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Metformin And Hypoglycemia

Metformin, Sulfonylureas, Or Other Antidiabetes Drugs And The Risk Of Lactic Acidosis Or Hypoglycemia

Metformin, Sulfonylureas, Or Other Antidiabetes Drugs And The Risk Of Lactic Acidosis Or Hypoglycemia

Metformin, Sulfonylureas, or Other Antidiabetes Drugs and the Risk of Lactic Acidosis or Hypoglycemia 3Boston Collaborative Drug Surveillance Program, Boston University School of Medicine, Lexington, Massachusetts 4Department of Epidemiology, School of Public Health, Boston University, Massachusetts 3Boston Collaborative Drug Surveillance Program, Boston University School of Medicine, Lexington, Massachusetts 4Department of Epidemiology, School of Public Health, Boston University, Massachusetts 5Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacology and Toxicology, University Hospital Basel, Basel, Switzerland 1Division of Clinical Pharmacology and Toxicology, University Hospital Basel, Basel, Switzerland 2Division of Endocrinology, Diabetes, and Clinical Nutrition, University Hospital Basel, Basel, Switzerland 3Boston Collaborative Drug Surveillance Program, Boston University School of Medicine, Lexington, Massachusetts 4Department of Epidemiology, School of Public Health, Boston University, Massachusetts 5Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacology and Toxicology, University Hospital Basel, Basel, Switzerland Corresponding author: Christoph R. Meier, [email protected] Received 2008 Jun 27; Accepted 2008 Aug 10. Copyright 2008, American Diabetes Association Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See for details. This article has been cited by other articles in PMC. OBJECTIVELactic acidosis has been associated with use of metformin. Hypoglycemia is a major concern using sulfonylureas. The aim of this study was to compare the risk of lactic acidosis and hypoglycemia among patients with type 2 diabetes using oral antidiabetes drugs. RESEAR Continue reading >>

Metformin Causing Hypoglycemia?

Metformin Causing Hypoglycemia?

Registration is fast, simple and absolutely free so please,join our community todayto contribute and support the site. This topic is now archived and is closed to further replies. I don't actually have diabetes... I have insulin resistance due to PCOS....but I figured the people here would know a good deal about drugs such as metformin. I was pretty lucky with metformin at the start, the only side effects I had was periods of weakness/shakiness. Which I'm starting to wonder if it's because my blood sugar is dropping too low. Just tonight, my heart started pounding, my hands were shaking, my mind was racing, I got chills and hot flashes, I felt weak and my head started hurting. This happened about 4hrs after taking a dose of metformin. I had eaten about 5 hours prior. Most of those effects are gone now except my head still hurts a little and I still feel weak. I never had these little spells prior to metformin, but now they happen on a daily basis, usually in the evening. I do not have a glucose meter, so I can't test it. I go back to see my doctor next week anyway. I'm afraid to mention it to him because I don't want to be taken off metformin and my insulin resistance progress into type II diabetes or anything like that. No, I don't have a meter. Prior to this, my blood glucose has always been fine. It's never been high, though I do remember it being tested once when I was in the hospital and it was 70. My mother has type 1 diabetes and my grandmothers on both sides of my family had type II - and my brother is prediabetic if not full diabetic by now, so doctors do tend to check a lot because of my family history and because I am overweight (probably due to PCOS and hypothyroidism, or possibly because I eat junk LOL). Another thing I've been wondering....should I be mod Continue reading >>

Metformin, Sulfonylureas, Or Other Antidiabetes Drugs And The Risk Of Lactic Acidosis Or Hypoglycemia

Metformin, Sulfonylureas, Or Other Antidiabetes Drugs And The Risk Of Lactic Acidosis Or Hypoglycemia

A nested case-control analysis Abstract OBJECTIVE—Lactic acidosis has been associated with use of metformin. Hypoglycemia is a major concern using sulfonylureas. The aim of this study was to compare the risk of lactic acidosis and hypoglycemia among patients with type 2 diabetes using oral antidiabetes drugs. RESEARCH DESIGN AND METHODS—This study is a nested case-control analysis using the U.K.-based General Practice Research Database to identify patients with type 2 diabetes who used oral antidiabetes drugs. Within the study population, all incident cases of lactic acidosis and hypoglycemia were identified, and hypoglycemia case subjects were matched to up to four control patients based on age, sex, practice, and calendar time. RESULTS—Among the study population of 50,048 type 2 diabetic subjects, six cases of lactic acidosis during current use of oral antidiabetes drugs were identified, yielding a crude incidence rate of 3.3 cases per 100,000 person-years among metformin users and 4.8 cases per 100,000 person-years among users of sulfonylureas. Relevant comorbidities known as risk factors for lactic acidosis could be identified in all case subjects. A total of 2,025 case subjects with hypoglycemia and 7,278 matched control subjects were identified. Use of sulfonylureas was associated with a materially elevated risk of hypoglycemia. The adjusted odds ratio for current use of sulfonylureas was 2.79 (95% CI 2.23–3.50) compared with current metformin use. CONCLUSIONS—Lactic acidosis during current use of oral antidiabetes drugs was very rare and was associated with concurrent comorbidity. Hypoglycemic episodes were substantially more common among sulfonylurea users than among users of metformin. Metformin plays a pivotal role in the treatment of patients with t Continue reading >>

Metformin

Metformin

A popular oral drug for treating Type 2 diabetes. Metformin (brand name Glucophage, Glucophage XR, Glumetza, Riomet) is a member of a class of drugs called biguanides that helps lower blood glucose levels by improving the way the body handles insulin — namely, by preventing the liver from making excess glucose and by making muscle and fat cells more sensitive to available insulin. Metformin not only lowers blood glucose levels, which in the long term reduces the risk of diabetic complications, but it also lowers blood cholesterol and triglyceride levels and does not cause weight gain the way insulin and some other oral blood-glucose-lowering drugs do. Overweight, high cholesterol, and high triglyceride levels all increase the risk of developing heart disease, the leading cause of death in people with Type 2 diabetes. Another advantage of metformin is that it does not cause hypoglycemia (low blood glucose) when it is the only diabetes medicine taken. Metformin is typically taken two to three times a day, with meals. The extended-release formula (Glucophage XR) is taken once a day, with the evening meal. The most common side effects of metformin are nausea and diarrhea, which usually go away over time. A more serious side effect is a rare but potentially fatal condition called lactic acidosis, in which dangerously high levels of lactic acid build up in the bloodstream. Lactic acidosis is most likely to occur in people with kidney disease, liver disease, or congestive heart failure, or in those who drink alcohol regularly. (If you have more than four alcoholic drinks a week, metformin may not be the best medicine for you.) Unfortunately, many doctors ignore these contraindications (conditions that make a particular treatment inadvisable) and prescribe metformin to people Continue reading >>

Metformin And Hypoglycemia

Metformin And Hypoglycemia

so today i finally had a doc do something I didn't expect. He actually listened to me about being hypo instead of telling me there is now way i could get that. I am not diabetic but because i deal with hypo does Metformin create that as a side effect? any info you have on how this drug works would be much appreciated Georgia: Yes, I see that Metformin is used to regulate blood sugars, probably in T2's. What are you taking it for? I also saw something about using it for PCOS. I didn't read all the details. Maybe you're sensitive to it. It sounds logical to me if it's making you hypo!!! What else did the doctor say. You are your best doctor!!!! You live in your body - they don't. I've been precribed meds for certain things and I refuse to take them. Use your intuition. so today i finally had a doc do something I didn't expect. He actually listened to me about being hypo instead of telling me there is now way i could get that. I am not diabetic but because i deal with hypo does Metformin create that as a side effect? any info you have on how this drug works would be much appreciated Metformin is a well known drug that's been around for a long time. It does a couple of things. It helps with insulin resistance and it also regulates how much glucose the liver puts out in the morning, reducing dawn phenomenen. It can cause digestive problems especially at first. It is a considered to be very safe drug. I took it for about 6 months but it didn't help (or hurt) Last edited by itotito; 12-28-2009 at 04:25 PM. I just got the drug today but i read in it where hypo can be a side effect for some. that just makes me nervous to take it I just got the drug today but i read in it where hypo can be a side effect for some. that just makes me nervous to take it I would bet it reduces your Continue reading >>

Hypoglycemia Induced By Therapeutic Doses Of Metformin In The Absence Of Other Anti-diabetic Drugs

Hypoglycemia Induced By Therapeutic Doses Of Metformin In The Absence Of Other Anti-diabetic Drugs

Abstract Context: Hypoglycemia due to metformin used in therapeutic dose is not frequently encountered. Metformin induced hypoglycemia has been linked previously to metformin overdose, but the presence of other co-ingestions (e.g., a sulfonylurea) was not definitively excluded. Case details: A 64-year-old male ingested 750 mg of metformin. On examination in the emergency department 8 h later, he was drowsy; nevertheless he had normal vital signs. He developed severe hypoglycemia (21 mg/dL), requiring a bolus of 50%dextrose followed by resumption of oral intake. This episode of hypoglycemia occurred approximately 8 h after ingestion. Discussion: Metformin ingestion in therapeutic doses can cause hypoglycemia in the absence of other glucose-lowering drugs, there for blood glucose levels should be monitored closely. Mechanisms via which metformin can induce hypoglycemia include reduction in hepatic glucose production, decreased glucose absorption, and poor oral intake. Discover the world's research 14+ million members 100+ million publications 700k+ research projects Join for free Context: Hypoglycemia due to metformin used in therapeutic dose is not frequently encountered. Metformin induced hypoglycemia has been linked previously to metformin overdose, but the presence of other co-ingestions (e.g., a sulfonylurea) was not definitively excluded. Case details: A 64-year-old male ingested 750 mg of metformin. On examination in the emergency department 8 h later, he was drowsy; nevertheless he had normal vital signs. He developed severe hypoglycemia (21 mg/dL), requiring a bolus of 50%dextrose followed by resumption of oral intake. This episode of hypoglycemia occurred approximately 8 h after ingestion. Discussion: Metformin ingestion in therapeutic doses can cause hypoglycem Continue reading >>

Side Effects Of Metformin: What You Should Know

Side Effects Of Metformin: What You Should Know

Metformin is a prescription drug used to treat type 2 diabetes. It belongs to a class of medications called biguanides. People with type 2 diabetes have blood sugar (glucose) levels that rise higher than normal. Metformin doesn’t cure diabetes. Instead, it helps lower your blood sugar levels to a safe range. Metformin needs to be taken long-term. This may make you wonder what side effects it can cause. Metformin can cause mild and serious side effects, which are the same in men and women. Here’s what you need to know about these side effects and when you should call your doctor. Find out: Can metformin be used to treat type 1 diabetes? » Metformin causes some common side effects. These can occur when you first start taking metformin, but usually go away over time. Tell your doctor if any of these symptoms are severe or cause a problem for you. The more common side effects of metformin include: heartburn stomach pain nausea or vomiting bloating gas diarrhea constipation weight loss headache unpleasant metallic taste in mouth Lactic acidosis The most serious side effect metformin can cause is lactic acidosis. In fact, metformin has a boxed warning about this risk. A boxed warning is the most severe warning from the Food and Drug Administration (FDA). Lactic acidosis is a rare but serious problem that can occur due to a buildup of metformin in your body. It’s a medical emergency that must be treated right away in the hospital. See Precautions for factors that raise your risk of lactic acidosis. Call your doctor right away if you have any of the following symptoms of lactic acidosis. If you have trouble breathing, call 911 right away or go to the nearest emergency room. extreme tiredness weakness decreased appetite nausea vomiting trouble breathing dizziness lighthea Continue reading >>

Just Been Told Reactive Hypoglycemia

Just Been Told Reactive Hypoglycemia

Diabetes Forum The Global Diabetes Community Find support, ask questions and share your experiences. Join the community Hodge1960 Reactive hypoglycemia Well-Known Member Hi, I have been told today that I will be taking Metformin for reactive hypoglycemia. I may sound crazy but this is a bit of a shock Don't worry, there are a few of us here with RH, and we have our own sub-board on the forum, So have a read, and ask anything you like. It IS a shock, but almost all of us have found that diet is the key, and most of us manage extremely well, virtually eliminating our hypos, and eating WELL, so please, come and join us. Hi, I have been told today that I will be taking Metformin for reactive hypoglycemia. I may sound crazy but this is a bit of a shock Hi, as Brun says have a look around and learn how to control RH! If you can understand what is happening, then you can get your head around how your life will improve with just dietary changes. I would also question the need for metformin. As my endocrinologist and doctor immediately stopped them because of the hypos. Have you an endocrinologist, if not have you been referred? It's important to get specialist help, even though we will help you. Ask away, it's good to have you in our unique club Hodge1960 Reactive hypoglycemia Well-Known Member i saw the Endocrinologist at the hospital , it was he who said i should take the Metformin... thanks for your kind words. |I will try not to be a pest with questions, thanks for the links too.x I want you to become a pest, because that way you can learn how to control your RH. The only stupid question is the one not asked. Kaz261 Reactive hypoglycemia Well-Known Member i saw the Endocrinologist at the hospital , it was he who said i should take the Metformin... thanks for your kind word Continue reading >>

New - Rh, Ogtt-results & Metformin

New - Rh, Ogtt-results & Metformin

Diabetes Forum The Global Diabetes Community This site uses cookies. By continuing to use this site, you are agreeing to our use of cookies. Learn More. Get the Diabetes Forum App for your phone - available on iOS and Android . Find support, ask questions and share your experiences. Join the community Thought I'd come right here as I'm not diabetic but recently had an OGTT done because of health issues and and increase in symptoms. Long story short: been battling debilitating fatigue and pain for the passed 10 yrs (useless chronic fatigue diagnosis). I had a bad crash again 2 months ago and was referred for a glucose test. I have episodes of extreme fatigue, weakness and at times hunger. I wake up at night feeling weak needing to eat. The endo told me I seem to have RH which could explain some of the fatigue but not all? She put me on Metformin and referred me to a dietician. I don't understand the Metformin as my levels are low (85mg/dl after drinking glucose?) and never been high I think. Can someone explain to me why my levels hardly rise? Is Metformin necessary and how is it supposed to help me? On the understanding that none of us here are professionals, and we are just speculating on the internet (sorry, but I have to add that disclaimer ) I am going to suggest that your body is very good at producing insulin (which prevents your blood glucose from rising), but not so good at turning it off once it has served its purpose. This would explain why your blood glucose barely rose, yet went lower and lower until at 2 and 3 hours you were well into hypo territory. Do you have your own home test meter? I suggest it would be a good idea to get one! What advice have they given you? Particularly what diet advice? Or are they waiting until you see the dietitian? Did they sug Continue reading >>

Metformin (oral Route)

Metformin (oral Route)

Precautions Drug information provided by: Micromedex It is very important that your doctor check your progress at regular visits, especially during the first few weeks that you take this medicine. Blood and urine tests may be needed to check for unwanted effects. This medicine may interact with the dye used for an X-ray or CT scan. Your doctor should advise you to stop taking it before you have any medical exams or diagnostic tests that might cause less urine output than usual. You may be advised to start taking the medicine again 48 hours after the exams or tests if your kidney function is tested and found to be normal. Make sure any doctor or dentist who treats you knows that you are using this medicine. You may need to stop using this medicine several days before having surgery or medical tests. It is very important to carefully follow any instructions from your health care team about: Alcohol—Drinking alcohol may cause severe low blood sugar. Discuss this with your health care team. Other medicines—Do not take other medicines unless they have been discussed with your doctor. This especially includes nonprescription medicines such as aspirin, and medicines for appetite control, asthma, colds, cough, hay fever, or sinus problems. Counseling—Other family members need to learn how to prevent side effects or help with side effects if they occur. Also, patients with diabetes may need special counseling about diabetes medicine dosing changes that might occur with lifestyle changes, such as changes in exercise or diet. Counseling on birth control and pregnancy may be needed because of the problems that can occur in pregnancy for patients with diabetes. Travel—Keep a recent prescription and your medical history with you. Be prepared for an emergency as you would norm Continue reading >>

Recurrent Lactic Acidosis And Hypoglycemia With Inadvertent Metformin Use: A Case Of Look-alike Pills

Recurrent Lactic Acidosis And Hypoglycemia With Inadvertent Metformin Use: A Case Of Look-alike Pills

Recurrent lactic acidosis and hypoglycemia with inadvertent metformin use: a case of look-alike pills We are experimenting with display styles that make it easier to read articles in PMC. The ePub format uses eBook readers, which have several "ease of reading" features already built in. The ePub format is best viewed in the iBooks reader. You may notice problems with the display of certain parts of an article in other eReaders. Generating an ePub file may take a long time, please be patient. Recurrent lactic acidosis and hypoglycemia with inadvertent metformin use: a case of look-alike pills Tess Jacob, Renee Garrick, and Michael D Goldberg Metformin is recommended as the first-line agent for the treatment of type 2 diabetes. Although this drug has a generally good safety profile, rare but potentially serious adverse effects may occur. Metformin-associated lactic acidosis, although very uncommon, carries a significant risk of mortality. The relationship between metformin accumulation and lactic acidosis is complex and is affected by the presence of comorbid conditions such as renal and hepatic disease. Plasma metformin levels do not reliably correlate with the severity of lactic acidosis. We present a case of inadvertent metformin overdose in a patient with both renal failure and hepatic cirrhosis, leading to two episodes of lactic acidosis and hypoglycemia. The patient was successfully treated with hemodialysis both times and did not develop any further lactic acidosis or hypoglycemia, after the identification of metformin tablets accidentally mixed in with his supply of sevelamer tablets. Early initiation of renal replacement therapy is key in decreasing lactic acidosis-associated mortality. When a toxic ingestion is suspected, direct visualization of the patients pi Continue reading >>

Metformin. What Do You Need To Know?

Metformin. What Do You Need To Know?

What is type 2 diabetes? People with diabetes are not able to make enough insulin and/or respond normally to the insulin their body does make. When this happens, sugar (glucose) builds up in the blood. This can lead to serious medical problems including kidney damage, amputations and blindness. Diabetes is also closely linked to heart disease. The main goal of treating diabetes is to lower the level of your blood sugar as close to normal as possible. How is type 2 diabetes usually controlled? High blood sugar can be lowered by diet and exercise, by a number of oral medications and by insulin injections. Before taking biguanidas (metformin hydrochloride tablets) you should first try to control your diabetes by exercise and weight loss. Even if you are taking biguanidas, you should still exercise and follow the diet recommended for your diabetes. Does Metformin work differently from other glucose-control medications? Yes it does. Until Metformin was introduced, al¡ the available oral glucose-control medications were from the same chemical group called sulfonylureas. These drugs lower blood sugar primarily by causing more of the body's own insulin to be released. Metformin lowers the amount of sugar in your blood by helping your body respond better to its own insulin. Metformin (metformin hydrochloride tablets) does not cause your body to produce more insulin. Therefore, Metformin rarely causes hypoglycemia (low blood sugar) and it doesn't usually cause weight gain. What happens if my blood sugar is still too high? When blood sugar cannot be lowered enough by either Metformin or a sulfonylurea, the two medications may be effective taken together. However, if you are unable to maintain your blood sugar with diet, exercise and glucose-control medication taken orally, then y Continue reading >>

Serious Hypoglycemia Risk Compared Among Oral Antidiabetics

Serious Hypoglycemia Risk Compared Among Oral Antidiabetics

Serious Hypoglycemia Risk Compared Among Oral Antidiabetics Sulfonylureas were associated with the highest rates Compared to other oral antidiabetic monotherapies , sulfonylureas were associated with the highest rates of serious hypoglycemia, according to a study published in Pharmacoepidemiology & Drug Safety. Researchers performed a retrospective cohort study to evaluate the risks of serious hypoglycemia among adults with diabetes receiving metformin, a sulfonylurea, a meglitinide, or a thiazolidinedione as monotherapy. Specifically, Medicaid patients newly initiated on metformin, glimepiride, glipizide, glyburide, pioglitazone, rosiglitazone, nateglinide, or repaglinide from California, Florida, New York, Ohio, and Pennsylvania were included. Patients who were using dipeptidyl peptidase-4 inhibitors, glucagon-like peptide-1 agonists, or sodium-glucose co-transporter 2 inhibitors were not included in the analysis. Study authors looked at the incidence of serious hypoglycemia within 180 days after treatment initiation using a diagnosis-based algorithm. They quantified incidence rates based on age and gender for each drug and calculated propensity score-adjusted hazard ratios vs. metformin using Cox proportional hazards regression. Admelog Tentatively Approved for Diabetes Mellitus The data showed glyburide had the highest standardized occurrence rate of serious hypoglycemia , followed by glimepiride, glipizide, repaglinide, nateglinide, rosiglitazone, pioglitazone, and metformin. Occurrence rates were higher for all study drugs taken at higher average daily doses. Compared to metformin, the adjusted hazard ratios were as follows: glyburide 3.95 (95% CI: 3.664.26), glimepiride 2.57 (95% CI: 2.382.78), glipizide 2.03 (95% CI: 1.642.52), repaglinide 1.21 (95% CI: 0.891.6 Continue reading >>

Oral Hypoglycemic Drugs

Oral Hypoglycemic Drugs

Oral hypoglycemic drugs are used only in the treatment of type 2 diabetes which is a disorder involving resistance to secreted insulin. Type 1 diabetes involves a lack of insulin and requires insulin for treatment. There are now four classes of hypoglycemic drugs: Sulfonylureas Metformin Thiazolidinediones Alpha-glucosidase inhibitors. These drugs are approved for use only in patients with type 2 diabetes and are used in patients who have not responded to diet, weight reduction, and exercise. They are not approved for the treatment of women who are pregnant with diabetes. SULFONYLUREAS – Sulfonylureas are the most widely used drugs for the treatment of type 2 diabetes and appear to function by stimulating insulin secretion. The net effect is increased responsiveness of ß-cells (insulin secreting cells located in the pancreas) to both glucose and non-glucose secretagogues, resulting in more insulin being released at all blood glucose concentrations. Sulfonylureas may also have extra-pancreatic effects, one of which is to increase tissue sensitivity to insulin, but the clinical importance of these effects is minimal. Pharmacokinetics – Sulfonylureas differ mainly in their potency & their duration of action. Glipizide, glyburide (glibenclamide), and glimepiride are so-called second-generation sulfonylureas. They have a potency that allows them to be given in much lower doses. Those drugs with longer half-lives (particularly chlorpropamide, glyburide, and glimepiride) can be given once daily. This benefit may be counterbalanced by a substantially increased risk of hypoglycemia. Side effects – Sulfonylureas are usually well tolerated. Hypoglycemia is the most common side effect and is more common with long-acting sulfonylureas. Patients recently discharged from hospit Continue reading >>

Metformin And Type 2 Diabetes Mellitus

Metformin And Type 2 Diabetes Mellitus

Each of the following statements about metformin as a treatment for type 2 diabetes mellitus is true except: It lowers hemoglobin AIc concentrations by 1.0% to 1.5%. It is not associated with weight gain. When metformin is used as monotherapy, hypoglycemia is a serious side effect. It has been shown to reduce all-cause mortality. Source: Cheng AY, Fantus IG. Oral antihyperglycemic therapy for type 2 diabetes mellitus. CMAJ 2005;172:213-26. This question is based on Question 32, Metformin and type 2 diabetes mellitus. Self Learning 2005;20(4):38-9. Published 6 times yearly, each issue of Self Learning contains a blend of questions from a range of peer-reviewed medical journals. College of Family Physicians of Canada members who subscribe to the Self Learning program may claim up to 5 Mainpro-M1 credits for each completed issue and up to 30 Mainpro-M1 credits for each year in which they subscribe. For further information please visit the College of Family Physicians of Canada website, which includes information on free trials of the on-line program, at Go to: The incorrect statement is: 3. When metformin is used as monotherapy, hypoglycemia is a serious side effect. Metformin lowers blood glucose among patients with type 2 diabetes mellitus largely by decreasing hepatic glucose output. It is also thought to increase glucose uptake by skeletal muscle. It is not protein bound and has maximum accumulation in the small intestine wall. It is excreted unmodified by the kidney. In placebo-controlled trials, metformin lowered hemoglobin AIc concentrations by 1.0% to 1.5%. The efficacy of metformin monotherapy is equivalent to that of sulfonylurea monotherapy. It is associated with weight loss or at least no weight gain. Improvements in lipid profiles have also been noted. The Uni Continue reading >>

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