What to keep in mind on Prolonged Use of Diabetes Drug Metformin?


What do I need to pay attention to when taking Metformin for a long time?

Doctor: Remember these 5 points, many people do not know.

Speaking of metformin, sugar friends are very familiar with this drug. It is a first-line basic drug for oral hypoglycemic drugs. Its efficacy and safety have been verified by diabetes treatment in recent decades in the world. It can be said to be the most prosperous drug at present. We are going to talk about what issues need to be paid attention to when taking metformin for a long time.


Briefly introduce the history of metformin

In 1929, people extracted "guanidine compounds" from a forage called "goat bean" for the treatment of diabetes. 

Later, phenformin, buformin, and metformin were successively developed and marketed, and used in the United States, France and other countries.

Clinical hypoglycemic treatment, in which phenformin was found to be likely to induce a complication with extremely high mortality: "Lactic acidosis", so delisting, during this time, metformin also eclipsed, people almost want to give up this drug.


However, gold always shines. In the era of evidence-based medicine, people have found that the chemical structure of metformin and phenformin are different, and their effectiveness and safety are better than other hypoglycemic drugs.

In recent years, even guidelines have declared that metformin is a clear proof of cardiovascular situations.

As a protective hypoglycemic agent, as long as there are no contraindications for all patients with type 2 diabetes, metformin should be included first.


Questions that sugar problem facing friends need to pay attention to when using metformin:


1. Metformin and body weight

Many sugar friends believe that metformin is only used for diabetic patients who are overweight or obese. In fact, this is wrong.

The correct view is: Regardless of whether the weight is high or low, regardless of fat or thin, as long as there are no contraindications, patients with type 2 diabetes can give priority to the use of metformin.


Diabetes Drug Metformin
Metformin Tablet Pack

In addition, some people want to lose weight by taking metformin, which is actually not scientific, because metformin is only for weight loss in obese people with type 2 diabetes, and for people without type 2 diabetes, there is no weight loss effect!


2. Metformin and Type 1 diabetes

Many people think that metformin can only be used for type 2 diabetes as an oral hypoglycemic agent. 

In fact, it is not the case. For type 1 diabetes, combined use of metformin can reduce the amount of insulin, and can avoid weight gain problems caused by insulin use.


3. Usage and dosage of metformin

Metformin should be administered in accordance with the principle of individualization. The initial dose can be slightly lower, and then the dose is gradually increased. 

It is generally believed that the minimum recommended dose is 500 mg per day, the maximum recommended dose is 2000 mg per day, and the best effective dose is 2000 mg per day.


Metformin ordinary tablets and sustained-release tablets can be taken after or during meals to avoid the stimulation of the gastrointestinal tract by drugs. 

Metformin enteric-coated tablets or enteric-coated capsules, due to the particularity of enteric-solvent type: dissolve and release in the intestinal tract, so it is relatively less irritating to the stomach. It is best to use 15-30 minutes before a meal.


4. What are the common side effects of metformin?

The most common side effects of metformin are gastrointestinal reactions, which generally occur in the first 3 months of starting medication, which can be manifested as diarrhea, nausea, vomiting, bloating, fatigue, indigestion, abdominal discomfort, and headache.


Metformin reduces vitamin B12 absorption, but rarely causes anemia. Long-term use of this medicine can be supplemented with vitamin B12.


Phenformin was delisted because of the side effects of lactic acidosis, but metformin is different. 

There is no evidence that metformin is related to lactic acidosis. 

Only in patients with severe renal impairment (eGFR <45) and patients with hypoxemia, the use of metformin is not recommended to prevent the accumulation of lactic acid.


5. Can metformin be used when liver and kidney function is abnormal?

Patients with mild liver and kidney function injury can actually take metformin, because metformin itself does not damage the liver and kidney.

Metformin does not undergo liver metabolism and there is no hepatotoxicity. It is generally recommended that the use of serum aminotransferases be more than 3 times the upper limit of normal. 

Avoidance of the metabolic capacity of lactic acid in the liver and accumulation of lactic acid in the body.


Metformin is metabolized by the kidneys as a prototype, and will not damage the kidneys. It is not necessary to stop metformin immediately when the renal function declines slightly. 

USFDA has issued warning on metformin use for people with reduced kidney functions. This indicates that in people already with compromised kidneys there may be some problems. 

It is generally recommended to decide whether to stop the drug according to the following criteria: Doctor adjusts the dose by estimating glomerular filtration rate (eGFR) 

No reduction is required when eGFR ≥60, reduction is required between 45-60, and it needs to be stopped when less than 45.

NB This write-up is not a medical advice. Consult directly with a medical specialist

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