Facts about metformin

Among the many medications used in management of diabetes, one mainstay is the drug known as metformin. Unfortunately, there are fake news articles out there that say metformin is bad for you, with misleading clickbait-type headlines that say doctors no longer prescribe metformin.

Contrary to one article, I still prescribe metformin on a regular basis for my patients, a medication that continues to save lives by helping control diabetes. Some patients have stopped taking their metformin just because they saw this headline without even reading the whole article. (If you actually read the article, at the end it becomes an advertisement selling some so-called “miracle” drug for diabetes which is not proven to work. Please do not buy medication without a prescription from your doctor, and definitely do not buy medication or supplements from social media sites).

Another frequent question is, “Doc, di ba nakakasira yan ng kidney?” The truth is that metformin does not damage the kidneys; it’s uncontrolled diabetes that can cause that. But when the kidneys are not functioning well, metformin can accumulate in the body and this can lead to toxic effects. Patients with worsening kidney function are taken off metformin because of the possibility of toxicity, and this has led to the common misconception that the metformin may have been the reason for the kidney failure.

It is very rare to have low blood glucose levels when taking metformin alone.

Metformin is derived from a substance called guanidine, the active ingredient in a plant called Galega officinalis (goat’s rue or French lilac) which was used to treat diabetes in medieval Europe. It has been in use since the 1950s and after proper diet and exercise, it is one of the first medications prescribed for patients with type 2 diabetes mellitus.

Metformin is known as an insulin sensitizer, meaning it helps our body use the insulin that we make. In type 2 diabetes, insulin produced by our pancreas is not able to get blood sugar into the cells of the body where it can work properly, a condition called insulin resistance. Metformin helps your body make better use of the insulin produced by the pancreas and regulates the amount of sugar released from places where sugar has been stored such as the liver. Metformin can also be used in combination with other oral medications and insulin for better diabetes control.

When starting metformin, common side effects are stomach upset, nausea and soft bowel movements. These symptoms usually go away after a few days, but if they persist let your doctor know so you can be advised on how to adjust your medication. One way to reduce these symptoms is to start with a low dose of metformin, with a gradual increase in dose over days to weeks. Taking the medication after a meal can also help. These side effects may be the reason some patients lose weight, although the weight loss is modest, about three kilos in a year.

Common side effects of metformin are stomach upset, nausea and soft bowel movements.

It is very rare to have low blood glucose levels when you are taking metformin alone. This can happen if metformin is taken with other blood sugar-lowering medications and insulin.

There are different formulations of metformin, as well as generic forms and different brands. Metformin is also available for free at barangay health centers. These are all effective in helping control blood sugar levels. If you are prescribed an extended-release form of metformin, sometimes you may see something that looks like the tablet in your stool. This is normal and not a cause for concern.

Only take metformin if it has been prescribed for you by your doctor, and keep taking your medication regularly. Metformin should not be used if you have advanced kidney or liver disease, in instances of dehydration or severe illness that requires hospitalization. Doctors request for lab tests be done regularly (usually every three months) to monitor not only your blood sugar control but also liver and kidney function to ensure that metformin is still safe for you to take.

So don’t believe everything you read or hear, especially when it comes to your health. Every patient is different, and what may work for one person may not for another. If you have concerns, talk to your doctor to make sure that you are taking medication that is safe and appropriate for you.