Everything You Need to Know About Metformin

Metformin is likely one of the hottest oral medicines used to deal with individuals with kind 2 diabetes.

Taking metformin as prescribed may also 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 accredited by the U.S. Meals and Drug Administration (FDA) as a weight-loss remedy, it will probably additionally assist individuals shed weight, in some circumstances.

This text will define all the things that you must find out about this well-liked diabetes drug.

What’s metformin?

Authorized in the US in 1994 and studied in people because the Nineteen Fifties, metformin is a prescription drug taken to assist handle diabetes. It’s the solely accessible medication in a category of medicine referred to as biguanides, and it is available in tablet kind and liquid kind.

Metformin drugs 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 medicine both day by day or two or thrice day by day with meals.

Metformin model names

Some model names embrace:

• Fortamet
• Glucophage
• Glucophage XR
• Glumetza
• Riomet
• Riomet ER

Metformin can also be an ingredient in a wide range of mixture medicines.

Learn extra: Metformin Mixture Medicine for Kind 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, lowered HbA1c ranges, and, generally, weight reduction.

Frequent uncomfortable side effects of metformin

Most individuals tolerate metformin nicely. It’s thought of extraordinarily secure and doesn’t sometimes trigger harmful hypoglycemia (low blood sugar) except you’re taking considerably greater than prescribed or are utilizing it together with different medicines that may trigger low blood sugar, corresponding to insulin or a sulfonylurea.

It’s a cheap and efficient medicine that’s extensively accessible. Nonetheless, some individuals might expertise delicate to average uncomfortable side 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 uncomfortable side effects of metformin embrace:

• Hypoglycemia (if taken together with insulin or sulfonylureas)
• Lactic acidosis (a doubtlessly deadly situation through which lactic acid builds up within the physique)
• Vitamin B12 deficiency

You possibly can study extra about potential uncomfortable side effects in our article: Metformin Aspect Results: What You Have to Know.

Hypoglycemia

Metformin not often 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 medicines.

Name your physician you probably have any signs of hypoglycemia, which may embrace:

• Weak spot
• Tiredness
• Nausea
• Vomiting
• Abdomen ache
• Dizziness
• Lightheadedness
• Abnormally quick or gradual heartbeat

Lactic acidosis

Metformin comes with a “black field” warning concerning the threat of lactic acidosis, probably the most extreme warning that the FDA points.

Signs of this situation can embrace:

• Nausea
• Vomiting
• Weak spot
• Fatigue
• Quick, deep respiratory
• Muscle cramps and physique aches

Nonetheless, in response to “The Phantom of Lactic Acidosis because of Metformin in Sufferers With Diabetes,” printed within the American Diabetes Affiliation’s (ADA) journal Diabetes Care, the overwhelming majority of research discovered no situations of lactic acidosis in individuals taking metformin.

Nearly all circumstances 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 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 circumstances.)

As a result of vitamin B12 isn’t produced by vegetation, supplementing with the vitamin if you’re vegan or eat a largely 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 will occur if you happen to’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 degree feels low.

The false lows ought to go away as your physique adjusts to your new blood sugar degree. (At all times test your blood sugar if you’re feeling low, because it will not be a false low.)

Tips on how to take metformin

Metformin must be taken complete (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, converse together 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 couple of hours as an alternative of instantly, you might expertise fewer digestive uncomfortable side effects with this method.

(Be aware 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 medicine has been absorbed by your physique.)

Dosages

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 kind:

It’s beneficial to start out with a low dose and improve it if you happen to tolerate the drug nicely and wish the next dose to manage your blood sugar ranges. At all times test together with your physician first earlier than growing your dose.

Learn extra: Metformin Dosage Information (Min and Max Doses).

What do you have to do if you happen to miss a dose?

Take your metformin as quickly as you may, except it’s nearly time on your subsequent dose. Don’t take two doses at one time.

Are you able to overdose on metformin?

Sure, that is attainable, nevertheless it’s very uncommon. A big overdose could cause extreme and doubtlessly harmful hypoglycemia or lactic acidosis.

Search emergency medical consideration if you happen to assume you may have overdosed.

When will I see outcomes after beginning metformin? 

The Mayo Clinic notes that “You could 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. Maintain repeatedly checking your blood sugar ranges and taking your medicine, and it’s best to ultimately see vital enhancements from this medicine.

Work together 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 might be experiencing.

How do I do know if the medicine is working?

Metformin’s effectiveness could be gauged by way 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 individuals may expertise modest weight reduction.

Nonetheless, persistent excessive blood sugar ranges, no enchancment in HbA1c, or unexplained weight acquire regardless of a wholesome life-style would possibly 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 must 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 drugs abruptly, since this may result in unfavorable well being results corresponding to excessive blood sugar and potential diabetes problems. At all times converse together with your physician for steerage on the best way to wean off the drug. This may increasingly contain adjusting the dosage over time and exploring different medicines or life-style modifications.

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 remedy for kind 2 diabetes, it might not swimsuit everybody because of uncomfortable side effects or lack of efficacy. Happily, a wide range of different medicine choices exist, every with their very own advantages and potential uncomfortable side effects.

Life-style modifications like weight loss plan and train may also be efficient, both to be used alongside a special medication or as standalone remedies, in some circumstances.

It’s essential to talk together 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 have a look at these choices, see: The Greatest Alternate options to Metformin for Kind 2 Diabetes Administration.

Who shouldn’t take metformin?

Folks with sure situations could also be suggested in opposition to taking metformin. Converse together with your physician previous to taking this medication if you happen to:

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 is just not beneficial. If you’re on any of those medicines, work together with your physician to find out the very 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 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. Converse together 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. Converse together 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?

Frequent questions on metformin

How ought to the drugs be saved?

It’s beneficial to retailer the drugs 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 if you’re touring.

The drugs 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 is just not a recognized reason for hair loss.

Nonetheless, 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 if you happen to discover hair loss or thinning hair.

Do I would like to alter my weight loss plan?

Adjusting your weight loss plan whereas taking metformin is vital for maximizing the drugs’s effectiveness and minimizing widespread 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 loss plan wealthy in complete fruits, greens, lean proteins, and lower-fat dairy may also 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 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 making an attempt to grow to be pregnant)?

Sure. Research haven’t proven any threat for mom and child when taking metformin. Nonetheless, at all times discuss to your physician concerning the medicines you’re taking once you’re pregnant or making an attempt to grow to be pregnant.

Are you able to grow to be 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 doubtlessly carcinogenic (cancer-causing).

In 2020 and 2021, a number of firms voluntarily recalled sure plenty of extended-release metformin based mostly on the FDA’s suggestions. You possibly can test to see in case your metformin was included in these remembers right here.

Even if you happen to take a metformin product that has been recalled, it’s essential that you just proceed to take your medicine till you discuss to your healthcare skilled.

There isn’t a short-term well being threat — no human most cancers circumstances have been immediately linked to NDMA at the moment — and the unfavorable 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 through 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 stated that extra medical doctors must 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 nicely, particularly for individuals underneath the age of 60.

Researchers are additionally finding out if metformin may also 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 sort 1 diabetes

Metformin is just not at present accredited in the US or Europe for the remedy of kind 1 diabetes.

Nonetheless, many individuals with kind 1 diabetes take metformin “off-label” (in a manner not accredited by the FDA) to assist handle blood sugar ranges, reduce insulin resistance, and even shed weight.

A 3-year examine printed within the journal The Lancet discovered that members with kind 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 kind 1 diabetes. Metformin has been proven to cut back required insulin doses in addition to HbA1c ranges in individuals 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. Subsequently, you will need to be aware of potential hypoglycemia, particularly in a single day.

Ultimate ideas

If you’re an individual with kind 2 diabetes, taking metformin is a straightforward, cheap, and efficient option to decrease your blood sugar ranges, scale back your HbA1c degree, enhance your insulin sensitivity, and perhaps even lose a bit 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 coated by practically all medical health insurance plans, together with Medicare and Medicaid).

In case your blood sugar ranges are usually not at goal together with your present remedy, converse together with your physician about the potential of including this medicine to your diabetes administration.