Brands Names: Fortamet, Glucophage, Glumetza, Riomet
Metformin is the most popular pharmacotherapy to manage Type 2 diabetes. This medication is also widely used as a treatment for weight loss as well as polycystic ovary syndrome in women. Metformin helps with lowering blood sugar and weight loss without causing serious side effects.
Metformin is available in tablet form dispensed in dosages of 500, 850, or 1000 mg. The active ingredient in this medication is indeed metformin. Metformin or metformin hydrochloride is considered as part of the biguanide class of drugs, which help with eliminating hyperglycemia (i.e., increased blood glucose levels). Metformin is primarily taken to treat Type 2 diabetes.
Indications for use of Metformin
When treating patients with Metformin, symptoms associated with hypoglycemia will be relieved because the following processes that are expected to occur within the body:
- Increased glucose absorption
- Deceleration of the process of splitting fats and proteins
- Rapid synthesis of glucose in the digestive tract and its transformation into lactic acid
- Inhibition of glycogen release from the liver
- Elimination of insulin resistance
- Stimulation of glucose accumulation in the liver
- Excretion of cholesterol, which favorably affects the state of lipids
For the most part, Metformin does not affect pancreas function, which produces insulin. Metformin cannot lead to hypoglycemia because of decreased glucose concentration in blood. This medication should always be prescribed by a doctor who takes into account individual patient characteristics. Always follow the directions recommended by the doctor when taking Metformin.
Indications for prescribing Metformin include the following:
- both Type 1 and 2 diabetes mellitus
- prediabetes (intermediate state)
- obesity with impaired insulin tolerance
- ocular polycystic estrogens
- metabolic syndrome
- while playing sports
- aging prevention
Despite the fact that Metformin can be prescribed for numerous health conditions, this medication is most commonly prescribed for treating Type 2 diabetes. In cases of Type 1 diabetes, Metformin is rarely prescribed, but in some instances may occur as a secondary treatment alongside insulin therapy.
Taking Metformin should only be used to complement the benefits of a healthy diet and regular physical activity as opposed to replacing these aspects of a healthy lifestyle.
Many studies have shown that while taking Metformin simultaneously with insulin injections, hormone need decreases by almost 25-50%. Additionally, after prolonged use of Metformin, compensation for carbohydrate metabolism is improved.
Metformin is prescribed in almost every case of Type 2 diabetes. During monotherapy, drug dosing should be increased gradually. When initiating this therapy, it is recommended that Metformin be taken as one tablet per day (500 or 850 mg). To avoid disruption of the gastrointestinal tract, Metformin tablets should be taken with food twice per day, once in the morning and once in the evening.
Metformin dose can be increased after an extended period of time taking this medication. However, the maximum daily dose of Metformin should not exceed 2.5 mg. After two weeks of taking Metformin, carbohydrate metabolism can be expected to begin to return to normal. After reaching normal blood sugar levels, Metformin dosage can be gradually reduced.
The combination of Metformin and sulfonylureas can produce a short-term positive effect. In 66% of patients with diabetes, this combination of drugs normalized carbohydrate metabolism. Nevertheless, the human body quickly builds tolerance to these combinations of medicines. Therefore, monotherapy with Metformin can have a long-lasting effect.
Many diabetics diagnosed with the Type 2 variant also suffer from being overweight or are obese. In such cases, use of Metformin may demonstrate a positive effect on reducing patient body weight. However, to avoid harm to the body, it is important that patients strictly adhere to drug recommendations:
- course of therapy should last no more than 22 days
- patients should lead an active lifestyle
- every day a diabetic patient must engage in some form of physical activity
Patients should refrain from consuming bakery products, pastries, chocolate, jam, honey, sweet fruit, and fatty and fried foods.
Initial treatment with Metformin should begin with a daily dosage equal to 500-850 mg while slowly increasing this does to maximum levels equal to 2550 mg (i.e., three 850 mg tablets). For sustained release tablets, the maximum daily dose is 2000 mg. Drug dosing is typically increased if patients do not demonstrate serious side effects. However, this should not occur more than once per week; and ideally every 10-15 days. Sustained release tablets should be taken one time per day in the evening. Regular Metformin tablets should be taken three times per day with meals.
When taking Metformin, patients often complain of diarrhea, nausea, loss of appetite, and/or a violation of taste. These are not dangerous side effects, and they usually go away in a few days. To avoid these side effects, start with a 500 mg daily dose and do not rush to increase this dosage. Metformin use negatively affects the absorption of dietary vitamin B12.
Metformin should not be taken in the presence of poor control of diabetes with episodes of ketoacidosis and/or diabetic coma. This drug should also not be taken in the presence of severe renal failure (i.e., glomerular filtration rate (GFR) is below 45 ml/min, creatinine in blood is higher than 132 μmol/l in men and above 141 μmol/l in women. Metformin should also not be taken if the following are present:
- Liver failure
- Acute infectious diseases
Metformin use should also be avoided in cases of:
- children <10 years of age
- pathology of kidneys, liver, heart, and respiratory system
- diabetic coma or precoma
- lactic acidosis or predisposition
- low-calorie diet
- serious injuries and surgical interventions
Some conditions may lead to the development or aggravation of lactic acidosis:
- kidney dysfunction leading to the inability to excrete acid
- cardiac and respiratory insufficiency
- obstructive pulmonary disease
- infectious diseases leading to dehydration coupled with vomiting, diarrhea, and fever
- diabetic ketoacidosis (carbohydrate metabolism dysfunction)
- myocardial infarction
Improper consumption of Metformin (i.e., overdose) can lead to negative consequences for patients such as:
- indigestion, nausea, vomiting, flatulence, diarrhea, metallic aftertaste, and/or decreased or no appetite
- allergic reactions leading to rashes on the skin and itching
- lactic acid coma is rare, but can be a dangerous complication
In most cases, if adverse reactions are experienced, these could be expected to go away after two weeks using Metformin. This is because Metformin prevents the absorption of glucose within the intestine. As a result, carbohydrates begin to wander, causing flatulence and other signs of gastrointestinal tract disruption. Often times the body is able to adapt to the effects of Metformin. If side effects are not too difficult to tolerate, no symptomatic treatment should be done.
Metformin should be withdrawn 48 hours prior to a forthcoming surgery or radiopaque examination or lactic acidosis may occur. This is a serious complication to which blood pH drops from 7.37-7.43 to 7.25 and below. Signs and symptoms of this adverse event include general weakness, abdominal pain, shortness of breath, vomiting, and/or coma. Nevertheless, for most people the risk for this complication is almost zero, but may be higher for those who take Metformin when contraindicated or in-excess of recommended daily doses.