Metformin is without doubt one of the hottest oral medicines used to deal with individuals with sort 2 diabetes.
Taking metformin as prescribed can assist decrease each blood sugar ranges and HbA1c ranges (a measure of glucose management over the earlier 2 to three months) and struggle insulin resistance (a situation by which the physique doesn’t use insulin effectively).
Though it’s not permitted by the U.S. Meals and Drug Administration (FDA) as a weight-loss therapy, it may well additionally assist individuals drop a few pounds, in some circumstances.
This text will define every little thing you want to find out about this in style diabetes drug.
What’s metformin?
Authorized in the US in 1994 and studied in people for the reason that Nineteen Fifties, metformin is a prescription drug taken to assist handle diabetes. It’s the solely obtainable drugs in a category of medicine referred to as biguanides, and it is available in capsule type and liquid type.
Metformin tablets can be found in each immediate-release and extended-release formulations. Relying in your administration wants and the kind of drugs you take, it’s possible you’ll be instructed to take your treatment both each day or two or 3 times each day with meals.
Metformin model names
Some model names embody:
- Fortamet
- Glucophage
- Glucophage XR
- Glumetza
- Riomet
- Riomet ER
Metformin can be an ingredient in quite a lot of mixture medicines.
Learn extra: Metformin Mixture Medication for Sort 2 Diabetes.
How does metformin work?
Metformin lowers blood sugar ranges by three strategies:
Together with adopting a nutritious diet and interesting in common bodily exercise, this may result in decrease blood sugar ranges, decreased HbA1c ranges, and, generally, weight reduction.
Widespread unintended effects of metformin
Most individuals tolerate metformin nicely. It’s thought of extraordinarily protected and doesn’t sometimes trigger harmful hypoglycemia (low blood sugar) until you are taking considerably greater than prescribed or are utilizing it together with different medicines that may trigger low blood sugar, akin to insulin or a sulfonylurea.
It’s an affordable and efficient treatment that’s extensively accessible. Nonetheless, some individuals might expertise gentle to average unintended effects, together with:
- Stomachache
- Abdomen cramps
- Nausea
- Vomiting
- Diarrhea
- Lack of urge for food
- Weight reduction
- Metallic style within the mouth
- Weight achieve (uncommon)
Much less widespread however extra critical potential unintended effects of metformin embody:
- Hypoglycemia (if taken together with insulin or sulfonylureas)
- Lactic acidosis (a doubtlessly deadly situation by which lactic acid builds up within the physique)
- Vitamin B12 deficiency
You possibly can study extra about potential unintended effects in our article: Metformin Aspect Results: What You Must Know.
Hypoglycemia
Metformin not often causes hypoglycemia in individuals with diabetes who usually are not additionally on insulin (or one other drug that will increase insulin manufacturing) as a result of it doesn’t improve insulin manufacturing like many different diabetes medicines.
Name your physician if in case you have any signs of hypoglycemia, which may embody:
- Weak spot
- Tiredness
- Nausea
- Vomiting
- Abdomen ache
- Dizziness
- Lightheadedness
- Abnormally quick or sluggish heartbeat
Lactic acidosis
Metformin comes with a “black field” warning in regards to the threat of lactic acidosis, probably the most extreme warning that the FDA points.
Signs of this situation can embody:
- Nausea
- Vomiting
- Weak spot
- Fatigue
- Quick, deep respiratory
- Muscle cramps and physique aches
Nonetheless, within the research “High quality and Traits of 4241 Case Stories of Lactic Acidosis in Metformin Customers Reported to a Giant Pharmacovigilance Database,” researchers examined over 4,000 circumstances the place metformin was suspected in lactic acidosis incidents, as reported to a serious database.
They discovered that precise metformin-associated lactic acidosis was confirmed in solely 9 p.c of those circumstances.
The research highlighted that top ranges of lactate within the blood, fairly than metformin ranges, have been linked to larger dangers of loss of life, particularly when coupled with kidney points.
This analysis is probably the most in depth thus far in exploring the true impression of metformin on extreme lactic acidosis, suggesting that the drug is basically protected (however warrants additional investigation in particular teams of individuals).
Nearly all of circumstances of lactic acidosis from metformin use are outcomes of overdoses — not regular use of the drug.
Learn extra: Can Metformin Trigger Lactic Acidosis?
Metformin and vitamin B12 deficiency
In research, researchers have discovered that long-term use of metformin may cause vitamin B12 deficiency. Left untreated, this may result in important nerve injury.
Everybody taking metformin ought to have their B12 ranges examined yearly. In session with their healthcare supplier, anybody with insufficient ranges ought to begin taking a B12 complement instantly. (Vitamin B12 injections each few months could also be really useful in some circumstances.)
As a result of vitamin B12 isn’t produced by vegetation, supplementing with the vitamin in case you are vegan or eat a largely plant-based food regimen could also be particularly vital.
Metformin and “false lows”
Some individuals expertise “false lows” (signs of hypoglycemia even when blood sugar ranges are inside regular vary) when beginning metformin.
This could occur in case you’re used to having near-constant excessive blood sugar ranges. As a result of your physique is used to those excessive ranges, a standard blood sugar stage feels low.
The false lows ought to go away as your physique adjusts to your new blood sugar stage. (At all times verify your blood sugar in case you are feeling low, because it will not be a false low.)
Find out how to take metformin
Metformin must be taken entire (not crushed, damaged, or chewed) with a drink of water with a meal to assist keep away from an upset abdomen.
Attempt to take it with a higher-protein meal or snack, and by no means take metformin on an empty abdomen. The medication is normally higher tolerated within the night, so taking it with dinner is greatest.
If you’re experiencing extreme gastrointestinal points whereas taking metformin, communicate along with your physician. They might cut back your dose or change you to an extended-release model of the medication.
As a result of the extended-release drugs is launched over a couple of hours as a substitute of instantly, it’s possible you’ll expertise fewer digestive unintended effects with this method.
(Notice that when utilizing the extended-release type of the pill, it’s widespread and never a trigger for concern to seek out a part of the pill in your stool. This happens after the treatment has been absorbed by your physique.)
Dosages of metformin
The most typical doses for adults with diabetes are:
Quick-release tablets:
- 500 milligrams (mg)
- 850 mg
- 1,000 mg
Prolonged-release tablets and liquid type:
It’s really useful to start out with a low dose and improve it in case you tolerate the drug nicely and want a better dose to control your blood sugar ranges. At all times verify along with your physician first earlier than rising your dose.
Learn extra: Metformin Dosage Information (Min and Max Doses).
What must you do in case you miss a dose?
Take your metformin as quickly as you possibly can, until it’s nearly time in your subsequent dose. In that case, skip the missed dose and resume your common schedule until your supplier advises in any other case. Don’t take two doses at one time.
Are you able to overdose on metformin?
Sure, that is potential, but it surely’s very uncommon. A big overdose may cause extreme and doubtlessly harmful hypoglycemia or lactic acidosis.
Search emergency medical consideration in case you suppose you might have overdosed.
When will I see outcomes after beginning metformin?
The Mayo Clinic notes that “You might discover an enchancment in your blood glucose management in 1 to 2 weeks, however the full impact of blood glucose management might take as much as 2 to three months.”
Be affected person. Preserve frequently checking your blood sugar ranges and taking your treatment, and it is best to finally see important enhancements from this treatment.
Work along with your healthcare supplier to find out how your present metformin dose is working for you, and what (if any) changes must be made to enhance outcomes or reduce any unfavourable unintended effects it’s possible you’ll be experiencing.
How do I do know if the treatment is working?
Metformin’s effectiveness may be gauged by means of a number of indicators. A discount in blood sugar ranges and HbA1c, noticeable after a couple of weeks to months, usually signifies that it’s working. Some individuals may expertise modest weight reduction.
Nonetheless, persistent excessive blood sugar ranges, no enchancment in HbA1c, or unexplained weight achieve regardless of a wholesome life-style may recommend that it’s not working as supposed.
For a extra detailed understanding, learn: Indicators Metformin Is Working (Or Isn’t Working).
Can I cease taking metformin?
Stopping metformin must be a fastidiously thought of resolution, prompted by lack of effectiveness, extreme unintended effects, or adjustments in your healthcare wants and life-style.
It’s essential to not cease the medication abruptly, since this may result in unfavourable well being results akin to excessive blood sugar and potential diabetes issues. At all times communicate along with your physician for steerage on easy methods to wean off the drug. This will contain adjusting the dosage over time and exploring different medicines or life-style adjustments.
For additional insights, learn: Stopping Metformin: When and How You Can Cease Taking Metformin.
Are there different medicines?
Whereas metformin is a extensively used and efficient therapy for sort 2 diabetes, it might not swimsuit everybody because of unintended effects or lack of efficacy. Happily, quite a lot of different treatment choices exist, every with their very own advantages and potential unintended effects.
Life-style adjustments like food regimen and train may also be efficient, both to be used alongside a unique drugs or as standalone therapies, in some circumstances.
It’s vital to talk along with your healthcare supplier to seek out probably the most appropriate different based mostly in your particular person wants and circumstances.
For an in-depth take a look at these choices, see: The Greatest Options to Metformin for Sort 2 Diabetes Administration.
Who mustn’t take metformin?
Individuals with sure situations could also be suggested in opposition to taking metformin. Communicate along with your physician previous to taking this drugs in case you:
What medicine to keep away from whereas taking metformin
The Mayo Clinic lists the medicine that will work together negatively with metformin.
Utilizing metformin with the next medicines just isn’t really useful. If you’re on any of those medicines, work along with your physician to find out one of the best method:
- Acetrizoic Acid
- Diatrizoate
- Ethiodized Oil
- Iobenzamic Acid
- Iobitridol
- Iocarmic Acid
- Iocetamic Acid
- Iodamide
- Iodipamide
- Iodixanol
- Iodohippuric Acid
- Iodopyracet
- Iodoxamic Acid
- Ioglicic Acid
- Ioglycamic Acid
- Iohexol
- Iomeprol
- Iopamidol
- Iopanoic Acid
- Iopentol
- Iophendylate
- Iopronic Acid
- Ioseric Acid
- Iosimide
- Iotasul
- Iothalamate
- Iotrolan
- Iotroxic Acid
- Ioxaglate
- Ioxitalamic Acid
- Ipodate
- Metrizamide
- Metrizoic Acid
- Tyropanoate Sodium
Utilizing metformin with any of the next medicines is often not really useful, however could also be required. On this case, your physician might alter the dose or how typically one or each of the medicines is used. Communicate along with your physician to determine what’s going to work greatest for you:
- Abiraterone Acetate
- Acetazolamide
- Alogliptin
- Aspirin
- Bexagliflozin
- Bictegravir
- Brinzolamide
- Bupropion
- Capmatinib
- Chloroquine
- Chlorpropamide
- Cimetidine
- Ciprofloxacin
- Dasabuvir
- Delafloxacin
- Dichlorphenamide
- Dofetilide
- Dolutegravir
- Dorzolamide
- Enoxacin
- Fedratinib
- Fexinidazole
- Gatifloxacin
- Gemifloxacin
- Glimepiride
- Glipizide
- Glyburide
- Grepafloxacin
- Hydroxychloroquine
- Insulin
- Insulin Aspart, Recombinant
- Insulin Bovine
- Insulin Degludec
- Insulin Detemir
- Insulin Glargine, Recombinant
- Insulin Glulisine
- Insulin Lispro, Recombinant
- Iopromide
- Ioversol
- Isavuconazole
- Lanreotide
- Levofloxacin
- Levoketoconazole
- Liraglutide
- Lomefloxacin
- Methazolamide
- Moxifloxacin
- Nateglinide
- Norfloxacin
- Octreotide
- Ofloxacin
- Ombitasvir
- Paritaprevir
- Pasireotide
- Pioglitazone
- Pramlintide
- Ranolazine
- Repaglinide
- Semaglutide
- Sitagliptin
- Somatrogon-ghla
- Sotagliflozin
- Sparfloxacin
- Tafenoquine
- Thioctic Acid
- Tolazamide
- Tolbutamide
- Topiramate
- Trovafloxacin
- Vandetanib
- Zonisamide
Keep away from extreme alcohol use when taking metformin. Communicate along with your physician about how a lot, if any, alcohol use is protected for you.
Be taught extra about this mixture in: Metformin & Alcohol: Can You Drink Whereas Taking Metformin?
Widespread questions on metformin
How ought to the tablets be saved?
It’s really useful to retailer the tablets at room temperature, between 68 to 77 levels Fahrenheit (20 to 25 levels Celsius) however they are often stored safely at 59 to 86 levels Fahrenheit (15 to 30 levels Celsius) for some time in case you are touring.
The tablets ought to at all times be saved in a light-resistant container (just like the container they initially got here in) away from warmth and extra moisture.
Can metformin trigger hair loss?
No, metformin just isn’t a identified reason for hair loss.
Nonetheless, long-term use of metformin may cause vitamin B12 deficiency. This could in flip forestall hair follicles from receiving oxygenated blood, resulting in hair loss. Ask your physician for a vitamin B take a look at in case you discover hair loss or thinning hair.
Do I would like to vary my food regimen?
Adjusting your food regimen whereas taking metformin is important for maximizing the medication’s effectiveness and minimizing widespread unintended effects. Though no particular meals are strictly prohibited, it’s advisable to restrict alcohol, saturated and trans fat, refined carbohydrates, and high-sodium objects. Specializing in a balanced food regimen wealthy in entire fruits, greens, lean proteins, and lower-fat dairy can assist improve metformin’s advantages in managing blood sugar ranges.
Extreme consumption of sure objects can decrease the drug’s effectiveness and worsen unintended effects.
For detailed steerage on optimizing your food regimen whereas on metformin, learn: Meals to Keep away from Whereas Taking Metformin.
Can I take advantage of metformin if I’m pregnant (or making an attempt to develop into pregnant)?
It might be protected to think about taking metformin in case you are pregnant or plan to develop into pregnant. Nonetheless, at all times speak to your physician in regards to the medicines you are taking while you’re pregnant or making an attempt to develop into pregnant.
Are you able to develop into hooked on metformin?
No, there is no such thing as a proof that metformin is addictive.
Does metformin trigger most cancers?
In 2019, the FDA investigated whether or not some types of metformin contained excessive ranges of a chemical referred to as N-nitrosodimethylamine (NDMA), which is doubtlessly carcinogenic (cancer-causing).
In 2020 and 2021, a number of corporations voluntarily recalled sure a lot of extended-release metformin based mostly on the FDA’s suggestions. You possibly can verify to see in case your metformin was included in these remembers right here.
Even in case you take a metformin product that has been recalled, it’s vital that you just proceed to take your treatment till you speak to your healthcare skilled.
There isn’t any short-term well being threat — no human most cancers circumstances have been instantly linked to NDMA presently — and the unfavourable results of abruptly stopping metformin therapy far outweigh the advantages.
Testing by the FDA didn’t present NDMA in immediate-release metformin merchandise.
Are there different advantages of metformin?
Metformin is at the moment getting used to deal with gestational diabetes (a sort of diabetes that happens throughout being pregnant) and polycystic ovary syndrome (PCOS, a situation by which a lady’s hormones are out of stability, ensuing within the improvement of small, cyst-like sacs on the ovaries).
The American Diabetes Affiliation has mentioned that extra medical doctors must be prescribing metformin to their sufferers to deal with prediabetes (a situation by which blood glucose ranges are excessive, however not within the vary for a diabetes prognosis) as nicely, particularly for individuals beneath the age of 60.
Researchers are additionally learning if metformin can assist within the struggle in opposition to situations together with most cancers, coronary heart illness, weight problems, neurodegenerative situations (like Huntington’s illness and Parkinson’s illness), age-related macular degeneration (AMD), and even function an anti-aging complement.
Metformin and sort 1 diabetes
Metformin just isn’t at the moment permitted in the US or Europe for the therapy of sort 1 diabetes.
Nonetheless, many individuals with sort 1 diabetes take metformin “off-label” (in a means not permitted by the FDA) to assist handle blood sugar ranges, reduce insulin resistance, and even drop a few pounds.
A 3-year research revealed within the journal The Lancet discovered that contributors with sort 1 diabetes taking metformin misplaced weight in comparison with placebo (inactive therapy).
Analysis has proven that metformin might assist cut back blood glucose ranges in individuals with sort 1 diabetes. Metformin has been proven to cut back required insulin doses in addition to HbA1c ranges in individuals with sort 1 diabetes.
Bear in mind that taking metformin whereas on insulin for sort 1 diabetes may cause decrease blood sugars and the necessity for much less insulin. Subsequently, it is very important be conscious of potential hypoglycemia, particularly in a single day.
Last ideas
If you’re an individual with sort 2 diabetes, taking metformin is a simple, cheap, and efficient option to decrease your blood sugar ranges, cut back your HbA1c stage, enhance your insulin sensitivity, and possibly even lose slightly weight.
The unintended effects are normally gentle and the drug is taken into account very protected. And since there are such a lot of generic types, metformin is extraordinarily reasonably priced (and it’s lined by almost all medical health insurance plans, together with Medicare and Medicaid).
In case your blood sugar ranges usually are not at goal along with your present therapy, communicate along with your physician about the potential for including this treatment to your diabetes administration.
