Metformin is a well-liked prescription drug that’s used as a first-line remedy for kind 2 diabetes.
For almost all of customers, metformin is efficient and well-tolerated. However if you’re experiencing extreme or persistent unintended effects when taking this medication, or if it merely isn’t working, chances are you’ll marvel if there are every other choices.
The reply is sure. This text will examine one of the best options to metformin for folks with kind 2 diabetes.
Why would you not take metformin?
Metformin helps higher handle blood sugar ranges, battle insulin resistance (a situation wherein the physique doesn’t use insulin effectively), and might even assist with weight reduction. Most pointers advocate it because the first-line remedy for kind 2 diabetes.
It’s also very inexpensive and usually efficient, however that effectiveness can include a price: unintended effects.
Unwanted effects
Metformin may cause a wide range of probably detrimental unintended effects, together with:
For some individuals who have strict work or faculty schedules, enduring a few of these unintended effects will not be attainable.
Moreover, experiencing these unintended effects can even affect different areas of your life. Coping with power gastrointestinal points, for instance, can change into an impediment to consuming properly or stop you from sustaining an everyday train behavior.
Learn extra in: Metformin Aspect Results (Frequent and Critical) and Can Metformin Trigger Lactic Acidosis?
Contraindications
In different instances, folks might keep away from taking metformin as a result of it’s contraindicated (not suggested) to take with many different frequent pharmaceuticals. (Right here is an summary of the medication which will work together with metformin.)
Generally it’s not possible to cease taking one other medication that negatively interacts with metformin, and subsequently, a substitute is important.
Ineffectiveness
And for some folks, metformin merely will not be efficient. It doesn’t assist everybody higher handle their blood sugars, decrease their HbA1c ranges (a measure of glucose management over the earlier 2 to three months), or drop some pounds. The truth is, some folks even acquire weight when taking metformin.
See extra in: Indicators Metformin Is Working (Or Isn’t Working).
Insurance coverage or life-style concerns
Lastly, some folks might decide to not take metformin as a result of their medical health insurance doesn’t cowl it, or they want to handle their diabetes with out the usage of prescription drugs.
Learn extra in: Every thing You Have to Know About Metformin.
What are options to metformin?
The next are some options which you could focus on together with your physician.
(Bear in mind to all the time work together with your healthcare supplier earlier than making any adjustments to your diabetes administration.)
Sulfonylureas
Sulfonylureas are oral diabetes drugs which can be usually taken with or earlier than a meal. They work to decrease blood sugar by growing the manufacturing of insulin from the beta cells within the pancreas. These drugs are normally both taken as soon as a day earlier than breakfast or twice every day, earlier than each breakfast and dinner.
Sulfonylureas embody:
- Glipizide (model title Glucotrol)
- Glimepiride (Amaryl)
- Glyburide (Diabeta, Glynase)
Sulfonylurea unintended effects
Some attainable unintended effects embody:
Thiazolidinediones (TZDs)
TZDs are an oral class of kind 2 diabetes treatment that will increase insulin sensitivity and helps lower glucose manufacturing by the liver.
They’re simply accessible and inexpensive and wouldn’t have a excessive threat of inflicting hypoglycemia.
Thiazolidinediones embody:
- Pioglitazone (Actos)
- Rosiglitazone (Avandia)
Thiazolidinedione unintended effects
Some attainable unintended effects embody:
- Weight acquire
- Elevated threat for coronary heart illness
- Edema (swelling) of ft, legs, arms, and fingers
- Elevated threat for bone fracture
DPP-4 inhibitors
DPP-4 inhibitors decrease blood sugar and HbA1c ranges with out inflicting low blood glucose (except taken with different medicines that may trigger hypoglycemia, corresponding to insulin or sulfonylureas).
They perform by interfering with the breakdown of two hormones within the physique, GLP-1 and GIP, that cut back blood glucose ranges.
These hormones are usually damaged down in a short time. By serving to sluggish this course of, DPP-4 inhibitors enable the hormones to perform for longer, reducing blood sugar ranges solely when they’re elevated.
These medication are taken orally, usually together with metformin, however they are often taken with out metformin as properly.
Learn extra in: Metformin Mixture Medication for Kind 2 Diabetes.
DPP-4 inhibitors embody:
- Sitagliptin (Januvia)
- Saxagliptin (Onglyza)
- Linagliptin (Tradjenta)
- Alogliptin (Nesina)
DPP-4 inhibitor unintended effects
Doable unintended effects embody:
- Low blood sugar, if taken together with insulin or sulfonylureas
- Gastrointestinal points like upset abdomen
- Elevated threat for pancreatitis (irritation of the pancreas)
- Fever, physique aches, and different flu-like signs
GLP-1 receptor agonists
GLP-1 receptor agonists can both be taken orally or via an injection (both as soon as a day or as soon as weekly), relying on the precise medication used. They perform equally to the GLP-1 and GIP hormones within the physique that decrease insulin ranges however are extra proof against being damaged down.
Along with reducing blood sugar and HbA1c ranges, a few of these medicines additionally defend towards coronary heart illness.
Notably, though they don’t seem to be weight-loss medication, GLP-1 receptor agonists can help with weight reduction. In keeping with the Mayo Clinic, research point out that each one GLP-1 medication can result in a complete weight lack of between 10.5 and 15.8 kilos.
GLP-1 receptor agonists embody:
GLP-1 receptor agonist unintended effects
Doable unintended effects embody:
- Nausea
- Vomiting
- Low blood sugar ranges (if taken together with insulin)
- Decreased want for insulin, if on insulin remedy
- Diarrhea
- Weight reduction
SGLT-2 inhibitors
SGLT-2 inhibitors are a category of oral treatment, usually taken every day, used to decrease blood sugar ranges and HbA1c ranges by inflicting the discharge of extra glucose within the urine. They not often trigger low blood sugar.
These drugs can defend towards coronary heart failure and enhance outcomes in individuals who have coronary heart illness, kidney illness, or coronary heart failure.
SGLT-2 inhibitors embody:
SGLT-2 inhibitor unintended effects
Doable unintended effects embody:
- Frequent urination
- Elevated frequency of urinary tract infections (UTIs)
- Elevated threat for kidney harm
- Elevated threat for diabetic ketoacidosis (DKA)
- Dehydration
- Thirst
- Low blood stress
- For Invokana, particularly, elevated threat of amputations
GIP/GLP-1 receptor agonists
The primary medication on this class was authorized in 2022. It’s an injectable drug taken as soon as weekly, and it features by mimicking the actions of each GLP-1 and GIP to assist decrease blood sugar ranges.
Analysis signifies that this treatment results in a median weight lack of about 15 % to twenty %.
GIP/GLP-1 receptor agonists embody:
GIP/GLP-1 receptor agonist unintended effects
Doable unintended effects embody:
- Gastrointestinal points
- Hypoglycemia, significantly when used with one other medication that may trigger low blood sugar corresponding to a sulfonylurea or insulin
- Weight reduction
- Pancreatitis
- Modifications in ldl cholesterol and triglyceride ranges
- Kidney points
- Fatigue and dizziness
Insulin
Insulin has been a cornerstone in diabetes remedy since its discovery in 1921. In kind 2 diabetes, it’s usually used when different medicines don’t present sufficient blood sugar management.
The purpose of insulin remedy is to imitate the physique’s pure insulin manufacturing. It’s administered through injection, infusion (from an insulin pump), or inhalation. The various kinds of insulin differ in onset, peak occasions, and length of motion.
A few of the extra frequent insulins utilized in america embody:
Speedy-acting insulin
- Insulin lispro (Humalog, Admelog)
- Insulin aspart (NovoLog, Fiasp)
- Insulin glulisine (Apidra)
Brief-acting insulin
- Common human insulin (Humulin R, Novolin R)
Intermediate-acting insulin
- NPH (isophane) insulin (Humulin N, Novolin N)
Lengthy-acting insulin
- Insulin glargine (Lantus, Basaglar, Toujeo)
- Insulin detemir (Levemir)
- Insulin degludec (Tresiba)
Doable unintended effects
- Hypoglycemia, significantly if the insulin dose will not be balanced with meals consumption and bodily exercise
- Weight acquire
- Modifications in fats tissue at injection websites
- Allergic reactions, starting from native injection web site reactions to systemic ones
- Swelling of legs and arms
- Insulin resistance, particularly with greater doses over time
Much less-commonly used options
Alpha-glucosidase inhibitors
The starches you eat are damaged down into sugars by your physique. Alpha-glucosidase inhibitors assist decrease blood sugar ranges by blocking the digestion of starches. They’re taken with the primary chunk of every meal.
Alpha-glucosidase inhibitors embody:
- Acarbose (generic solely)
- Miglitol (Glyset)
Alpha-glucosidase inhibitor unintended effects
Frequent unintended effects embody:
- Gastrointestinal points corresponding to fuel and diarrhea
Meglitinides
Meglitinides are a kind of oral treatment that stimulates the insulin-producing beta cells of the pancreas to launch insulin. They’re taken earlier than every meal to assist decrease after-meal blood glucose ranges.
Meglitinides embody:
- Repaglinide (Prandin)
- Nateglinide (Starlix)
Meglitinide unintended effects
Frequent unintended effects embody:
Life-style adjustments
Lastly, adopting wholesome life-style adjustments is all the time an excellent method, whether or not or not you take treatment. Participating in common bodily exercise and consuming a balanced, nutritious weight loss plan may help handle blood sugar ranges, decrease your HbA1c, and probably result in weight reduction as properly.
This can be the most cost effective choice, however it may be laborious to keep up. And it’s additionally not assured that life-style adjustments will can help you cease taking drugs.
Different elements, corresponding to a genetic predisposition for diabetes, could make treatment mandatory, even if you’re in nice bodily situation and in any other case wholesome.
Speak together with your physician and meet with a registered dietitian (RD) to develop an train and consuming plan that may work in your life-style and well being targets.
Last ideas
Whereas metformin is a particularly in style, inexpensive, and accessible drug for kind 2 diabetes administration, it’s not for everybody.
Some folks expertise debilitating unintended effects that make taking this drug over the long run not possible. Others might not have insurance coverage protection for metformin or might not want to take extra medicines, or metformin might merely not be working for them.
Luckily, different choices can be found. Drug courses together with sulfonylureas, thiazolidinediones, DPP-4 inhibitors, GLP-1 receptor agonists, SGLT-2 inhibitors, GIP/GLP-1 receptor agonists, and fewer frequent options like alpha-glucosidase inhibitors and meglitinides can be utilized to deal with kind 2 diabetes.
Adopting wholesome life-style approaches corresponding to elevated bodily exercise and a nutritious weight loss plan can even assist, whether or not or not you’re taking medication.
Do a little analysis to see what your medical health insurance will cowl to guarantee that any adjustments in your diabetes drugs are financially sustainable over the long run.
If metformin will not be working properly and also you need to make a change, converse together with your physician about attainable options, and focus on what is going to work finest for you, your life-style, and your well being targets.
