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METFORMIN SIDE EFFECTS
What exactly is the situation when it comes to metformin side effects? The fact that it helps type 2 diabetics better control their blood sugar levels is well known, and studies are even beginning to show that it can actually help you live longer when compared to those who do not have the disease, which is also well known, but what about the negative side effects? Many individuals abandon metformin because of gastrointestinal metformin side effects. Adverse effects other than gastrointestinal side effects can also occur with metformin and they are common. For example, metformin can cause headaches, a flushed appearance to your skin, changes to your fingernails, and muscle soreness or even chest pain. Let’s start with the most common side effects which are gastrointestinal side effects.
Gastrointestinal Side Effects of Metformin
A metallic taste in the mouth, slight appetite reduction, nausea, abdominal discomfort, and soft bowel movements or diarrhea are some of the most prevalent gastrointestinal adverse effects of metformin. Most of the time, these side effects are modest, temporary, and reversible after the medicine is reduced in dose or stopped altogether. By taking the drug with food, you can keep the side effects to a minimum.
Despite the fact that metformin is generally well tolerated, people using metformin may experience gastrointestinal adverse effects, even after years of treatment with the medication. If you experience gastrointestinal issues while taking metformin, we recommend that you take a metformin break, which may help you feel better. A gentle titration of either the immediate-release or extended-release formulations can be used to successfully resume metformin treatment after a period of non-use. The dose can be kept the same or reduced.
Vitamin B12 absorption in the intestine is reduced in up to 30% of metformin patients, and serum vitamin B12 levels are reduced in 10-20% of metformin patients. However, only a small number of patients develop megaloblastic anemia, which may be caused by folic acid supplementation of the United States food supply. A deficit in vitamin B12 may manifest itself as peripheral neuropathy in some individuals. We recommend SugarMD Neuropathy Support to prevent neuropathy due to diabetes and B12 deficiency.
The amount of metformin taken and the length of time it is taken is associated with the risk of vitamin B12 insufficiency. In one trial, a decrease in serum vitamin B12 levels was found to be attributable to poor absorption of vitamin B12 in the ileum, and this was reversed by administering oral calcium carbonate (1.2 g daily) to the participants. In a separate investigation, supplementation with a daily multivitamin such as Diavitamin (a vitamin complex designed for diabetics) was found to be associated with a lower prevalence of vitamin B12 insufficiency.
Because of evidence that vitamin B12 deficiency is often asymptomatic and anemia is not a sensitive indicator, as well as a prevalence of vitamin B12 deficiency (or borderline low levels) in metformin-treated patients that may approach 20% over five years, routine vitamin B12 monitoring or
administration may be considered in patients with poor dietary intake or absorption.
LACTIC ACIDOSIS-A RARE BUT SERIOUS SIDE EFFECT OF METFORMIN
Lactic acidosis is a condition in which the body produces too much acid. It appears that the frequency of lactic acidosis in metformin users is somewhat low unless patients also have chronic kidney disease. Despite its rarity, lactic acidosis associated with metformin continues to be a source of concern due to the high death risk associated with the condition.
In a review of 347 randomized trials and prospective cohort studies, it was found that there were no cases of lactic acidosis. About half of the studies allowed people with creatinine levels of more than 1.5 mg/dL (133 micromol/L), and almost all of the studies allowed people who had at least one typical reason not to take metformin to take part. However, no information was given about how many people had these standard contraindications, which made it impossible to figure out how safe metformin was for people who had them.
Another study looked at the risk of acidosis in metformin users across the entire range of kidney function and found that the risk of acidosis as a metformin side effect was the same for metformin users and nonusers when the estimated glomerular filtration rate (eGFR) was less than 30 mL/min/1.73 m2. Metformin users had a higher risk of acidosis if their eGFR was less than 30 mL/min/1.73 m2. When their eGFR was less than that, metformin users had a higher risk of acidosis.
It is possible to develop metformin-induced lactic acidosis in people who have normal renal and hepatic function in the following clinical settings:
- Metformin overdose with a specific goal
- Maternally inherited diabetes and deafness (MIDD) is a genetic diabetes syndrome in which individuals are at an increased risk of developing lactic acidosis when treated with metformin.
- Acute kidney injury occurs from a variety of sources and occurs repeatedly. The appearance of nausea, vomiting, or dehydration should trigger the cessation of metformin therapy if present.
Acute or progressive renal impairment, acute or progressive heart failure, acute lung disease decompensation, sepsis, and dehydration are all conditions that increase the likelihood of lactic acid accumulation. So the use of metformin in a hospital setting is frowned upon as these conditions tend to happen in hospitalized patients. Lactic acid accumulation is also more severe in patients with chronic kidney disease. In response to this discovery, conventional contraindications to metformin were developed, which include markedly compromised kidney function, heart failure, liver illness, and heavy alcohol consumption.
Factors That Increase the Likelihood of Side Effects of Metformin
While using metformin, there are a number of factors that increase your chance of developing lactic acidosis. If any of these issues apply to you, make sure to discuss them with your doctor before beginning treatment with this medication.
Problems with the kidneys
Metformin is eliminated from your body by your kidneys. If your kidneys are not functioning properly, you will have higher levels of metformin in your system. This increases your chances of developing lactic acidosis. If you have mild or severe kidney problems, your doctor may recommend that you begin taking metformin at a reduced dosage or not start at all.
If you have significant kidney problems or are over the age of 80, metformin may not be an appropriate treatment option for you. Your doctor will most likely do a kidney function test before you begin taking metformin, as well as once a year thereafter.
Take metformin with caution if you have acute heart failure or have just had a heart attack, as metformin side effects may worsen your heart condition. It is possible that your heart does not pump enough blood to your kidneys. This would hinder your kidneys from eliminating metformin from your body as efficiently as they would otherwise, increasing your chance of developing lactic acidosis (a kind of kidney failure).
Problems with the liver
If you have serious liver problems, you should avoid taking metformin. Lactic acid is removed from your body by your liver. A buildup of lactic acid may occur as a result of severe liver issues. Lactic acid accumulation increases your chances of developing lactic acidosis. Metformin also increases your risk of developing liver problems, making it risky to take if you already have liver problems.
Consumption of alcoholic beverages
Consuming alcoholic beverages while taking metformin increases your risk of developing low blood sugar. It also increases your risk of developing lactic acidosis since it boosts the amount of lactic acid in your body. While using metformin, you should avoid consuming excessive amounts of alcoholic beverages. This encompasses long-term alcohol consumption as well as binge drinking episodes. If you consume alcoholic beverages, consult with your doctor about the amount of alcohol that is safe for you to consume while taking metformin.
How to Use Metformin Around Procedures involving surgery or Imaging
When planning surgery or a radiological procedure that will involve the use of iodine contrast, you must stop taking metformin at least one week before the procedure. These treatments can make the clearance of metformin from your body more difficult, increasing your chance of developing lactic acidosis. Inquire with your doctor about the precise timing of when you should discontinue taking metformin.
Your doctor will also be able to tell you when it is safe to restart taking metformin once the surgery has been completed. When your kidney function tests have returned to normal, you will most likely be given the green light to proceed.
How to Prevent Side Effects of Metformin
Here are three suggestions for dealing with the long-term impacts of metformin:
1) To get the most out of metformin, take it with a full meal.If you have food in your stomach, you are less prone to suffering from issues. If you only take metformin once a day, make sure to take it with your largest meal of the day to maximize its effectiveness. Even if you are taking it twice a day, try to take it at opposite ends of the day to avoid fatigue (e.g., take it at breakfast and dinner instead of at lunch and dinner).
2) Change to metformin with extended-release (ER). When metformin is administered for the first time, it is almost always the immediate-release (IR) formulation that is used. Although it is less likely to cause an upset stomach, it does have the potential to do so. The coating on the ER tablets allows the medication to be released more slowly, which makes it less irritating for the stomach. Learn more about the differences between metformin IR and metformin ER, including how they compare in pricing and how to properly switch between the two medications by clicking or tapping here.
3) Use caution when making dietary changes or taking supplements. It’s possible that you’ve read on the internet that modifying your diet or taking probiotics will alleviate an upset stomach. There is, in fact, no evidence to support this claim. It is only when your healthcare practitioner or a dietician recommends that you make dietary changes that you should follow their advice.
Metformin can have side effects. If your doctor has given you metformin and you’re worried about side effects, talk to your doctor! Discuss berberine or dihydroberberine as an alternative. Dihydroberberine has fewer side effects but similar biological action to metformin. Consider using Diavitamin to overcome some of the side effects.
Dr. Ahmet Ergin
Author of ” The Ultimate Diabetes Book“
Creator of SugarMD Youtube channel.