Metformin (Glucophage): A Common Medication for Type 2 Diabetes

Diabetes in America is a common diagnosis. In fact, the prevalence of diabetes in 2018 was 34.2 million Americans, or 10.5% of the population. Of those more than 34 million people, which breaks down to about 1 in 10, 90-95% have Type 2 Diabetes. In addition 88 million American adults, aged 18 or older have prediabetes, that’s 34.5% of the adult population. Diabetes is the seventh leading cause of death in the United States. (1) What this all means is that there are many Americans that have diabetes and prediabetes and are in need of treatment. Whether the treatment is with diet and exercise with or without pharmacology treatment is up to the person with diabetes and the physician.

One of the medications Type 2 diabetics are treated with is metformin (generic) – Glucophage (trade). It is a specific class of oral diabetic medication called biguanides, and metformin is the only medication in that class of medications. Metformin is considered first-line treatment of glucose control. It is also used to improve cardiovascular risk in people with Type 2 Diabetes.

While doing research in HRST (Health Risk Screening Tool), I discovered that metformin is a commonly prescribed medication for the people that we support. This common medication is prescribed for 167 people within Milestone HCQU West’s nine counties. As a Certified Diabetic Educator I wanted to reach out and give some education on what is metformin, what does it do for diabetics, what side effects are there, and give information that may be beneficial to assist a person who has been prescribed this medication.

This medication in generic form is metformin, United States brand names include:

Fortamet
Glucophage
Glucophage XR
Glumetza
Riomet (a form of liquid metformin)

Metformin is used to treat high blood sugar levels that are caused with Type 2 Diabetes. This product is available in the following dosage forms:

Tablet, Extended Release
Suspension, Extended Release
Tablet
Solution
Tablet, Extended Release, 24 HR

As with any medication, tell the ordering physician if you have ever had any unusual or allergic reactions to this medication. Also, tell the physician if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. In addition, metformin should not be used in people with severe kidney disease or metabolic acidosis or diabetic ketoacidosis. Never crush this medication, always take as given.

This medication acts on the liver and reduces the overproduction of sugar (energy), thereby keeping the blood sugar down with the assist of diet and exercise. This medication also has a minor effect on the muscle cells by allowing sugar (energy) into the cells.

Although appropriate studies on the relationship of age to the effects of metformin have not been performed in the geriatric population, geriatric-specific problems are not expected to limit the usefulness of metformin in the elderly. However, elderly patients are more likely to have age-related kidney problems, which may require caution in patients receiving metformin. This medicine is not recommended in patients 80 years of age and older who have kidney problems.

As with all medications it is important to watch for drug interactions. Therefore, always let the ordering physician be aware of all other medications, herbal supplements, or dietary supplements.

It is important to take this medication with meals to help reduce stomach or bowel side effects that may occur during the first few weeks. In addition, this medication may be increased slowly to reduce the gastrointestinal side effects. Some people on this medication say they have a “metallic taste”, and that is the drug in the saliva and is quite common. Swallow the medication whole with a full glass of water, unless contraindicated.

While taking the extended-release tablet, part of the tablet may pass into your stool after your body has absorbed the medicine. This is normal and nothing to worry about.

Measure the oral liquid with a marked measuring spoon, oral syringe, or medicine cup. The average household teaspoon may not hold the right amount of liquid.

Use the supplied dosing cup to measure the mixed extended-release oral suspension. Ask your pharmacist for a dosing cup if you do not have one.

Use only the brand of this medicine that your doctor prescribed. Different brands may not work the same way.

You may notice improvement in your blood glucose control in 1 to 2 weeks, but the full effect of blood glucose control may take up to 2 to 3 months. Ask your doctor if you have any questions about this.

The dose that someone is on may be different from someone else. Follow the ordering physician’s dosing. Not everyone needs the same dose or can tolerate the same dosing.

The side effects of medications can be different from person to person. It is important to remember, medication that can cause an effect can cause a side effect. For this medication these are some of the more common side effects:

abdominal or stomach discomfort
cough or hoarseness
decreased appetite
diarrhea
fast or shallow breathing
fever or chills
general feeling of discomfort
lower back or side pain
muscle pain or cramping
painful or difficult urination
sleepiness
may reduce vitamin B-12 with long-term therapy

There are less common side effects also. Remember, any side effects should be reported to the ordering physician.

It is important to be aware that a rare condition called “lactic acidosis” can occur. Metformin very infrequently can cause a buildup of lactic acid. Lactic acidosis, the dangerous build-up of lactic acid in the blood, is more common in people taking metformin with underlying conditions such as a severe infection, chronic alcoholism, or being over the age of 65. This condition has vague symptoms similar to the flu but can have severe consequences with a 50% mortality. Symptoms of lactic acidosis that represent a medical emergency are fruity smelling breath, confusion and change in level of conciseness, jaundice or yellowing of the skin and the whites of the eyes, difficulty breathing.

Common symptoms of lactic acidosis are:

exhaustion or extreme fatigue
muscle cramps or pain
body weakness
abdominal pain
diarrhea
decrease in appetite
headache
rapid heart rate

It is always important to understand the importance of reporting any side effects that are unusual to the physician. *Anyone on this medication having any type of iodinated contrast dye study, the ordering physician needs to be aware of the test.* This medication may need to be held for up to 48 hours to prevent kidney impairment that can lead to lactic acidosis.

Metformin may stimulate ovulation in a premenopausal woman and can lead to an increase chance of pregnancy. It is important to speak with the ordering physician about any risk factor and need for birth control if necessary.

It is important with all medications to have knowledge about what the drug is for and why someone you support is on it. If you have any further questions/concerns contact your physician.