In Brief: New Recommendations For Use Of Metformin In Renal Impairment
The FDA has required labeling changes that replace serum creatinine (SCr) with estimated glomerular filtration rate (eGFR) as the parameter used to determine the appropriateness of treatment with the biguanide metformin (Glucophage, and others) in patients with renal impairment. These changes will allow more patients with mild to moderate renal impairment to receive metformin, which is generally the first drug prescribed for treatment of type 2 diabetes. Metformin was previously contraindicated in women with a SCr level ≥1.4 mg/dL and in men with a SCr level ≥1.5 mg/dL, but use of SCr as a surrogate indicator tends to underestimate renal function in certain populations (e.g., younger patients, men, black patients, patients with greater muscle mass). The calculation of eGFR takes into account age, race, and sex, as well as SCr level, providing a more accurate assessment of kidney function. A literature review summarized in an FDA Drug Safety Communication concluded that, based on eGFR, metformin is safe to use in patients with mild renal impairment and in some patients with moderate renal impairment.1 The eGFR should be calculated before patients begin treatment with metformin and at least annually thereafter. Metformin is now contraindicated in patients with an eGFR <30 mL/min/1.73 m2, and starting treatment with the drug in patients with an eGFR between 30 and 45 mL/min/1.73 m2 is not recommended. If the eGFR falls below 45 mL/min/1.73 m2 in a patient already taking metformin, the benefits and risks of continuing treatment should be assessed. Metformin should be not be administered for 48 hours after an iodinated contrast imaging procedure in patients with an eGFR <60 mL/min/1.73 m2 or a history of liver disease, alcoholism, or heart failure, or in those receiving Continue reading >>
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Creatine And Diabetics
For any of the Docs out there, I would appreciate any assistance. I have been diabetic for about two years now. I want to take creatine to help with my workouts. If taken appropriately will it hurt my kidneys. For that matter as a diabetic will I be able to take any supplements safely. Thx for the help. Wow glad you asked about creatine im boarderline diabetic. And started taking it. Ill hold off till there is an answer. I tied it for a couple of days several times but get nervous and stop. Hopefully someone on here has some guidance if creatine or supplements in general should be used. Theres a diabetic thread and a lot of the guys there take creatine as well as myself and have been fine. If you drink a lot of water it should be alright. Thx you guys...I really appreciate the info. I think I might try Kre-Alk which says it does not turn to Creatinine...I want to see how it works for a couple of weeks to a month...Will let you guys know what happens. Reps to both you guys. Last edited by vegasvln; 07-20-2008 at 11:46 AM. Reason: spelling Thx for the info. Roke. Will research both. For any of the Docs out there, I would appreciate any assistance. I have been diabetic for about two years now. I want to take creatine to help with my workouts. If taken appropriately will it hurt my kidneys. For that matter as a diabetic will I be able to take any supplements safely. Thx for the help. No studies have examined the effects of creatine loading on individuals with diabetes. However, you should be cautious in your use of this substance due to the additional stress placed on your kidneys caused by its excretion and the risk of dehydration. Given the added health risks, if you choose to supplement, your intake should not exceed 20 grams per day for a period of five days (loading p Continue reading >>
Is Metformin Causing My Bun/creatine Ratio To Be High
Is Metformin causing my bun/creatine ratio to be high You are here: Home Is Metformin causing my bun/creatine ratio to be high Questions Is Metformin causing my bun/creatine ratio to be high I am a 74 year old woman in great health except that my glucose level has been increasing over the years and is now at 109. I am 50 tall and weigh 124 lbs. and I cant lose the fat around my abdomen so I presume I have metabolic syndrom. My primary care doc prescribed Metformin once a day after I showed him your wonderful articles. I have been taking Metformin for over a month now, my fasting blood glucose level has not dropped, and suddenly my bun/creatine ratio is up (bun is 24, ratio is 43, creatine is .68). Is this due to the Metformin and should I be concerned about my kidney function? I do not eat a lot of carbs or sugars, but I do eat a lot of protein. I cannot talk to my doctor about this because he passed away very recently and unexpectedly so I am reaching out to you. Thank you for your help Continue reading >>
Use Of Metformin In The Setting Of Mild-to-moderate Renal Insufficiency
ADVANTAGES OF METFORMIN There is some evidence that early treatment with metformin is associated with reduced cardiovascular morbidity and total mortality in newly diagnosed type 2 diabetic patients (4). However, the data come from a small subgroup of a much larger trial. In contrast, despite multiple trials of intensive glucose control using a variety of glucose-lowering strategies, there is a paucity of data to support specific advantages with other agents on cardiovascular outcomes (5–7). In the original UK Prospective Diabetes Study (UKPDS), 342 overweight patients with newly diagnosed diabetes were randomly assigned to metformin therapy (8). After a median period of 10 years, this subgroup experienced a 39% (P = 0.010) risk reduction for myocardial infarction and a 36% reduction for total mortality (P = 0.011) compared with conventional diet treatment. Similar benefits were not observed in those randomly assigned to sulfonylurea or insulin. In an 8.5-year posttrial monitoring study, after participants no longer were randomly assigned to their treatments, individuals originally assigned to metformin (n = 279) continued to demonstrate a reduced risk for both myocardial infarction (relative risk 33%, P = 0.005) and total mortality (relative risk 27%, P = 0.002) (9). The latter results are even more impressive when one considers that HbA1c levels in all initially randomly assigned groups had converged within 1 year of follow-up. Unlike sulfonylureas, thiazolidinediones, and insulin, metformin is weight neutral (10), which makes it an attractive choice for obese patients. Furthermore, the management of type 2 diabetes can be complicated by hypoglycemia, which can seriously limit the pursuit of glycemic control. Here, too, metformin has advantages over insulin and some Continue reading >>
Metformin And Creatinine Clearance
Diabetes Forum The Global Diabetes Community Find support, ask questions and share your experiences. Join the community My kidney specialist has taken me off metformin after five years because he says it is affecting my creatine clearance and reducing my kidney function. Anyone else had this problem My kidney specialist has taken me off metformin after five years because he says it is affecting my creatine clearance and reducing my kidney function. Anyone else had this problem No, but If you find out which tests showed him this and how, I would sure like to know I had a 24 hour urine collection and blood test to measure creatinine clearance which has been climbing. After going off the metformin and other drug adjustment (blood pressure meds) the number has reduced. The specialist wont let me go back to metformin but has prescribed Diamicron 30mg (gliclazide??). Trouble is now this makes me hungry, have put on a little weight and don't have such good glucose control. Also can have hypos unless I have a mid morning snack. Continue reading >>
Fda Issues Guidance For Metformin Use In Renal Impairment
FDA Issues Guidance for Metformin Use in Renal Impairment The FDA has issued new guidance for the use of the first-line diabetes drug metformin in patients with renal impairment. Metformin was approved by the FDA in 1994 for the management of type 2 diabetes. Since its approval, its labeling has warned of a contraindication in elevated serum creatinine (>1.5 mg/dL for males, >1.4 mg/dL for females) due to a risk of lactic acidosis secondary to metformin accumulation.1 Other risk factors for lactic acidosis include contrast dye exposure within 48 hours, chronic or excessive alcohol intake, dehydration, sepsis, acute congestive heart failure, and age. This absolute contraindication was based on clinical trials of an older biguanide called phenformin, which showed a greater risk of lactic acidosis associated with significant mortality and was subsequently pulled off the market in 1977.2 Although phenformin is no longer available in the United States, its still available in European and South American markets. Notably, the incidence of lactic acidosis associated with metformin is as low as 0.03 cases per 1000 patient-years. The FDA reviewed several studies to determine whether patients with mild to moderate renal impairment could safely continue on metformin to manage their type 2 diabetes. One of the larger trials reviewed was an observational study of 51,675 type 2 diabetes patients to determine the effect metformin would have on primary outcomes of cardiovascular disease (CVD), all-cause mortality, and acidosis or serious infections with varying degrees of renal function.3 Based on subgroup analyses of patients with varying degrees of renal impairment, the investigators determined that patients with an estimated glomerular filtration rate (eGFR) >45 mL/min/m2 showed no Continue reading >>
Metformin And Creatine And Metabolic Acidosis: Really?
Metformin and Creatine and Metabolic Acidosis: Really? Severe metabolic acidosis secondary to coadministration creatine and metformin, a case report. Saidi H, Mani M. Am J Emerg Med (2010) 28:388.e5-e6 This case report from Tehran describes a 42-year-old body builder who developed anion-gap metabolic acidosis (pH 7.25, anion gap 22 mEq/L) after taking a combination of metformin and creatine for 3 weeks. He presented with anuria (creatinine 3.5 mg/dL)and respiratory distress due to pulmonary edema. The authors conclude that creatine use was the only predisposing factor for the development of acute renal failure in this patient, and imply that this caused metformin-induced lactic acidosis (MALA), which contributed to the unfortunate outcome in this case. As they say on Saturday Night Live Really?? The authors fail to evaluate fully that inconvenient unfortunate outcome the patient suffered a fatal cardiac arrest during dialysis. Its hard to attribute this solely to the metabolic acidosis which despite the articles title is not severe. There is no consideration that cardiac dysnfunction might have caused both the pulmonary edema and the moderate acidosis, and that metformin was quite likely an innocent bystander. In addition, the evidence for creatine causing renal dysfunction is at this point anecdotal, based on scattered case reports. Finally, the editing of the manuscript is surprisingly sloppy, with at least two typosor mistakes: There are 4 principal causes for high-anion-gap acidosis that we can roll out 3 of them (emphasis mine) Lactic acidosis is characterized by a broad anion-gap metabolic acidosis, pH level greater than 7.35 . . . (this should of course be less than 7.35). In general, a poor performance all around. Continue reading >>
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Last edited by Nelson Vergel; 04-13-2017 at 10:01 AM. Interesting video. I wonder how true it all is. When I take a lot of creatine, I do get muscle cramping and the benefits of metformin are proven in many studies. I am not a medical practitioner. Any suggestions I provide are not medical recommendations and are just my opinions. Please consult with your physician on any matters concerning your health. This is very interesting thanks for sharing Effects of creatine supplementation on glucose tolerance and insulin sensitivity in sedentary healthy males undergoing aerobic training Recent findings have indicated that creatine supplementation may affect glucose metabolism. This study aimed to examine the effects of creatine supplementation, combined with aerobic training, on glucose tolerance in sedentary healthy male. Subjects (n = 22) were randomly divided in two groups and were allocated to receive treatment with either creatine (CT) (10 g day over three months) or placebo (PT) (dextrose). Administration of treatments was double blind. Both groups underwent moderate aerobic training. An oral glucose tolerance test (OGTT) was performed and both fasting plasma insulin and the homeostasis model assessment (HOMA) index were assessed at the start, and after four, eight and twelve weeks. CT demonstrated significant decrease in OGTT area under the curve compared to PT (P = 0.034). There were no differences between groups or over time in fasting insulin or HOMA. The results suggest that creatine supplementation, combined with aerobic training, can improve glucose tolerance but does not affect insulin sensitivity, and may warrant further investigation with diabetic subjects. Creatine and metformin likely and excellent combo, but there's no where near enough data on creating to Continue reading >>
Use Of Metformin In The Setting Of Mild-to-moderate Renal Insufficiency
Go to: HISTORICAL PERSPECTIVE Despite these proven benefits, metformin remains contraindicated in a large segment of the type 2 diabetic population, largely because of concerns over the rare adverse effect of lactic acidosis. For these reasons, the drug has been restricted to individuals with normal creatinine levels as a surrogate for renal competence. Other contraindications (e.g., any significant hypoxemia, alcoholism, cirrhosis, a recent radiocontrast study) also increase the risk for or the consequences of lactic acidosis, but these are not the topic of this review. Metformin belongs to the biguanide drug class (previous members include phenformin and buformin), developed for lowering glucose in the 1950s. Initial enthusiasm for biguanides was tempered over the next two decades by the growing recognition of their risk of lactic acidosis. A marked reduction in biguanide use occurred in the mid-1970s because phenformin, extensively adopted in clinical practice, was implicated in a number of fatal cases of this severe metabolic decompensation (17). The association with lactic acidosis eventually led to its withdrawal from the market. Importantly, lactic acidosis with phenformin seems to occur ~10–20 times more frequently than with metformin (18). In contrast to metformin, modestly raised phenformin concentrations may reduce peripheral glucose oxidation and enhance peripheral lactate production, which can increase circulating lactate levels. In fact, phenformin levels correlate with lactate concentration, whereas metformin levels do not (19). In addition, ~10% of European Caucasians have an inherent defect in phenformin hydroxylation, which may lead to drug accumulation and, as a result, elevated lactate levels (20). The experience with phenformin resulted in cautiou Continue reading >>
Taking Creatine With Metformin | Family Meds!
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Metformin Use Being Limited?
Current black box warning may be overstating the kidney risk. Metformin—the blockbuster drug utilized as the primary agent to treat patients with type 2 diabetes—may potentially be hindered in usage due to its current prescribing grounds. Despite its establishment as the first-line therapy for type 2 diabetes, about one-half of the patients currently in the United States do not take it. A major proponent of this is its current labeling, which expresses unjustifiable concerns about its use for treatment in those with mild to moderate renal insufficiency. The current label carries a contraindication against use of metformin when serum creatinine levels exceed 1.4mg/dL in women or 1.5mg/dL in men. Over the past few years, clinicians throughout the country have come to an overwhelming consensus that the US Food and Drug Administration (FDA) labeling for metformin could be more lenient and also that it can be expressed in the more precise estimated glomerular filtration rates (eGFRs), rather than serum creatinine. The FDA’s initial rationale behind the label was due to resilient evidence that phenformin caused lactic acidosis (another biguanide which has been removed from the US market). Metformin is cleared from the body via the kidneys and for patients with significant renal failure, there were increasing concerns that metformin could potentially build up to relatively high levels that could leave patients to have lactic acidosis. There is now an overwhelming two decades’ worth of research and evidence showing no serious increased risks for lactic acidosis in patients with mild-to-moderately impaired renal function. The American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) have furthermore supported the removal of restric Continue reading >>
Kidney Function Cutoffs For Safe Metformin Use
Volume: 46 Urologic Diseases The risk of complications (such as lactic acidosis) that can be associated with metformin increases in patients with renal insufficiency. At what creatinine clearance should this agent be discontinued? — Ivanka Vassileva, MD Lawton, Okla Currently, the contraindication for metformin use in patients with renal insufficiency is rigidly defined as a serum creatinine level of 1.5 mg/dL or higher in men and 1.4 mg/dL or higher in women. As you know, the serum creatinine level is often not a precise indicator of renal function. Measuring creatinine clearance, which is most often done using the Modification of Diet in Renal Disease (MDRD) equation, is probably a better way to assess for renal insufficiency. Current prescribing guidelines suggest confirming that creatinine clearance is normal in older persons and in others in whom the serum creatinine level may be misleading. Metformin appears to accumulate once the creatinine clearance falls below 60 mL/min. Thus, it would be unwise to use metformin in any patient whose creatinine clearance is lower than this. — Silvio Inzucchi, MD Professor of Medicine Division of Endocrinology Yale University School of Medicine New Haven, Conn Continue reading >>
Affordable Prices - Taking Creatine With Metformin
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Creatine For Diabetics
Creatine is a popular supplement for weight lifters and athletes because it may enhance strength and endurance. Creatine is naturally produced from amino acids in the body and delivered by blood to the muscles; the supplements provide additional creatine. They are generally safe for diabetics and exercise is beneficial for diabetes sufferers, though most research in these areas have been done on people with Type 2 diabetes. About 90 percent of people with diabetes have Type 2. Speak with your doctor before beginning any exercise program so he can advise you on precautions to take. Creatine and any other supplements should also be cleared with your doctor. Video of the Day Creatine supplements in low dosages, 5 to 10 grams per day, are beneficial and don't cause any health problems, according to the Diabetes Action Research and Education Foundation. The concern that creatine may impair kidney function and thus be dangerous for diabetes sufferers was found to be false in a 2011 study published in the "European Journal of Applied Physiology." The study followed participants taking creatine or a placebo for 12 weeks while on an exercise regime. No adverse effects were noted. The name of the study is "Creatine Supplementation Does Not Impair Kidney Function in Type 2 Diabetic Patients: A Randomized, Double-blind, Placebo-controlled, Clinical Trial." Exercise and Diabetes Diabetes affects the production of the hormone insulin, which allows your body to control blood sugar. People with type 1 diabetes have pancreases that cannot make insulin at all, and people with type 2 diabetes either cannot make enough or their cells ignore the insulin. Exercise helps regulate blood sugar levels, which is why it is recommended for diabetes sufferers. According to an article in "Time" magaz Continue reading >>