Microsoft word - metformin (glucophage).doc
(METFORMIN HYDROCHLORIDE) The medication and its uses:
Metformin is an insulin
Table 1: Health Problems Associated
sensitizing agent – it makes the job of insulin easier. Insulin
With Insulin Resistance
resistance is almost always part of the problem in type 2
diabetes, and many consider metformin the best available
treatment for type 2 diabetes – after increasing physical
activity, decreasing carbohydrate intake and losing weight.
Early on in the course of type 2 diabetes the body still makes
lots of insulin, just not enough to overcome the underlying
insulin resistance. Treating the insulin resistance may be all
that is needed for the insulin still remaining to control blood
sugar. Or metformin can be used to treat type 2 diabetes
together with other medications or even with insulin
injections. Because metformin simply helps the body’s
own insulin to do its job, metformin cannot by itself cause
significantly low blood sugar.
Insulin resistance usually precedes type 2 diabetes by many years, and it is associated with many other health problems – see table 1. Metformin can be used as a treatment in all these conditions and as part of a diabetes prevention plan – again best with weight loss, exercise and diet changes.
Metformin preparations and doses:
Metformin is available
Table 2: Metformin preparations
as brand-name Glucophage, but also as a generic medication.
Early on some patients found the generic preparations much
less effective, but that does not seem to be a problem any
more. However, as with all medications, it is best to stick to
Do not switch between the regular and the “XR” preparations, unless
metformin of one manufacturer, and if you have to switch,
pay attention to the possibility of new side-effects or changes in effect.
Metformin comes as plain or as “XR” or “ER” for extended release. The plain may actually be better, and is the one to
Table 3: How and when to take
start with. However, the extended release may have fewer
side-effects. Do not switch between them unless instructed to
do so. Metformin comes in tablets of 500 mg, 1,000 mg (1 g)
and an older version not much used any more – 850 mg. The
“XR” and “ER” preparations come in 500 mg and 750 mg,
Don’t bother trying to “line up” metformin with a particular meal or
and there is also a liquid form. If tolerated metformin should
be used in the total dose of 2,000 mg (2 g) per day.
Metformin is also included in combination pills with several other diabetes medications.
How to take metformin:
Metformin is best taken with food to limit some of the unpleasant side-effects
described below. However, metformin works in the body for a long time and does not work just on the meal
that it is taken with. It can even just be taken all at once for the day, in particular the “XR” preparation. It
does not do any good to shift metformin to a different time of
day to try to get a better match to a larger meal, for instance,
or to try to deal with the blood sugar that seems to be always
Table 4: How start metformin
Metformin almost always causes digestive (gastrointestinal -
GI) side-effects, which include some bloating, diarrhea, upset
stomach, nausea and/or gas. These symptoms usually
improve over one to three weeks. Metformin must be started
slowly – see table 4 to the right – to minimize these problems.
If other abnormal symptoms arise, such as a rash or severe GI
problems, stop the metformin and call our office for
GI* symptoms become tolerable, go to step 2.
Metformin and Lactic Acidosis:
In addition to the common
GI side-effects, metformin can cause VERY RARELY the
severe and serious complication of Lactic Acidosis. There are
no real symptoms of Lactic Acidosis, other than feeling
terrible, but fortunately Lactic Acidosis does not usually “just
happen”. It is usually precipitated by another illness or
So, STOP taking metformin if you get ill at home, any
more than just “the sniffles” and do not restart till you feel
During this time monitor your blood sugar more and
don’t forget to look at your “Sick Day Protocol”, or call us
after you have stopped the metformin, if you are not sure what
If after three weeks at any level
to do. As you might expect, patients sick enough to be in the
your GI* symptoms do not
become tolerable, or if you
Another time of some concern is when an x-ray test with
simply cannot tolerate them
“contrast” is performed. This applies to IVP, most CT
earlier, go back to a lower dose
scans, angiograms and cardiac catheterization, but NOT
level and stay there.
MRI. If you are to have one of these done, tell the doctor
If you are not sure how to
ordering the test that you are taking metformin.
proceed, call our office at
Lactic Acidosis is also more common with certain other
(814) 234 8800.
illnesses. Metformin should not be taken by patients with
GI = gastrointestinal
significant heart failure problems, cardiomyopathy (weak heart), kidney function impairment and liver problems.
Significant alcohol intake can also be a concern and we recommend that patients taking metformin should not consume more than 1-2 alcoholic beverages per day, and no more than 5 week. In addition it is generally recommended that persons over the age of 70 or 75 not take metformin.
Metformin and vitamin B-12:
Metformin can interfere with the absorption from the gut into the body of
vitamin B12. This is a very important vitamin and we strongly recommend that you take 1,000 micrograms
of supplemental vitamin B12 daily, as long as you are taking metformin. You can get vitamin B12 over the
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