Diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. Insulin is a hormone that regulates blood sugar. Hyperglycaemia, or raised blood sugar, is a common effect of uncontrolled diabetes and over time leads to serious damage to many of the body’s systems, especially the nerves and blood vessels.
Among the US population overall, crude estimates for 2018 were: 34.2 million people of all ages—or 10.5% of the US population—had diabetes. 34.1 million adults aged 18 years or older—or 13.0% of all US adults—had diabetes.
The general symptoms of diabetes include:
• increased hunger
• increased thirst
• weight loss
• frequent urination
• blurry vision
• extreme fatigue
• sores that don’t heal
Symptoms in men
In addition to the general symptoms of diabetes, men with diabetes may have a decreased sex drive, erectile dysfunction (ED), and poor muscle strength.
Symptoms in women
Women with diabetes can also have symptoms such as urinary tract infections, yeast infections, and dry, itchy skin.
What is Metformin?
Metformin sold under the brand name Glucophage among others is a medication used alone or with other medications, including insulin, to treat type 2 diabetes (a condition in which the body does not use insulin normally and, therefore, cannot control the amount of sugar in the blood). Metformin is in a class of drugs called biguanides.
Metformin helps to control the amount of glucose (sugar) in your blood. It decreases the amount of glucose you absorb from your food and the amount of glucose made by your liver. Metformin also increases your body’s response to insulin, a natural substance that controls the amount of glucose in the blood. Metformin is not used to treat type 1 diabetes (a condition in which the body does not produce insulin and therefore cannot control the amount of sugar in the blood).
Metformin is a prescription medication and therefore must be prescribed by a doctor and cannot be purchased over the counter. This is because metformin and other diabetes medications are not right for everyone, and only a doctor can decide if it should be a part of your treatment plan. According to studies, metformin use has substantially increased within the past 15 years, which is mainly driven by older adults.
How is Metformin taken?
Metformin is usually taken with meals, either once or twice a day depending on the brand. Available dosages of pills include 500 mg, 850 mg, and 1000 mg.
The treatment plan will differ for each patient, but a common starting regimen is listed below:
- To avoid stomach upset, patients usually start with a very low dose (500 mg), taken with dinner.
- After a few weeks, the dose may increase to 500 mg with breakfast and 500 mg with dinner.
- A few weeks later, the dose may increase again to 500 mg with breakfast and 1 g with dinner.
- If the patient has no side effects, the dose may increase to 1000 mg with breakfast and 1000 mg with dinner. This is usually the maximum dose.
What is the best time to take metformin?
Standard metformin is taken two or three times per day. Be sure to take it with meals to reduce the stomach and bowel side effects that can occur – most people take metformin with breakfast and dinner.
Extended-release metformin is taken once a day and should be taken at night, with dinner. This can help to treat high glucose levels overnight.
Does metformin lower blood sugar immediately?
Metformin does not instantly reduce blood sugar levels. The effects are usually noticeable within 48 hours of taking the medication, and the most significant effects take 4–5 days to occur.
What are the signs metformin is not working?
The most important sign that metformin is working for you is the lowering of your blood sugar, or blood glucose, levels. Metformin lowers your blood sugar levels by improving the way your body handles insulin. Metformin is very effective at controlling blood glucose and lowers A1c levels by as much as 1.5% at maximum doses.
When metformin starts working some men may notice improvements in diabetes-related erectile dysfunction(ED). One recent study showed that metformin treatment positively affects two of three pathways that contribute to ED, including activating the nitric oxide response required to increase blood flow to the penis.
In addition, women may also notice a reduction in the incidence and severity of urinary tract infections, yeast infections, and dry, itchy skin. If these symptoms as well as other diabetes symptoms do not improve, then metformin might not be working for you.
If you discover that metformin is not working for you, discuss with your doctor for possible alternatives. It is important to note that switching from one medication class to another, or to a different medication within the same class, may affect your blood sugar level. Test your blood sugar more often for a few days after switching and watch for early signs of low blood sugar levels
What is “Faux Low”?
This is a common side effect often experienced by people taking metformin for the first time. A faux low happens when you drop your blood sugars to a “normal” range after running consistently high (i.e. above 180 mg/dl), whether by starting on a therapy like metformin or going on a low-carb diet, or both! Your body responds to this change as if it’s in real hypoglycemia (below 70 mg/dl).
Although every person with diabetes has a different blood-sugar threshold and different symptoms, people often feel irritable, tired, shaky, and dizzy when their blood sugar is 70 mg/dl or lower.
If you experience symptoms like these and have confirmed with a glucose meter the low you are feeling is indeed false (i.e. your meter says you’re at 96 mg/dl), keep taking your metformin as directed. Don’t start carb-loading (eating carb-rich foods like orange juice to bring sugars back up).
If metformin does not work for you or you cannot take metformin or experience side effects, there are alternative treatments. Here are some alternative medications that your doctor may prescribe:
- Sulfonylureas: These medications stimulate the pancreas to release insulin, which helps to lower blood sugar levels. Examples include glipizide, glyburide, and glimepiride.
- DPP-4 inhibitors: These medications help to lower blood sugar levels by increasing the amount of insulin released by the pancreas and reducing the amount of glucose produced by the liver. Examples include sitagliptin, saxagliptin, and linagliptin.
- GLP-1 receptor agonists: These medications stimulate the release of insulin and slow the absorption of glucose in the gut. Examples include exenatide, liraglutide, and dulaglutide.
- SGLT2 inhibitors: These medications lower blood sugar levels by preventing the kidneys from reabsorbing glucose, which is then excreted in the urine. Examples include canagliflozin, dapagliflozin, and empagliflozin.
It is important to note that the suitability of these medications as alternatives to metformin will depend on individual circumstances and medical history. Your doctor will be able to advise you on the best treatment option for you.