Metformin
About
Metformin belongs to a group of anti-diabetic medicines called biguanides used in the treatment of diabetes. It helps to lower the increased blood glucose level in type 2 diabetes patients. Type 2 diabetes is a chronic or lifelong disorder that affects the way our body processes glucose. People with type 2 diabetes either do not produce enough insulin or the insulin produced is unable to perform its function in the body (insulin resistance). Middle-aged or older individuals are most likely to suffer from type 2 diabetes, so it is also known as adult-onset diabetes.
Metformin is prescribed for the condition of type 2 diabetes when diet and exercise alone cannot control their blood sugar levels. It is the first-line therapy for patients with type 2 diabetes. Metformin restores the body's response to insulin, decreases the amount of blood sugar produced by the liver, and delays the absorption of sugar by the stomach or intestines. Besides, Metformin has off-label usage in women with polycystic ovary syndrome (PCOS) where it helps normalize the menstruation cycle by restoring the body's hormonal balance, lowers blood sugar levels, and stimulates ovulation.
Usually, Metformin does not cause very significant side effects. Common side effects include diarrhoea, nausea, vomiting, or a metallic taste in the mouth. In very rare cases, it may cause a condition known as lactic acidosis (too much lactic acid in the body) with symptoms like dizziness, drowsiness, muscle pain, etc. Your sugar level may go down while taking this medicine with heavy exercise, drinking excessive alcohol, or skipping meals. Talk to the doctor about any of the health conditions listed above that may require urgent medical treatment.
Metformin works best when coupled with a healthy lifestyle like losing weight if you are overweight (BMI >25), eating fewer calories (low fat and sugary food), and being more physically active (at least 150 min of activity every week).
Uses of Metformin
Medicinal Benefits
Metformin plays a vital role in managing diabetes and achieving good control of blood sugar levels by delaying the absorption of sugar and increasing insulin sensitivity in the body. Metformin does not cause a sudden lowering of the blood glucose level or cause significant hypoglycaemia. Unlike other anti-diabetic therapies like sulfonylureas or insulin, Metformin does not cause weight gain but may cause modest weight loss. In the prediabetic condition, Metformin is the only recommended treatment available. Metformin also helps to prevent serious complications of diabetes such as kidney damage (Diabetic Nephropathy), blindness (Diabetic Retinopathy), loss of sensation in your hands and feet (Diabetic Neuropathy) or even loss of foot! Metformin also helps to reduce your chance of having a heart attack or stroke.
Directions for Use
Storage
Side Effects of Metformin
- Digestive problems
- Nausea
- Vomiting
- Diarrhoea
- Abdominal pain
- Loss of appetite
In-Depth Precautions and Warning
Drug Warnings
Some diabetic patients taking Metformin may develop a serious condition called lactic acidosis. In lactic acidosis, there is too much lactic acid accumulated in the blood. So, your liver and kidney proper functioning is required for the elimination of excess lactic acid from the blood. You should not take metformin if you have kidney disease, as measured by a blood test. Metformin may lower vitamin B-12 levels, so try to have blood test annual blood and vitamin. Metformin, when used with insulin, may extremely lower the blood sugar level. So, the doctor may lower the dose of insulin.
Drug Interactions
Drug-Drug Interactions: Metformin interacts with an anti-depressant (bupropion), drugs used to treat glaucoma, antibiotics (cephalexin, ciprofloxacin), anti-acidity drugs (cimetidine), heart condition drugs (digoxin), anti-HIV drugs (dolutegravir), ethanol, saliva reducing drugs (glycopyrrolate), iodinated X-ray contrast agents, anti-epileptic drugs (topiramate, lamotrigine), heart-related chest medicine (ranolazine). Other drug interactions can contribute to increased low blood sugar, including sex hormones (androgens), anti-oxidant (alpha-lipoic acid), painkillers (aspirin), anti-TB drugs (prothionamide), growth hormones (pegvisomant), and other antidiabetic medicines.
Drug-Food Interactions: Intake of excessive alcoholic beverages may increase the chance of a life-threatening condition known as Lactic Acidosis. So, avoid intake of alcoholic beverages with Metformin.
Drug-Disease Interactions: People affected with heart diseases (like congestive heart failure and myocardial infarction), Vitamin B12 deficiency, and alcoholism should avoid intake of Metformin.
Drug-Drug Interactions Checker List:
Safety Advice
Alcohol
unsafeIt is advisable not to consume alcohol along with Metformin to avoid unpleasant side-effects like lactic acidosis.
Pregnancy
cautionMetformin is not recommended during pregnancy. However, your doctor may prescribe it for you during pregnancy if he/she feels that the benefit to you outweighs the risk. You should not take Metformin without doctor's advice.
Breast Feeding
cautionMetformin is not recommended if you are breast-feeding or if you are planning to breast-feed your baby.
Driving
safe if prescribedMetformin monotherapy (the treatment of a disease with a single drug) does not cause hypoglycaemia (low blood sugar) and therefore has no effect on the ability to drive or to use machines.
Liver
cautionMetformin to be taken with caution, especially if you have a history of liver diseases/conditions. The dose may have to be adjusted by your doctor.
Kidney
cautionMetformin to be taken with caution, especially if you have a history of Kidney diseases/conditions. The dose may have to be adjusted by your doctor depending on your renal functions. Metformin is not recommended in severe kidney disease. Regular monitoring of kidney function tests is therefore important if you're taking Metformin.
Children
safe if prescribedMetformin is not recommended for children below 10 years of age. For children above 10 years, dose to be adjusted and recommended by a child specialist only.
Habit Forming
Diet & Lifestyle Advise
- Invest at least 150 min of your week in moderate-intensity physical activity or one hour and 15 minutes of high-intensity exercise every week.
- Losing weight gradually to achieve a healthy body mass index (18.5 to 24.9).
- Replacing refined carbohydrates-containing foods with whole grain foods and increasing intake of fruits and veggies and other fiber enriched foods.
- Reduce intake of saturated fat (or hidden fats) in food like chips, crisps, pastries, biscuits, and samosas. Choose omega-3 fatty acid-containing oils for daily cooking. For frying, you can use palm oil, mustard oil, groundnut oil, rice bran oil, and safflower oil.
- Avoid taking too much stress as it may elevate your blood sugar level. You can adopt stress management techniques like mindfulness to control stress-related blood sugar changes or meditation or yoga.
- Opt for low-fat dairy products (low-fat yogurt, fat-free milk, cheese, etc.).
- Keep your blood pressure as normal (140/90) as possible as it reduces the risk of cardiovascular diseases in diabetes patients.
Special Advise
- Keep taking Metformin even if you think your blood sugar levels are under control. If you miss a dose, do not take a larger dose, consult your treating physician for advice.
- Take short frequent meals, avoid prolonged fasting when taking Metformin. Beware of symptoms of hypoglycaemia (low blood sugar) which include sweating, dizziness, palpitations, shivering, intense thirst, dry mouth, dry skin, frequent urination etc. Whenever you experience any of the above mentioned symptoms, immediately consume 5-6 candies or 3 glucose biscuits or 3 teaspoons of honey/sugar and also get in touch with your physician. Make sure to carry these with you at all times, especially during long travels.
- It is always better that your physician knows about any underlying conditions like kidney disease or liver disease, prior heart attack, alcohol intake, etc before the doctor prescribes you Metformin.
- Avoid drinking alcohol while on Metformin as it increases the risk of hypoglycaemia (decrease in blood sugar which might be fatal in some cases) and lactic acidosis (when the lactic acid increases in the body which impacts the functioning of various organs in the body).
- Try to quit smoking and reduce intake of carbohydrate rich food like potato, rice, mangoes, bread, sugar etc.
- Remember, lifestyle modifications are the most important step in controlling blood sugar levels.
Patients Concern
Disease/Condition Glossary
Type 2 diabetes: It is a chronic or lifelong disease that keeps the body away from properly utilizing insulin. Hence, people affected with type 2 diabetes either do not produce enough insulin, or there is resistance to the action of insulin. Middle-aged or older are most likely to suffer from type 2 diabetes, so it is also known as adult-onset diabetes. Symptoms of type 2 diabetes include increased thirst, frequent urination at night, slow wound healing, increased hunger, fatigue, and blurred vision. In some cases, there may be weight gain while in rare cases weight loss may be observed. The complication of type 2 diabetes also includes neuropathy (nerve problems), nephropathy (kidney problems), and retinopathy (damaged retina of eyes or blindness), loss of limbs, sexual dysfunction, and increase chance of heart attack or stroke.
FAQs
Yes, Metformin can cause the minor upset of stomach. However, do not stop taking it. Discuss with your doctor in case of severe stomach upset.
Yes, initial treatment with Metformin is known to cause weight loss. However, if you experience excessive weight loss while on treatment with Metformin, inform your doctor without any delay. There is a possibility that your dosage needs to be adjusted.
Usually taking Metformin does not cause constipation. However, some people may experience flatulence, stomach pain and constipation while on Metformin. In case you experience discomfort, speak with your doctor.
Yes. If you are taking Insulin regularly you need to consult Doctor before taking Metformin.
If you forget to take Metformin, do NOT take a double dose to make up for your forgotten dose. Taking overdose might cause your sugar level to fall down rapidly. Try to take the next dose at the usual time.
Do not take excessive alcohol while taking Metformin, as this may increase the risk of a life-threatening condition called as lactic acidosis (too much of lactic acid in the body) which causes symptoms like dizziness, drowsiness, muscle pain, fast, shallow breathing etc.
Contact your doctor before having an X-ray or scan which involves the use of the injection of contrast materials that contain iodine into your bloodstream as it may affect your kidney function.
Your doctor will decide when you must stop and when to restart your treatment with Metformin before and after the surgery.
No. Metformin is only prescribed for the treatment of type 2 diabetes also called as 'non-insulin-dependent diabetes'.
