Today, we are going to focus on one of the oldest classes of medication uses for diabetes.  It is called Metformin and belongs to a class of drugs called biguanides.  It is sold under several trade names: Glucophage, Fortinet, Glumetza, and Riomet.  Metformin is most commonly used to treat type 2 diabetes, either alone or combined with other agents.  By all standards, Metformin is the first drug of choice for type 2 diabetes. Metformin has been around for a long time and the studies have found this agent to have good efficacy, good safety profile, and it is cheap.

How Metformin works?

Liver (hepatocyte) and Intestine are the two organs that come to play when we talk about the mechanism of Metformin. This medicine does not increase insulin levels in the body but instead causes the liver to produce less glucose, and the intestine to absorb less, from the foods (glucose) we eat.  Besides, it boosts the body’s sensitivity to insulin by increasing the metabolism of skeletal muscle and by improving the utilization of glucose by muscle tissues.

Most Side Effects of Metformin:

Most side effects are nausea, gastric distress such as stomach pain, gas, bloating, and diarrhea that are somewhat common among people starting up on metformin. To lessen these problems, one needs to start with a small dose and build the dosage up over time.  Furthermore, the new extended-release version of Metformin can keep these symptoms away. 

This medication can cause more serious side effects, even though these are rare. The most serious of these is lactic acidosis, a condition caused by a buildup of lactic acid in the blood. This can occur if too much metformin accumulates in the blood due to chronic or acute (e.g. dehydration) kidney problems. That is why one must keep an eye on creatinine and creatinine clearance which is the Kidney function test.  Last but not least, severe acute heart failure or severe liver problems can also result in a lactate imbalance.

Remember: Ask your health care provider which diabetes drug may be the best fit for you. Your doctor will make recommendations based on the type of diabetes you have, your health, and other factors. Your body is the Temple of God, please take good care of it.

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Dr. Jude Fabius Pharm.D
Dr. Jude Fabius Pharm.D

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