Metformin (brand names include Glucophage, Fortamet, Glumetza) is the most widely prescribed medication for Type 2 diabetes worldwide. It belongs to a class of drugs called biguanides.
Here is a comprehensive breakdown of what it is, how it works, and what you need to know if you are taking it.
1. Primary Uses
Type 2 Diabetes: It is the first-line medication recommended for lowering blood sugar levels. It is often used alone or in combination with other drugs (like insulin).
Prediabetes (Off-label): Doctors often prescribe it to prevent the progression from prediabetes to full Type 2 diabetes, particularly in people with a high BMI.
Polycystic Ovary Syndrome (PCOS) (Off-label): It helps lower insulin levels and androgen (male hormone) levels, which can help regulate menstrual cycles and improve fertility/ovulation.
Gestational Diabetes: Sometimes used during pregnancy when insulin is not an option or not preferred, though insulin remains the gold standard.
2. How It Works
Metformin does not increase the amount of insulin your body makes (so it rarely causes low blood sugar/hypoglycemia on its own). Instead, it works in three main ways:
Stops the Liver: It reduces the amount of sugar (glucose) your liver produces and releases into your bloodstream.
Boosts Sensitivity: It makes your muscle tissue more sensitive to insulin, allowing your cells to use glucose more effectively.
Reduces Absorption: It slightly decreases the amount of sugar your gut absorbs from the food you eat.
3. Side Effects
Common (The "Metformin Tummy"):
The most common complaints are digestive. These usually happen when you first start the drug and often go away after a few weeks.
Diarrhea
Nausea/Vomiting
Stomach cramps/bloating
Metallic taste in the mouth
Serious (Rare):
Lactic Acidosis: A dangerous buildup of lactic acid in the blood. This is very rare (approx. 1 in 30,000 users) but can be fatal. Symptoms include extreme fatigue, muscle pain, difficulty breathing, and slow heart rate. It is mostly a risk for people with kidney or liver failure.
Vitamin B12 Deficiency: Long-term use can block the absorption of Vitamin B12. Your doctor may monitor your levels periodically.
4. Important Warnings & Contraindications
Kidney Function: Metformin is cleared by the kidneys. If you have severe kidney disease (typically eGFR < 30 mL/min), you cannot take it because it increases the risk of lactic acidosis.
CT Scans/Contrast Dye: If you are having an imaging scan that uses iodinated contrast dye, you may need to stop taking Metformin for 48 hours before and after the procedure to protect your kidneys.
Alcohol: Excessive alcohol intake (acute or chronic) drastically increases the risk of lactic acidosis.
Liver Disease: Used with caution or avoided in severe liver disease.
5. Practical Tips for Success
If you have been prescribed Metformin, these strategies can help minimize side effects:
Take with Food: Always take it in the middle of a meal or immediately after to buffer your stomach.
Start Low, Go Slow: Doctors usually start you on a low dose (e.g., 500mg once daily) and slowly increase it over weeks. Do not rush this titration.
Ask for Extended Release (XR/ER): If the standard "immediate release" tablets give you severe stomach upset, ask your doctor for the Extended Release version. It releases the drug slowly and is generally much gentler on the stomach.
6. Research on Longevity
You may hear Metformin discussed in "biohacking" or anti-aging circles. Some research suggests it might mimic the effects of calorie restriction and activate longevity pathways (like AMPK). However, there is currently no definitive clinical evidence that it extends lifespan in healthy humans, and it is not FDA-approved for anti-aging.
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