Metformin is a well-liked prescription drug that’s used as a first-line remedy for sort 2 diabetes.
For almost all of customers, metformin is efficient and well-tolerated. However if you’re experiencing extreme or persistent unwanted side effects when taking this drugs, or if it merely isn’t working, you could marvel if there are some other choices.
The reply is sure. This text will examine the perfect options to metformin for individuals with sort 2 diabetes.
Desk of Contents
Why would you not take metformin?
Metformin helps higher handle blood sugar ranges, struggle insulin resistance (a situation wherein the physique doesn’t use insulin effectively), and might even assist with weight reduction. Most tips advocate it because the first-line remedy for sort 2 diabetes.
It is usually very reasonably priced and usually efficient, however that effectiveness can include a value: unwanted side effects.
Unintended effects
Metformin could cause a wide range of doubtlessly detrimental unwanted side effects, together with:
For some individuals who have strict work or college schedules, enduring a few of these unwanted side effects is probably not potential.
Moreover, experiencing these unwanted side effects can even influence different areas of your life. Coping with power gastrointestinal points, for instance, can change into an impediment to consuming effectively or forestall you from sustaining an everyday train behavior.
Learn extra in: Metformin Facet Results (Widespread and Critical) and Can Metformin Trigger Lactic Acidosis?
Contraindications
In different instances, individuals might keep away from taking metformin as a result of it’s contraindicated (not suggested) to take with many different frequent prescribed drugs. (Right here is an summary of the medication that will work together with metformin.)
Generally it’s not possible to cease taking one other drugs that negatively interacts with metformin, and subsequently, a substitute is important.
Ineffectiveness
And for some individuals, metformin merely shouldn’t 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 shed extra pounds. In truth, some individuals even achieve weight when taking metformin.
See extra in: Indicators Metformin Is Working (Or Isn’t Working).
Insurance coverage or life-style concerns
Lastly, some individuals 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 using prescription drugs.
Learn extra in: All the things You Have to Know About Metformin.
What are options to metformin?
The next are some options that you could focus on along with your physician.
(Bear in mind to at all times work along with your healthcare supplier earlier than making any adjustments to your diabetes administration.)
Sulfonylureas
Sulfonylureas are oral diabetes drugs which might be typically 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 each day, earlier than each breakfast and dinner.
Sulfonylureas embrace:
- Glipizide (model identify Glucotrol)
- Glimepiride (Amaryl)
- Glyburide (Diabeta, Glynase)
Sulfonylurea unwanted side effects
Some potential unwanted side effects embrace:
Thiazolidinediones (TZDs)
TZDs are an oral class of sort 2 diabetes medicine that will increase insulin sensitivity and helps lower glucose manufacturing by the liver.
They’re simply accessible and reasonably priced and do not need a excessive danger of inflicting hypoglycemia.
Thiazolidinediones embrace:
- Pioglitazone (Actos)
- Rosiglitazone (Avandia)
Thiazolidinedione unwanted side effects
Some potential unwanted side effects embrace:
- Weight achieve
- Elevated danger for coronary heart illness
- Edema (swelling) of toes, legs, arms, and fingers
- Elevated danger for bone fracture
DPP-4 inhibitors
DPP-4 inhibitors decrease blood sugar and HbA1c ranges with out inflicting low blood glucose (until taken with different medicines that may trigger hypoglycemia, corresponding to insulin or sulfonylureas).
They operate by interfering with the breakdown of two hormones within the physique, GLP-1 and GIP, that scale 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 operate for longer, reducing blood sugar ranges solely when they’re elevated.
These medication are taken orally, usually in mixture with metformin, however they are often taken with out metformin as effectively.
Learn extra in: Metformin Mixture Medication for Kind 2 Diabetes.
DPP-4 inhibitors embrace:
- Sitagliptin (Januvia)
- Saxagliptin (Onglyza)
- Linagliptin (Tradjenta)
- Alogliptin (Nesina)
DPP-4 inhibitor unwanted side effects
Potential unwanted side effects embrace:
- Low blood sugar, if taken together with insulin or sulfonylureas
- Gastrointestinal points like upset abdomen
- Elevated danger 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 by way of an injection (both as soon as a day or as soon as weekly), relying on the particular drugs used. They operate 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 in opposition to coronary heart illness.
Notably, though they aren’t weight-loss medication, GLP-1 receptor agonists can support with weight reduction. In accordance with the Mayo Clinic, research point out that every one GLP-1 medication can result in a complete weight lack of between 10.5 and 15.8 kilos.
GLP-1 receptor agonists embrace:
GLP-1 receptor agonist unwanted side effects
Potential unwanted side effects embrace:
- 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 medicine, typically taken each day, used to decrease blood sugar ranges and HbA1c degrees by inflicting the discharge of extra glucose within the urine. They not often trigger low blood sugar.
These drugs can defend in opposition to coronary heart failure and enhance outcomes in individuals who have coronary heart illness, kidney illness, or coronary heart failure.
SGLT-2 inhibitors embrace:
SGLT-2 inhibitor unwanted side effects
Potential unwanted side effects embrace:
- Frequent urination
- Elevated frequency of urinary tract infections (UTIs)
- Elevated danger for kidney harm
- Elevated danger for diabetic ketoacidosis (DKA)
- Dehydration
- Thirst
- Low blood stress
- For Invokana, particularly, elevated danger of amputations
GIP/GLP-1 receptor agonists
The primary drugs 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 medicine results in a median weight lack of about 15 p.c to twenty p.c.
GIP/GLP-1 receptor agonists embrace:
GIP/GLP-1 receptor agonist unwanted side effects
Potential unwanted side effects embrace:
- Gastrointestinal points
- Hypoglycemia, notably when used with one other drugs 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 sort 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 range in onset, peak instances, and length of motion.
Among the extra frequent insulins utilized in the US embrace:
Fast-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)
Potential unwanted side effects
- Hypoglycemia, notably if the insulin dose shouldn’t be balanced with meals consumption and bodily exercise
- Weight achieve
- Modifications in fats tissue at injection websites
- Allergic reactions, starting from native injection website 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 chew of every meal.
Alpha-glucosidase inhibitors embrace:
- Acarbose (generic solely)
- Miglitol (Glyset)
Alpha-glucosidase inhibitor unwanted side effects
Widespread unwanted side effects embrace:
- Gastrointestinal points corresponding to fuel and diarrhea
Meglitinides
Meglitinides are a sort of oral medicine 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 embrace:
- Repaglinide (Prandin)
- Nateglinide (Starlix)
Meglitinide unwanted side effects
Widespread unwanted side effects embrace:
Way of life adjustments
Lastly, adopting wholesome life-style adjustments is at all times a great method, whether or not or not you’re taking medicine. Partaking in common bodily exercise and consuming a balanced, nutritious weight loss plan will help handle blood sugar ranges, decrease your HbA1c, and doubtlessly result in weight reduction as effectively.
This can be the most cost effective choice, however it may be exhausting to take care of. And it’s additionally not assured that life-style adjustments will mean you can cease taking drugs.
Different components, corresponding to a genetic predisposition for diabetes, could make medicine vital, even if you’re in nice bodily situation and in any other case wholesome.
Speak along with your physician and meet with a registered dietitian (RD) to develop an train and consuming plan that may work to your life-style and well being targets.
Closing ideas
Whereas metformin is a particularly common, reasonably priced, and accessible drug for sort 2 diabetes administration, it’s not for everybody.
Some individuals expertise debilitating unwanted side 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 further medicines, or metformin might merely not be working for them.
Fortuitously, different choices can be found. Drug lessons 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 sort 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 drugs.
Perform some research 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 shouldn’t be working effectively and also you wish to make a swap, communicate along with your physician about potential options, and focus on what’s going to work greatest for you, your life-style, and your well being targets.