Effects On Body Weight
Metformin may have a neutral effect on body weight of patients with T2DM when compared to diet or may limit or decrease the weight gain experienced with sulfonylureas , TDZ , insulin , HAART , and antipsychotics drugs .
Modest weight loss with metformin has been observed in subjects with IGT . However, a meta-analysis of overweight and obese non-diabetic subjects, found no significant weight loss as either a primary or as secondary outcome .
The mechanisms by which metformin contributes to weight loss may be explained through the reduction in gastrointestinal absorption of carbohydrates and insulin resistance , reduction of leptin and ghrelin levels after glucose overload , and by induction of a lipolitic and anoretic effect by acting on glucagonlike peptide 1 .
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How Metformin Works And Why It’s Effective For Type 2 Diabetes
- Metformin works by decreasing the amount of sugar in your blood and increasing your body’s response to insulin.
- Metformin is one of the most commonly used oral medications for people with type 2 diabetes, and it is very effective at lowering blood sugar and A1C levels.
- There are a few side effects of metformin, but these can be reduced by taking it with a meal.
- This article was reviewed by Jason R. McKnight, MD, MS, a family-medicine physician and clinical assistant professor at Texas A& M College of Medicine.
- This story is part of Insider’s guide to Diabetes.
Metformin is an oral medication most often used to treat type 2 diabetes. Roughly 80 million Americans take the drug, making it the most commonly prescribed medication to treat diabetes.
“Overall, metformin is a safe drug, and it reduces A1C up to 1.5% to 2.0%, which proves that it is very effective,” says Dr. Anis Rehman, an assistant professor of clinical medicine in the division of endocrinology, diabetes, and metabolism at Southern Illinois University.
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What Are Less Common Side Effects Of Metformin
The medication can cause more serious side effects, though these are rare. The most serious of these is lactic acidosis, a condition caused by buildup of lactic acid in the blood. This can occur if too much metformin accumulates in the blood due to chronic or acute kidney problems. Severe acute heart failure, or severe liver problems can also result in a lactate imbalance.
Metformin can also increase the risk of hypoglycemia , particularly for those who take insulin and drugs which increase insulin secretion , but also when combined with excessive alcohol intake. Even though Im not on insulin, I started on continuous glucose monitoring to be able to keep a closer eye on my blood sugar levels. Of course, regular checking with a blood glucose meter is also helpful in preventing low blood sugar episodes.
Because long-term use of metformin can block absorption of vitamin B12, causing anemia, sometimes people need to supplement vitamin B12 through their diet as well.
For most people who take metformin, side effects are mild and relatively short in duration.
Does Metformin Cause Cancer
In 2019 the FDA investigated whether some forms of metformin contain high levels of a carcinogenic chemical called N-nitrosodimethylamine . In 2020, the FDA recommended the recall of several versions of extended-release metformin, and more than a dozen companies have since voluntarily recalled certain lots of the medication. While low levels of NDMA are commonly found in foods and drinking water, high levels of the substance are toxic and can cause cancer.
You can check to see if your metformin has been recalled here. For people taking extended-release metformin, the FDA recommends that you continue to take your medication until you talk to your healthcare professional.
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Effects On The Inflammatory Pathway
The benefits of metformin on macrovascular complications of diabetes, separate from its conventional hypoglycemic effects, may be partially explained by actions beyond glycemic control, particularly by actions associated with inflammatory and atherothrombotic processes . Metformin can act as an inhibitor of pro-inflammatory responses through direct inhibition of NF-kB by blocking the PI3KAkt pathway. This effect may partially explain the apparent clinical reduction of cardiovascular events not fully attributable to metformins anti-hyperglycemic action .
Some studies also point to a modest effect on inflammatory markers in subjects with IGT in T2DM while others have found no effect at all .
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Why Metformin Failure Is A Concern
Metformin is prescribed because your healthcare provider believes that you need it to help control your blood sugar. It is often prescribed after lifestyle interventions fail to provide glucose control.
If metformin is unable to control your blood sugar, you need to take action. In people with uncontrolled or poorly controlled diabetes, excessive accumulation of glucose in the bloodstream can cause progressive damage to blood vessels, nerves, and organs.
Among the possible complications of uncontrolled diabetes are:
How Effective Is Metformin
Metformin is very effective for most people with type 2 diabetes. In fact, a widely cited 2012 scientific review in Diabetes Care found that metformin reduced A1C levels by an average of 1.12% for patients with type 2 diabetes.
A more recent 2019 study published in the Pakistan Journal of Medical Sciences found that type 2 patients with the highest A1C levels saw the most dramatic increase after starting metformin.
The best way to measure the efficacy of metformin is to take an A1C test, which shows average blood-glucose levels over the past 12 weeks. As a result, you’ll need to wait about three months after starting metformin to measure your A1C levels and get an accurate result, Rehman says.
Most people are prescribed metformin long term and should not stop the medication without talking to their doctor. “Diabetes type 2 is a chronic life-long disease, which means metformin is mostly prescribed for the long term,” Rehman says.
It should be used along with lifestyle changes, like exercising more and counting carbohydrates, both of which can help control blood-sugar levels. In rare cases, in which patients effectively make major lifestyle changes, their doctor might wean them off metformin.
“In a small set of patients, with new diabetes type 2 diagnosis, lifestyle changes such as 10% body weight loss and carb-controlled diets can lead to diabetes type 2 remission,” Rehman says.
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Why Does Metformin Smell Like Fish
Some people complain there is a strong fish smell prompting them to think their pills are no good. The medical literature does not report any information about the odor in metformin. If this is of concern, speak with your pharmacist and your doctor. There are no reports that the odor affects the effectiveness of the medication. Do not stop taking it without notifying your healthcare team.
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Effects On Oxidative Stress
Oxidative stress is believed to contribute to a wide range of clinical conditions such as inflammation, ischaemia-reperfusion injury, diabetes, atherosclerosis, neurodegeneration, and tumor formation .
Metformin has antioxidant properties which are not fully characterized. It reduces reactive oxygen species by inhibiting mitochondrial respiration and decreases advanced glycosylation end product indirectly through reduction of hyperglycemia and directly through an insulin-dependent mechanism .
There is some evidence that metformin also has a beneficial effect on some components of the antioxidant defense system. It can upregulate uncoupled proteins 2 in adipose tissue and can also cause an increase in reduced glutathione .
Metformin has been proposed to cause a mild and transient inhibition of mitochondrial complex I which decreases ATP levels and activates AMPK-dependent catabolic pathways , increasing lipolysis and ß-oxidation in white adipose tissue and reducing neoglucogenesis . The resultant reduction in triglycerides and glucose levels could decrease metylglyoxal production through lipoxidation and glycoxidation, respectively .
What Does Metformin Do
Metformin is an oral medication that helps to control blood sugar levels. It does this by helping your body to make less glucose and to use your naturally produced insulin more effectively. It is available in immediate release and extended release versions. The brand-name IR version is known as , which is available as generic metformin. Then, the ER versions are sold under the brand names , , and , and each has their own generic versions.
For those at high risk of developing diabetes, metformin can be a great choice. The medication has been studied for several decades and is very safe and easy to use. It has a very low risk of sudden hypoglycemia and requires minimal monitoring by both you and your doctor.
It is also an effective medication, with the most research to support its treatment of prediabetes in those under 60 years old. In fact, it is the only medication the ADA currently recommends for prediabetes.
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Can Metformin Cause Weight Loss
The FDA has also not officially approved metformin as an aid in losing weight. Many people with type 2 diabetes have lost weight after taking the drug, as researchers are still torn over exactly how metformin affects the weight. Some believe it decreases appetite, while others say it affects the way the body stores and uses fat.
Scientists are also examining metformins potential to protect against heart disease in people with type 2 diabetes some older data supports this. While robust heart outcome trials with metformin are yet to be conducted, more attention is being paid to this research area.
What Are The Contraindications To Taking Metformin
There are a few scenarios in which taking metformin is contraindicated .
- Kidney disease or poor kidney function
- Current or history of lactic acidosis
- Allergy or hypersensitivity to metformin
If you need radiological studies with intravenous contrast, like a CT scan, you should temporarily stop your metformin to prevent kidney problems. Also, people with liver disease, in general, should avoid using metformin because it increases your risk of developing lactic acidosis .
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How Are You Sweetening Your Coffee What You Add To Your Cup May Affect Your Blood Sugar Levels
Whether you were recently diagnosed with type 2 diabetes or have been living with the condition for several years, you know how fickle blood sugar levels can be, and how important it is that they stay controlled.
Proper blood sugar control is key for warding off potential diabetes complications, such as kidney disease, nerve damage, vision problems, stroke, and heart disease, according to the National Institutes of Health . Plus, keeping your levels in check on a daily basis can help you stay energized, focused, and in a good mood, explains Lisa McDermott, RD, CDCES, a diabetes specialist with the Pittsburgh-based Allegheny Health Network.
According to the American Diabetes Association , proper medication, effective meal planning, regular exercise, and regular blood sugar checks can all help you keep your levels within a healthy range. The ADA recommends blood glucose stay within 80 to 130 milligrams per deciliter before meals and below 180 mg/dL two hours after the start of a meal. Furthermore, the organization recommends getting an A1C test, which measures your average blood glucose over the past two to three months, at least twice per year if your levels are stable and you are meeting treatment goals.
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Animals And Experimental Setup
Three-months-old C57BL/6J strain susceptible to development of obesity as well as transgenic male AMPK2-KO mice and their wild-type littermates on C57BL/6J background were kept in a controlled environment, i.e. at 22°C, 50% humidity, and 12-h light-dark cycle, with food and water ad libitum. Mice were fed either STD , containing 9wt% as lipids, or corn oil-based HFD containing 35wt% as lipids for 8 weeks. On the day before each experiment, food was removed from the cages for ~15hours . On the day of experiment, mice were randomly assigned to treatments at a number of 56 mice per group. The experiments followed guidelines for the use and care of laboratory animals of the Institute of Physiology which are based on the Czech law regarding the protection of animals against cruelty . The experiments were approved by the Ethical Committee of the Czech Academy of Sciences under the protocol no. 81/2016.