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T2D Medicine Biguanide (Metformin)

T2D Medicine Biguanide (Metformin)

Biguanide diabetes medication lowers the amount of glucose made by the liver; thus, blood-glucose levels cannot go too high helps to treat insulin resistance.

Biguanides lower your blood-glucose level by attenuating your liver glucose production, boost glucose update by improving insulin sensitivity. You may lose some weight when you start taking metformin, which further helps your diabetes control.

Metformin can additionally improve blood cholesterol levels, which are often a problem among type 2 diabetes. Metformin is primarily used in obese not responding to dietary therapy. Metformin can increase insulin sensitivity and reduce insulin requirements. Additionally, biguanides can lower fasting levels of insulin in plasma.

Metformin is suitable for monotherapy and in combination with sulfonylureas and other secretagogues, thiazolidinediones, and insulin. The combination of glyburide and metformin is more effective than either glyburide or metformin alone.

Metformin mechanism of action

Biguanide’s mode of working to lower your blood-glucose level is by reducing gluconeogenesis in the liver (limiting your liver to make too much glucose).

In addition to attenuation of hepatic glucose production, metformin improves insulin sensitivity, boost peripheral glucose uptake, and limit glucose absorption from the gastrointestinal tract.

Biguanide’s diabetes medications

  • Generic name: Metformin (Brand name: Glucophage, Glucophage XP (long-acting form), Glumetza, Fortamet, Riomet -liquid form)

Metformin dosage

Start with Metformin 500 mg daily and increase it to 500 mg twice daily (after one week) and up to three times a day (after another one week), to minimize gastrointestinal side effects. You can further reduce the side effects by taking it along with food. The usual dose is 500 mg three times a day, the maximum dose 1.0g twice daily.

Metformin retards 850 mg tablet is a slow-release formulation. The usual dose is twice daily, maximum dose of 1700 mg every morning or 850 mg every night.

Side effects of Metformin

Adverse effects of metformin include gastrointestinal distress such as abdominal pain, nausea, and diarrhea. These effects occur in up to 50% of patients; however, you can minimize this frequency with slow titration of therapy and food consumption. The more severe side effect is lactic acidosis; i.e., low pH in body tissues and blood.

Sometimes you will need to stop taking this type of diabetes medicine for a short time so you can avoid developing lactic acidosis. If you have severe vomiting, diarrhea, or a fever, or if you cannot keep fluids down, call your doctor right away. You should also talk with your doctor well ahead of time about stopping this type of medicine if

  • you’ll be having special x-rays that require an injection of dye
  • you’ll be having surgery
  • your doctor will tell you when it is safe to start retaking your medicine.

What can you expect for Metformin?

Metformin can lower your HbA1c levels by 1 to 2% and fasting plasma glucose (FPG) by 60 to 70 mg/dl or 3.333 to 3.889 mmol/l or up to 20%. Metformin has weight loss or no weight gain and much fewer hypoglycemic episodes than sulfonylurea. Other non-glycemic benefits of Metformin can decrease in low-density lipoprotein cholesterol (LDL-C) levels and triglyceride levels.

Similarly, adding repaglinide to metformin therapy produces more fasting plasma glucose-lowering.

Who can benefit from Metformin?

Metformin can be useful for overweight/obese individuals. You may lose some weight when you start taking metformin, which in turn help your blood-glucose control. Additionally, metformin improves your blood cholesterol level, thus helps to lower your cholesterol level if you are hyperlipidemia.

Metformin is considering as a therapy of pre-diabetes to prevent diabetes, and it may prevent cancer.

Who should avoid using Metformin?

Avoid Metformin, when you are having advanced liver or kidney disease, drink excessive amounts of alcoholic beverages, pregnant (or planning to get,) or breastfeeding.

It should not use in patients with:

  • impaired renal function, i.e., serum creatinine more than 130 μmol/l or creatinine less than 60 mL/min,
  • older adults of age above 70 years,
  • patients with congestive heart failure, hepatic dysfunction, metabolic acidosis, dehydration, alcoholism, or increased risk for lactic acidosis.

If a patient, who takes metformin and has had a partial gastrostomy, and terminal ileal disease may develop vitamin B12 deficiency.

Patients receiving oral anticoagulant drug and metformin may require a higher dosage of warfarin.

Patients taking metformin should monitor hemoglobin, hematocrit, red blood cell indexes, and renal function at least annually.

Due to lactic acidosis, discontinue metformin treatment during surgery, severe infection, and illness. 

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