In this video we are going to be going over the medication Metformin. Keep watching because
we are going to teach you about why you take it, what are the most common side effects,
will give you some tips on how to avoid those side effects as well as warn you about some
of the things you need to be careful with while taking it.
Welcome to Family Med, I'm Dr. Richardson and this is your home for practical and accurate
information to help your family make healthy decisions. This is the channel that focuses
on bringing better health to your home. If this sounds like the kind of information that
would be helpful to you make sure you hit that subscribe button and follow along with
us. On today's episode we are going to be talking
about one of the most common medications that we use to treat diabetes called metformin.
This is a medication that has been available in the United States since 1995. It's main
use is to help control blood sugars in diabetes but it is also used in conditions such as
polycystic ovarian syndrome and some use it to help with weight loss.
Metformin belongs to the class of medications called Biguanides. It works a little different
than any other diabetic medications. There are several different effects it has on the
body that help control blood sugar. The first is that it works on decreasing how much sugar
your liver releases into the blood. Now Maybe you didn't know this but the liver is actually
one of the biggest storage organs for sugar in the body. When you need a boost of energy
the liver releases glucose to give you that little extra boost that you need. Normally
this works well. In diabetes though, it can be a problem. You don't want to have that
extra sugar released, so metformin helps slow that down. Also, it Decreases how much sugar
is absorbed from the intestines and helps to work on improving your bodies sensitivity
to insulin. That's one of the big problems in conditions like diabetes or PCOS. In these
conditions, your body is resistant to the hormone that helps bring the sugar from the
blood into the cells in order to be utilized. So that's why metformin is such a great
choice for most people with these conditions. It does a great job in trying to decrease
that resistence and counteract the effects that this causes.
So at this point you may have asked why you should even care that your blood sugars are
elevated? This is a great question and unfortunately one that I have to talk about a lot. Diabetes
is extremely common and getting more and more so as time goes on. Untreated diabetes has
some awful complications that can happen including dramatically increasing your risk for heart
attacks and strokes. It can affect your eyes putting you at risk for going blind, it can
affect your kidneys causing them to fail as well as affect your nerves and circulation
in your legs and feet especially causing damage to the nerves. This is a big deal because
it makes it easier to get injured and then it doesn't heal well putting you at risk
for infections even leading sometimes to amputations. So, diabetes is not a good thing and not treating
it is obviously not a good thing. So if you are taking this for diabetes that's the
reason you need to be motivated to control and treat this as best as you can.
Now, certainly medication is not the only way you should treat diabetes. Diet and lifestyle
changes are the absolutely most essential thing to be working on to control this and
keep it from getting worse. But unfortunately for many, diet and lifestyle changes are not
enough or we can't make them fast enough in order to get your sugars under control.
That's likely why your doctor is recommending that you take the metformin. So what should
you expect from this medication? Well, first of all it comes in both a tablet
and liquid form. Tablets come in either an immediate release or an extended release version
of 500, 850 or 1000mg. Depending on which formulation you have you can take it either
once or twice a day. An important thing to remember about this medication specifically,
and diabetes medications in general, is that it only works while you are taking it. I have
people come in all the time with their blood sugars high after we originally had it controlled
telling me that they stopped the medicine because we fixed it. Unfortunately, this isn't
the way it works. Unless you have some underlying lifestyle issues that are causing your blood
sugars to be high and you fix those, you need to stay on these medications. Don't stop
them unless you discuss it with your doctor. Metformin is typically the first medication
that we start people on when they are diagnosed with diabetes. Overall for most people its
tolerated quite well but there are some issues that people can have with taking the medication
that we need to talk about. The most common side effects that we tend
to see with metformin are some sort of stomach type symptoms. This can be nausea, bloating,
gas, diarrhea or all of the above. This can be anywhere from mild to more severe symptoms.
There are ways that we try to avoid this though so don't despair. If you are patient as
you start this medication, we can usually get you to the appropriate dose without having
to live with the side effects. One of the tricks that we use is starting the medication
at a low dose and increasing it slowly. For example we will start somebody at 500mg once
a day and then increase their dose every few days to a week until they are the goal dose.
This usually does the trick. Taking the higher doses too quickly is usually the reason people
start to have side effects. We have also noticed that taking it with meals or in the evening
at first can also make a difference. And finally, I've found that for a lot of people, putting
them on the extended release version tends to help them avoid these side effects.
The other thing that you can do to minimize these side effects is be more careful with
your diet. If you remember, one of the ways this medication works, is by blocking how
much sugar is absorbed from the gut. When less sugar is absorbed, more stays in the
gut and the bacteria in your gut start to digest that sugar causing it to ferment. Well,
that causes gas and all the other pleasant side effects that come with it. So, as a diabetic,
you need to be watching your sugar or carb intake anyway so this can add a little more
motivation to do so. Unfortunately some people just aren't able
to tolerate it and we have to reach for something else to treat. But for the majority, if we
just increase the dose slow and watch our diet better, we can avoid this main side effect.
So besides the nausea, gas and diarrhea, other side effects that we can see are some decreased
appetite, feeling of weakness, headaches, sometimes a metallic taste in the mouth and
a rash. These last side effects I don't see as much. Usually if somebody doesn't
want to take the medication its because of the stomach symptoms.
There are more some more serious albeit rare reactions that you should be aware of and
watch for. The most concerning of which is a condition called Lactic Acidosis. This is
when the pH or acid level drops in your blood and can make you very sick and even be fatal.
This is very uncommon but can happen when your kidney's are not functioning well.
We watch for this in those who have chronic kidney disease, in those who are really sick
and dehydrated as well as some people undergoing certain medical procedures where they are
giving IV contrast. Your doctor should be keeping an eye on your kidney function overtime
so its not something that we see much. I will also recommend to my patients that if they
are sick and vomiting and not taking in fluids that they avoid taking their metformin during
these times. It would be a good conversation to have with your doctor to see how they would
want you to handle it. One other thing that you should keep an eye
on. More recently we've seen that metformin can possibly affect your Vitamin B12 absorption,
which if unrecognized might contribute to certain anemias or something well call neuropathy-this
is where the nerves are damaged and can cause some chronic pain issues. This can easily
be checked in your routine blood work. Overall this is a great medication to treat
diabetes. In fact we consider it the foundational medicine in the treatment of this condition
because of how it works and how it helps everything else you do to treat diabetes work better.
It's a great medicine that just works and best of all it is cheap. You can get a 30
day supply of the 500mg extended release metformin for $4.
If diet and lifestyle changes have not been enough to control your diabetes or you suffer
from conditions such as PCOS and your doctor recommends that you take metformin as part
of your treatment regimen, hopefully you have a little more confidence in using this as
a part of your treatment plan. This certainly isn't an all inclusive and in-depth discussion
of everything that could be told about this medication. That's not what I'm trying
to do here. My purpose in sharing this information is to help give information that you can think
about and discuss with your own doctor. Please don't take this as direct medical advice.
Take everything you learned today and discuss it with your doctor in how it applies to your
own situation. If you've found this information to be helpful
do me a favor, go ahead hit that like button and share it with your friends and family.
And if your health is really important to you consider subscribing and hit that notification
button so you don't miss out on any of our other content. Now don't go anywhere, because
if you are looking at ways that you can make that start in your diet and lifestyle changes
to treat your diabetes click here to watch simple steps you can take to start your diet
journey. And click here to watch one of my other videos that you may like.
So until next time, this is FamilyMed with Dr. Richardson and remember to take care of
your body because it's the only one you have.