Downsides of metformin?
March 8, 2022 5:05 PM Subscribe
I have type 2 diabetes that’s well controlled by diet (at a level considered “in remission”). My doctor hasn’t suggested putting me on any medications. However, I started reading about metformin recently and wondering if I should request to try taking it, since it appears to have a lot of general anti-ageing benefits for things like cardiovascular health, dementia, and cancer risk. People on metformin seem to live longer in general.
My instinct is to avoid going on medications wherever possible, but it occurred to me that maybe that’s a gut feeling not backed up by science and there could be a lot of benefits to taking this drug even if it’s not strictly necessary for blood sugar control. The main side effects seem to be gastrointestinal. It’s inexpensive. If I find I can tolerate it, are there reasons I should or shouldn’t start taking metformin regularly? Are there downsides or risks I’m not aware of? Interested both in any scientific/research-backed opinions and any anecdotal experiences or advice based on personal opinions. Thank you!
My instinct is to avoid going on medications wherever possible, but it occurred to me that maybe that’s a gut feeling not backed up by science and there could be a lot of benefits to taking this drug even if it’s not strictly necessary for blood sugar control. The main side effects seem to be gastrointestinal. It’s inexpensive. If I find I can tolerate it, are there reasons I should or shouldn’t start taking metformin regularly? Are there downsides or risks I’m not aware of? Interested both in any scientific/research-backed opinions and any anecdotal experiences or advice based on personal opinions. Thank you!
Best answer: I was on Metformin for over a year. Basically no, but like all drugs, there are a number of unknowns- but so is the idea that it extends life expectancy. The one thing my doctor advised me was to take B12 pills, as it has been shown to reduce that.
posted by coffeecat at 5:23 PM on March 8, 2022 [1 favorite]
posted by coffeecat at 5:23 PM on March 8, 2022 [1 favorite]
I was diagnosed as having Type-2 diabetes almost a year ago. I was put on metformin, taking three a day. I worked on my weight and when I was tested 7 months later, my A1C was low enough that I was not even in the pre-diabetic level. My doctor cut me back to two a day, with the proviso that if my daily test numbers went up, I should go back to three. So far so good. I’ll be going back in Mayto see how I’m doing.
I have Medicare with a Part-D plan and my cost is zero.
I had no side effects from it.
posted by jvbthegolfer at 5:49 PM on March 8, 2022 [1 favorite]
I have Medicare with a Part-D plan and my cost is zero.
I had no side effects from it.
posted by jvbthegolfer at 5:49 PM on March 8, 2022 [1 favorite]
Best answer: I am not a doctor. ALWAYS talk to your doctor, and preferably an endocrinologist before considering your medication plans. General practitioners are often unfamiliar with the latest trends in diabetes, so it's a good idea to have an endocrinologist, a cardiologist and a nephrologist (kidney doctor) in your long-term health planning. Keep up with your dental health as well, because poor oral hygiene can lead to inflammation and can affect your blood sugar. I also recommend boot camp, and meeting with a registered dietician, if your coverage allows it. Those caveats aside, here is what I can tell you from experience (I was diagnosed with Type 2 twenty years ago):
Your A1C is a good measure for overall diabetes control, but you can still have high sugar spikes, not eat for a long time, and then spike again. These blood sugar spikes can damage your health, but your A1C would not register it.
You're looking at the long game. High blood sugar slowly degrades your capillaries over time, which is why some diabetics eventually lose their feet...deprive the extremities of blood, and your skin will no longer heal, cuts and bruises become dangerous, etc. - it is especially dangerous for the kidneys, because those don't actually regenerate or heal. This is why, in addition to Metformin, most doctors will also prescribe medication for hypertension (high blood pressure). You may not even have high blood pressure, but again, those capillaries need to be healthy as long as you can keep them.
WRT Metformin, the drug has several effects:
It aids in reducing insulin resistance, it reduces sugar absorption in the digestive tract and it reduces the production of glucose in the liver (from how I understand it, this is more prevalent at night when you're sleeping, which is why early morning tests are often higher). If your body is predisposed to diabetes, the potential risk of taking Metformin would (maybe) be low blood sugar, which is uncommon in the early stages of diabetes, and even under control...but as your Type 2 eventually progresses, low blood sugar is increasingly a risk. IMO, taking Metformin would not be that risky for you, even if your blood sugars are under control.
The list of side effects for Metformin are pretty long, but the one that tends to get me is diarrhea. My sister took Metformin, and wound up being terribly nauseated until they changed the manufacturer, and altered the dosage, but generally, I did not even notice it other than the increased frequency of the runs...just make sure you stay hydrated and get more fiber in your diet, both soluble and insoluble. Higher fiber diets tend to lower your blood sugar, too, so it's a win-win.
Some doctors will automatically put you onto a statin, to keep your cholesterol in check (heart disease is a side effect of diabetes as well, it's an insidious disease), but I'd see how you do with the Metformin first and introduce that later, if the labs indicate you don't have an issue with cholesterol. I personally haven't had good experiences with some statins, and would rather not take them, but I haven't ever stopped taking Metformin or blood pressure meds.
I didn't see much difference in my A1C between the 24-hour version or the 2-a-day version (I liked the 24-hour release pills because I'm inherently lazy about my pill regimen and once a day was cool while it lasted). Everything changed for me when I caught viral pneumonia and almost died in the hospital. I wound up on insulin for a couple of years, and have recently lost a ton of weight using Ozempic, which has taken me off the insulin and lowered my A1C.
Everyone's different. You aren't alone. We all have our good days and bad days and sometimes that equates to months, and sometimes it equates to years. If you can get a walk in every day, do it. If you can moderate your meals, do your best. It's easy to get depressed, it's easy to feel overwhelmed, it's easy to be stressed out about it...all of this happens, it's normal and you don't have to go it alone. You can live a long, healthy life with diabetes, but it's not going away. I like to err on the side of "doing everything I can when it counts." I'm not always good at it, but most of the time, when I've got my A1C under control, the good days far outweigh the bad...
Hope this helps.
posted by Chuffy at 7:23 PM on March 8, 2022 [5 favorites]
Your A1C is a good measure for overall diabetes control, but you can still have high sugar spikes, not eat for a long time, and then spike again. These blood sugar spikes can damage your health, but your A1C would not register it.
You're looking at the long game. High blood sugar slowly degrades your capillaries over time, which is why some diabetics eventually lose their feet...deprive the extremities of blood, and your skin will no longer heal, cuts and bruises become dangerous, etc. - it is especially dangerous for the kidneys, because those don't actually regenerate or heal. This is why, in addition to Metformin, most doctors will also prescribe medication for hypertension (high blood pressure). You may not even have high blood pressure, but again, those capillaries need to be healthy as long as you can keep them.
WRT Metformin, the drug has several effects:
It aids in reducing insulin resistance, it reduces sugar absorption in the digestive tract and it reduces the production of glucose in the liver (from how I understand it, this is more prevalent at night when you're sleeping, which is why early morning tests are often higher). If your body is predisposed to diabetes, the potential risk of taking Metformin would (maybe) be low blood sugar, which is uncommon in the early stages of diabetes, and even under control...but as your Type 2 eventually progresses, low blood sugar is increasingly a risk. IMO, taking Metformin would not be that risky for you, even if your blood sugars are under control.
The list of side effects for Metformin are pretty long, but the one that tends to get me is diarrhea. My sister took Metformin, and wound up being terribly nauseated until they changed the manufacturer, and altered the dosage, but generally, I did not even notice it other than the increased frequency of the runs...just make sure you stay hydrated and get more fiber in your diet, both soluble and insoluble. Higher fiber diets tend to lower your blood sugar, too, so it's a win-win.
Some doctors will automatically put you onto a statin, to keep your cholesterol in check (heart disease is a side effect of diabetes as well, it's an insidious disease), but I'd see how you do with the Metformin first and introduce that later, if the labs indicate you don't have an issue with cholesterol. I personally haven't had good experiences with some statins, and would rather not take them, but I haven't ever stopped taking Metformin or blood pressure meds.
I didn't see much difference in my A1C between the 24-hour version or the 2-a-day version (I liked the 24-hour release pills because I'm inherently lazy about my pill regimen and once a day was cool while it lasted). Everything changed for me when I caught viral pneumonia and almost died in the hospital. I wound up on insulin for a couple of years, and have recently lost a ton of weight using Ozempic, which has taken me off the insulin and lowered my A1C.
Everyone's different. You aren't alone. We all have our good days and bad days and sometimes that equates to months, and sometimes it equates to years. If you can get a walk in every day, do it. If you can moderate your meals, do your best. It's easy to get depressed, it's easy to feel overwhelmed, it's easy to be stressed out about it...all of this happens, it's normal and you don't have to go it alone. You can live a long, healthy life with diabetes, but it's not going away. I like to err on the side of "doing everything I can when it counts." I'm not always good at it, but most of the time, when I've got my A1C under control, the good days far outweigh the bad...
Hope this helps.
posted by Chuffy at 7:23 PM on March 8, 2022 [5 favorites]
I've been on Metformin for 9 years, off-label style for metabolic syndrome. When I start taking it again (stop to have a medical test or reset my body or whatever) I take 1/4 of the dose for a couple days, 1/2 for a couple days, etc to build up.
I haven't had any side effects other than the stomach issues. I am also on a statin. Metformin has helped me lose weight.
posted by getawaysticks at 9:21 PM on March 8, 2022 [1 favorite]
I haven't had any side effects other than the stomach issues. I am also on a statin. Metformin has helped me lose weight.
posted by getawaysticks at 9:21 PM on March 8, 2022 [1 favorite]
If you do decide to initiate, as Chuffy states above, the thing that got me when starting metformin was the GI issues. My PCP immediately switched me to the extended-release version and things got much better.
posted by kuanes at 3:33 AM on March 9, 2022 [1 favorite]
posted by kuanes at 3:33 AM on March 9, 2022 [1 favorite]
Best answer: I've been on metformin for six or seven years, one with breakfast and one after dinner, and combined with Jardiance the last two or so, for type II diabetes. I never had any side effects. When I was first prescribed it the pharmacist asked if I was on it for diabetes or for weight loss, and someone above mentioned another non-diabetes reason to take it, so from what I gather it's a medication that's prescribed a lot so there's a lot of evidence of it being low risk, and with side-effects that are mostly discomfort problems, so the non-doctor-me doesn't have any red flags for you.
One thing about the health benefits: my (again, non-doctor) understanding is those life-extending statistics are compared to people with high blood sugar problems not on metformin. The diabetes causes cardiovascular disease and neurological issues and other physical problems, so if you're controlling your blood sugar satisfactorily you may already be keeping those problems at bay.
posted by AzraelBrown at 6:00 AM on March 9, 2022 [1 favorite]
One thing about the health benefits: my (again, non-doctor) understanding is those life-extending statistics are compared to people with high blood sugar problems not on metformin. The diabetes causes cardiovascular disease and neurological issues and other physical problems, so if you're controlling your blood sugar satisfactorily you may already be keeping those problems at bay.
posted by AzraelBrown at 6:00 AM on March 9, 2022 [1 favorite]
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The side-effects only lasted two-three days if I recall correctly and were solved by remaining near a bathroom.
posted by aramaic at 5:09 PM on March 8, 2022 [1 favorite]