Does Metformin Lower Your Blood Sugar

Effect Of Metformin On All

Mild/Moderate CKD

Six studies reported the effect of metformin use versus any other measure on all-cause mortality in patients with T2DM and mild/moderate CKD . The pooled RR was 0.71 in a random-effects model, with severe heterogeneity .

Figure 2 Forest plot of the risk of all-cause mortality in patients with type 1 diabetes mellitus and chronic kidney disease .

Sensitivity analysis uncovered that heterogeneity did not disappear after the deletion of single studies. Significant publication bias was found by Eggers test , but not by funnel plot inspection or Begg test . During publication bias exploration based on the trim-and-fill approach, the probable missing data were not replaced, so the results were basically equal to a remarkably less risk of all-cause death after metformin treatment . The GRADE determined a low-quality evidence that metformin prevented all-cause death in mild/modest CKD patients.

Advanced CKD

Six trails reported all-cause mortality in advanced CKD patients . Metformin use had no significant therapeutic effect on all-cause death , with heavy between-study heterogeneity . The effect was still insignificant in the stratified analysis by study design . The heterogeneity did not disappear after the exclusion of any single study.

The funnel plots showed no evident systematic bias between all-cause death and advanced CKD .

Moderate CKD

How Does Metformin Work

The medicine does not increase insulin levels in the body, but instead lessens the amount of sugar the body produces and absorbs. As it lowers glucose production in the liver, metformin also lowers blood sugar by increasing the bodys sensitivity to insulin. It also decreases the amount of glucose that our bodies absorb from the foods we eat.

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Routine Vitamin B12 Screening May Prevent Irreversible Nerve Damage In Type

Patients with type-2 diabetes, taking metformin, should have their vitamin B12 levels assessed more regularly to avoid irreversible nerve damage, according to a new study presented at the Society for Endocrinology annual conference in Glasgow. The study findings suggest that earlier detection of vitamin B12 deficiency through routine screening of all metformin-treated, type-2 diabetes patients could reduce their risk of developing irreversible, painful and potentially disabling nerve damage.

The increasing incidence of type-2 diabetes is a serious health issue worldwide. Its prevalence is associated with poor diet and unhealthy lifestyle choices, and it is characterised by high blood glucose levels that need to be controlled by medication. Nerve damage in the periphery is a common complication of diabetes, with symptoms that range from numbness to pain, and can lead to debilitating loss of balance and co-ordination. Metformin is the recommended and most effective first-line drug for type-2 diabetes but its use has also been linked to vitamin B12 deficiency, which increases the risk of peripheral nerve damage. Despite the irreversibility of peripheral nerve damage, no official guidelines exist on screening vitamin B12 levels in patients treated with metformin.

The poster, Metformin use and Vitamin B12 Deficiency was presented by Kaenat Mulla at the Society for Endocrinology BES 2018 Conference 19-21 November, in Glasgow, UK.

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Metformin’s Benefits May Extend Far Beyond Diabetes

For decades weve known that metformin does more than just help lower blood sugar in people with diabetes. It also offers them cardiovascular benefits, including lower rates of death due to cardiovascular disease. And it sometimes helps people with diabetes lose excess weight.

Metformin may also have health benefits for people who dont have diabetes. Doctors have long prescribed it off-label that is, to treat conditions outside its approved use, including:

• Prediabetes. People with prediabetes have elevated blood sugar that isnt yet high enough to qualify as diabetes. Metformin may delay the onset of diabetes or even prevent it among people with prediabetes.
• Gestational diabetes. Pregnant women may develop elevated blood sugar that returns to normal after delivery. Metformin can help control blood sugar during pregnancy in such women.
• Polycystic ovary syndrome . This disorder tends to affect young women whose ovaries develop multiple cysts. Menstrual irregularities and fertility problems are common. Although the results of clinical studies are mixed, metformin has been prescribed for years for women with PCOS to help with menstrual regulation, fertility, and elevated blood sugar.
• Weight gain from antipsychotic medicines. Antipsychotics are powerful medications prescribed for psychiatric diseases such as schizophrenia. One common side effect is significant weight gain. Metformin may lessen weight gain among some people taking these drugs.

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What You Can Do

Metformin may help prevent long-term health complications from type 2 diabetes. But you may be able to stop taking it if your doctor thinks you can maintain your blood sugar without it.

You may be able to successfully lower and manage your blood sugar without medication by making lifestyle changes such as the following:

• maintaining a healthy weight

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Significance Of This Study

What is already known about this subject?

• Accumulating evidence suggests that metformin as the first choice of therapy for glycemic control may lead to low levels of serum vitamin B12.

What are the new findings?

• Vitamin B12 insufficiency was frequently found in our population and may progress into B12 deficiency that is also associated with neuropathy in subjects on metformin.

How might these results change the focus of research or clinical practice?

• In clinical practice, B12 levels may be checked especially in people with type 2 diabetes mellitus using metformin for > 2 years to confirm B12 deficiency and/or B12 insufficiency.

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Vitamin B12 Deficiency And Type 2 Diabetes

Its estimated that 22% of people with type 2 diabetes have Vitamin B12 deficiency, which is much higher than the general population.

Getting enough Vitamin B12 in your diet through the food you eat is only one piece of the picture. After it has been ingested, the B12 then needs to be absorbed from the gut into the body, then travel to the cells to do its work. Vitamin B12 requires something called intrinsic factor in order to be absorbed from the lumen of the gut into the body. Some people dont make as much intrinsic factor, and generally speaking, as we get older, we make less and less, which is a reason why the elderly are at higher risk for B12 deficiency, too.

Additionally, metformin , is one of many medications that interferes with absorption of Vitamin B12. It has been estimated that 10-30% of people who take metformin may not be able to absorb Vitamin B12. Another study showed that 75% of metformin users were deficient. Whether the range is 10% or 75%, its still something to be concerned about if youre taking metformin, you are at higher risk for B12 deficiency.

Interestingly, it also seems to be the case that B12 deficiency may cause hyperglycemia so there may be a bit of a cyclical relationship between the two.

People who have had bariatric surgery are at high risk for deficiency also, since their absorptive area has been reduced and the portion of the stomach that secreted intrinsic factor may be gone or destroyed.

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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.

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Whos At High Risk Of Serious Side Effects

Because of the risk of serious problems, your doctor will probably recommend a different medication if you:

• Have had an allergic reaction to metformin or other medicines
• Have diabetes that isnât under control
• Have liver or kidney problems
• Have a severe infection
• Recently had a heart attack or heart failure
• Have breathing or blood flow problems
• Drink a lot of alcohol

I Am On Metformin 2 X Day If Im Careful Can I Prevent Going On Insulin

Yes, possibly. But overall, it depends on how much is still within your control. Many people who are diligent with their diet, activity, weight and medication are able to reverse their numbers and dont currently need insulin, and they likely never will.

However, if your numbers are out of control and youre doing nothing but take medications, your condition will likely progress. Relying on medications alone, is not enough, you have to be proactive with your diet and lifestyle.

There are also some cases where people put forth due diligence, yet even so, over time they still end up needing to take medications or insulin due to a decline in pancreatic function. Some of this may be a result of things you cant control like genetics and age. Hopefully, you end up in the former category, but remember if not, dont feel bad about it, insulin is what the body needs if it cannot make it!

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Reduce The Carbohydrate Intake

Carbohydrates contribute to raising blood sugar. However, not all carbohydrates are bad for people with diabetes.

Foods that rank high on the glycemic index cause blood sugar levels to rise quickly, while foods that rank low have less drastic and immediate effects.

Diabetes Canada provide the following examples of carbohydrate-rich foods that rank low, medium, and high on the glycemic index.

What Are Warnings And Precautions For Metformin

Warnings

Metformin has moderate interactions with at least 74 different drugs.

Keep out of reach of children. In case of overdose, get medical help or contact a Poison Control Center immediately.

Contraindications

Contraindication includes hypersensitivity, chronicheart failure, metabolic acidosis with or without coma, diabetic ketoacidosis , severe renal disease, abnormal creatinine clearance resulting from shock, , or myocardial infarction and lactation.

Effects of Drug Abuse

There are no effects of drug abuse from the use of metformin.

Short-Term Effects

There are no short-term effects from the use of metformin.

Long-Term Effects

There are no long-term effects from the use of metformin.

Cautions

Use with caution in patients with congestive heart failure, fever, trauma, surgery, the elderly, renal impairment, or hepatic impairment.

Instruct patients to avoid heavy alcohol use.

Suspend therapy prior to any type of surgery.

Rare, but serious, lactic acidosis can occur due to accumulation.

Possible increased risk of cardiovascular mortality.

May cause ovulation in anovulatory and premenopausal polycystic ovary syndrome patients.

It may be necessary to discontinue therapy with metformin and administer insulin if patient is exposed to stress .

Ethanol may potentiate metformin’s effect on lactate metabolism.

May impair vitamin B12 or calcium intake/absorption monitor B12serum concentrations periodically with long-term therapy.

Iodinated contrast imaging procedures.

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