Today I’ll discuss Metformin, a medication commonly prescribed to manage type 2 diabetes. When taken correctly, Metformin can effectively control your diabetes. How and when to take your Metformin, how Long Does It Take for Metformin to Take Effect, how long you’ll need to take it, and if there are any side effects. Don’t worry; we’ll be answering the most frequent questions about your medication today.
What is Type 2 Diabetics?
It’s a condition of high blood sugar where your body doesn’t effectively respond to insulin, the natural hormone your body produces to reduce blood sugar levels. Common symptoms include increased thirst, passing urine more frequently, and always feeling tired. If left uncontrolled, diabetes can lead to significant problems with your heart, blood vessels, eyes, kidneys, and nervous system.
What is Metformin?
Metformin is a popular medication prescribed to individuals with type 2 diabetes. Metformin works by lowering your blood sugar. Firstly, it does this by reducing the number of sugars released into your bloodstream and increasing the effectiveness of insulin. Metformin can be used in adults and children above the age of 10 years. It’s available in both liquid and oral forms and may be prescribed under any commercial branded names: Glucophage, Bolumin, Digimet, Glucient, Metabet, and Rio Met.
What are recommended doges of Metformin?
You should take Metformin in the morning if prescribed to take it once daily. However, if you are instructed to take it twice daily, you should take it in the morning and evening.
Metformin typically comes in 500-milligram doses with a maximum dose of around 2 grams per day, and usually, this will usually be spread throughout the day and gradually increased.
The usual dose for those prescribed metformin IR is once or twice a day, depending on your prescribed dose. A typical starting dose is 500 mg twice daily or 850 mg once daily. The maximum daily dose is 2,250 mg. If your dose exceeds 2,000 mg daily, your healthcare provider may suggest splitting the total dose into three smaller doses throughout the day.
In the case of metformin ER, it is generally taken once a day. The usual starting dose is 500 mg daily, gradually increasing by 500 mg each week until the dose of 2,000 mg is achieved. However, doses less than 1,500 mg per day may not be effective. If you have any questions or concerns about your medication, please don’t hesitate to ask me or your healthcare provider.
How Does Metformin Work?
I want to explain to you about Metformin and how it works. It is one of the oldest diabetes medications but is still considered one of the best.
Metformin is commonly used in type 2 diabetes. However, Metformin can also be used in type 1 diabetes because just because you have type 1 diabetes doesn’t mean your body cannot develop insulin resistance like someone with type 2 diabetes.
It has two mechanisms of action.
Metformin’s first mechanism helps address the underlying insulin resistance that we typically see in type 2 diabetes. This means that although you produce insulin, it is not working as efficiently as it should.
Metformin works by resetting your body cells to insulin’s message, allowing glucose to get from the blood into the cells, which can be used for energy. It helps improve insulin sensitivity and reduces insulin resistance in type 2 diabetes.
Metformin’s second mechanism of action is that it works on the liver. Your liver provides you with an internal supply of glucose, which is particularly up-regulated between periods of eating.
Usually, when you release insulin, it goes to the liver. It tells it to dial down or turn off the glucose production so that you don’t need an internal supply because you’re eating food and have an external supply of glucose. However, with type 2 diabetes, a layer of fat has accumulated around the liver, so insulin can’t quite get to it and tell it to turn off.
As a result, we end up releasing more glucose from the liver than we should. Metformin also helps act on the liver receptor, sizing it to insulin’s message and telling it to down-regulate or switch off its glucose production internally.
Therefore, your blood glucose levels are reduced.
How long does it take for Metformin to take effect?
Talking Metformin does not lead to an immediate reduction in blood sugar levels. The medication usually takes about 48 hours to show its effects, and the most significant changes may take 4-5 days to occur, although the exact timing can vary depending on your dosage.
Find that Metformin and changes to your diet and exercise routine are not effectively managing your blood sugar levels. Your doctor may consider increasing your dosage of Metformin or prescribing additional medications.
How to Speed Up Metformin Effect?
If you ever feel like your diabetes treatment plan is not working as well as it should be, make any necessary adjustments as described below.
For those with type 2 diabetes, the treatment plan often includes a combination of lifestyle changes and medications such as Metformin. Metformin is only effective when combined with recommended changes to your diet and exercise habits.
Some people may meet their blood sugar targets through dietary changes, regular exercise, and self-monitoring without medication. However, others may require drug treatments.
If you are taking medications to control your blood sugar levels, please take them exactly as prescribed. I recommend Metformin as a first-line treatment and changes to your diet and activity levels. Metformin does not lower blood sugar levels instantly like insulin injections, and it may take a few weeks or months for me to be able to tell whether it’s working.
Certain medications, like insulin and sulfonylureas, can rapidly reduce blood sugar levels. However, a common side effect of sulfonylureas is low blood sugar or hypoglycemia.
Regular exercise can increase sensitivity to insulin, helping the body remove sugar from the blood more efficiently. I recommend an approved exercise plan for those taking Metformin to have the best effect.
Reducing carbohydrate intake is also an important part of managing diabetes. Some carbohydrates, like those with a high glycemic index, can cause blood sugar levels to rise quickly. Foods, like spelled bread, steel-cut oats, and sweet potatoes rank low on the glycemic index and have less immediate effects on blood sugar levels.
Finally, I recommend increasing dietary fiber intake by eating beans and other legumes. This type of fiber is not digested in the small intestine and does not contribute to drastic increases in blood sugar like foods with lower fiber contents.
Side Effects of Metformin
I want to discuss some important points to remember if you are taking Metformin to avoid its side effects.
Metformin delays gastric emptying and reduces appetite, causing common side effects such as nausea, vomiting, diarrhea, anorexia, and constipation. You can avoid these side effects by taking Metformin with meals or gradually increasing your dose.
Metformin can also cause heartburn and dyspepsia, increasing acid reflux and epigastric pain.
Feeling dizzy is another side effect that you may experience while taking Metformin. This can be due to metformin-induced orthostatic hypotension. If you are experiencing these side effects, you should avoid getting up too fast and avoid activities with a chance of falling, such as driving or other household activities.
Hypoglycemia is another important side effect of Metformin. Hypoglycemia means low blood sugar, and although Metformin usually doesn’t cause hypoglycemia, skipping meals while taking Metformin can lead to low blood sugar levels. Some other conditions, like strenuous exercise and excessive alcohol intake, can also precipitate hypoglycemia. It would help if you watched for signs and symptoms like weakness, tiredness, nausea, vomiting, stomach pain, dizziness, lightheadedness, headache, irritability, excessive hunger, excessive sweating, tachycardia, and abnormally fast or slow heartbeat.
If you experience hypoglycemia, you can eat or drink 15 to 20 grams of fast-acting carbohydrates, such as sugary foods or drinks without protein or fat that are easily converted to sugar in the body. You can try glucose tablets, gel, fruit juice, regular soda, honey, or sugar candy.
Long-term use of Metformin can cause vitamin B12 deficiency. Metformin interferes with the calcium-dependent vitamin B12 intrinsic factor complex absorption in the terminal helium. Periodic screening of vitamin B12 deficiency should be considered, especially in patients with peripheral neuropathy or macrocytic anemia. Increased intake of calcium may prevent metformin-induced vitamin B12 malabsorption.
Metformin’s most concerning side effect is lactic acidosis, which more commonly occurs in renal failure patients. Metformin is excreted unchanged in the urine, and in renal failure patients, the excretion of Metformin is decreased, increasing its levels in the blood. This leads to increased lactic acid in the blood, eventually leading to lactic acidosis. Other conditions that increase the chances of lactic acidosis include severe respiratory disease, liver disease, congestive heart failure, and chronic alcohol abuse. Metformin is contraindicated in these situations or conditions.
Other side effects of Metformin include weakness (also called asthenia), an increased association of upper respiratory tract infection, metallic taste, muscle weakness and fatigue, myalgia (muscle pain and muscle tenderness), excessive sweating (diaphoresis), and rhinitis (inflamed, runny nose, or congestion).
How does Metformin interact with Other Medications?
Metformin can interact with several medications, and your doctor may need to make appropriate adjustments to your existing medications to ensure they remain effective for you. The medications to watch out for are other diabetic medications, steroids, and hormone treatments, including oral contraceptives. This is because contraceptive pills can affect your blood sugars. So if you take this medication, your doctor may need to adjust your existing diabetic medications, heart medications, and those used for controlling blood pressure, water tablets, which make you pass more urine and control how much fluid your body holds onto, such as Fluorusamide.
Is Metformin safe in pregnancy and breastfeeding?
Metformin is generally considered safe to use in pregnancy, so much so that it’s recommended for a form of temporary diabetes of pregnancy some women can develop called gestational diabetes. In breastfeeding, a small amount of Metformin is present in your breast milk. This is not considered harmful to the baby in such small amounts.
What foods to avoid with Metformin?
You should limit your intake of sugary foods, particularly cakes, biscuits, fizzy drinks, and fruit juices. Doing this will ensure you get closer to your diabetic target and reduce your risk of long-term complications associated with poor diabetic control.
Can you Drink Alcohol with Metformin?
It’s safe to take alcohol with Metformin. However, excess alcohol in combination with Metformin can lead to your blood sugars becoming too low. Therefore, please drink sensibly when taking this medication.
What to do if you miss a dose of Metformin?
If you’ve missed your dose, don’t worry. Please take it as soon as you remember. However, if it’s almost time for your next dose, skip the missed one. Remember to take your next dose at the regular time. Do not double dose to make up for a missed one.
What will happen If you Overdose Metformin?
Let’s talk about accidental overdoses. If you’ve taken too much of this medication, you should consult an emergency doctor. Taking too much can cause a buildup of acid (lactic acid) in your blood, which in severe cases can be life-threatening. Overdose of Metformin can cause symptoms such as stomach pains, decreased appetite and diarrhea, the sensation of being very cold, tiredness, sleepiness or weakness, changing your breathing pattern, or even muscle cramping.
What are the alternatives to Metformin?
Metformin is a medication that belongs to a group of drugs called biguanides. It is a commonly used medication for diabetes, and there are no alternatives in this class.
However, other diabetes medications work in different ways. These medications include:
- Sulfonylureas such as tolbutamide (Orinase), glipizide (Glucotrol), and glyburide (Diabeta)
- Meglitinides such as repaglinide (Prandin) and nateglinide (Starlix)
- Alpha-glucosidase inhibitors such as acarbose (Precose) and miglitol (Glyset)
- Thiazolidinediones such as pioglitazone (Actos) and rosiglitazone (Avandia)
- Glucagon-like peptide-1 agonists such as exenatide (Byetta), lixisenatide (Lyxumia), liraglutide (Victoza), albiglutide (Tanzeum), dulaglutide (Trulicity), and semaglutide (Ozempic)
- Dipeptidyl peptidase IV inhibitors such as sitagliptin (Januvia), saxagliptin (Onglyza), linagliptin (Tradjenta), and alogliptin (Vipidia)
- Selective amylinomimetics such as pramlintide (Symlin)
- Sodium-glucose transporter-2 inhibitors such as canagliflozin (Invokana), dapagliflozin (Farxiga), and empagliflozin (Jardiance)
Doctors choose the most appropriate diabetes medication for each person based on their needs. Some of these medications are injected, and some people may prefer not to use them. Your doctor will consider your preferences and health status when recommending medication.
When to Consult a doctor
There are certain conditions where you should not take Metformin. It’s best to speak with your doctor if you have previously suffered an allergic reaction to this type of medication, have heart conditions such as heart failure, or have kidney disease. Increased caution is also required in older patients. Additionally, your doctor may ask you to temporarily stop your medication if you’re currently suffering from an infection, plan to have a scan requiring a special dye, or before surgical procedures where you will be put to sleep.
If you’ve been taking Metformin as prescribed and have yet to notice improvements in blood sugar control after a few weeks, consult your healthcare provider. They may recommend adjusting the dosage or exploring alternative treatments.
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You’ll most likely remain on Metformin for the long term. Most patients with type 2 diabetes on this medication take it for life. Stopping Metformin without an alternative medication is likely to result in poorer blood sugar control and increase your risk of long-term diabetic issues.
The time it takes for Metformin to take effect can vary based on individual factors such as age, weight, health conditions, and medication interactions. By adhering to a healthy lifestyle, monitoring blood sugar levels, and taking Metformin as prescribed, individuals with type 2 diabetes can maximize the medication’s effectiveness and achieve optimal blood sugar control. If you have concerns about Metformin’s efficacy, contact your healthcare provider for guidance.