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Reducing Metformin Dosage

Stopping Metformin: When Is It Ok?

Stopping Metformin: When Is It Ok?

The most common medication worldwide for treating diabetes is metformin (Glumetza, Riomet, Glucophage, Fortamet). It can help control high blood sugar in people with type 2 diabetes. It’s available in tablet form or a clear liquid you take by mouth before meals. Metformin doesn’t treat the underlying cause of diabetes. It treats the symptoms of diabetes by lowering blood sugar. It also increases the use of glucose in peripheral muscles and the liver. Metformin also helps with other things in addition to improving blood sugar. These include: lowering lipids, resulting in a decrease in blood triglyceride levels decreasing “bad” cholesterol, or low-density lipoprotein (LDL) increasing “good” cholesterol, or high-density lipoprotein (HDL) If you’re taking metformin for the treatment of type 2 diabetes, it may be possible to stop. Instead, you may be able to manage your condition by making certain lifestyle changes, like losing weight and getting more exercise. Read on to learn more about metformin and whether or not it’s possible to stop taking it. However, before you stop taking metformin consult your doctor to ensure this is the right step to take in managing your diabetes. Before you start taking metformin, your doctor will want to discuss your medical history. You won’t be able to take this medication if you have a history of any of the following: alcohol abuse liver disease kidney issues certain heart problems If you are currently taking metformin, you may have encountered some side effects. If you’ve just started treatment with this drug, it’s important to know some of the side effects you may encounter. Most common side effects The most common side effects are digestive issues and may include: diarrhea vomiting nausea heartburn abdominal cramps Continue reading >>

Fda Issues Guidance For Metformin Use In Renal Impairment

Fda Issues Guidance For Metformin Use In Renal Impairment

Chris Tanski received his PharmD from the University at Buffalo School of Pharmacy and Pharmaceutical Sciences and is now working as a clinical staff pharmacist for Pinnacle Health in Harrisburg, Pennsylvania. He entered the field of hospital pharmacy directly from school, and he was one of the first to pilot a decentralized pharmacist role in the hospital. His other notable work contributions include working on palliative projects and transition of care for COPD patients. Chris was an editor and contributor to a film theory blog, a sketch comedy writer throughout pharmacy school, and he has a significant amount of experience writing drug information papers on neurology and infectious disease topics for both school and work. 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, it’s 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 10 Continue reading >>

Can I Reduce My Metformin Dosage ?

Can I Reduce My Metformin Dosage ?

Home Q & A Questions Can I reduce my metformin... I am taking 500mg metformin a day, half morning n half at night. My sugar level hit as low to 78 mg/dl for fasting. Can i reduce dosage to 250mg daily ? Absolutely not. 78 is a perfect blood sugar, not low by any stretch of the imagination. You need the dose you're on, which is very low, btw. A normal fasting blood sugar is 70-100 My question was triggered when yesterday, at standing position, I suddenly felt dizzy as if hit by earth tremor. My head was spinning left right and almost going to collapse. I then sat down on a bench and rested a while, before I got back to my car. I feared my blood sugar could be below the low limit at that time. I took a cough drop that I had on my pocket. ( Before that, I went for an hour stroll in the park. ) When I reached home, I immediately checked my blood sugar. It was 103 under non fasting or RBS test. This incidence is my first experience, after been on Metformin for 4 months now. Could you kindly share your view again, what could likely be my problem here ? Or could it be a symptom of Vertigo case ? Continue reading >>

Metformin Dosage

Metformin Dosage

Usual Adult Dose for Diabetes Type 2 Immediate-release: Initial dose: 500 mg orally twice a day or 850 mg orally once a day Dose titration: Increase in 500 mg weekly increments or 850 mg every 2 weeks as tolerated Maintenance dose: 2000 mg daily in divided doses Maximum dose: 2550 mg/day Extended-release: Initial dose: 500 to 1000 mg orally once a day Dose titration: Increase in 500 mg weekly increments as tolerated Maintenance dose: 2000 mg daily Maximum dose: 2500 mg daily Comments: -Metformin, if not contraindicated, is the preferred initial pharmacologic agent for treatment of type 2 diabetes mellitus. -Immediate-release: Take in divided doses 2 to 3 times a day with meals; titrate slowly to minimize gastrointestinal side effects. In general, significant responses are not observed with doses less than 1500 mg/day. -Extended-release: Take with the evening meal; if glycemic control is not achieved with 2000 mg once a day, may consider 1000 mg of extended-release product twice a day; if glycemic control is still not achieve, may switch to immediate-release product. Use: To improve glycemic control in adults with type 2 diabetes mellitus as an adjunct to diet and exercise. Usual Pediatric Dose for Diabetes Type 2 10 years or older: Immediate-release: Initial dose: 500 mg orally twice a day Dose titration: Increase in 500 mg weekly increments as tolerated Maintenance dose: 2000 mg daily Maximum dose: 2000 mg daily Comments: Take in divided doses 2 to 3 times a day with meals. Titrate slowly to minimize gastrointestinal side effects. Safety and effectiveness of metformin extended-release has not been established in pediatric patients less than 18 years of age. Use: To improve glycemic control in children with type 2 diabetes mellitus as an adjunct to diet and exercise. Le Continue reading >>

Trying To Reduce Metformin ...

Trying To Reduce Metformin ...

As many of you know, I cut back to 1000 mg of metformin last year from the 2000 mg I had been taken, and did it pretty much without incident. Bg ticked up maybe a few points, but mostly was stable and I cut carbs a bit more and maintained control. Night before last I decided to try going without. My eating has been erratic lately, so it would have been wiser to try this without so many variables, but my blood sugar was really high today. I have been maintaining a range of 80-95 fasting, and not higher than 110 after meals or w/ random testing. 118 - Fri 9 AM (not fasting, already up 2.5 hrs) Lunch was at a friends so I contributed the cheese and crme fraiche Lunch: large kale salad (kale, few pine nuts, blue cheese crumbles, oil/vinegar), yellow pepper with triple cream cheese, 1 optimist cracker, 1 small cream cheese muffin (basically baked cream cheese) with heaping tablespoons of crme fraiche. Now Im thinking Ill take 500 mg met tonight and see if that helps, and work on going deeper into ketosis instead of skating around in this range. Ive gained 2 lbs, though I know thats not real weight. My liver seems to be getting frisky w/out the metformin leash. A1C: . . . . . . . . . . . . . . . Other Stuff I'd been taking 2500mg of Met a day and found that I was feeling massively tired and sort of, well, generally icky. I've been reducing it in 500mg increments every two weeks. The first week was pretty amazing. When you say your liver is frisky I can totally identify. It was like it had been let out of the paddock and was running wild! I couldn't control my blood sugar for love or money. By the end of the week, however, things had calmed down and control returned. I'm down to 1500mg a day and am feel so much better. I may try one more leg down in the next week or so, but t Continue reading >>

Metformin Dosage

Metformin Dosage

Metformin Dosage There have been no human studies to identify the optimal dose of metformin that is needed to duplicate the beneficial gene expression effects that are described in the June 2003 issue of Life Extension magazine. For people who want to derive the many proven health benefits of metformin, it might be prudent to follow the dosage schedule used by Type II diabetics. According to the Physician's Desk Reference, the starting dose should be 500 mg of metformin twice a day. (An alternative option is 850 mg of metformin once a day). After one week, increase the dose of metformin to 1000 mg as the first dose of the day and 500 mg as the second dose. After another week, increase to 1000 mg of metformin two times a day. The maximum safe dose described in the Physician's Desk Reference is 2550 mg a day (which should be taken as 850 mg three times a day). According to the Physician's Desk Reference, clinically significant responses in Type II diabetics are not seen at doses below 1500 mg a day of metformin. Anti-aging doctors, on the other hand, have recommended doses as low as 500 mg twice a day to healthy non-diabetics who are seeking to obtain metformin's other proven benefits such as enhancing insulin sensitivity and reducing excess levels of insulin, glucose, cholesterol and triglycerides in the blood. It could be the dosage range is highly individualistic in healthy people, meaning some may benefit from 500 mg twice a day, while others may need 1000 mg twice a day for optimal effects. Blood tests to ascertain if the dose of metformin you are taking is improving glucose/insulin metabolism would be: Hemoglobin A1c Fasting insulin CBC/Chemistry panel that includes glucose, cholesterol triglycerides and indicators of liver and kidney function A hemoglobin A1c test Continue reading >>

About Metformin

About Metformin

Metformin is a medicine used to treat type 2 diabetes and sometimes polycystic ovary syndrome (PCOS). Type 2 diabetes is an illness where the body doesn't make enough insulin, or the insulin that it makes doesn't work properly. This can cause high blood sugar levels (hyperglycemia). PCOS is a condition that affects how the ovaries work. Metformin lowers your blood sugar levels by improving the way your body handles insulin. It's usually prescribed for diabetes when diet and exercise alone have not been enough to control your blood sugar levels. For women with PCOS, metformin stimulates ovulation even if they don't have diabetes. It does this by lowering insulin and blood sugar levels. Metformin is available on prescription as tablets and as a liquid that you drink. Key facts Metformin works by reducing the amount of sugar your liver releases into your blood. It also makes your body respond better to insulin. Insulin is the hormone that controls the level of sugar in your blood. It's best to take metformin with a meal to reduce the side effects. The most common side effects are feeling sick, vomiting, diarrhoea, stomach ache and going off your food. Metformin does not cause weight gain (unlike some other diabetes medicines). Metformin may also be called by the brand names Bolamyn, Diagemet, Glucient, Glucophage, and Metabet. Who can and can't take metformin Metformin can be taken by adults. It can also be taken by children from 10 years of age on the advice of a doctor. Metformin isn't suitable for some people. Tell your doctor before starting the medicine if you: have had an allergic reaction to metformin or other medicines in the past have uncontrolled diabetes have liver or kidney problems have a severe infection are being treated for heart failure or you have recentl Continue reading >>

Quantifying The Effect Of Metformin Treatment And Dose On Glycemic Control

Quantifying The Effect Of Metformin Treatment And Dose On Glycemic Control

Quantifying the Effect of Metformin Treatment and Dose on Glycemic Control Jennifer A. Hirst , MSC,1 Andrew J. Farmer , MD,1 Raghib Ali , MSC,2,3 Nia W. Roberts , MSC,4 and Richard J. Stevens , PHD1 1Department of Primary Care Health Sciences, University of Oxford, Oxford, U.K., and the National Institute for Health Research School for Primary Care Research, Oxford, U.K. 1Department of Primary Care Health Sciences, University of Oxford, Oxford, U.K., and the National Institute for Health Research School for Primary Care Research, Oxford, U.K. 2Cancer Epidemiology Unit, University of Oxford, Oxford, U.K. 3Department of Community Medicine, United Arab Emirates University, Al Ain, United Arab Emirates 1Department of Primary Care Health Sciences, University of Oxford, Oxford, U.K., and the National Institute for Health Research School for Primary Care Research, Oxford, U.K. 1Department of Primary Care Health Sciences, University of Oxford, Oxford, U.K., and the National Institute for Health Research School for Primary Care Research, Oxford, U.K. 2Cancer Epidemiology Unit, University of Oxford, Oxford, U.K. 3Department of Community Medicine, United Arab Emirates University, Al Ain, United Arab Emirates 4Bodleian Health Care Libraries, University of Oxford, Oxford, U.K. Corresponding author: Jennifer A. Hirst, [email protected] . Received 2011 Aug 3; Accepted 2011 Oct 31. Copyright 2012 by the 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. Metformin is the first-line oral medication recommended for glycemic control in patients with type 2 diabetes. We reviewed the literatur Continue reading >>

Anyone Able To Reduce Their Metformin Dose?

Anyone Able To Reduce Their Metformin Dose?

Anyone able to reduce their metformin dose? If this is your first visit, be sure tocheck out the FAQ by clicking thelink above. You may have to register before you can post: click the register link above to proceed. To start viewing messages,select the forum that you want to visit from the selection below. Anyone able to reduce their metformin dose? I finally realized that the metformin is why with my new increase in exercise is making me so darned tired. I take 850 mgs twice a day. I am exahusted despite low carb diet and lots of exercise. I could'nt get my doctor but when I told the Pharmacist he was like stop! Cut the pills in half of take only one a day! I have been unbelievably tired to the poitn of wanting to sleep at the pool. very unusual for me. I was expecting a huge boost in energy. Has anyone else reduced their meds due to naturally lowering their insuling levels via diet and exercise? and had to reduce to 1000 due to the decrease in weight by exercise and change in diet. I was having severe blood sugar issues at night especially. Glucophage XR 2000 mgs 3 years (Switched to Generic Metformin XR on Dec. 23 rd) Diagnosed at age 21 rediagnosed at 34 due to all symptoms. Normal weight, feeling great! 5'0 113 lbs My Endo put me on 2000mg and I was so tired I was not coming into work and was getting written up or dirty looks. I told the OB doctor and he put me on 1500mg and I started to have periods even but there were 2 changes I recently went back to 2000mg becuase the other OB said I needed to be on the 2000mg but I tell ya I just can't do 2000mg I went back to the 1500mg on my own and am telling her I did so next appointment. (Me) 43 (hubby) 33 Hidden Content 13 years strong My Endo put me on 2000mg and I was so tired I was not coming into work and was gettin Continue reading >>

How To Wean Off Of Diabetes Medication

How To Wean Off Of Diabetes Medication

One of my greatest pleasures in life is to help patients achieve remission of their type 2 diabetes. This means their blood sugar levels have become normal in the absence of any diabetes medication. Many clinicians and patients are interested in learning my views about how to go about decreasing and discontinuing diabetes medications. The main role for medications is to help reduce or delay the risk of nasty complications of diabetes, particularly the damage to the retina, kidney, nerves, and circulation. The higher the average blood sugar level, as indicated by the hemoglobin A1c level, the greater the complication risk (which increases exponentially with increasing A1c). We know from clinical trials that using medication to keep the A1c at or below 7% can help reduce the risk of these complications. There is broad agreement that clinicians should recommend starting or increasing diabetes medications to patients who cannot get their A1c level to 7% or less via lifestyle change. Many patients come to me because the A1c is already over 7% and their primary care provider proposes increasing their diabetes medication, unless the patient can get to 7% or less with improved eating and/or exercise habits. Some of these patients are already on many pills, and insulin shots are the frequently the next appropriate treatment. Many patients would rather make the lifestyle changes than take more medication, so when the doctor frames the issue in this way, then a patient might become inspired to renew or increase the lifestyle efforts. The clinician might say “lets recheck the A1c in 3 months, and start the new medication if it is still above 7.0%”. My goal with patients is to use the lifestyle strategies I’ve discussed previously in this blog to drive the A1c as low as possib Continue reading >>

Reducing Metformin Dose

Reducing Metformin Dose

My husband has been treating his Type 2 diabetes for approx 10 years. He has started having a problem with diarrhea after his evening meal. He is taking 1000 mg per day 2X per day. His doctor advised cutting to 500 mg at night and 1000 mg in the morning. He is a worrier type and is convinced that his BG will spike in the evening. I should say that he has lost a significant amount of weight @ 70 lbs in the past year. Experienced complications due to leg surgery in June 2016 and has since been approved for SS Disability. He has no appetite, eats very small meals, is tired all the time and weak. Sure seems like it may be took much Metformin. I advised him to just do as the doctor asked and take his BG readings each day for at least a week before deciding if his numbers are too high. I have taken the max dose of Metfoemin for 10 years. Last year I ended up with 6 weeks of dirahea. At first we thought it was the Metformin and my ENDO cut the dose, but it didn't help and my bgs went up to 300+. They sent me to a GI doc who advised me to give up all dairy and fat and start taking a probiotic. It worked. 115 pounds, Breast Cancer dx'd 6/16, 6 months of chemo and 6 weeks of radiation 2000 metformin ER, 100 mg Januvia,Glimperide, Prolia, Gabapentin, Meloxicam, Probiotic with a Prebiotic, , Lisinopril, B-12, B-6, Tumeric, Magnesium, Calcium, Vit D, and Occuvite mostly vegan diet, low fat and around 125 carbs a day, walk 5-6 miles every other day and 1 hour of yoga and light weights. Has your husband's doctor tested him for other causes for the diarrhoea, lack of appetite, tiredness and weakness? If he's been on metformin for a long time and tolerated it well until recently, the symptoms could be caused by something else. Or it could be a change in origin of the generic metformin Continue reading >>

Metformin Wonder Drug

Metformin Wonder Drug

A while back I wrote about why metformin is the number one treatment for Type 2 diabetes. Now new research finds metformin prevents cancer and heart disease and may actually slow aging! Where can I get this stuff? A study from Scotland found that people on metformin had only roughly half the cancer rate of people with diabetes who weren’t on the drug. This is important, because diabetes is associated with higher risks of liver, pancreas, endometrial, colon and rectum, breast, and bladder cancer. Nobody could explain how metformin helped, but then Canadian researchers showed that metformin reduces cell mutations and DNA damage. Since mutations and DNA damage promote both cancer and aging, this is striking news. No one thought we could limit mutations before, but perhaps metformin can do it. A study on mice exposed to cigarette smoke showed that those given metformin had 70% less tumor growth. A small study of humans in Japan showed similar improvements in colorectal cancer outcomes. Metformin is now being studied in clinical trials for breast cancer. The researchers write, “Women with early-stage breast cancer taking metformin for diabetes have higher response rates to [presurgical cancer therapies] than diabetic patients not taking metformin.” They also had better results than people without diabetes. How Does It Work? According to Michael Pollak, MD, professor in McGill’s Medicine and Oncology Departments, metformin is a powerful antioxidant. It slows DNA damage by reducing levels of “reactive oxygen species” (ROS). ROS are produced as byproducts when cells burn glucose. Just as oxygen helps fires burn or metals rust, ROS will oxidize (“burn” or “rust”) the nuclei or other parts of cells. ROS are what the antioxidant vitamins are supposed to block. Continue reading >>

Does Metformin Help With Weight Loss? (the Answer Is Yes & Here’s Why)

Does Metformin Help With Weight Loss? (the Answer Is Yes & Here’s Why)

Metformin may be one of the cheapest and most underused weight loss medications out there. Metformin is traditionally reserved for those with diabetes or insulin resistance, but many studies show that it can be effective in overweight or obese patients without diabetes. The only problem? You wouldn't know about it unless you do the research yourself! Use this post to learn everything you need to know about using metformin (both if you have diabetes or if you are simply just overweight): Metformin & How it May Help With Weight Loss Does metformin help with weight loss? The answer is more complex than just a standard "yes" or "no", instead the correct answer is more of a "maybe". What do I mean? Well metformin is a medication that falls into the class of biguanides. The most popular of these medications is metformin (and the topic of our discussion today) which is being used by at least 120 million people worldwide. Classically, metformin is used to treat blood sugar issues, insulin resistance and type II diabetes. It was found a long time ago, that if used for these conditions, metformin does indeed help some patients lose weight. Studies have shown that patients who take metformin with insulin resistance do tend to lose weight - most studies showing a "modest" amount to the tune of around 5-10 pounds. Because these studies have been favorable to some patients (especially those with the conditions listed above), it's normal to ask if it also works for patients who don't have type II diabetes. In order to understand that, we need to understand how metformin works. As it relates to weight loss metformin has powerful actions in 2 main areas: In the mitochondria respiratory chain complex: Activating the mitochondrial pathway is a powerful way to increase energy production an Continue reading >>

Safe Prescribing Of Metformin In Diabetes

Safe Prescribing Of Metformin In Diabetes

Metformin is the first-line pharmacological therapy for type 2 diabetes. It is the only glucose-lowering oral drug that has been shown to reduce mortality in patients with diabetes. The most common adverse effect is gastrointestinal upset. Starting at a low dose and increasing it slowly reduces this risk. Taking metformin with food also helps. Numerous contraindications to the use of metformin are listed in the product information, including reduced renal function. Strict adherence to these recommendations may deny a valuable drug to many patients. Introduction Metformin lowers both fasting and postprandial blood glucose. It reduces hepatic glucose output 1 and increases peripheral glucose uptake, and may delay intestinal glucose absorption. Its use is not associated with weight gain and hypoglycaemia is extremely rare when metformin is used on its own. It lowers triglyceride concentrations and has small but beneficial effects on total and high-density lipoprotein cholesterol. In the UK Prospective Diabetes Study metformin reduced diabetes-related and all-cause mortality, and reduced the risk of myocardial infarction in obese patients with type 2 diabetes when used as first-line therapy. It also reduced the risk of microvascular complications, but was no more effective than insulin or sulfonylureas. 2 A retrospective cohort study from the USA found a lower rate of hospitalisations for myocardial infarction and stroke and a reduced death rate when metformin was used first-line in type 2 diabetes in comparison with a sulfonylurea. 3 Metformin is effective when used with other glucose-lowering drugs. A standard-release (3000 mg/day maximum dose) and an extended-release preparation of metformin (2000 mg/day maximum dose) are available. The extended-release preparation can b Continue reading >>

Quantifying The Effect Of Metformin Treatment And Dose On Glycemic Control

Quantifying The Effect Of Metformin Treatment And Dose On Glycemic Control

Abstract OBJECTIVE Metformin is the first-line oral medication recommended for glycemic control in patients with type 2 diabetes. We reviewed the literature to quantify the effect of metformin treatment on glycated hemoglobin (HbA1c) levels in all types of diabetes and examine the impact of differing doses on glycemic control. RESEARCH DESIGN AND METHODS MEDLINE, EMBASE, and the Cochrane Library were searched from 1950 to June 2010 for trials of at least 12 weeks’ duration in which diabetic patients were treated with either metformin monotherapy or as an add-on therapy. Data on change in HbA1c were pooled in a meta-analysis. Data from dose-comparison trials were separately pooled. RESULTS A total of 35 trials were identified for the main analysis and 7 for the dose-comparison analysis. Metformin monotherapy lowered HbA1c by 1.12% (95% CI 0.92–1.32; I2 = 80%) versus placebo, metformin added to oral therapy lowered HbA1c by 0.95% (0.77–1.13; I2 = 77%) versus placebo added to oral therapy, and metformin added to insulin therapy lowered HbA1c by 0.60% (0.30–0.91; I2 = 79.8%) versus insulin only. There was a significantly greater reduction in HbA1c using higher doses of metformin compared with lower doses of metformin with no significant increase in side effects. CONCLUSIONS Evidence supports the effectiveness of metformin therapy in a clinically important lowering of HbA1c used as monotherapy and in combination with other therapeutic agents. There is potential for using higher doses of metformin to maximize glycemic control in diabetic patients without increasing gastrointestinal effects. Metformin is the most commonly prescribed antihyperglycemic medication for diabetes in the U.S. (1) and the U.K. (2) and is the recommended first choice for oral therapy (2–4). T Continue reading >>

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