Type 2 Diabetes: Learn More About Metformin!

Published May 7, 2020 • By Camille Dauvergne

Type 2 diabetes is the most common form of diabetes, making up more than 90% of all diabetes cases. It is characterized by a later diagnosis than type 1 diabetes and often occurs in people who are overweight or obese.

Type 2 diabetes involves an abnormal increase in blood sugar levels (hyperglycemia). This abnormality is not due to a defect in insulin secretion but to an insensitivity of the cells to insulin, which is why it is called NIDD (Non-Insulin-Dependent Diabetes). This type of diabetes is the counterpart to Insulin-Dependent Diabetes (IDDM), which is linked to a lack of insulin production by the pancreas. Permanent hyperglycemia caused by insensitivity to insulin hinders the production of insulin by the pancreas, which can lead to a progression from non-insulin-dependent diabetes to insulin-dependent diabetes.

Metformin is the leading oral antidiabetic treatment used as first-line therapy in the management of non-insulin-dependent type 2 diabetes.

Type 2 Diabetes: Learn More About Metformin!

Metformin is an oral hypoglycemic drug (OHD) that improves patients' sensitivity to insulin

Metformin is a type 2 diabetes drug, belonging to the biguanide family. It has hypoglycemic effects, meaning that it lowers blood sugar levels without stimulating insulin secretion, so it does not cause hypoglycemia (an excessive drop in blood sugar levels). Metformin lowers blood sugar levels by improving the sensitivity of the muscles and liver to insulin. Metformin therefore helps patients achieve their individual glycemic targets.

Metformin is indicated as a first-line treatment for the management of non-insulin-dependent diabetes, following the implementation of lifestyle and dietary changes and when such measures are not sufficient, to restore normal blood sugar levels. These dietary measures include a daily intake of between 50-55% carbohydrates, a good balance of carbohydrates throughout the day (approximately 20% in the morning - 40% at lunchtime - 40% in the evening), a preference for foods with a low glycemic index, eating sufficient soluble fiber and at least 30 minutes of physical activity five times per week.

Metformin is an oral hypoglycemic drug that can be used alone or in combination with other oral hypoglycemic drugs (OHDs) if it is not effective for non-insulin-dependent type 2 diabetes on its own. 

In the case of insulin-dependent diabetes, it can be used in combination with insulin.

Metformin is present in several medications prescribed to type 2 diabetes patients

Some medicines contain Metformin exclusively while others are composed of Metformin in combination with other molecules.

Medicines containing only Metformin

  • GLUCOPHAGE 500/850/1000 mg
  • GLUCIENT 500/750/1000 mg
  • METFORMIN 500/850/1000 mg; under various brand names and generics (Fortamet, Glumetza, Riomet, etc.)

Medicines containing Metformin in combination

The drugs below are all oral antidiabetic combinations, and are indicated for the treatment of type 2 diabetes, if the glycemic target is not achieved by using Metformin alone:

  • GLUCOVANCE (Metformin + Glyburide)
  • JANUMET (Metformin + Sitagliptin)
  • KOMBIGLYZE XR (Metformin + Saxagliptin)
  • XIGDUO XR (Metformin + Dapaglifozin)

Some advice for those taking Metformin

On the administration of Metformin

Metformin comes in swallowable tablet form. To reduce the adverse digestive effects of Metformin, which are frequently observed at the start of treatment, it is preferable to gradually increase doses and to take Metformin with or after a meal.

Usually, Metformin is introduced with 500mg or 850mg doses, 2 or 3 times a day, with or after meals. Then after 10 to 15 days, the doctor adjusts the dosage according to blood sugar levels.

Close monitoring is necessary during treatment

It is particularly important to have a kidney workup before starting treatment, and at least once a year during treatment with Metformin.

In cases of moderate kidney failure and/or stable chronic heart failure, Metformin may be used but regular monitoring of heart and kidney function is essential.

If you ever need to undergo an imaging test with contrast or surgery, Metformin should be stopped beforehand and resumed at least 48 hours later. Tell your doctor about all your current treatments before any examinations or surgery!

The combination of Metformin with other oral antidiabetic drugs (such as AMARYL or PRECOSE) requires closer and more regular monitoring of blood glucose levels because there is a higher risk of hypoglycemia for the patient.

Pregnancy and breastfeeding

Metformin is not indicated for the treatment of gestational diabetes or type 2 diabetes during pregnancy and lactation. Insulin will be preferred in these cases. Talk to your doctor about your plans for pregnancy and do not change your prescription without medical advice.

Metformin is contraindicated for certain conditions

The following conditions do not permit treatment with Metformin:

  • Allergy to Metformin or any of the excipients listed in its composition
  • Any type of acute metabolic acidosis
  • Diabetic precoma
  • Severe kidney failure (GFR < 30 mL/min)
  • Dehydration, severe infection, shock
  • Decompensated heart failure, respiratory failure, recent heart attack
  • Liver failure, acute alcohol intoxication, alcoholism

Caution is particularly recommended in patients with kidney failure, as the concentration of Metformin in the blood can rise and lead to lactic acidosis, which is a medical emergency!

This is an accumulation of lactic acid often caused by decreased renal excretion, which can be fatal if not treated in time.

Although lactic acidosis is rare, it is important to be able to detect the warning signs early: vomiting, muscle cramps, abdominal pain, difficulty breathing, general feeling of discomfort associated with fatigue, hypothermia and decreased heart rate. If you experience these symptoms suddenly, consult your doctor immediately.

The consumption of alcohol is also not recommended and increases the risk of lactic acidosis.

Some drugs should be used with caution in combination with Metformin

Metformin should be used with caution when combined with the following medications, and should be taken at the dosage recommended by your doctor or pharmacist:

  • NSAIDs (Ibuprofen, Advil, Nurofen, Ketoprofen, Flurbiprofen, etc.)
  • Drugs that affect the kidney (ACE inhibitors, ARBs, diuretics)
  • Glucocorticoids
  • Verapamil
  • Rifampicin
  • Crizotinib and Olaparib

Carenity members are satisfied with the efficacy and ease of use of Metformin, but are concerned about the side effects

Here are some of our members' opinions on Metformin:

“I used to take 500mg of Metformin morning and evening, since January (HbA1c at 7.3) my doctor has increased the doses: 500mg morning and 1000mg evening. From there: I had immediate side effects like bellyache and diarrhea. I started taking 500mg in the morning and evening again and now everything is fine.”

“I take 1000mg of Glucophage after each meal, and 60mg of Diamicron in the morning along with a 45-minute walk a day and a light diet: HbA1c results at 6.2. I'm satisfied!”

“I have been on 3 different types of Metformin over 16 years and suffered with gastric and bowel problems - but I put up with the Metformin until I started using insulin.

“I've been taking 1000mg of Metformin since 1999, I take it before meals, it suits me very well, I've had no adverse effects and my blood sugar is balanced.”

“Unbearable digestive problems. I have had stomach and intestinal pain and diarrhea alternating with constipation. As my stomach was no longer emptying, I lost 5 kg very quickly at the beginning of the course without changing my already very balanced diet. Loss of appetite. Eventually, I stopped taking it.”

Although the digestive side effects of Metformin may seem difficult for patients to manage, its efficacy as a first-line oral treatment for non-insulin-dependent type 2 diabetes is significant.

Feel free to share your opinion and experience with Metformin by commenting! Did it help regulate your blood sugar? Have you experienced any side effects? If so, what were they?

1 comment

on 12/21/20

Hello I had been taken  500 mg of Metformin twice a day which I tolerated very well.  Prescriber increased to 1000 mg twice a day and had terrible bouts of diarrhea.  Requested prescriber to write a replacement, however it seems as though he is using the newer medications (Trulicity is one)  but all are unaffordable even with prescription insurance, because co-pays are above $100.00 per month.  I was wondering what medications people are using that are reasonable priced.

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