METFORMIN

Metformin is an oral medication primarily used to manage type 2 diabetes. It belongs to the drug class called biguanides and works by improving blood sugar control. Here’s an overview of its key details:

How Metformin Works

1. Decreases Liver Glucose Production: It reduces the amount of glucose the liver releases into the bloodstream.
2. Improves Insulin Sensitivity: Enhances the body’s response to insulin, making it easier for cells to take in glucose from the blood.
3. Slows Glucose Absorption: Slightly reduces glucose absorption in the gut.

Common Uses

• Type 2 Diabetes Management: It is often the first-line treatment.
• Polycystic Ovary Syndrome (PCOS): Used off-label to improve insulin sensitivity and regulate menstrual cycles.
• Pre-Diabetes: Helps prevent the progression to type 2 diabetes in some cases.

Forms and Dosing

Metformin is available in multiple forms:

• Immediate-release tablets
• Extended-release tablets (XR): Designed to reduce gastrointestinal side effects.
• Liquid form (for those who have difficulty swallowing pills).

Typical dosing ranges from 500 mg to 2,000 mg daily, divided into one or two doses. The dose depends on individual needs and response to the medication.

Benefits

• Weight neutrality or mild weight loss: Unlike other diabetes medications, it doesn’t typically cause weight gain.
• Lowers A1C levels: Reduces average blood sugar levels over three months.
• Cardiovascular benefits: Shown to improve cardiovascular outcomes in many patients with type 2 diabetes.

Common Side Effects

1. Gastrointestinal (most frequent):
   • Nausea
   • Diarrhea
   • Stomach upset
   • Bloating
2. Vitamin B12 Deficiency: Long-term use may lead to lower B12 levels.
3. Metallic Taste: A less common side effect.

Rare but Serious Risk

• Lactic Acidosis: A rare but potentially life-threatening condition where lactic acid builds up in the blood. Risk factors include:
  • Kidney impairment
  • Liver disease
  • Excessive alcohol intake
  • Severe dehydration

Who Should Avoid Metformin?

• People with severe kidney or liver dysfunction.
• Those prone to hypoxia (e.g., heart failure, severe lung disease).
• Situations like planned contrast dye studies (may temporarily discontinue due to kidney strain).

Lifestyle Considerations

• Often combined with a healthy diet, exercise, and other medications for optimal blood sugar control.
• Alcohol consumption should be minimized as it increases the risk of lactic acidosis.