Metformin Explained: Usage, Dosage, And Side Effects

Roughly 1 in 10 Americans suffer from diabetes, according to the Centers for Disease Control and Prevention (CDC). Per the organization's estimates, 90% to 95% of those are type 2 diabetes patients. Type 2 diabetes is a disease that affects insulin, a hormone your body uses to regulate blood sugar levels. When it doesn't work properly, your blood sugar can fluctuate and rise too high, which leads to other problems like heart disease, vision loss, and kidney disease. 

It can be hard to detect type 2 diabetes, but your doctor will be able to tell you if you have it. Usually, a blood test is sufficient. Among the first things your doctor might recommend if you have type 2 diabetes are diet adjustments and exercise. They can prescribe insulin to help regulate your blood sugar if they decide it's necessary. Another option is to take Metformin, which is a drug used to treat type 2 diabetes, according to Medline Plus.

Metformin treats type 2 diabetes

To avoid the possible dangerous side effects of type 2 diabetes, it's best to find treatment as soon as possible. Unlike type 1 diabetes which requires insulin medication, type 2 diabetics can treat their disease without needing insulin. One class of drugs called biguanides is effective at treating type 2 diabetes. The only marketed drug of this type is Metformin, as stated in a study from the Journal of Intensive Care Medicine.

The food you eat is broken down into smaller parts. Sugars are broken down into glucose, which makes its way into the bloodstream. Metformin works by decreasing the amount of glucose you absorb from your food (per MedlinePlus). Another source of glucose is the liver, which creates its own storage and releases that into the bloodstream. Metformin also decreases the amount of glucose your liver produces. Another way it helps is by making the insulin that your body produces more effective at controlling blood sugar levels.

Is Metformin effective?

Relying on a drug to help with an intimidating disease can be very nerve-wracking. Naturally, you want to know that whatever you're using will help with your condition. 

study published in Therapeutic Advances in Endocrinology and Metabolism investigated whether Metformin was effective as a first-line therapy against type 2 diabetes. The researchers point out that Metformin is fairly cheap compared to other medications. It's also effective and mostly safe, making it an attractive drug.

However, they also note that for some high-risk people, Metformin might not be the best option. That includes people who have cardiovascular or kidney problems and need to address those as well as type 2 diabetes. However, those drugs can be costly. Therefore, it remains true that most people should take Metformin since it's effective, cost-friendly, and safe. They recommend starting Metformin soon after the initial diagnosis of type 2 diabetes. It's even on the World Health Organization's list of essential medications.

What else can Metformin help with?

Metformin is primarily known for its ability to regulate blood sugar levels in people with type 2 diabetes. There are other uses that might be lesser known, and potentially even more uses in the future. An article published by StatPearls explains some of the different uses, which are not yet FDA-approved. One use is in gestational diabetes, which is a form of diabetes that some pregnant women suffer from. Some doctors might also recommend it for the treatment of pre-diabetes.

There are also potential uses for Metformin that aren't related to diabetes. One that the authors mention is antipsychotic-induced weight gain. In other words, it can treat the weight gain caused by taking certain antipsychotic medications. Metformin can also treat and prevent polycystic ovary syndrome (PCOS). They also note that there's some research being done on Metformin to see if it's useful as an antiaging, anticancer, or neuroprotective drug.

Metformin lowers cardiovascular risk

Of the many problems that Metformin can help with, perhaps the most important is cardiovascular disease. 

One of the major causes of death and disability worldwide is cardiovascular disease, according to a study published in Cardiovascular Diabetology. That's why the researchers in the study set out to examine how Metformin could help. They looked at people who had coronary artery disease, a condition in which the arteries that feed blood to the heart are blocked.

In the study, the researchers found that Metformin helped reduce the risk of death for any reason. They also found that the risk of death from cardiovascular disease was lower. Additionally, they looked at another type of drug, sulfonylureas, which did not turn out to be as effective at Metformin. Another study published in the Annals of Internal Medicine found the same thing. The authors state that Metformin also helped some people lose weight. The only drawback is that gastrointestinal issues were more common in people who took Metformin.

Can Metformin extend your lifespan?

It's a bold claim to say that any drug can help you live longer, but by helping you avoid harmful diseases, it's possible. 

A study published in Frontiers in Endocrinology set out to determine just how effective Metformin could be at extending a person's lifespan. The researchers note that there are certain benefits of Metformin, such as decreased risk of developing cardiovascular disease. There's also some evidence that Metformin could reduce the risk of cancer. By reducing the risk of disease, Metformin can increase your lifespan. 

Even if Metformin doesn't extend your life, it could improve your remaining years by keeping your risk of developing certain problems (like cardiovascular disease) lower. In other words, it could improve your quality of life. However, the researchers caution that there isn't much evidence that healthy individuals could benefit much from taking Metformin. Another problem they point out is that people could lean on Metformin, using it as a crutch to help their health problems, and ignore proper diet and exercise. 

How Metformin works

A single drug that helps with various serious diseases might seem like a miracle. That said, Metformin has been FDA-approved since 1994, says a paper published by StatPearls. In other words, it's been around for a while. 

When you take Metformin, you decrease your liver's ability to produce glucose, which is a type of sugar that your body uses for fuel. It also makes it harder for your body to extract sugar from the food you eat. The authors of the paper note that Metformin decreases your blood sugar both at rest and after a meal.

They go on to describe the way Metformin helps with polycystic ovary syndrome (PCOS). Women who have too much insulin circulating their bodies also have high luteinizing hormone and androgens. Metformin makes your insulin more efficient, so your body doesn't have to produce as much. When your insulin levels drop, other hormones return to normal levels and the menstrual cycle normalizes.

Metformin is euglycemic

For diabetics, the benefit of Metformin is that it's a euglycemic. The University of California, San Francisco explains that a euglycemic is something that restores your blood sugar to normal or pre-diabetic levels. That's the primary use of Metformin, but it comes with a caveat. 

For those taking any other medication that lowers blood sugar, it could cause your blood sugar levels to drop too low. While high blood sugar is problematic, it can be just as dangerous if it drops to sub-normal levels.

Low blood sugar is also known as hypoglycemia, says the CDC. While your blood sugars constantly fluctuate, if they drop too low, you can have a fast heart rate, shaking, dizziness, irritability, and confusion. It can happen as a result of a lot of activity or not eating enough. The risk for hypoglycemia is higher in people who take Metformin with some type of insulin medication.

Who shouldn't take Metformin?

While it can help many people live healthier lives, Metformin isn't for everyone. Like many drugs, there are possible side effects or interactions with other medications that your doctor will examine to figure out if the drug is right for you. The University of California, San Francisco says that people with liver problems or heart failure, as well as those who are very sick, shouldn't take Metformin. 

These might seem like serious problems, but the majority of people who experience side effects only have mild symptoms. The article points out that diarrhea and stomach cramps are the main problems associated with the drug. Taking food with the drug can minimize these potential problems, but people with digestive problems might want to avoid it or figure out a solution to mitigate these problems with their doctor. 

One of the most serious side effects is lactic acidosis. It's a buildup of lactic acid in your blood, and it can be fatal. The people who are at the highest risk for this side effect are people who shouldn't be taking the drug in the first place, such as people with kidney problems or alcohol addiction.

How to take Metformin

There aren't really any terribly complex instructions for taking Metformin, but you should be aware of some key details.

When you pick up your medicine, it will likely be in tablet form. The Cleveland Clinic recommends taking your Metformin with a glass of water and a meal. You should only take the amount recommended by your doctor. Also, make sure to take the medication at regular intervals. They warn that you shouldn't stop taking the medication suddenly, especially without consulting your doctor.

If you miss a dose, simply take it as soon as you can. Don't double up or take any extra doses to make up for it. Your doctor should consistently take blood tests when you start taking this medicine, to see how you respond. They might need to change the dose of your medicine if your blood sugar is too high, if you've been exercising a lot, or if you're sick. Another thing to watch out for is low blood sugar. The Cleveland Clinic recommends keeping a quick sugar source with you (such as juice) to get a blood sugar boost if you need it.

What drugs interact with Metformin?

Your doctor or pharmacist should know what drugs will interact with Metformin and how it could affect you. 

The Cleveland Clinic lists medicines or drugs that could interact with Metformin and potentially cause harm. The list includes alcohol, which you might want to talk to your doctor about. Drinking isn't advised when taking Metformin, at least in certain doses. You should also notify your doctor if you smoke or take illegal drugs, since those could interact with the medication as well. Be sure to mention any dietary supplements you take as well.

Among the prescription drugs to watch out for are steroids such as cortisone. Women should be aware that birth control pills, including estrogen and progestins, can interfere with Metformin. People on stimulant medications for attention disorders or weight loss might have problems with Metformin. Some people have cardiovascular problems like high blood pressure along with type 2 diabetes. Blood pressure medication, or drugs that regulate your heart beat, could interact with Metformin.

Common side effects of Metformin

Metformin is generally safe, but some side effects can occur. Some are mild, while others are serious. 

The National Health Services lists non-serious side effects that mostly include digestive issues. Nausea and vomiting can occur, as can loss of appetite. You might experience a metallic taste in your mouth as well. You can call your doctor if you experience any of these symptoms while on Metformin.

Low blood sugar or hypoglycemia is also listed as a non-serious side effect. Feeling hungry, shaky, dizzy, or confused are all symptoms of low blood sugar. This can happen if you skip a meal or if you go for a long time without eating. When you sleep, for instance, you could go many hours without food. It's important to eat all regular meals if you experience these symptoms. People who are fasting or exercising too much, those who drink, and those with kidney or liver problems should watch out for a drop in blood sugar.

Serious side effects of Metformin

Although they do happen, serious side effects from Metformin are rare. Per the National Health Services, 1 in 10,000 people who take the medication experience serious side effects. If you're taking the medication, watch out for some key warning signs that could indicate a serious problem. For example, if you suddenly feel cold and your heart rate goes down, you should call a medical professional. 

Since the liver helps process Metformin, you can develop liver problems. If either the whites of your eyes or your skin starts to turn yellow, that's a sign of more serious liver problems. Another potential problem is B12 deficiency and anemia. Possible symptoms would be sudden weakness and lack of energy, "pins and needles" sensations, mouth ulcers, and disturbed vision.

 You could also be allergic to Metformin. Serious allergic reactions have occurred from taking this drug. However, such occurrences are extremely rare.

Treatment options other than Metformin

It's possible that you can't take Metformin because it'll interact with another drug you take. You might also be at a high risk for developing side effects. In such cases, there are alternative options to control your blood sugar that don't involve Metformin, according to the American Diabetes Association

Alpha-glucosidase inhibitors are similar to Metformin in that they block the absorption of the carbohydrates you eat in the intestines. This type of drug also makes sugar break down slowly after you eat a lot of it, which helps you prevent a spike in blood sugar.

Sulfonylureas actually work to stimulate your pancreas to release insulin, the hormone that helps regulate blood sugar levels. This type of drug has been used since the 1950s, says the American Diabetes Association, and comes in a variety of different types. Sometimes these sulfonylureas are used in conjunction with a biguanide such as Metformin to better control blood sugar levels. However, mixing drugs can be a much more costly option.

Can you work out while taking Metformin?

Exercise is part of a healthy lifestyle. It can even help lower your blood sugar levels, says the American Diabetes Association

When you work out, your muscles use glucose as fuel, thus lowering your blood sugar levels. Exercise also makes your body more sensitive to insulin, which means that the insulin already being produced by your pancreas becomes better at lowering blood sugar levels. Low blood sugar is a possible side effect of taking Metformin, but a study published in Diabetes Care suggests that exercise and Metformin can help each other.

The researchers looked at what happened when subjects took Metformin and participated in aerobic activities. They found that Metformin could actually make workouts more effective, because it increased heart rate in the people that took it. That means if you're on Metformin, you don't have to exercise as intensely to raise your heart rate. Interestingly, exercise made Metformin slightly less effective at lowering blood sugar after a meal. The researchers believe that more research should be done on the effects of working out while taking Metformin.