Are you on Metformin for DM or PCOS. In this video I will go through six scenarios where
your Doctor has to stop Metformin! Coming up
Let us look at the most common diabetes complications. Some of these complications caused by diabetes
may make your Doctor stop Metformin. So please make sure your blood sugars are being well
monitored and you are taking control of your blood sugars. It’s not my body or your Doctor’s
body it is your body. Take care of it.
Diabetes is sometimes called a silent disease because you don’t feel it, but unfortunately
it can affect so many organs in your body.
You are twice as likely to have a stroke or a heart attack. One of the reasons is because
diabetes can raise your triglycerides ( a type of fat) as well as your “bad cholesterol”
called LDL and decrease your good cholesterol called HDL.
You are at an increased risk for eye problems and even blindness. The vessels in your eye,
in particular your retina can get damaged. This is called diabetic retinopathy and you
will have to follow up regularly with your eye doctor. Your eye lens can get cloudy,
also known as cataracts. You are also at an increased risk for glaucoma, where the eye
pressure in your eye increases.
Diabetes causes your blood sugars to go up and this can damage your kidneys. Especially,
if you are older you are at an increased risk as the kidney functions worsens with age.
This type of chronic kidney disease caused by diabetes can lead to kidney failure. Very
bad kidney disease (we Doctors refer to this a stage 5 kidney disease) might require dialysis
to filter your blood. Your nerves can also get damaged. You might
be experiencing numbness, tingling or even pain especially in your hands or feet. This
is called diabetic neuropathy. Damage to the vessels especially in your feet
can lead to circulation problems with an increased risk for pain, difficulty walking, infection
and in very severe cases amputations of digits and limbs.
Another complication can be gum disease leading to increased risk of infection. The increased
amount of sugar in your saliva can be helpful for bacteria to grow in your mouth. There
is higher risk for tooth plaque, caries and tooth loss.
Other complications to think about are an increased risk for depression as the disease
progresses and with advancing disease because of damage to the nerves and reduced blood
flow to the vessel’s you have bladder problems such bladder incontinence and sexual problems
such as erectile dysfunction.
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Going back to the first question of this video I going to list six conditions or scenarios
where your Doctor will have to stop giving you Metformin. All the following conditions
can predispose you to a condition called LACTIC ACIDOSIS when there is too much acid in your
body.
1) If your kidney function becomes worse your Doctor will stop giving you Metformin. He
or she will look at a value called GFR (glomerular filtration rate). If that value is less than
30ml/min/1.7 m2 Metformin will be discontinued. I typically use a higher value as I also see
a lot of elderly patients and I stop it at a GFR of 45 or below. Between 30-and 45 some
Doctors reduce the dose of Metformin by half but no more than 1000mg /day.
If you are interested in other side effects of Metformin hit on that link above.
2) If you are abusing alcohol your Doctor will be stop Metformin, so stay away from
those temptations. 3) If you have progressive liver disease or
liver cirrhosis Metformin will be stopped. However, Fatty liver disease is not seen as
a contraindication unless your liver disease progresses.
4) Now the question about using Metformin and heart failure can become tricky. If your
heart failure is well managed and stable you do not have to stop the drug. However, in
situations of acute heart failure or unstable heart failure you will have to stop Metformin.
5) If in the past you have had a history of lactic acidosis, when there was too much acid
in your blood (you would know) … you cannot use Metformin.
6) Other situations your Doctor can’t use Metformin are situations where there is decreased
blood flow to your tissues such as sepsis, or prolonged low blood pressure and hemodynamic
instability… that just means your blood pressure and circulation is unstable. Those kinds of patients
are usually quite sick and in the ICU. Did you know that Metformin can cause B12
deficiency, click on the link above to find out more.
Question of the Day? Are you on Metformin and do you know what
your GFR is? And if you are interested in more videos especially on Metformin
and diabetes you can click right here, click right here, right here
Think your Health and have a good day!