2 doses would bring your blood level to less than 50% of steady state level.

The 8 hour half-life you quoted is from data representing a single dose of the 850mg tablet taken. The elimination half-life is the true representation of what actually occurs in the body. Elimination half-life is measured once a patient reaches steady state concentrations.

Not trying to be smug but wanted to clarify the pharmacokinetics of the drug.

no problem I am only speaking from experince taking 1000 a day for a summer and trying to be a hammerhead, so I have done experimentation while doing sustained efforts right on the LT

I am chiming in here a little late, but I am also a type 2 diabetic and have high blood pressure and have a pretty hard time finding medicine that won't affect me while riding. I used to have a Dr. that didn't really care about what affects certain meds were having one me so I switched. I really don't think Glucophage bothers me, but Lipitor did and I had a combination of BP meds that did as well.

Just like others have said this isn't the place for advice, but many medications will affect you and you need to find a Dr that will work with you so you both manage you illnesses and still ride strong. I am 54 years old and ride about 6,000 miles a year between road and mountain and I ride with some pretty strong guys and gals.

It is possible, but you do have to work at it.

And like you I have inherited my problems, because I have never been over weight and have always been active. You can't pick your parents nor there relatives. Some of us get good genes and some don't.