Metformin (Drug class: biguanides) is an oral medication that aids in managing blood sugar levels in people with Diabetes. It is prescribed to only to people with Type 2 Diabetes. It is often used along with insulin or other oral medication. Metformin increases insulin sensitivity, enhances peripheral glucose (sugar) uptake, decreases insulin-induced suppression of fatty acid oxidation and decreases absorption of glucose from the gastrointestinal tract.Metformin controls blood sugar levels by decreasing both the amount of glucose absorbed through your diet and the amount of glucose produced by your body.Metformin improves the body's response to insulin which in turn better manages the amount of sugar in the blood. Metformin is available in: Liquid form which is usually taken with meals one or two times a dayTablet form which is usually taken with meals two or three times a dayThe extended-release tablet is usually taken once daily with the evening meal People with Diabetes are advised to ingest metformin around the same time every day to avoid missed dosages. The metformin extended-release tablets must be swallowed whole and not be split or chewed or crushed.In people with Diabetes, usually lower doses of 500 mg to 1 gram per day (divided in 1-2 doses) are started and then gradually increased with doses up to 3 grams given if well tolerated. Dose is titrated based on blood glucose level. In people who do not have Diabetes, doses beyond 1.5 grams are avoided. Other drugs such as cimetidine and cephalexin increase concentration of metformin and so doses may need to be reduced accordingly.BenefitsBenefits of metformin include that it is most time tested medication. It has good safety data. Doctors have a lot of experience prescribing metformin as it is inexpensive and weight neutral (neither increases nor decreases weight). The confidence that clinicians have in metformin make it so popular. There is no proven effect of metformin on weight loss in people with Diabetes. However, some studies show benefits in people who do not have Diabetes, a fact not universally proven. Metformin is useful as it:increases insulin sensitivityaids in weight lossdoes not cause hypoglycemic eventscan be used in PCOD where ovulation can resume in women with anovulatory polycystic ovary syndrome.can cause minor improvements in blood lipid profile, mostly those with hyperlipidemia.Can help overweight individuals lower risk of heart attacks by 39 per cent.Side effectsThere are some side effects which may occur while on metformin such as:Gastrointestinal side effects like loose motions, nausea and vomiting.It can cause lactic acidosis in patients with kidney/liver or heart disease patients.Hypoglycaemia may occur usually when used with other Diabetes medicines like sulfonylureas or insulin..B12 deficiencyThere has been some concern in recent years regarding people who take metformin risk vitamin B12 deficiency. Vitamin B12 is necessary for the development of blood cells, DNA and the nervous system. It may also help prevent heart disease and possibly even Alzheimer disease. B12 is a water soluble vitamin and can be stored in the liver for up to one year. Vitamin B12 is found primarily in animal foods, such as beef, seafood, eggs, and dairy products which is why some vegetarians are at risk for a B12 deficiency. Elderly people are often at risk for deficiency due to problems with absorption from the gastrointestinal tract. According to some studies, between 10 and 30 per cent of people who take metformin on a regular basis have some evidence of decreased B12 absorption.Symptoms of B12 deficiency include:certain types of anaemianeuropathy (numbness, pain, or tingling in your hands or feet)memory lossconfusiondementiaVitamin B12 deficiency can be managed with either oral or injected, or inhaled forms of B12. Strict vegetarians or the elderly may require regular B12 oral supplements or injections. However, B12 supplement must only be taken with your doctor's advice because too much vitamin B12 may be harmful as it may interact with certain medicines..Metformin is prescribed for:People with Type 2 DiabetesPre-diabetes (where it slows down progression to Type 2 Diabetes)ObesityPolycystic ovarian diseaseWomen with gestational Diabetes (one of the few oral medications that may be prescribed for Diabetes in pregnancy)Lowering blood lipid, or fat, levels (cholesterol and triglycerides)Dr R. Dharini is Consulting Physician
Metformin (Drug class: biguanides) is an oral medication that aids in managing blood sugar levels in people with Diabetes. It is prescribed to only to people with Type 2 Diabetes. It is often used along with insulin or other oral medication. Metformin increases insulin sensitivity, enhances peripheral glucose (sugar) uptake, decreases insulin-induced suppression of fatty acid oxidation and decreases absorption of glucose from the gastrointestinal tract.Metformin controls blood sugar levels by decreasing both the amount of glucose absorbed through your diet and the amount of glucose produced by your body.Metformin improves the body's response to insulin which in turn better manages the amount of sugar in the blood. Metformin is available in: Liquid form which is usually taken with meals one or two times a dayTablet form which is usually taken with meals two or three times a dayThe extended-release tablet is usually taken once daily with the evening meal People with Diabetes are advised to ingest metformin around the same time every day to avoid missed dosages. The metformin extended-release tablets must be swallowed whole and not be split or chewed or crushed.In people with Diabetes, usually lower doses of 500 mg to 1 gram per day (divided in 1-2 doses) are started and then gradually increased with doses up to 3 grams given if well tolerated. Dose is titrated based on blood glucose level. In people who do not have Diabetes, doses beyond 1.5 grams are avoided. Other drugs such as cimetidine and cephalexin increase concentration of metformin and so doses may need to be reduced accordingly.BenefitsBenefits of metformin include that it is most time tested medication. It has good safety data. Doctors have a lot of experience prescribing metformin as it is inexpensive and weight neutral (neither increases nor decreases weight). The confidence that clinicians have in metformin make it so popular. There is no proven effect of metformin on weight loss in people with Diabetes. However, some studies show benefits in people who do not have Diabetes, a fact not universally proven. Metformin is useful as it:increases insulin sensitivityaids in weight lossdoes not cause hypoglycemic eventscan be used in PCOD where ovulation can resume in women with anovulatory polycystic ovary syndrome.can cause minor improvements in blood lipid profile, mostly those with hyperlipidemia.Can help overweight individuals lower risk of heart attacks by 39 per cent.Side effectsThere are some side effects which may occur while on metformin such as:Gastrointestinal side effects like loose motions, nausea and vomiting.It can cause lactic acidosis in patients with kidney/liver or heart disease patients.Hypoglycaemia may occur usually when used with other Diabetes medicines like sulfonylureas or insulin..B12 deficiencyThere has been some concern in recent years regarding people who take metformin risk vitamin B12 deficiency. Vitamin B12 is necessary for the development of blood cells, DNA and the nervous system. It may also help prevent heart disease and possibly even Alzheimer disease. B12 is a water soluble vitamin and can be stored in the liver for up to one year. Vitamin B12 is found primarily in animal foods, such as beef, seafood, eggs, and dairy products which is why some vegetarians are at risk for a B12 deficiency. Elderly people are often at risk for deficiency due to problems with absorption from the gastrointestinal tract. According to some studies, between 10 and 30 per cent of people who take metformin on a regular basis have some evidence of decreased B12 absorption.Symptoms of B12 deficiency include:certain types of anaemianeuropathy (numbness, pain, or tingling in your hands or feet)memory lossconfusiondementiaVitamin B12 deficiency can be managed with either oral or injected, or inhaled forms of B12. Strict vegetarians or the elderly may require regular B12 oral supplements or injections. However, B12 supplement must only be taken with your doctor's advice because too much vitamin B12 may be harmful as it may interact with certain medicines..Metformin is prescribed for:People with Type 2 DiabetesPre-diabetes (where it slows down progression to Type 2 Diabetes)ObesityPolycystic ovarian diseaseWomen with gestational Diabetes (one of the few oral medications that may be prescribed for Diabetes in pregnancy)Lowering blood lipid, or fat, levels (cholesterol and triglycerides)Dr R. Dharini is Consulting Physician
