Metformin

Metformin is one of the most commonly used drugs in the world and has earned its place as the first medication to prescribe for type 2 diabetes and those with type 1 who have insulin resistance. It is effective, inexpensive and has limited side effects. You can read more about why in this 2013 study.

Metformin is in a class of drugs called biguanides. It significantly lowers blood sugar for most people. Studied in human since the 1950s, it has a very strong track record of safety and improved outcomes. Side effects tend to be minimal and temporary, though there is a minority of people who do not tolerate it well. It does not cause weight gain or low blood sugars.

Brand Names for Metformin

Glucophage
Glumetza
Glucophage XR
Riomet
Fortamet

Brand Names for Metformin in Combination with Other Drugs

Glucovance (glyburide)
Metaglip (glipizide)
Actoplus Met (pioglitazone)
PrandiMet (repaglinide)
Avandamet (rosiglitazone)
Janumet (sitagliptin)

How Does Metformin Work?

Metformin works by lowering the amount of sugar the liver makes and by increasing your sensitivity to insulin and lowering the amount of glucose you absorb from the food you eat. This combined effect results in lowered blood sugar levels.

Metformin does not cause hypoglycemia (low blood sugar) and so is generally considered a safe drug to use.

Precautions Before Taking Metformin

If you have any heart problems you should not take metformin.

Gary Scheiner, a Certified Diabetes Educator wrote in his book Until There is a Cure, page 81: “It should not be used by people with kidney impairment and should be used with caution by those with liver problems. Those who drink excessive amounts of alcohol should not use metformin.”

This is because anyone with kidney or liver problems has a higher risk of developing lactic acid build-up, referred to as lactic acidosis, which is a life-threatening condition.

Side Effects of Metformin

It is important to take metformin the way your healthcare provider has indicated.

Common side effects of metformin include:

• Stomach upset and cramping. This generally may happen during the first couple of weeks of treatment while you adjust to the medication.
• Loose bowels or diarrhea. This is also a common side effect as someone first adjusts to the medication.
• Suppressed appetite and subsequent weight-loss.
• In studies, researchers have found that long-term use of metformin causes vitamin B12 deficiency which can cause nerve damage. If you take metformin, it is a good idea to have your healthcare provider check your B12 levels and to consider taking a B12 supplement.
• Lactic acidosis. The incidence of lactic acidosis is only about nine per 100,000 person-years. Coincidentally, this is exactly how common it is in the general population. You can read more in this research review. According to the University of California, San Francisco, this is considered a rare side effect and is usually due to people with kidney, heart or liver damage taking metformin when they should not.

Metformin should be taken with meals to help reduce stomach or bowel side effects that may occur during the first few weeks of treatment. If stomach upset is a big problem for you, talk to your doctor about reducing your dose so that you can gradually adapt to metformin or ask your doctor if you can take your metformin in the middle of your meal to help with stomach side effects.

According to the University of California, San Francisco, metformin does not cause low blood sugar levels but if taking in combination with insulin or insulin releasing pills, be aware of the possibility of low blood sugar episodes. In this case, since metformin increases your sensitivity to insulin, any insulin you are taking may raise your risk of having low blood sugar and you will need to be sure to carry glucose tablets or some other fast acting source of glucose with you at all times.

Metformin does not cause weight gain.

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