blood sugar testing by pricking finger, metformin (Glucophage), lower blood sugar, diabetes care

The fascinating compound called metformin was discovered nearly a century ago. Scientists realized that it could lower blood sugar in an animal model (rabbits) as early as 1929, but it wasn’t until the late 1950s that a French researcher came up with the name Glucophage (roughly translated as glucose eater). The FDA gave metformin (Glucophage) the green light for the treatment of type 2 diabetes in 1994, 36 years after it had been approved for this use in Britain.

Uses of Generic Metformin:

Glucophage lost its patent protection in the U.S. in 2002 and now most prescriptions are filled with generic metformin. This drug is recognized as a first line treatment to control blood sugar by improving the cells’ response to insulin and reducing the amount of sugar that the liver makes. Unlike some other oral diabetes drugs, it doesn’t lead to weight gain and may even help people get their weight under control.

Starting early in 2000, sales of metformin (Glucophage) were challenged by a new class of diabetes drugs. First Avandia and then Actos challenged metformin for leadership in diabetes treatment. Avandia later lost its luster because it was linked to heart attacks and strokes. Sales of this drug are now miniscule because of tight FDA regulations.

Actos is coming under increasing scrutiny as well. The drug has been banned in France and Germany because of a link to bladder cancer. The FDA has also required Actos to carry its strictest black box warning about an increased risk of congestive heart failure brought on by the drug. Newer diabetes drugs like liraglutide (Victoza), saxagliptin (Onglyza) and  sitagliptin (Januvia) have become very successful. But metformin remains a mainstay of diabetes treatment. It is prescribed on its own or sometimes combined with the newer diabetes drugs.

Metformin As First-Line Treatment for Type 2 Diabetes:

This all means that metformin (Glucophage) has regained its reputation as the best bang for the buck when it comes to type 2 diabetes management. The American College of Physicians has recommended metformin as the first line of treatment when lifestyle changes (diet, exercise and weight loss) have not led to adequate blood glucose control. That may be why nearly 50 million metformin prescriptions were dispensed in 2011. Despite a large number of new medications for type 2 diabetes, metformin still seems to offer the best value.

Despite all the warm, fuzzy feelings about using this medication for type 2 diabetes, there are some caveats. This drug does cause a number of side effects, especially when it comes to the gastrointestinal tract. They can be especially bothersome during the first few weeks of treatment. After several weeks, however, the digestive symptoms often fade away. If they recur, notify your doctor immediately as they could be symptoms of lactic acidosis (see below). Here is a list of adverse reactions to watch out for:

METFORMIN SIDE EFFECTS

  • Heartburn
  • Stomach ache
  • Diarrhea
  • Gas
  • Headache
  • Nausea
  • Loss of appetite
  • Weakness
  • Rash
  • Lactic acidosis (symptoms may include irregular heart rate, nausea, stomach pain, lethargy, anxiety, low blood pressure and rapid heart rate) Notify your physician immediately if you notice any of these symptoms!

These side effects may seem daunting, but most people tolerate this medication quite well. The drug can be dangerous for people with kidney disease, however. They should not take the drug, and everyone on metformin should have their kidney function monitored regularly (at least once a year). People with congestive heart failure should not take metformin either.

Metformin Against Cancer:

There is an unexpected bonus to metformin therapy. There is growing evidence that this drug has an anti-cancer effect that may prevent cancers from both developing and spreading. In particular, there are data suggesting that metformin may lower the risk of developing breast cancer, liver cancer, pancreatic cancer and colorectal cancer in people with diabetes and that the overall risk of developing cancer in such patients is substantially lower. More about this below.

A final word of caution, though. There are some nutritional consequences of metformin therapy. Here are some stories from readers. Please add your own comments about metformin treatment below theirs.

Q. I have read that metformin can cause a deficiency of Vitamin B12. I have not been able to find again the source of this information and would like your input.

Abigail

A. This is from the prescribing information at DailyMed, identical to what is published in the PDR:

“Vitamin B12 Levels: In controlled clinical trials of metformin of 29 weeks duration, a decrease to subnormal levels of previously normal serum Vitamin B12 levels, without clinical manifestations, was observed in approximately 7% of patients. Such decrease, possibly due to interference with B12 absorption from the B12-intrinsic factor complex, is, however, very rarely associated with anemia and appears to be rapidly reversible with discontinuation of metformin or Vitamin B12 supplementation. Measurement of hematologic parameters on an annual basis is advised in patients on metformin and any apparent abnormalities should be appropriately investigated and managed (see PRECAUTIONS: Laboratory Tests).
 Certain individuals (those with inadequate Vitamin B12 or calcium intake or absorption) appear to be predisposed to developing subnormal Vitamin B12 levels. In these patients, routine serum Vitamin B12 measurements at two- to three-year intervals may be useful.”

Q. My husband took metformin for years with no known side effects. Then his kidney function started to deteriorate, so he was seen by a specialist who immediately took him off metformin. He said that this drug was very hard on the kidneys and anyone who had any variations in kidney functions should not be taking it.

A. As mentioned above, kidney function must be monitored regularly to prevent just such a complication.

Q. I am suffering from such severe diarrhea I am sometimes afraid to leave the house. I also have bad gas and bouts of abdominal pain. I suspect the metformin I take for diabetes, but my doctor says my symptoms are not from my medicine.

The Prevacid I take for my heartburn isn’t helping enough to justify the expense. I am also experiencing pain and tingling in my toes.

A. Metformin (Glucophage) can cause diarrhea, nausea, heartburn, flatulence and stomachache. Acid-suppressing drugs like lansoprazole (Prevacid), omeprazole (Prilosec) or esomeprazole (Nexium) won’t solve the problem completely and may interfere with absorption of vitamin B12.

Metformin is also linked to reduced levels of vitamin B12. Because this vitamin is crucial for nerve function, deficiency can contribute to numbness, tingling or pain of the toes, feet or fingers, trouble walking, memory problems, depression, confusion and burning tongue.

The Miracle of Metformin:

Before you give up on metformin because of side effects and scary stories, we want to tell you about some surprising benefits of this drug. There is growing evidence that it may have impressive anti-cancer activity. Not only does the drug seem to reduce the risk of developing a number of common cancers but it might reduce the spread of cancer once it is diagnosed.

Researchers are beginning to tease out one of the proposed mechanisms for the anti-tumor action of metformin, especially in prostate cancer. A study in the journal Prostate Cancer and Prostatic Diseases (Jul. 28, 2015) reported that effective treatment for aggressive or advanced disease is challenging. The researchers note:

One potential target is the cancer stem cell (CSC). CSCs have been described in several solid tumors, including prostate cancer, and contribute to therapeutic resistance and tumor recurrence. Metformin, a common oral biguanide used to treat type 2 diabetes, has been demonstrated to have anti-neoplastic effects. Specifically, metformin targets CSCs in breast cancer, pancreatic cancer, glioblastoma and colon cancer.”

By exploiting a metabolic weakness in cancer stem cells, metformin theoretically makes these problem cells more vulnerable to conventional cancer therapies and could reduce the likelihood of cancer resistance and recurrence. One study found that women with endometrial cancer were less likely to have a recurrence if they were taking metformin (International Journal of Gynecological Cancer, online Nov. 19, 2015).

The Latest Chapter-Anti-Aging Activity:

It almost sounds too good to be true. Could this old diabetes drug actually slow down biological aging? In a review article in the journal Postepy Higieny i Medycyny Doswiadczainej (online, March 3, 2017) the authors note:

“Interestingly, there is a quickly growing body of literature demonstrating its potential in the therapy of multiple disorders other than diabetes. Many epidemiologic analyses have reported that metformin may improve prognosis of cancer patients and also may prevent tumor initiation. Moreover, there is evidence suggesting that metformin acts as an anti-aging factor and modulates the microbiota, promoting health. Thus, metformin is currently being investigated for new applications.”

The authors describe potential mechanisms for an anti-aging action of this medication along with ways the drug could combat cancer. They characterize metformin’s potential on both fronts as “promising.”

The Bottom Line:

Metformin is an old diabetes drug that is being rediscovered for its potential role against cancer. Only time will tell whether it will live up to expectations. Will it turn out to be a fountain of youth? Doubtful, but if it can improve longevity, that would be an added bonus.

In the meantime, metformin remains one of the least expensive prescription drugs in the pharmacy. As long as people are vigilant about side effects and complications, it could become one of the most intriguing drugs on pharmacy shelves. Here is a link to our article “Is Metformin a Modern Miracle Medicine?

If you have experience using metformin (good or bad), we’d love to hear about it. Please share your story below in our comment section.

Revised 3/16/17

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  1. Vivian
    California
    Reply

    I have been on Metformin for 12 years. I was on 1000 mgs twice a day but realized it was causing me so much bloating and burping. Now i take only 1000 mgs with evening my meal. My bloating and burping are almost non existent.

    Also, i was taking a prilosec type antacid and the pain in my body and bones was intense due to the calcium and b12 absortion being blocked. I now use Ranitidine 150 mgs twice a day and their is no more pain in my bones. My daily vitamins are a multi vitamin, b-complex, b12 sublingual 5000 mgs and d3… I have been a type 2 diabetic for 12 years and the circulation in my lower extremities is pretty good.

    I have been insulin dependant for approx 3 years. My a1c’s range from 6.8 to 7.2. I don’t try to be perfect with my diabetes because i dont like the feeling of having to be so rigid… ☺

  2. Kidane Gebremariam
    Grayson, GA
    Reply

    I have night-time dry mouth, and I pee like 0 – 3 times a night. One time I went to visit a doctor to do a regular check up. I gave blood, and I did not even tell the doctor about the dry mouth and increasing pee I have, because I was not suffering that much. Anyway, after around 2 – 3 days the doctor called me and told me I am prediabetic. So prescribed me Metformin. I told him that I can exercise but he said that Metformin can help me to lower the sugar in addition to exercising.

    As soon as I started to take this medicine I felt a lot of depression, had nightmares, and I am going to restroom to pee all night. Remember, I never had that much problem before this medicine. I was sleeping much better. I immediately stopped this medicine. Right now I am thinking how would I get this medicine out of my system . Because I don’t see it helping me, instead it dropped me to the complete disease of nightmares, depression,peeing the whole night, I am not sleeping because of pee. I have to visit this doctor again . Guys if they told you that you are pre diabetic, and they told they are going to prescribe you Metformin, think about my honest experience. It may happen to you too.

  3. Lynette
    Brisbane, Qld
    Reply

    I first became a diabetic type 2 when I was in early 40s. I was taking metformin 3 times a day then. I started getting chronic diarrea and put up with it for 12months. Went to doctor and had to have a colonoscopy and that came back normal. I was referred to a specialist and he put me on a new medication at that time and BINGO never got diarrea again.

    Over the years, tried a few different medications and they made me hyper so 2 years ago I tried metformin again but did the same thing. But then I tried the slow release metformin and it is excellent. I only take 1x 500mg in evening.

  4. Ed
    Panama city fl
    Reply

    I have been on metformin for 1 month. I am bloating lots of trapped gas. My A1c is 6.5 and I am needing to lose 30lbs to help my fatty liver. I take Nexium and hope the metformin will work together as I have been taking Nexium for about 10 years.

  5. Sharon
    Missouri
    Reply

    I was diagnosed with Type II Diabetes in 2015. I take 500mg metformin at dinner (larger doses make me sick). It’s been almost 2 years and I have gained weight and have several other side effects from this drug. I count my carbs, try to walk approx 3 miles 2x a week. I live in a remote area where you can’t just go out and walk. I’m on a fixed income so I can’t always buy the foods that I need to be eating, but I try. I can’t work out due to a broken wrist that did not heal due to a Doctors incompetency. My blood sugar just won’t go down. My dad passed away due to complications of the diabetic drugs given to him, so I’m very cautious about taking prescription drugs for this condition. I know that there has to be a herbal supplement that can do the same thing, as I have found other herbal supplements that have done wonders for other issues. Just wondering if anyone has tried a herbal supplement for their type II diabetes. I know if I could lose the weight that would help significantly, but I can’t lose the weight and as I said have increased my weight since taking the metformin

  6. Orlean
    GA
    Reply

    I went on Metformin when my A1C went up to 6.2. There were no sign of me being a diabetic, no symptoms that there was anything going on. After 3 months on 500 MG 3 times per day, my A1C dropped to 5.9. She checked my kidneys, then started me on 500 MG twice per day.

    At first I was nauseated and had stomach cramps, then that subsided. then a few days later I started having diarrhea really bad. After the diarrhea came the heart burn which I think is the worst so far, even without eating I get the heart burn. The latest one is feeling like my bladder is full, and when I go to empty it there is only a drop of urine and I still feel like there is pressure. I go back in July to have my kidneys and my A1C checked, and I am hoping that my A1C is lower than 5.9. I need to get off this medication to start feeling like myself again. I like the fact that it seems to help with all the different cancers, because that runs rampant in my family.

    I wish everyone good luck with or without this medication, I only wish that I could find something that would help my heart burn, nothing seems to help.

  7. Jean
    Florida
    Reply

    I have been taking Metformin for approximately 2 years. My biggest problem is GI related. I was tested with the ECG and it was found that I have 4 healing gastric ulcers and 1 active following the use of Omeprazole. Recently I have been having severe leg cramping at night while asleep. I have regular lab work and am scheduled for labs and Doctor visit in July. I dread what will show up.

  8. Anne
    Denver, PA
    Reply

    I’m 66, have multiple autoimmune and other chronic diseases (hypothyroid, hypertension, vitaligo, history of alopecia areata, osteoarthritis, ulcerative colitis, stage 1 primary biliary cirrhosis, stage 3 kidney disease, elevated cholesterol and triglycerides, and associated heartburn, fatigue, anxiety). I’ve also had long-term insomnia. Now I also have diabetes type 2. Was started on Tradjenta last year and my blood sugar was better. But after some steroid injections for the OA, and antibiotics for URI, and narcotic pain meds for severe dental pain (failed/extracted implant and bone graft), my sugar rose significantly and had still not come back to my new “normal” after several weeks. My Endocrinologist added Metformin to my already long list of meds. After 4 days it seems to be lowering my blood sugar but I am having terrible GI results (worsening heartburn, nausea, diarrhea – was in ulcerative colitis remission for 3 years till now, and nearly vomitted today). I won’t be able to reach my doctor till next week but I’m not planning to take any more metformin until I do reach him. I’m also concerned because my kidney doctor told me I should not ever take the usual diabetes drugs because of my kidney disease. I do exercise and try to eat well, trying to lose my extra 25 pounds. I was grateful to be in relatively good health despite all my diseases but I fear the results of uncontrolled diabetes if I can’t tolerate effective meds for that problem.

    • Ed
      Florida
      Reply

      Yes I was having bad leg cramps but I started taking 2 tablets of magnesium and potassium morning and night, and they have gone away. I still have one occasionally but usually when I miss my dose, good luck.

  9. Peter
    Australia
    Reply

    I have been on metformin for a month and my bsl went from 24 to 12. My doc put me on the extended release plus nesina in the hope of getting bsl lower. I take effexor for depression, somac for heartburn to control barrett’s esophagus, exforge and perindorial for systolic hypertension and arthritis upper, lower back with a degenerative facet joint C2. I plan on taking the fist script of extended release and nesina the doc gave me and see if the side effects settle, if not look at alternative and if no alternative

  10. Jackie
    Texas
    Reply

    I have been taking Metformin ER 500 mg- 2 tablets at dinner. My knee and finger joints are sore. I have Osteoarthritis but the pain has never been this intense. I read that Metforman can cause joint pain. Will this go away after I have taken the meds for awhile? Has anyone else had this problem?

  11. cindi
    VA
    Reply

    I was on Metformin for a number of years, 1000mg twice a day. I had frequent diarhea but I also don not have a gall bladder. I began using a fat enzyme to correct believed effect of no gall bladder and was better. Then my new doctor put me on Metformin ER 500 mg 4 a day. I began to vomit about every 5-6 days. I went off the Metformin ER for 2 days and the vomiting seems to have stopped. I am getting a replacement for Metformin.

  12. Rich
    Omaha
    Reply

    Stopped metformin due to intestinal issues. Also nerve pain in feet went away.

  13. Brenda A
    NJ
    Reply

    Stopped taking metformin 4 months ago. Started taking glucocil. After 4mos had my A1c checked. Went up .7. Dr encouraged me to start metformin again. A1c recheck in 2mos. Hoping for an improvement.

  14. Stephanie Grey
    USA
    Reply

    I started in November 2016 and have lost five pounds so far. I hope it will prevent fatty liver and help me lose more weight. My AIC reduced from 6.3 to 5.9 but I take it for other reasons and to help reverse diabetes and complications. its been around a very long time, it must be all they said it does.

  15. adele
    Michigan
    Reply

    I have been on Metformin for about 6 months and I take no other medications (other than a daily aspirin); my A1C was 6.7, but was down from three years prior (8.3) due to major diet changes (Dr. Fuhrman eating plan and losing 20 pounds). I am anxious to see my A1C in the end of this summer, as I’ve been off the good eating plan, but avoiding sugar and white flour most of the time, and have had a rather sedentary winter.
    This morning, I woke up with puffy hands and face and became concerned . . . thus the search for Metformin side effects, which lead me here. I hope the side-benefits of Metformin are true; what a plus!

  16. Eric Hooper
    California
    Reply

    I was on met Forman it made my hair start falling out also started getting sores on my head .how long do the is side effects last ?I have whet on a diet and lost over 120lbs and I am no longer diabetic I have been off met Forman for three months and my md.says I am borderline to being diabetic but I am still having the side effects no one in my family has ever been bald and I honestly hope that I won’t be the first has anyone else had the same side affects ?my md.said that the sores on my scalp could be toxic discharge from losing weight and my body is getting rid of toxins but I don’t believe that. ..

  17. Paul C
    Garland,TX
    Reply

    I’ve been taking Metformin for more than 5 yrs, and haven’t noticed any particular
    side effects. It has been part of controlling my blood sugar. I hope it does have
    some of the side benefits that have been discussed here. I’m looking to live taking
    Metformin for 40+ years,if Drumph gives me the chance!

  18. Larry
    central New York
    Reply

    I’m 69 years old, and I too have GI problems with Metformin. I’ve been using it for about 4 years and initially was taking 500mg 2x a day and tolerated it quite well. The doc raised the script to 1000 mg 2x per day, and the diarrhea and gas began. My doc told me to take Metamucil fiber wafers to boost fiber intake which supposedly absorbs excess water in the intestines. Works somewhat but not 100%. On my own I began taking probiotics, the ones for adults over 50. This seems to mitigate the symtoms somewhat too but not 100%. Sometimes taking 1 pill 4x daily seems to alleviate the GI problems but, once again, not fool proof. Good to hear about the anti-cancer properties because I have a family history of kidney & colo-rectal cancers.

  19. Sabrina
    San Diego
    Reply

    I was diagnosed with prediabetes Type 2 and prescribed 500 mg Metformin a day. My Ac1 was 7. Also prescribed Simvastatin and hydrochlorothiazide and told I had Metabolic Syndrome. I watched my diet but next Ac1 was even higher.

    Side effects of Metformin were constant dairrhea to the point that I couldn’t leave the house, hair loss, belly ache. I did some research and found that the statin and water pill raised blood sugar. A year into this my primary care provider moved away, and I quit all drugs and went with Nopal Cactus, apple cider vinegar, cut out dairy and feel great. I did this for 2 years before finding a new Doc.

    I now have a new primary care and a diabetic nutritionist I see. Both amazed that my A1C is a 7, I’m on Losartin for blood pressure and working on the cholesterol (270). They don’t insist on Metformin or anything else for diabetes.

    So many people have written about their doctors ignoring them. When I first met my new primary care provider we talked for about 30 minutes. She listened as I explained how I felt about Doctors and big pharma and taking meds. Told her my medical history (cancer survivor) and then she said “I think we are going to be a good match”. I was floored. The moral to this story is if your provider doesn’t listen to you, get a new doctor until you find one that does. Thank you, Terry and Joe, and everyone who contributes

  20. David
    Richardson
    Reply

    I also had gastrointestinal problems with Metformin until I switched to the extended release formula. Now I have no symptoms at all. With Metformin, diet, and exercise, my A1C numbers have been kept in the normal range (4.4 – 6.4%) for several years. I would recommend asking your doctor about the extended release formula before giving up on metformin. It is available as a generic.

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