The Side Effects Of Metformin
Metformin has proven to be safe and effective and is usually well tolerated. However, many patients cannot tolerate the medication due to its side effects. Therefore, optimal metformin use requires a clear understanding of its side effects and safety . Metformin oral tablets can cause side effects that can be mild or serious . The usual side effects include nausea, abdominal bloating, flatulence, vomiting, diarrhoea/constipation, heartburn, headache, agitation, chills, dizziness, tiredness, abdominal cramps or pain, loss of appetite, asthenia, myalgia, upper respiratory tract infection and an altered or metallic taste . However, evidence shows that the symptoms which are gastrointestinal and symptoms of the digestive tract are mostly observed with metformin treatment. GI symptoms were confirmed to be more in participants who had metformin compared to the ones who had placebo . The reason for this could be because the microbiome within the intestine changes due to metformin . One of the main sites of metformin action is the liver, however current research shows that metformin also affects the gut due to an association with the gut-brain-liver axis. The bile acids in the intestine increase with metformin, which can affect the microbiome and as a result, the secretion of GLP-1, cholesterol levels and stool consistency are affected .
How Does Metformin Work
Metformins primary effect is to decrease glucose coming from the liver. It does that by reducing glucose production in the liver. Metformin also helps to increase glucose uptake by the cells, such as muscle and fat. That effect is more prominent, particularly after meals. Metformin also reduces the fat circulating in the bloodstream. As a result of these effects, metformin reduces insulin levels. There is also indirectly reduce his insulin resistance. Metformin also has a slight impact on appetite. It can help reduce the weight slightly. There are some suggestions that metformin can reduce the risk of cancer as well. Kidneys clear metformin. As a result, there is confusion about whether metformin is the cause of kidney damage.
Does Metformin Decrease Insulin Resistance Cause Protein Urine Gestational Can
Women with a history of gestational diabetes are at significantly increased risk for developing type 2 diabetes and many don’t know Radiology Rheumatology Transplantation Mcintire DD et al.: Pregnancy outcomes in women with gestational diabetes comparedwith the general obstetric Patient & Family Services. Persons with diabetes have a higher than normal potential for renal disease, Clinical Guidelines > ADA 2013 Guidelines – Diabetes and Pregnancy ADA Guidelines: Detection and Diagnosis of Gestational Diabetes Mellitus GDM=gestational diabetes mellitus OGTT=oral glucose tolerance test Chapter 9: The Diabetic Foot/Wound Care. diabetes type 2 diet australia. Doctors use glucose test strips to screen patients for diabetes. Insulin shock Risks, causes, treatment, and prevention. eat less of the foods you usually have. Diabetes and Pregnancy 37 An Endocrine Society Clinical Practice Guideline Diabetes and Pregnancy: CME Learning Objectives and Post-Test Questions LEARNING diabetes insipidus n. When consumed with food, moderate amounts of alcohol do not cause hypoglycemia increased appetite changes in temperament or behavior blurred vision poor woundContinue reading > >
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Metformin Is Not Usually The Cause Of La
Diabetes mellitus per se disposes to hyperlactemia, the concentration of lactate being double the level of healthy controls , and physical exercise in untreated T2DM causes a 2.8 times increase in p-lactate, similar to metformin-treated patients . Ketoacidosis is commonly accompanied by LA . The increased LA rates seen in patients with heart failure can be related to poor circulation, and, in patients with hepatic failure, to reduced hepatic metabolism of lactate. A controlled investigation showed no increase in lactate concentration or turnover in metformin-treated patients .
Diabetic Kidney Damage May Be Reversible
Diabetes is the most common cause of kidney failure. Until recently, it was thought that once a diabetic leaks protein into his urine, the kidneys are damaged and can never heal. However, kidneys damaged by diabetes have healed after high blood pressure has returned to normal and after pancreatic transplants. Blood pressure medications called Ace inhibitors and angiotensin receptor blockers have also healed diabetes-damaged kidneys. The kidney is supposed to allow urine, but not protein, to pass through its filters. Doctors used to tell diabetics that since damaged kidneys never heal, they could never take metformin, an important drug for treating diabetes. Now all diabetics should be told to get their diabetes under control by avoiding refined carbohydrate , losing weight, exercising, stopping smoking, and getting their HBA1C blood tests to normal. If their kidneys stop spilling protein, they may be able to take metformin again. 1) Remission and regression of diabetic nephropathy. Hypertension Research, 2003, Vol 26, Iss 7, pp 515-519. H Makino, Y Nakamura, J Wada. Makino H, Okayama Univ, Grad Sch Med & Dent, Dept Med & Clin Sci, 2-5-1 Shikata Cho, Okayama 7008558, JAPAN. 2) Regression of albuminuria: latest evidence for a new approach. Journal of Hypertension, 2003, Vol 21, Suppl. 3, pp S24-S28. G Viberti. Guys Kings & St Thomas Sch Med, Dept Diabet Endocrinol & Internal Med, Sch Med, London SE1 9RT, ENGLAND Checked 2/23/17Continue reading > >
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Can Metformin Cause Anemia
Yes. Metformin can interfere with the absorption of vitamin B12, a vitamin you need to maintain healthy blood levels. Low vitamin B12 levels can lead to anemia and iron deficiency.
Your blood work should be monitored by your doctor to make sure that you are not seeing a significant decrease in B12. If this happens, taking a B12 supplement may help. If you and your healthcare provider decide its necessary, stopping metformin should bring your vitamin B12 levels back to normal.
Metformin And Kidney Stones
D.D. Family Type 2 since 1993, on pump since 3/10 My son was recently diagnosed with T2. His doctor prescribed Metformin however, my son has read somewhere that Metformin has been linked to kidney stones so he does not want to take it. Has anyone heard about this? D.D. Family diabetic since 1997, on insulin 2000 Tell him to drink a lot of water each day probably at least 3 litres and the stones should not be an issue. I don’t think stones and met are that related. D.D. Family Getting much harder to control Sure is a whole lot of stuff to read out there. I know at least 8 type 2 on met and none have had stones. Now could you get them I would suppose one could but in 29 yrs I never had any and I been on met that long. If you are disposed toward them then it’s possible that this could bring them on faster, although this is something that I would research a lot more if I felt that this was a possible issue. My son was recently diagnosed with T2. His doctor prescribed Metformin however, my son has read somewhere that Metformin has been linked to kidney stones so he does not want to take it. Has anyone heard about this? I don’t see anything in the package insert for metformin that says anything about kidney stones however, it’s not recommended for those have kidney problems. He might want to ask his pharmacist about metformin and kidney stones.Continue reading > >
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What If I Forget To Take It
If you miss a dose of metformin, take the next dose at the usual time. Do not take a double dose to make up for a forgotten dose.
If you often forget doses, it may help to set an alarm to remind you.
You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.
Will My Dose Go Up Or Down
Your doctor will check your blood sugar levels regularly and may change your dose of metformin if necessary.
When you first start taking metformin standard-release tablets, you’ll be advised to increase the dose slowly. This reduces the chances of getting side effects.
For example:
- one 500mg tablet with or after breakfast for at least 1 week, then
- one 500mg tablet with or after breakfast and your evening meal for at least 1 week, then
- one 500mg tablet with or after breakfast, lunch and your evening meal
If you find you cannot tolerate the side effects of standard-release metformin, your doctor may suggest switching to slow-release tablets.
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Some Side Effects Can Be Serious If You Experience Any Of These Symptoms Or Those Listed In The Important Warning Section Call Your Doctor Immediately Or Get Emergency Treatment:
- chest pain
- rash
Metformin may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.
If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration’s MedWatch Adverse Event Reporting program online or by phone .
Metformin Side Effects On The Heart
Metformin, sold under the brand name Glucophage, is an anti-hyperglycemic medication used alone or in combination with other medication, such as insulin, to control blood glucose levels in those with Type 2 diabetes 1. It belongs in the biguanide class of medication. According to Drugs.com, metformin works by decreasing the amount of glucose obtained from food and glucose produced by the liver, lowering blood glucose levels 12.
If you are experiencing serious medical symptoms, seek emergency treatment immediately.
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How To Cope With Side Effects
What to do about:
- feeling sick â take metformin with food to reduce the chances of feeling sick. It may also help to slowly increase your dose over several weeks. Ask a pharmacist or your doctor for advice.
- being sick or diarrhoea â drink lots of fluids, such as water or squash, to avoid dehydration. Take small, frequent sips if you’re being sick. Speak to a pharmacist if you have signs of dehydration, such as peeing less than usual or having dark, strong-smelling pee. Do not take any other medicines to treat diarrhoea or vomiting without speaking to a pharmacist or doctor.
- stomach pain â try to rest and relax. It can help to eat and drink slowly and have smaller and more frequent meals. Putting a heat pad or covered hot water bottle on your stomach may also help. If you’re in a lot of pain, speak to your pharmacist or doctor.
- loss of appetite â eat when you’d usually expect to be hungry. If it helps, eat smaller meals more often than usual.
- a metallic taste in the mouth â if you find that metformin is giving you a metallic taste in the mouth, try chewing sugar-free gum
Drug Interactions Warnings And Precautions For Metformin
Drug interactions involving metformin that are clinically significant are not very common . However, a few medications can interfere with metforminâs actions. The concentrations of metformin can increase if cimetidine, frusemide or nifedipine are also administered simultaneously . Dosages should be adjusted if a patient is on frusemide, prednisolone, oestrogen, progesterone, testosterone, contraceptive pills or other diabetes medicines and blood glucose levels may need to be checked more often . Some medications excreted by renal tubular secretion, such as morphine, quinine, ranitidine, digoxin, quinidine, amiloride, procainamide, triamterene, vancomycin and trimethoprim, may be competing against metformin for being eliminated . Therefore, patients who take metformin simultaneously with these agents need close monitoring for any toxic reactions .
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What Conditions Are Treated With Metformin
An estimated ten percent of Americans have diabetes, which exists in two types: Type 1 and Type 2. Type 1 diabetes, or juvenile diabetes, is defined by the bodys failure to produce enough insulin, while Type 2 diabetes results from insulin resistance.
Most people with diabetes have Type 2 diabetes, which is heavily influenced by lifestyle factors such as weight, diet, and activity level. People with both forms of diabetes cannot properly utilize the glucose, or sugar, in the foods we consume and turn it into energy.
In a healthy body, our digestive systems break down the food we eat into glucose, which is released into the bloodstream. As glucose enters the bloodstream,the levels of sugar in the blood rise, causing the pancreas to start to release insulin. Insulin is a hormone that is responsible for directing the body to begin converting the sugar in the blood into energy.
In people with Type 2 diabetes, the directions given by insulin are ignored, so levels of sugar in the blood remain high for a prolonged period of time, causing potentially serious complications.
Metformin helps to increase the bodys sensitivity to insulin, which allows glucose in the blood to be used for energy. Although some people are able to control their Type 2 diabetes through lifestyle changes alone, others require medications like metformin in order to avoid dangerous health effects and complications.
Different Types Of Metformin
Metformin comes as 2 different types of tablet: standard-release tablets and slow-release tablets.
Standard-release tablets release metformin into your body quickly. You may need to take them several times a day depending on your dose.
Slow-release tablets dissolve slowly so you do not have to take them as often. One dose is usually enough, and you’ll take it with your evening meal.
Your doctor or pharmacist will explain what type of metformin tablets you’re on and how to take them.
Metformin is also available as a liquid for children and people who find it difficult to swallow tablets.
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What Should I Know About Storage And Disposal Of This Medication
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from light, excess heat, and moisture .
Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA’s Safe Disposal of Medicines website for more information if you do not have access to a take-back program.
It is important to keep all medication out of sight and reach of children as many containers are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location â one that is up and away and out of their sight and reach.
What Other Information Should I Know
Your doctor will tell you how to check your response to this medication by measuring your blood sugar levels at home. Follow these instructions carefully.
If you are taking the extended-release tablets, you may notice something that looks like a tablet in your stool. This is just the empty tablet shell, and this does not mean that you did not get your complete dose of medication.
You should always wear a diabetic identification bracelet to be sure you get proper treatment in an emergency.
Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.
It is important for you to keep a written list of all of the prescription and nonprescription medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.
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How Should This Medicine Be Used
Metformin comes as a liquid, a tablet, and an extended-release tablet to take by mouth. The liquid is usually taken with meals one or two times a day. The regular tablet is usually taken with meals two or three times a day. The extended-release tablet is usually taken once daily with the evening meal. To help you remember to take metformin, take it around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take metformin exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.
Swallow metformin extended-release tablets whole do not split, chew, or crush them.
Your doctor may start you on a low dose of metformin and gradually increase your dose not more often than once every 1â2 weeks. You will need to monitor your blood sugar carefully so your doctor will be able to tell how well metformin is working.
Metformin controls diabetes but does not cure it. Continue to take metformin even if you feel well. Do not stop taking metformin without talking to your doctor.
Ask your pharmacist or doctor for a copy of the manufacturer’s information for the patient.
Change In Best Practice Treatment
Until now, the FDA has actually cautioned against prescribing higher doses of metformin to patients with kidney disease because of a potential increase in lactic acidosis, which would further stress the kidneys.
This new research suggests that patients in the earlier stages of kidney disease could benefit from metformin without seeing an increase in lactic acid levels.
Only one participant in the entire study experienced an event related to high levels of lactic acidosis directly related to metformin use
The findings are reassuring that the risk of lactic acidosis is very low even in stage 4 CKD, added the studys authors.
There is increasing evidence that treatment with metformin in patients with mild to moderate CKD is safe and may also confer a survival benefit, said expert Samira Bell, MB, a consultant nephrologist at the Renal Unit of Ninewells Hospital in Dundee, UK.
However, randomized controlled trial evidence is required before the widespread use of metformin in patients with eGFR < 30 mL/min/1.73m2 can be recommended.
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