Magical Metformin

Written by Dr Harold Gunatillake-FRCS, FIACS, FICS, AM (Sing), MB, BS (Cey) Health writer

Metformin is a magical drug that works to bring down your level of blood sugar and also a drug used for many other ailments. The other names for it are Diabex, Fortmet, Glucophage, Glumetza and Riomet. Primarily, it is prescribed for diabetes type2 and does not work for type 1 diabetes.

Most doctors prescribe metformin as a first line of medication to normalize blood sugar levels among diabetics for the last half a century- world-wide.

Most drugs that bring down the sugar level works by increasing the level of insulin secreted by the pancreas. Others act by increasing the sensitivity to target organs by insulin, and others work through decreasing the rate at which glucose is absorbed through the gut when carbs are ingested.

What works best when the above medications given singly or in combination fails would be insulin injections for both diabetes type 1 and 2. The great advantage of injected insulin in Type II is that a well-educated patient can adjust the dose, or even take additional doses, when blood glucose levels measured by the patient, usually with a simple gluco-meter, as needed by the measured amount of sugar in the blood.

Metformin can be complimented or combined with all other agents, including insulin injections. That is what magic about in metformin, because it works differently to all others with no side effects combining.

Metformin helps to metabolize the carbs you take in and the insulin secreted by the pancreas is less stressed and the sugar levels will be able to stay more in line.
Generally the liver also produces glucose a mechanism that comes into effect during starvation or says when you get lost in the jungle. This method of glucose formation in the liver from non-carbohydrates like amino acids (proteins) and glycerol is referred to as ”Neo-glucogenesis”. This life-saving mechanism also occurs in the kidneys and other tissues, at times of emergencies.

Metformin is considered to be one of the most effective therapeutics for treating type 2 diabetes because it specifically reduces the glucose manufacture in the liver (neoglucogenesis), thereby helping to reduce the sugar levels in the blood, and further does not increase the insulin secretion in the pancreas, does not induce weight gain or pose a risk of hypoglycemia (low blood glucose levels in blood)

Another magic point about metformin is that still we do not know how this agent prevent glucose formation in the liver (neoglucogenesis)
Summarizing- Metformin decreases hepatic glucose production, decreases intestinal absorption of glucose, and improves insulin sensitivity by increasing peripheral glucose uptake and utilization, and also transports insulin to the cells in a more effective way.

Prophylactic use

Metformin can be used for people having diabetes type 2 but can be used prophylactically to prevent type 2 diabetes. New research presented at the American Diabetic Association -2017 Scientific Sessions showed that long term use of metformin is useful to prevent type 2 diabetes and also for women who suffered from diabetes during their pregnancies (gestational diabetes).

Another beneficial use of metformin is in the treatment of polycystic ovarian syndrome (PCOS). Studies at the University of Chicago have confirmed its efficacy. This treatment has still not been approved by the Federal Drug Administration (FDA) in US.

Metformin may also help to restore menstrual cycles in women and improve metabolism, assisting in weight loss in women with PCOS. Most obese women are prescribed metformin in general as a weight-reducing drug with no side effects.

A 2017 study published in ‘Pediatrics’ found that metformin might be helpful in treating the effects childhood obesity in prepubescent children. Prepubescent means before attaining puberty. It was found that when metformin was given to these prepubescent boys for six months saw improvement in insulin sensitivity and other inflammatory and cardiovascular –related obesity parameters. When given to children who have already attained puberty the results were not as good.

Lowers pancreatic cancer: Increasing evidence suggests that taking metformin may change a person’s risk of developing pancreatic cancer. In general people who suffer from type 11 diabetes has a higher risk of developing pancreatic cancer. A new study showed that those women, who were treated with metformin for diabetes type 2, had a lower risk of developing pancreatic cancer than the general population.

On the contrary, it was found that men who used insulin as diabetic treatment had slightly increased risk of pancreatic cancer.

Lowers risk of breast and ovarian cancers

Studies have shown that women who take metformin for diabetes type11 are at a lower risk of developing breast and ovarian cancers.

Dosage

It is important to take metformin regularly on a daily basis for diabetes. The regular tablet should be taken with or immediately after meals once twice or three times a day. The maximum strength to be taken daily is 3000mg and the minimum is 500mg. There are extended-release tablets to be swallowed, not chewed or crushed or split. It is stressed that metformin should be taken without a skip daily at the same time to get its best effects.
You are not advised to take high doses initially as it may cause severe diarrhea. It is better to start on a lower dosage and increase gradually on the advice of your doctor.

Drinking alcohol when you are on metformin medication your blood sugar level can drop further. It is best to avoid alcohol when your diabetes type 2 is well regulated with metformin or combined with other medication.

Side effects

Metformin can give severe stomach bloating, nausea, gas, indigestion and diarrhea. Some get constipated on metformin. Some may experience heart burn, skin flushes, muscle pains, headaches and you may need to discuss with your doctor if these side effects persists.

More serious side effect could be chest pain mimicking a heart attack. You may need to stop the drug with the consultation with your doctor.

Very rarely it may cause a condition called lactic acidosis a very serious life threatening condition needing immediate admission to the closest hospital. The condition results in oxygen deprivation to the body’s tissues, impaired liver function, respiratory and cardiac failure

People who drink heavily and those having kidney dysfunction and liver disease should not take metformin. If you are on metformin you need to stop metformin when your blood creatinine level reaches high levels as in chronic renal disease. Your doctor will stop the drug, if the kidney functions gradually get worse when on metformin.
If you go for radiological examination with dye studies you’ll be advised to stop metformin 48 hours before the test. Also you need to drink water in fair amounts to flush the excessive excretory products from your kidneys.

Generally, when you are on metformin medication you need to drink a larger volume of water daily.

Hope this article helps to understand more for those on metformin for various ailments.

Some reference to the article written byJessie Szalay, Live Science Contributor