Metformin Review! The Ultimate Guide to Metformin

As an endocrinologist/diabetes specialist, I treat and use metformin for my diabetic patients all the time. Yet it remains one of the most controversial medicines of all time. Have you just been prescribed with this medicine or are now concerned because you have been on it for a long time? Is metformin safe? We will try to digest that question in this ultimate guide. Diabetes cases have been steadily increasing worldwide.

Metformin has been the gold standard first agent for many people to try first with all the drawbacks patients experience. There are lots of medicines available for people with diabetes. Some, like insulin, are widely available but also quite expensive. Some are relatively unknown to the general public and known only to experts and physicians. One, however, is primarily known to the public at large. This diabetes drug is one of the most popular medicines for people with diabetes.

What is Metformin and What Does It Do?

What is metformin HCL?

Metformin hydrochloride or metformin HCL is one of the most common types available in the market. As a diabetes drug, it could be administered to both adults and children for long-term treatment of diabetes. Its generic version is widely available worldwide, making it one of the more accessible diabetes drugs. Experts estimate that more than 120 million people are taking this to manage and control their diabetes.

Metformin drug class

This diabetes medicine belongs to the anti-diabetes drug class. Specifically, it belongs to drug class biguanides. Biguanides belong to the class called non-sulfonylureas, one class of drugs used for treating diabetes type-2 diabetes and PCOS(polycystic ovarian syndrome). Non-sulfonylureas like biguanides work by inhibiting the liver from producing too much glucose.

It also helps in the body's insulin response by lowering insulin resistance. Finally, it helps tissues to absorb glucose from the bloodstream. They are in the form of tablets, however, cannot be used in treating type-1 diabetes. Type-1 diabetes is caused by poor insulin production, and this medication is not intended to address that issue.

Chemical Composition

The chemical composition of this diabetes drug is C4H11N5. It means that it has four molecules of carbon, eleven of hydrogen, and five of nitrogen. It is an organic compound, and organic compounds are vital to the survival of any organism here on earth.

The chemical composition allows for better absorption of glucose in the cells. Glucose itself is an organic compound mostly made of carbon molecules. Nitrogen and hydrogen within help facilitate the transfer of glucose from the bloodstream into the cells and tissues.

The synthesis of those chemicals allows it also to become a diabetic agent. They can lower blood sugar levels in the body. All in all, those things mentioned make it ideal as a treatment for diabetes. Is metformin free of side effects? Definitely no. We will dwell on that later in this article.

What Are the Forms?

It is usually in the form of tablets or pills. They are produced by numerous pharmaceutical companies worldwide. The most common is the regular one, also known as “immediate release.” The regular ones comes in three doses: 500 mg, 850 mg, and 1000 mg.

They are the ones available worldwide and are widely used. Aside from regular tablets and pills, there is also the “extended-release”, the so-called extended version. As a medication, the "extended-release" is available in 500 mg and needs to be taken only once a day.

This can be taken only by adults. Aside from tablets and pills, there is also a version of liquid. However, all regular forms is available only as tablets and pills. Only the "extended-release" is available as an oral solution.

Who Should Take Metformin?

Those who have diabetes and PCOS can take this drug. In fact, many consider it to be one of the best initial treatments for those who are recently diagnosed with diabetes and/or PCOS. Some doctors even prescribe this medication to those suffering from prediabetes, which is what they call borderline cases.

These are people who, despite changes in lifestyle and eating habits, do not improve and are in danger of suffering from full-blown diabetes.  As diabetic drug it could be prescribed to those people as a preventive measure. At the end of today PCOS, prediabetes and diabetes are connected to each other.

They are all related to insulin resistance most of the time One reason for the popularity of this drug among physicians is that it largely works on metabolic functions. It is unlike other diabetic drugs which induce the pancreas to produce more insulin.

What exactly does it do to the body?

It increases the body’s receptivity to insulin. By doing so, it allows the body to absorb more glucose, without increasing the production of either insulin or glucose. That is why most doctors prefer this drug. Depending on the need, they will administer doses of 500 mg, 850 mg, or  1000 mg.

The dosage and doses will depend on the doctor’s discretion. It will also depend on how advanced the diabetes is in a particular patient and how much they can tolerate at a time. Overall, however, most doctors usually want to improve insulin sensitivity before prescribing any other diabetes pills. Hence, they prescribe this for most patients first.

Who Should Not Take Metformin?

Those who have not consulted their doctors and have no diabetes should not take this whether in tablets or pills. There is some risk involved, as with most diabetic drugs. The doctors will eventually know which medicines their patients must take. For our general knowledge, though, as a diabetes drug this is strictly not for those with severe kidney or liver issues.

This may cause problems for those health issues, putting the lives of people with diabetes at significant risk. We mentioned that this is also prescribed to some who have prediabetes. People who have prediabetes but are over 60, however, do not have to take this. Those who are suffering from diabetic ketoacidosis must also not take this drug.

Can Pregnant Women Take Metformin?

Taking this drug during pregnancy is entirely safe unless the pregnant woman has advanced kidney or liver problems. On the other hand, discussing with your Diabetes doctor prior to starting taking this drug is the best. Actually, this helps patients who have PCOS become pregnant and maintain healthy blood sugar levels during pregnancy as well.

How Should this Drug be Taken?

This is taken orally. The dosage, of course, will depend upon the patient's need and the doctor's orders. Usually, tablets are administered once, twice, or even three times a day.

One who has diabetes can have a dosage as high as 2000 mg per day. Meaning they have to take the diabetic drug  1000 mg twice a day. Others, however, are usually administered 1000 mg, taking the 500 mg twice a day. Starting the dose low and gradually increasing the dose help tolerate this significantly. Also taking this after meals lowers the side effects.

Important reminder: do not double up your intake if you ever missed or skip your dosage. It will cause some side effects like an upset stomach. Patients usually take it in the morning and evening, after breakfast and dinner. Some people are prescribed to take 500 mg thrice a day to make it more effective. It means they also have to take it after lunch.

An important reminder: for extended release you must not chew or crush the tablets. Some do cut or crush the tablets, especially if they have difficulty swallowing. For extended release, however, the coating is important, so avoid it at all cost.  

What Are the Side Effects?

What are the side effects? There are some side effects of that you must know. We must note, however, that there are other factors involved that make a person more susceptible to side effects. 

Common Side-Effects

The most common side-effects are the loss of appetite and upset stomach. They are probably why most people assume that aside from treating diabetes, is also an effective tool if one wants to reduce weight. But this side effect is usually caused by taking it without taking a full meal. This is why you must take after a meal.

You are prone to upset stomach and diarrhea if you take without taking your meals. Upset stomach also results in persistent stomach pain. It could also increase acidity in the body. It could lead to heartburn and gastro-intestinal reflux disorder.

You have to avoid those side effects by doing the right thing, which is to eat your meals before taking the pills. There are other reported side-effects associated. Among these are dizziness and nausea, malaise or a general feeling of unease, and not feeling well even chest pain and rash.

The Worst Side-Effects

Another serious side-effect of taking metformin tablets for quite some time is lactic acidosis. Lactic acidosis is the condition when your body accumulates too much lactic acid in your bloodstream. It occurs when oxygen levels in your cells become low.

It could result in difficulties breaking down glucose and glycogen for your body. Among the symptoms of lactic acidosis include fatigue, extreme weakness, cramps, abdominal pain, palpitation, loss of appetite, diarrhea, and headache.

Some cases need immediate medical attention, like when you are experiencing trouble breathing or shortness of breath. Lactic acidosis could have severe complications and can be life-threatening. It could lead to major organ failure, loss of consciousness, and long-term irregular heart rhythm.

Does Metformin Cause Kidney Damage?

Metformin does not cause kidney damage however, Side effect potential especially lactic acidosis is much more likely if GFR is below 30 which means stage IV kidney disease. The same thing applies for the liver. If you have decompensated liver failure Metformin is not appropriate.

Does Metformin Cause cancer?

Actually many studies indicate that diabetic patients who take Metformin are much less likely to have cancer than diabetic patients who do not take Metformin. As a result, the answer is no. Metformin does not cause cancer but actually lowers the risk of cancer more than likely.

Metformin Recall

There was a recent metformin recall for only 500 mg ER Metformin. Only a few companies and a few batches were affected. If you are concerned you need to talk to your pharmacist or your doctor to make sure that the Metformin batch you have taken was not effective. This was an isolated incident and FDA has published information about that as well.If you want more information you can click here.

How to avoid metformin side effects?

If you take the medication metformin properly, you do not have to worry about side effects. Side effects are common because they think of metformin just like the way treat paracetamol and other medicines. It is not the case with metformin.

As a rule, metformin tablets should be taken after eating a meal. If you do this you will avoid having an upset stomach. By avoiding that side effect, you will also avoid other side effects like dizziness and nausea as well. Some severe complications arise from the use of metformin due to poor diet and lifestyle. Prime example is lactic acidosis.

Diabetes and alcohol are a poor mix, but more so are metformin and alcohol. Alcohol increases your body’s toxicity and acidity, but more so if you are under the medication metformin. This could lead to lactic acidosis.

So the best way to avoid lactic acidosis if one is under the medication metformin is to properly regulate one’s diet and lifestyle. Drinking alcohol and engaging in binge drinking is a sure way to have lactic acidosis. Avoid this at all costs if you are taking metformin.

What Happens If I Overdose on Metformin?

What usually happens when one overdoses on metformin are that he develops lactic acidosis, one of the more common side effects of metformin. Nausea and vomiting are also among the common symptoms exhibited by those who take metformin more than what is needed. 

Cardiac arrest and acute renal failure are some of the more severe consequences of overdosing on metformin. But it should not happen unless you really take too much metformin such as over 5000 mg. But why will others take too much metformin? Well, sometimes they do so unwittingly.

It usually happens when a patient forgets to take the medicine and then decides to double up on the doses. As mentioned previously, you must never double up on the doses. This is a sure way to avoid overdosing on metformin.  

Does Metformin Reduce Belly Fat and Cause Weight Loss?

Most people who are obese or overweight tend to lose weight significantly after taking some metformin pills for quite some time. Experts, however, even then, warned that the weight loss effects of metformin pills are gradual.

It may take one to two years before those taking this drug can experience significant weight loss. We may ask the question: Does metformin reduce belly fat and cause drastic weight loss?  All the available evidence points out that this is not the case.

No, it does not reduce belly fat, yet it can help you lose 2-3% of your body weight gradually in time. Judging from this metformin, whether metformin HCL 500 mg, metformin 850 mg, metformin 1000 mg, or metformin ER, and oral solutions are not appropriate to use as a weight loss pill.  

Is Metformin A Blood Thinner?

Metformin, strictly speaking, is not a blood thinner. However, as diabetic drug metformin can help in making the blood thinner. Although the mechanism of action is not known metformin helps lower blood clotting which could explain why patients who take metformin have fewer heart attacks.  

Will Metformin Be Affected by Other Drugs?

Some drugs affect the effectiveness of metformin. Metformin pills, for instance, are not that effective when used in tandem with drugs for high blood pressure. These drugs interfere with metformin due to them being primarily diuretics. Furthermore, drugs for high blood pressure could result in some metformin side effects.

As a diabetes/PCOS drug, metformin also does not work or at least is not effective when used in tandem with tuberculosis drugs. Antipsychotic drugs also interfere with and affect metformin. It has been proven that those who are taking antipsychotic drugs do not benefit much in their drive to manage diabetes, using metformin. The blood sugar levels do not respond as well to metformin as other patients taking metformin.

Does Metformin Affect Other Medications?

Though in itself it could not cause hypoglycemia(low blood sugar), one who takes a metformin tablet may also suffer from low blood sugar if they take it with other diabetic drugs such as insulin or sulfonylureas. Symptoms of hypoglycemia include fatigue, sweating, numbness, and confusion, among others.

In some cases, it could lead to seizures and loss of consciousness. People with diabetes need to put their cholesterol at manageable levels. Metformin and others, however, interfere with the effectiveness of cholesterol drugs.

The result is the reduced efficiency of those drugs in maintaining appropriate cholesterol levels for the patient. We already mentioned lactic acidosis and metformin's tendency to increase the risks of patients having one.

They are even at greater risk if they also take medications for glaucoma, nerve pain, and seizures aside from taking metformin pills. Metformin tablets of all dosages increase the risk and make the patient taking drugs for those ailments more predisposed to acquiring lactic acidosis. And lactic acidosis, as mentioned, can cause many and severe complications for people with diabetes.

Metformin also makes certain hormonal drugs less effective taken by people with diabetes or PCOS. The drugs mentioned above have issues, one way or another, towards metformin hydrochloride. Suffice it to say that it does not matter whether one is taking metformin HCL 500 mg or metformin 1000 mg.

Either they reduce the efficiency of metformin hydrochloride, or metformin itself rendered those drugs ineffective. It is most important, therefore, to consult regularly with your doctor. Your physician is in the best position to know what medicines you need to take, whether talking about diabetes or other diseases.

Medications affected by other drugs are common, and that is why you have to ask your endocrinologist/diabetologist’s advice when you are taking other drugs for your other health issues. But that is also why metformin is best for those who are recently diagnosed, especially the younger ones. As diabetic drug metformin really works wonders if a patient does not have to deal with other medical issues.

What are a Few Natural Alternatives/Herbs to Metformin?

A lot of people turn to berberine. Most recently dihydroberberine has been discovered and started to become popular. On this website, you can actually find dihydroberberine supplements. Both berberine and dihydroberberine have been shown to work very similarly to Metformin.

The benefit of dihydroberberine over berberine is the fact that dihydroberberine has much fewer side effects and somewhat better efficacy. Berberine sometimes exerts similar side effects to Metformin although it is natural.

On this website, you can find dihydroberberine and concentrated Ceylon cinnamon supplement that has a tremendous impact on blood sugars. Visit our Shop page for more information.  

Patient Testimonials about Metformin (Positive)

Millions of people are taking metformin to manage, control, and even reverse diabetes or PCOS. Some have positive attitudes regarding metformin. They claim that it has worked wonders for them and feel way better upon taking the medication metformin.

One medical doctor who has more than 3000 patients has metformin as the medicine of choice for managing diabetes. The doctor stated that the only side effect of metformin of note is an upset stomach. That, however, should not present any problem as long as the patient takes meals before taking metformin pills.

Eating much fiber also helps in lowering the “gas” in the stomach. Overall, the doctor recommends metformin to people who have diabetes or PCOS. One testimonial also made a connection between diarrhea and diet.

Taking metformin for the past four months, he did not have any issues with metformin until he indulged in some carb-loading. He suffers from diarrhea every time he is on a carbohydrate binge. This person concludes that metformin’s side effects, particularly diarrhea, may have something to do with a high glucose level diet.

Another one, a woman, taking metformin, claimed that metformin “expels sugar” from your system, and this is what causes diarrhea. Most doctors actually make the connection between diet and metformin side effects.

Alcohol which we have discussed is just one among the many. Many are also happy with the way they have managed their diet once they began taking metformin. Most of them no longer indulge in “binge eating.” They have managed to eat moderately, and are more disciplined in their food and diet.

The result is that they have lost some weight. Obese and overweight people are the happiest with the result. We have inpatient images examples of people who have significantly lost weight after taking the medication metformin.  

Patient Testimonials about Metformin (Negative)

Some, however, are not happy with metformin. Some complained about the side effects they have to endure. A few wondered whether they have to endure it for the rest of their lives. The most common side effect noted by those who complain about metformin is diarrhea. Some reported experiencing loose bowel movements just a few minutes after eating.

For instance, a 59-year-old female had to stop taking metformin because of severe diarrhea and dizziness. Her glucose level also did not drop, despite taking the medication metformin. However, we should note that the woman admitted that she was on antidepressants. The antidepressants may affect the metformin, interfering with it, rendering it ineffective.

One person with diabetes also reported suffering from metformin 500 mg side effects. This person takes it twice daily, and at first, seemed not to have any problem with it. After four months, however, the person began having diarrhea. The incident prompted the person to stop taking it. But so far, the blood sugar levels of that person remain normal.

This despite not taking any anti-diabetes drugs, metformin or otherwise. Judging from the testimonials, it seems that the side effects are different per person. It also seems that the difference is due to lifestyle and eating habits rather than chemical composition per see. It is also interesting to note that, side effects aside, no one really complains about the effectiveness of metformin.

The key for most people, physicians, and doctors included, is to know what causes those side effects. Knowing them will allow people to avoid them. Then they can take the medication metformin without hassle.

Why Are Some Doctors No Longer Prescribing Metformin?

Though popular and prescribed to millions, why are some doctors no longer prescribing metformin in America and worldwide? There are some issues, but all of them have nothing to do with the nature of the treatment or medicine. Rather, it has something to do with the situation of the patient itself.

• Patients sometimes become unresponsive

Metformin, as mentioned, is the first choice of most doctors to prescribe for those who are suffering from diabetes. The reason is that it helps in metabolic function, relieving pressure from the pancreas to produce more insulin, and from the liver to produce more glucose.

Metformin HCL and the like, however, by its very nature, must be taken long-term. After all, managing and controlling diabetes is usually a long-term affair, and sometimes, a lifetime one. As a medication, metformin must be taken regularly, and like other diabetic drugs, for long periods.

Experts found out that as a diabetes drug metformin, taken regularly and for an extended period, is no longer effective in managing and controlling diabetes. What we mean is that "for some" the longer they take it, the less it delivers on what it promised.

Sometimes, the physician’s recourse is to increase the doses of metformin. Sometimes it will be taken three times a day. Some doctors will just increase the dosage, from metformin 500 mg to metformin 850 mg, or even metformin 1000 mg twice a day, to be taken regularly.

But for some, their bodies, after a while, no longer respond to metformin, whether metformin 500 mg, metformin 850 mg, or metformin 1000 mg. In this case, the medicine no longer functions the way it needs to be. It is no longer effective in helping body cells absorb glucose and glycogen. It is no longer helpful in helping the liver secrete glucose needed by the body for metabolism.

But Why Do They No Longer Respond to the Diabetes Drug Metformin?

There are some reasons why a patient may eventually become unresponsive to metformin. The most common culprit cited by medical doctors is poor diet. Metformin could only be effective if changes were made in lifestyle and diet.

People with diabetes must make some changes in their eating habits. Doing the same things that cause you to have diabetes will make you unresponsive to medicines, whether metformin or others. Metformin is a medicine that helps metabolism.

If your body has poor metabolism because of your diet, not even medicine such as metformin could help you. Other variables such as age are also a factor. In general, as people get older, their metabolism gets slower and it functions poorly.

If that is the case, metformin may not be the appropriate treatment for their diabetes. In these instances, doctors may choose other alternative medicines. They may also choose other approaches, like boosting your insulin production, instead of boosting your body’s capacity to absorb glucose.

• Persistent side effects

Everyone is different as far as metabolism and physiology are concerned. Some respond better to medications, some do not. Some are more “at home” with particular medicines, some are not. That people have different responses regarding particular medicines and drugs is not surprising. If ever, it should be expected.

Some respond favorably to metformin in general, but some do not. Some exhibit worse symptoms and side effects, while others do not experience any side effects at all. Metformin, composed mostly of carbon, hydrogen, and nitrogen molecules, in general, is fit and good for the general public.

That one may experience particular or several side effects may be due to the physiology of an individual more than the chemical make-up of the medication metformin itself. Again, there are several reasons for this.

Diet, once again, is more or less the culprit. Some food and drinks, like alcohol and other beverages, if taken while under the medication metformin, have really adverse effects on the body. Alcohol, for instance, taken with the medicine, even if only metformin 500mg, could lead to high levels of acidity. This in turn could lead to severe complications, like gastro-intestinal reflux and lactic acidosis.

In situations where a person with diabetes has developed those particular illnesses, the doctor has no choice but to prescribe other medicine as a substitute to the medication metformin. It could remain so until the body eventually recovered from such complications. Then the doctor will allow the patient to take metformin again to manage and control diabetes.

• The patient is under medication for various illnesses

As mentioned previously, some medications impede the effectiveness of metformin. The prime example of this is tuberculosis drugs. People who are under medications for tuberculosis must not take metformin, as simple as that.

As diabetic drug metformin will simply not work for tuberculosis patients. To summarize, the reason why some doctors no longer prescribe metformin is that either metformin is no longer effective, could no longer be maximized, or could lead to further complications.

This does not mean, however, that as a diabetic drug metformin is not effective. It is actually one of the more efficient medications for treating and managing diabetes and PCOS. But all medicines have some limitations and could be maximized only under certain conditions.

As one gets older or develops other complications, the doctor must find a more suitable treatment for his patient. All things being equal, however, metformin is one of the more effective, more ideal treatments for people with diabetes. No wonder it is one of the most popular therapies for managing diabetes, not only in the US but worldwide.

Final Thoughts

The medication metformin is one of the most popular treatments for diabetes and PCOS. It is so because it is affordable, readily available, and delivers much on what it promises. It is the first medicine usually administered by doctors to their patients.

There are some side effects, but most of them are sometimes the results of improper intake of medicine and poor lifestyle and eating habits. In the right doses and taken properly, metformin is of tremendous help to people with diabetes and PCOS. But all medicines, metformin included, will be rendered ineffective if one continues engaging in unhealthy eating habits and lifestyles.

 As a medication, metformin works best when partnered with good eating habits and a healthy lifestyle. Also, Consider our dihydroberberine as a natural alternative to metformin if you are after the benefits but do not want the side effects of metformin. Ahmet Ergin, MD,FACE,CDCESECNU Endocrinologist/Diabetes expert Founder of SugarMD Follow us on Youtube, Facebook, and Twitter.