Metformin is used alone or with other medications, including insulin, to treat type 2 diabetes (condition in which the body does not use insulin normally and, therefore, cannot control the amount of sugar in the blood). Metformin is in a class of drugs called biguanides. Metformin helps to control the amount of glucose (sugar) in your blood. It decreases the amount of glucose you absorb from your food and the amount of glucose made by your liver. Metformin also increases your body’s response to insulin, a natural substance that controls the amount of glucose in the blood. Metformin is not used to treat type 1 diabetes (condition in which the body does not produce insulin and therefore cannot control the amount of sugar in the blood).
Metformin treatment of people at risk for type 2 diabetes may decrease their chances of developing the disease, although intensive physical exercise and dieting work significantly better for this purpose. In a large U.S. study known as the Diabetes Prevention Program, participants were divided into groups and given either placebo, metformin, or lifestyle intervention, and followed for an average of three years. The intensive program of lifestyle modifications included a 16-lesson training on dieting and exercise, followed by monthly individualized sessions with the goals to decrease the body weight by 7% and engage in a physical activity for at least 150 minutes per week. The incidence of diabetes was 58% lower in the lifestyle group and 31% lower in those given metformin. Among younger people with a higher body mass index, lifestyle modification was no more effective than metformin, and for older individuals with a lower body mass index, metformin was no better than placebo in preventing diabetes. After ten years, the incidence of diabetes was 34% lower in the group of participants given diet and exercise and 18% lower in those given metformin. It is unclear whether metformin slowed down the progression of prediabetes to diabetes (true preventive effect), or the decrease of diabetes in the treated population was simply due to its glucose-lowering action (treatment effect).
An FDA advisory subcommittee voted unaminously in March 1994 that Metformin be approved for the treatment of insulin resistance and type 2 (insulin resistant) diabetes that cannot be controlled by diet alone. It had the strong endorsement of the American Diabetes Association and is presently used in over 80 countries. By September 1996, over one million U.S. patients had been prescribed the medication. Use is predicted to sharply rise. Metformin enhances the body’s sensitivity to insulin and inhibits glucose production from the liver without the risk of hypoglycemia. It does not lower blood glucose levels, but acts to improve the body’s sensitivity to insulin without affecting insulin secretion. Some patients have shown weight loss, improved lipid profiles, lowering of blood pressure, return of menstruation, and pregnancy.
Metformin appears to have an excellent safety profile and is generally well tolerated. Gastrointestinal upset and a tendency toward looser stools, or more frequent bowel movements, are the most frequent side effects. These are common in the first month, and can be reduced by starting at lower doses and increasing. These side-effects are also more commonly experienced after a fatty meal, or dessert. Lactic acidosis, a rare and potentially fatal condition, has been associated with Metformin use. The reported incidence of lactic acidosis is 3 /100,000 patients using the drug for 1 year. Almost all cases occurred in older patients with other significant diseases and risk factors. A relative disadvantage of Metformin therapy may be the postponement of more aggressive fertility therapy. The usual dose is 500 mg, three times daily.
Note from Heather: I know Met will make you sick when you first start taking it. However . . . take your bloody* Metformin if your doctor prescribes it to you! It protects your liver from Fatty Liver Disease and cirrhosis from chronic inflammation, will help you lose weight, may help you conceive if you’re trying, AND, above all else, it will help you regulate your blood sugar. The insidious thing is that you can’t SEE what this pill is doing for you. All you can feel at first is that it is making you ill. Stick with it. The illness WILL subside.
Talk to your doctor about going on a controlled release version if nausea persists beyond the initial 30 days after a new increase, or introduction of this medication to your normal routine.
Pairing Met with Spironolactone can help slow hair loss / hirsutism too! These effects are even greater when you incorporate lifestyle changes, such as a high protein / reduced carbohydrate diet and deliberate moderate daily exercise, such as talking a 40-minute walk every night after dinner.
* I’m borrowing a bit of British slang, since the word I wanted to use is perhaps a bit too harsh. ;)