Let’s Talk About METFORMIN

April 14, 2014 • Prescription Drugs • Views: 6766

Note:  This article is NOT intended to replace the advice of your pharmacist or physician about treating your diabetes.  Nor is it a comprehensive discussion on everything related to metformin (a medication for diabetes).  That could get boring quickly.  I’m talking about metformin in a way that answers the most common questions that arise in my own practice setting. 

Do you take metformin?  Has your doctor suggested metformin to treat your Type II Diabetes?  Maybe you are just doing some research on this medication for yourself or a friend and Google sent you here.  Whatever the case, I hope this brief article provides some useful information.

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What Is Metformin (for diabetes)?

Metformin is the most widely prescribed anti-diabetic drug in the world.  First introduced to the U.S. market back in 1995 under the brand name “Glucophage” (the name literally means sugar-eater) it is now considered to be the best first-line prescription drug for the treatment of elevated blood sugar in patients with Type II diabetes.  And this makes sense.  Folks taking it live longer.  It’s that simple.  Metformin is also associated with fewer side effects (like low blood sugar) and is generally well-tolerated (hang in there, we’ll chat a bit more about this in a moment).  It’s also relatively cheap when compared to other currently available options.

How Does Metformin Work?

Ever seen that nifty 3-in-1 avocado slicer gadget?  It will split, pit, slice and scoop your avocado all with 1 convenient tool.  I like stuff like that.  I’ve seen this 3-in-1 pen that writes, is a thumb drive and also has a laser pointer.  My birthday is coming up in case you needed an idea.  Metformin is like that handy 3-in-1 tool.  Metformin (for diabetes) lowers the amount of sugar in your blood.  Like the nifty avocado tool, it does at least 3 things to lower your blood sugar level:

  • Reduces the production of sugar in your liver
  • Decreases the absorption of sugar from the food you eat
  • Increases the amount of sugar your cells use by making them (we think) more sensitive to insulin

How Do You Take Metformin?

It depends.  One thing I like about my practice setting is that we see patients who have just been recently diagnosed with Type II diabetes.  They will typically be started on a low dose of approximately 500mg twice daily with meals.  Your dose may be different, and it will typically be increased once we see how you tolerate the medication.  They also make several varieties of extended-release metformin that can be taken once daily with your evening meal.  Important:  The goal here is to treat you with the LOWEST effective dose.  By “effective” we mean that it will lower your FBG (fasting blood glucose) and HbA1c to near-normal.


What Will Happen When I Take Metformin?

All drugs have some possible side effects.  You might notice an upset stomach, nausea or diarrhea when you first start taking metformin.  That’s normal and it often improves over the course of the first week or two.  Some people also notice a metallic taste.  That also typically goes away in a few days. 

Is Metformin Safe?

That’s a good question.  All medications have side effects and risks.  At the same time – if you are considering NOT treating your diabetes with any medication at all – that has risks too.  We know full-well the dangerous complications of untreated hyperglycemia (high blood sugar).    If we have to lower your blood sugar by some type of prescription medication, metformin generally looks like a good choice.  It has some side-effects.  All drugs do.  For example, there is some association of vitamin B12 deficiency with metformin.  Consider a supplement (I’m not suggesting it is always necessary, just worth considering).  All things considered metformin is considered safe and effective for most patients with Type II diabetes.  It appears to be somewhat helpful in lowering your “bad” cholesterol and on the whole tends to promote a modest weight-loss in patients.  All that being said, there is one serious concern known as lactic acidosis, we can talk about that next.

What about Lactic Acidosis?

Metformin has been (rarely) associated with a serious condition known as lactic acidosis.  If this does occur, it is usually in patients with less-than-normal kidney or liver function.  Your doctor will check the way your kidneys and liver are functioning before starting you on metformin.  Lactic acidosis is also more common if you are dehydrated.  Symptoms of lactic acidosis include feeling very weak, tired or uncomfortable, unusual muscle pain, trouble breathing, unusual or unexpected stomach discomfort, feeling cold, feeling dizzy or lightheaded, or suddenly developing a slow or irregular heartbeat.  I’m not going to try to explain what is really going on when lactic acidosis occurs.  It is a complicated and serious condition that requires medical treatment.  If you experience those symptoms while on metformin you should contact your healthcare provided immediately.  But once again, let me be clear, for patients with otherwise normal liver and kidney function, this is extremely rare.

What about Alcohol And Metformin?

Here’s the deal.  The simple fact is that if you have Type II diabetes, alcohol isn’t your best friend.  Drinking alcohol influences blood sugar levels and can cause hypoglycemia.  Alcohol also can influence our eating patterns and it is hard to distinguish between a “buzz” and a serious hypoglycemic emergency.  Be smart.  If you must have a single drink, then it is imperative that you know where your blood sugar levels are and that you are working to maintain them through diet, exercise and medication.

Some Take Home Points:

  • Metformin is the most widely used prescription medicine for treating high blood sugar in patients with Type II diabetes.
  • Take your metformin as directed with food and don’t skip doses.  Seriously.  It is very important.  If side-effects are the reason you are not taking it as you should, contact your doctor and let them know.  Avoid alcohol (see above). 
  • Take charge of your condition and medication.  Monitor your blood sugar (need help with that? – ask your pharmacist!).  Stay well hydrated.  Ask your doctor to check your kidney and liver function.  They will.  Work with your provider to develop a good diet and exercise program to help control your weight.

The above comments are not everything you might want to know.  Maybe it is just enough to peak your interest to ask more.  That’s fine.

For a few more articles on metformin check out the Mayo Clinic article or WebMD article.

For an audible reading of a fuller counseling session on Metformin check out AudibleRx HERE.

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Author: Jason Poquette

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