Metformin is likely one of the hottest oral drugs 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 combat insulin resistance (a situation wherein 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 remedy, it may possibly additionally assist individuals reduce weight, in some instances.
This text will define every part you must learn about this widespread diabetes drug.
Desk of Contents
What’s metformin?
Authorized in the US in 1994 and studied in people because the Fifties, metformin is a prescription drug taken to assist handle diabetes. It’s the solely obtainable medication in a category of medication referred to as biguanides, and it is available in capsule kind and liquid kind.
Metformin tablets can be found in each immediate-release and extended-release formulations. Relying in your administration wants and the kind of medication you’re taking, you might be instructed to take your treatment both day by day or two or thrice day by day with meals.
Metformin model names
Some model names embody:
- Fortamet
- Glucophage
- Glucophage XR
- Glumetza
- Riomet
- Riomet ER
Metformin can be an ingredient in a wide range of mixture drugs.
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 interesting in common bodily exercise, this will result in decrease blood sugar ranges, diminished HbA1c ranges, and, typically, weight reduction.
“We had been steadily engaged on enhancing my glucose management and A1c, however I used to be nonetheless working excessive very often and my A1c had plateaued within the 7s, so [my healthcare provider] beneficial beginning metformin to handle that with out rising my danger for lows.”
Kat Schroeder, metformin consumer (examine Kat’s expertise with metformin)
Frequent unwanted effects of metformin
Most individuals tolerate metformin properly. It’s thought-about extraordinarily protected 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, comparable to insulin or a sulfonylurea.
It’s a cheap and efficient treatment that’s extensively accessible. Nevertheless, some individuals might expertise gentle to reasonable unwanted effects, together with:
- Stomachache
- Abdomen cramps
- Nausea
- Vomiting
- Diarrhea
- Lack of urge for food
- Weight reduction
- Metallic style within the mouth
- Weight acquire (uncommon)
Much less widespread however extra severe potential unwanted effects of metformin embody:
- Hypoglycemia (if taken together with insulin or sulfonylureas)
- Lactic acidosis (a doubtlessly deadly situation wherein lactic acid builds up within the physique)
- Vitamin B12 deficiency
You may study extra about potential unwanted effects in our article: Metformin Aspect Results: What You Must Know.
Hypoglycemia
Metformin hardly ever causes hypoglycemia in individuals with diabetes who are usually 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 drugs.
Name your physician when 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 concerning 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 respiratory
- Muscle cramps and physique aches
Nevertheless, within the examine “High quality and Traits of 4241 Case Reviews of Lactic Acidosis in Metformin Customers Reported to a Massive Pharmacovigilance Database,” researchers examined over 4,000 instances the place metformin was suspected in lactic acidosis incidents, as reported to a significant database.
They discovered that precise metformin-associated lactic acidosis was confirmed in solely 9 % of those instances.
The examine highlighted that top ranges of lactate within the blood, moderately than metformin ranges, had been linked to greater dangers of loss of life, particularly when coupled with kidney points.
This analysis is essentially the most intensive to this point in exploring the true affect of metformin on extreme lactic acidosis, suggesting that the drug is basically protected (however warrants additional investigation in particular teams of individuals).
The vast majority of instances 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 will result in vital 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 beneficial in some instances.)
As a result of vitamin B12 isn’t produced by vegetation, supplementing with the vitamin in case you are vegan or eat a principally plant-based weight loss plan could also be particularly essential.
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 should you’re used to having near-constant excessive blood sugar ranges. As a result of your physique is used to those excessive ranges, a traditional 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 test your blood sugar in case you are feeling low, because it is probably not a false low.)
Tips on 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 often higher tolerated within the night, so taking it with dinner is finest.
In case you are experiencing extreme gastrointestinal points whereas taking metformin, communicate along with your physician. They could scale back your dose or swap you to an extended-release model of the drugs.
As a result of the extended-release medication is launched over a number of hours as a substitute of instantly, you might expertise fewer digestive unwanted 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 search out a part of the pill in your stool. This happens after the treatment has been absorbed by your physique.)
Dosages of metformin
The commonest doses for adults with diabetes are:
Instant-release tablets:
- 500 milligrams (mg)
- 850 mg
- 1,000 mg
Prolonged-release tablets and liquid kind:
It’s beneficial to start out with a low dose and improve it should you tolerate the drug properly and want the next dose to control your blood sugar ranges. All the time test along with your physician first earlier than rising your dose.
Learn extra: Metformin Dosage Information (Min and Max Doses).
What must you do should you miss a dose?
Take your metformin as quickly as you possibly can, until it’s nearly time to 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, nevertheless it’s very uncommon. A big overdose may cause extreme and doubtlessly harmful hypoglycemia or lactic acidosis.
Search emergency medical consideration should you suppose you’ve got 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 repeatedly checking your blood sugar ranges and taking your treatment, and you must finally 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 destructive unwanted effects you might be experiencing.
How do I do know if the treatment is working?
Metformin’s effectiveness could be gauged by means of a number of indicators. A discount in blood sugar ranges and HbA1c, noticeable after a number of weeks to months, usually signifies that it’s working. Some individuals can also expertise modest weight reduction.
Nevertheless, persistent excessive blood sugar ranges, no enchancment in HbA1c, or unexplained weight acquire regardless of a wholesome way of life may recommend 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 must be a fastidiously thought-about choice, prompted by lack of effectiveness, extreme unwanted effects, or modifications in your healthcare wants and way of life.
It’s essential to not cease the drugs abruptly, since this will result in destructive well being results comparable to excessive blood sugar and potential diabetes issues. All the time communicate along with your physician for steerage on wean off the drug. This will contain adjusting the dosage over time and exploring different medicines or way of life modifications.
For additional insights, learn: Stopping Metformin: When and How You Can Cease Taking Metformin.
Are there different drugs?
Whereas metformin is a extensively used and efficient remedy for sort 2 diabetes, it could not go well with everybody attributable to unwanted effects or lack of efficacy. Luckily, a wide range of different treatment choices exist, every with their very own advantages and potential unwanted effects.
Life-style modifications like weight loss plan and train will also be efficient, both to be used alongside a special medication or as standalone therapies, in some instances.
It’s essential to talk along with your healthcare supplier to search out essentially the most appropriate different based mostly in your particular person wants and circumstances.
For an in-depth have a look at these choices, see: The Finest Alternate options to Metformin for Sort 2 Diabetes Administration.
Who shouldn’t take metformin?
Folks with sure situations could also be suggested towards taking metformin. Converse along with your physician previous to taking this medication should you:
What medication to keep away from whereas taking metformin
The Mayo Clinic lists the medication that will work together negatively with metformin.
Utilizing metformin with the next medicines shouldn’t be beneficial. In case you are on any of those drugs, work along with your physician to find out the most effective 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 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. Converse along with your physician to determine what’s going to work finest 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. Converse 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?
Frequent 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 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 shouldn’t be a identified explanation for hair loss.
Nevertheless, 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 check should you discover hair loss or thinning hair.
Do I want to vary my weight loss plan?
Adjusting your weight loss plan whereas taking metformin is important for maximizing the drugs’s effectiveness and minimizing widespread unwanted 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 weight loss plan 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 unwanted effects.
For detailed steerage on optimizing your weight loss 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 out to be pregnant)?
It might be protected to think about taking metformin in case you are pregnant or plan to turn out to be pregnant. Nevertheless, at all times speak to your physician concerning the drugs you’re taking if you’re pregnant or attempting to turn out to be pregnant.
Are you able to turn out to be hooked on metformin?
No, there isn’t 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 firms voluntarily recalled sure a number of extended-release metformin based mostly on the FDA’s suggestions. You may test to see in case your metformin was included in these remembers right here.
Even should you take a metformin product that has been recalled, it’s essential that you simply proceed to take your treatment till you speak to your healthcare skilled.
There isn’t any short-term well being danger — no human most cancers instances have been straight linked to NDMA right now — and the destructive results of abruptly stopping metformin remedy 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 present getting used to deal with gestational diabetes (a kind of diabetes that happens throughout being pregnant) and polycystic ovary syndrome (PCOS, a situation wherein a lady’s hormones are out of stability, ensuing within the growth of small, cyst-like sacs on the ovaries).
The American Diabetes Affiliation has stated that extra docs must be prescribing metformin to their sufferers to deal with prediabetes (a situation wherein blood glucose ranges are excessive, however not within the vary for a diabetes prognosis) as properly, particularly for individuals underneath the age of 60.
Researchers are additionally finding out if metformin can assist within the combat towards 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 present authorised in the US or Europe for the remedy of sort 1 diabetes.
Nevertheless, many individuals with sort 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 reduce weight.
A 3-year examine printed within the journal The Lancet discovered that members with sort 1 diabetes taking metformin misplaced weight in comparison with placebo (inactive remedy).
Analysis has proven that metformin might assist scale back blood glucose ranges in individuals with sort 1 diabetes. Metformin has been proven to scale 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 aware of potential hypoglycemia, particularly in a single day.
Ultimate ideas
In case you are an individual with sort 2 diabetes, taking metformin is a straightforward, cheap, and efficient method to decrease your blood sugar ranges, scale back your HbA1c stage, enhance your insulin sensitivity, and possibly even lose slightly weight.
The unwanted effects are often gentle and the drug is taken into account very protected. And since there are such a lot of generic kinds, metformin is extraordinarily reasonably priced (and it’s coated by almost all medical health insurance plans, together with Medicare and Medicaid).
In case your blood sugar ranges are usually not at goal along with your present remedy, communicate along with your physician about the potential for including this treatment to your diabetes administration.