Did you know that gas, diarrhea and stomach pain is the most common side effect of Metformin? It s
the absolute most common reason that my patients end up dumping this medication in the garbage,
but it doesn t have to be that way for most. Just by taking a few steps like when you take it,
what you take it with and even what type of metformin you have can can
make a big difference in being able to take this important medication.
Hi, I m Dr. Erik Richardson a board certified Family Practice physician. I d like to welcome
you to FamilyMed, a channel that focuses giving you practical and accurate medical
information to help you and your family. In today s video we are going to go over 4 simple steps
that can help you tolerate taking this important medication. If you are looking for a more in-depth
discussion of metformin you can check out my other video on metformin right here.
Abdominal pain, gas, diarrhea and bloating are still the most common effect that we see
with this medication. But there are 4 things that you can do to decrease this chance.
First is take it with food, Metformin can have a possibility of affecting the
stomach and gut lining and taking it on an empty stomach can increase that risk.
It s a medication that is usually given once or twice a day
so taking it with meals has been shown to improve your chances of avoiding those side effects.
This is especially true while just starting on it. As your body gets used to it, it doesn t seem
to be as important but if you at least start out taking it with food you will likely do better.
Second is ask your doctor if the extended release tablets would be appropriate for you. It comes in
both an immediate release and an extended release version. The good news is the 500mg
tablets are generic and cheap so it can be a great option. WE tend to see that those who take
the extended release version, tend to do better in avoiding the significant stomach symptoms.
Just a word of warning though, don t ask for the 1000mg Extended release metformin because they are
super expensive. The 500mg you can get for around 5-10 dollars a month while the 1000mg dose is
upwards of a $1000 a month. It s totally insane, and I don t get it, so just be warned.
The third is to start the dose low and slowly increase it.
The most common effective dose for many patients is 1000mg twice a day.
If you need to be up at the higher doses to get your sugars under control then start at a lower
dose like 500mg take that for several days up to a week or more before increasing to the next dose.
Keep doing that week by week until you get to the full dose. If you start right away at the
high dose you are more likely to spend your day in the bathroom than doing the things that you
want to do. Remember, start low and increase it slowly. Of course, always talk to your doctor
and pharmacist about how they recommend you take it, but ask them about this and see how you do.
The 4th step is watch your diet. One of the ways that metformin works is by decreasing how much
sugar is absorbed through your intestines. That s a good thing in trying to keep your sugars down
but can make a real mess when it comes to your bowels. One of the things that helps us digest
is the bacteria that resides in our intestines. All that extra sugar for the bacteria is like a
group of kids in a play gym after Halloween. It s not a pretty sight. The bacteria start
to ferment the sugars and create gas and all the other fun things that come with it. So,
avoiding foods that have sugar or a lot of refined carbohydrates can make a huge difference in being
able to tolerate the medication. Now if that diet sounds familiar, it s how you should be eating
as a diabetic anyway, so get to eating right and see how much it helps. Metformin is an important
medication that works well to treat diabetes when diet and exercise are not enough but the
fact of the matter is that not everybody is going to tolerate it. These steps will give you the best
chance of being able to do well with it but even then sometimes it s not going to work. If you find
yourself in this position, make sure you talk with your doctor as Metformin just may not be for you.
There are other options out there but you still need to remember that nothing is going to take
place of changing your lifestyle. If you are looking for non-medication ways that you should
be working on to control your diabetes then click here where we go over this in a bit more detail.
I really appreciate you watching today, I hope that you found this to be helpful. If you did,
make sure to give this video a like and share it with your friends. It helps our channel to grow
and reach others that may need this in their life. And don t leave without subscribing and hitting
that notification button so you don t miss out on any of our future content. We appreciate you
watching and will see you in the next video. 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.