Metformin is likely one of the hottest oral medicines used to deal with folks with kind 2 diabetes.
Taking metformin as prescribed may help decrease each blood sugar ranges and HbA1c ranges (a measure of glucose management over the earlier 2 to three months) and combat insulin resistance (a situation through which the physique doesn’t use insulin effectively).
Though it isn’t authorised by the U.S. Meals and Drug Administration (FDA) as a weight-loss therapy, it may well additionally assist folks drop a few pounds, in some instances.
This text will define every part you must learn about this widespread diabetes drug.
Key Factors:
- Metformin capabilities by decreasing glucose manufacturing within the liver, rising insulin sensitivity, and lowering sugar absorption from meals.
- It’s usually taken day by day or two or 3 times day by day with meals and is on the market in immediate-release (IR) and extended-release varieties (XR or ER).
- Metformin is taken into account secure, with a low danger of extreme low blood sugar. Widespread uncomfortable side effects embody gastrointestinal signs reminiscent of stomachache and nausea.
- Past kind 2 diabetes, metformin is being explored for treating situations reminiscent of gestational diabetes and polycystic ovary syndrome (PCOS), and in most cancers, coronary heart illness, and anti-aging analysis. It’s additionally used off-label for kind 1 diabetes and weight administration.
- Quite a lot of medicines might work together negatively with metformin, reminiscent of sure diuretics and antibiotics. Extreme alcohol consumption can also be suggested in opposition to whereas taking metformin.
- The medication is extremely accessible and inexpensive and lined by most medical health insurance plans, together with Medicare and Medicaid. Its cost-effectiveness and broad availability make it a sensible selection for many individuals managing kind 2 diabetes.
What’s metformin?
Accredited in america in 1994 and studied in people because the Fifties, metformin is a prescription drug taken to assist handle diabetes. It’s the solely out there drugs in a category of medication referred to as biguanides, and it is available in tablet 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, you could be instructed to take your treatment both day by day or two or 3 times day by day with meals.
Metformin model names
Some model names embody:
- Fortamet
- Glucophage
- Glucophage XR
- Glumetza
- Riomet
- Riomet ER
Metformin can also be an ingredient in quite a lot of mixture medicines.
Learn extra: Metformin Mixture Medicine for Sort 2 Diabetes.
How does metformin work?
Metformin lowers blood sugar ranges by three strategies:
Together with adopting a nutritious diet and fascinating in common bodily exercise, this may result in decrease blood sugar ranges, lowered HbA1c ranges, and, generally, weight reduction.
Widespread uncomfortable side effects of metformin
Most individuals tolerate metformin properly. It’s thought of extraordinarily secure and doesn’t usually trigger harmful hypoglycemia (low blood sugar) until you’re taking considerably greater than prescribed or are utilizing it together with different medicines that may trigger low blood sugar, reminiscent of insulin or a sulfonylurea.
It’s an affordable and efficient treatment that’s extensively accessible. Nevertheless, some folks might expertise delicate to reasonable uncomfortable side 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 frequent however extra severe potential uncomfortable side effects of metformin embody:
- Hypoglycemia (if taken together with insulin or sulfonylureas)
- Lactic acidosis (a probably deadly situation through which lactic acid builds up within the physique)
- Vitamin B12 deficiency
You may study extra about potential uncomfortable side effects in our article: Metformin Aspect Results: What You Must Know.
Hypoglycemia
Metformin hardly ever causes hypoglycemia in folks with diabetes who will not be 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 might 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 danger of lactic acidosis, essentially the most extreme warning that the FDA points.
Signs of this situation can embody:
- Nausea
- Vomiting
- Weak spot
- Fatigue
- Quick, deep respiration
- Muscle cramps and physique aches
Nevertheless, in accordance with “The Phantom of Lactic Acidosis because of Metformin in Sufferers With Diabetes,” revealed within the American Diabetes Affiliation’s (ADA) journal Diabetes Care, the overwhelming majority of research discovered no cases of lactic acidosis in folks taking metformin.
Virtually all instances of lactic acidosis from metformin use are outcomes of overdoses — not regular use of the drug.
Learn extra: Can Metformin Trigger Lactic Acidosis?
Vitamin B12 deficiency
In research, researchers have discovered that long-term use of metformin could cause vitamin B12 deficiency. Left untreated, this may result in vital nerve harm.
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 beneficial in some instances.)
As a result of vitamin B12 isn’t produced by crops, supplementing with the vitamin if you’re vegan or eat a principally plant-based weight-reduction plan could also be particularly essential.
Metformin and “false lows”
Some folks expertise “false lows” (signs of hypoglycemia even when blood sugar ranges are inside regular vary) when beginning metformin.
This will occur in the event 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. (All the time verify your blood sugar if you’re feeling low, because it is probably not a false low.)
How one can take metformin
Metformin ought to 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.
In case you are experiencing extreme gastrointestinal points whereas taking metformin, converse along with your physician. They could scale back your dose or swap 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, you could expertise fewer digestive uncomfortable side effects with this strategy.
(Observe that when utilizing the extended-release type of the pill, it’s frequent 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
The commonest doses for adults with diabetes are:
Instant-release tablets:
- 500 milligrams (mg)
- 850 mg
- 1,000 mg
Prolonged-release tablets and liquid type:
It’s beneficial to start out with a low dose and improve it in the event you tolerate the drug properly and want a better dose to manage your blood sugar ranges. All the time 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 the event you miss a dose?
Take your metformin as quickly as you possibly can, until it’s nearly time to your subsequent dose. Don’t take two doses at one time.
Are you able to overdose on metformin?
Sure, that is doable, however it’s very uncommon. A big overdose could cause extreme and probably harmful hypoglycemia or lactic acidosis.
Search emergency medical consideration in the event you assume you may have overdosed.
When will I see outcomes after beginning metformin?
The Mayo Clinic notes that “Chances are you’ll 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 usually checking your blood sugar ranges and taking your treatment, and you need to ultimately see vital 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 should be made to enhance outcomes or reduce any unfavorable uncomfortable side effects you could be experiencing.
How do I do know if the treatment is working?
Metformin’s effectiveness might 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, typically signifies that it’s working. Some folks may expertise modest weight reduction.
Nevertheless, persistent excessive blood sugar ranges, no enchancment in HbA1c, or unexplained weight achieve regardless of a wholesome life-style may counsel that it isn’t working as meant.
For a extra detailed understanding, learn: Indicators Metformin Is Working (Or Isn’t Working).
Can I cease taking metformin?
Stopping metformin ought to be a rigorously thought of choice, prompted by lack of effectiveness, extreme uncomfortable side effects, or modifications in your healthcare wants and life-style.
It’s essential to not cease the medication abruptly, since this may result in unfavorable well being results reminiscent of excessive blood sugar and potential diabetes problems. All the time converse along with your physician for steering on how you can wean off the drug. This may occasionally contain adjusting the dosage over time and exploring various medicines or life-style modifications.
For additional insights, learn: Stopping Metformin: When and How You Can Cease Taking Metformin.
Are there various medicines?
Whereas metformin is a extensively used and efficient therapy for kind 2 diabetes, it might not swimsuit everybody because of uncomfortable side effects or lack of efficacy. Luckily, quite a lot of various treatment choices exist, every with their very own advantages and potential uncomfortable side effects.
Life-style modifications like weight-reduction plan and train can be efficient, both to be used alongside a special drugs or as standalone remedies, in some instances.
It’s essential to talk along with your healthcare supplier to seek out essentially the most appropriate various primarily based in your particular person wants and circumstances.
For an in-depth have a look at these choices, see: The Greatest Alternate 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 the event you:
What medicine to keep away from whereas taking metformin
The Mayo Clinic lists the medicine which will work together negatively with metformin.
Utilizing metformin with the next medicines shouldn’t be beneficial. In case you are on any of those medicines, work along with your physician to find out one of the best strategy:
- 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 usually not beneficial however could also be required. On this case, your physician might regulate the dose or how typically one or each of the medicines is used. Communicate along with your physician to resolve what is 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 secure for you.
Study extra about this mix in: Metformin & Alcohol: Can You Drink Whereas Taking Metformin?
Widespread questions on metformin
How ought to the tablets be saved?
It’s beneficial to retailer the tablets at room temperature, between 68 to 77 levels Fahrenheit (20 to 25 levels Celsius) however they are often saved safely at 59 to 86 levels Fahrenheit (15 to 30 levels Celsius) for some time if you’re 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 shouldn’t be a identified explanation for hair loss.
Nevertheless, long-term use of metformin could cause vitamin B12 deficiency. This will 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 the event you discover hair loss or thinning hair.
Do I would like to vary my weight-reduction plan?
Adjusting your weight-reduction plan whereas taking metformin is vital for maximizing the medication’s effectiveness and minimizing frequent uncomfortable side effects. Though no particular meals are strictly prohibited, it’s advisable to restrict alcohol, saturated and trans fat, refined carbohydrates, and high-sodium gadgets. Specializing in a balanced weight-reduction plan wealthy in entire fruits, greens, lean proteins, and lower-fat dairy may help improve metformin’s advantages in managing blood sugar ranges.
Extreme consumption of sure gadgets can decrease the drug’s effectiveness and worsen uncomfortable side effects.
For detailed steering on optimizing your weight-reduction plan whereas on metformin, learn: Meals to Keep away from Whereas Taking Metformin.
Can I take advantage of metformin if I’m pregnant (or attempting to turn into pregnant)?
Sure. Research haven’t proven any danger for mom and child when taking metformin. Nevertheless, at all times discuss to your physician in regards to the medicines you’re taking if you’re pregnant or attempting to turn into pregnant.
Are you able to turn into hooked on metformin?
No, there isn’t any 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 probably carcinogenic (cancer-causing).
In 2020 and 2021, a number of corporations voluntarily recalled sure numerous extended-release metformin primarily based on the FDA’s suggestions. You may verify to see in case your metformin was included in these remembers right here.
Even in the event you take a metformin product that has been recalled, it’s essential that you just proceed to take your treatment till you discuss to your healthcare skilled.
There isn’t any short-term well being danger — no human most cancers instances have been instantly linked to NDMA right now — and the unfavorable 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 through which a girl’s hormones are out of steadiness, ensuing within the growth of small, cyst-like sacs on the ovaries).
The American Diabetes Affiliation has mentioned that extra medical doctors ought to be prescribing metformin to their sufferers to deal with prediabetes (a situation through which blood glucose ranges are excessive, however not within the vary for a diabetes analysis) as properly, particularly for folks underneath the age of 60.
Researchers are additionally finding out if metformin may help within the combat 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 kind 1 diabetes
Metformin shouldn’t be at the moment authorised in america or Europe for the therapy of kind 1 diabetes.
Nevertheless, many individuals with kind 1 diabetes take metformin “off-label” (in a means not authorised 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 individuals with kind 1 diabetes taking metformin misplaced weight in comparison with placebo (inactive therapy).
Analysis has proven that metformin might assist scale back blood glucose ranges in folks with kind 1 diabetes. Metformin has been proven to cut back required insulin doses in addition to HbA1c ranges in folks with kind 1 diabetes.
Remember that taking metformin whereas on insulin for kind 1 diabetes could cause decrease blood sugars and the necessity for much less insulin. Due to this fact, it is very important be conscious of potential hypoglycemia, particularly in a single day.
Closing ideas
In case you are an individual with kind 2 diabetes, taking metformin is a simple, cheap, and efficient solution to decrease your blood sugar ranges, scale back your HbA1c stage, enhance your insulin sensitivity, and perhaps even lose a bit of weight.
The uncomfortable side effects are normally delicate and the drug is taken into account very secure. And since there are such a lot of generic varieties, metformin is extraordinarily inexpensive (and it’s lined by practically all medical health insurance plans, together with Medicare and Medicaid).
In case your blood sugar ranges will not be at goal along with your present therapy, converse along with your physician about the potential for including this treatment to your diabetes administration.
