Metformin,Prascend Question


Hi ,
How long do I give  Metformin ? Forever? Even if her insulin numbers are tested and are good?
After I increase Prascend to 1ml should Saraphina be tested again? And then at 2ml?
how long before I should increase dose from 1ml to 2ml?I just started her on APF,she is on.5ml of Prascend at this time.
does 4 ml of APF sound like the right dose? Seemed like a lot to me.
i apologize if these questions have been answered. I need a refresher!

Cyndi Carlson in Colorado 2021


Hi Cyndi,
Here’s a blurb written on the use of Metformin.   I would keep her on metformin, as long as it seems to be doing the job.  If you take it away, it’s possible the insulin would shoot back up again.  You can test that later when she’s more stable but most likely it’s still working unless you see the insulin increase again.

I wouldn’t bother to test until you’ve reached 2 mg of pergolide, which was the suggested goal for her.  Wait until you’ve had her on 2 mg for three weeks.  I don’t believe you can accurately assess the results of a TRH stim test during the fall rise so you may want to see the results from an endogenous test (before stim) before deciding on how to proceed.

I would think 4 ml of APF is on the low end of the dosing - I believe I used something between 5 and 10.  You can search for ‘APF’ in the messages to see what you find.  There should be lots.  The dose is a bit arbitrary but you may find it helps her in ways that you notice, other than just preparing her for a pergolide increase.

As just a little bit of added information, pergolide (Prascend) is measured by weight and we’re speaking of milligrams (mg) here.  There are 454 grams in a pound and there are one thousand mg in a gram.  The APF is measured in milliliters (ml), reserved for measuring volumes, rather than weights.  A liter is just a bit more than a quart.  Things would be easier, after an initial adjustment period, if the US joined the rest of the world and switched from pounds and quarts to grams and liters.
Martha in Vermont
ECIR Group Primary Response
July 2012 
Logo (dec. 7/20/19), Tobit(EC) and Pumpkin, Handy and Silver (EC/IR)

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Sherry Morse

Martha's already provided you with the info on Metformin but I'd add that since elevated ACTH can drive insulin numbers up you may find that her insulin is better once her ACTH is under control.  Unfortunately the only way to confirm that would be to stop the metformin and then test again after a week or so to see if her numbers are trending up or not.  I would not recommend doing that until she's on the correct dose of Prascend to control her ACTH.

As far as when to retest ACTH - 3 weeks after getting to the target dose, which is most likely going to be at least 2g for Saraphina, although it may well be more.  Since we're heading into the seasonal rise's period of main effect the sooner you can get her to the target dose the better; but you may find at this point you're 'chasing the rise' with her dosing.


Hi Martha,
Thank you for getting this “clutter” out of my head!
Cyndi Carlson in Colorado 2021