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When Metformin Doesn't Work

Oral Diabetes Medications Fact Sheet

Oral Diabetes Medications Fact Sheet

Summa Health System developed this fact sheet for patients who need to take oral medicine to manage their diabetes. Care providers give it to patients during diabetes planned visits, and it is part of the Diabetes Planned Visit Notebook. Oral Diabetes Medications Family Medicine Center of Akron Copyright © 2006 American Diabetes Association Adapted from the ADA Patient Information The first treatment for type 2 diabetes is often meal planning for blood glucose (sugar) control, weight loss, and exercising. Sometimes these measures are not enough to bring blood glucose levels down near the normal range. The next step is taking a medicine that lowers blood glucose levels. How they work In people with diabetes, blood glucose levels are too high. These high levels occur because glucose remains in the blood rather than entering cells, where it belongs. But for glucose to pass into a cell, insulin must be present and the cell must be "hungry" for glucose. People with type 1 diabetes don't make insulin. For them, insulin shots are the only way to keep blood glucose levels down. People with type 2 diabetes tend to have two problems: they don't make quite enough insulin and the cells of their bodies don't seem to take in glucose as eagerly as they should. All diabetes pills sold today in the United States are members of five classes of drugs: sulfonylureas, meglitinides, biguanides, thiazolidinediones, and alpha-glucosidase inhibitors. These five classes of drugs work in different ways to lower blood glucose levels. Can diabetes pills help me? Only people with type 2 diabetes can use pills to manage their diabetes. These pills work best when used with meal planning and exercise. This way you have three therapies working together to lower your blood glucose levels. Diabetes pills Continue reading >>

What Happens If Metformin Etc Doesn't Work?

What Happens If Metformin Etc Doesn't Work?

Guest over a year ago Hello, I started on metformin one month ago and I'm currently taking in 250 carbs a day. I exercise every day by walking and biking. My current fasting BG is around 18.5. What happens if metformin etc and diet and exercise doesn't work? I'm over weight with a BMI of 32. I'm not seeing any real improvement in my sugar levels and I'm not sure what to do at this point. I realize it's only been a month but it seems I should see some difference by now. If anyone has any advice it would be greatly appreciated. Clearly I must be doing something wrong. Help! Thanks Hello, It's still early in the game. You've only been on metformin for a month so you need to wait a bit longer to see any results. However, I am a little perplexed as to why you are taking in 250 carbs a day. That is really a lot of carbs for a diabetic. If you were not diabetic and a body builder you might be okay. In all honesty, your carb intake should be between 30g to maybe 80g at most to help you stabilize sugar levels. Your BMI of 32 is high indicating you are considerably over weight which brings about insulin resistance which metformin is not going to be able to deal with. Your fasting measurement of 18.5 is over the top. I don't know whether you have been misadvised or you don't understand what you should be doing. My guess is that you won't see any improvement with metformin even in higher doses. You need to get with your diabetic nurse to determine a proper diet and exercise regime. You need a low carb diet to manage your diabetes. You need to be on a weight loss program as well to increase insulin sensitivity. I stay between 30 and 50 grams of carbs a day and do very well. I'm normal weight and metformin works well for me. In fact, I hope to be able to stop taking metformin because Continue reading >>

Metformin: New Benefits (and Risks) For This Old Diabetes Drug

Metformin: New Benefits (and Risks) For This Old Diabetes Drug

If type 2 diabetes is part of your life—whether you have the condition or are at risk of developing it—you’ve probably heard of a drug called metformin. Perhaps your doctor has told you about it, has recently started you on it or has been prescribing it to you for years to keep your blood sugar under control. It’s no newbie. Metformin has been available by prescription in the US for more than 20 years and in Europe for more than 40 years. US doctors write nearly 60 million prescriptions a year. It’s recommended as the go-to-first prescription for people with diabetes by the American Diabetes Association, the American Association of Clinical Endocrinologists and the American College of Physicians. Yet, in many ways, metformin remains a mystery. We know broadly but still not exactly, how it works. Even more surprising, new health benefits—and side effects—keep popping up. In fact, we’ve only recently learned that metformin might protect the heart, fight cancer and even boost longevity. On the other hand, it can, rarely, lead to a potentially fatal side effect, and it can even make a common diabetes complication worse. It’s time to take a closer look at metformin. MEDIEVAL FLOWER REMEDY, MODERN DRUG In medieval times, herbalists prescribed Galega officinalis—the bloom of the French lilac, also known as goat’s rue and Italian fitch—for patients with what we now recognize as diabetes. In the 1950s, medical researchers identified a compound in the lilac, metformin, that appeared to reliably and safely reduce high blood sugar. Metformin became widely available in Europe in the 1970s and was approved by the US Food and Drug Administration in 1995 to treat type 2 diabetes. Some combination prescriptions include metformin with other prescription medication Continue reading >>

Medication For Type 2 Diabetes

Medication For Type 2 Diabetes

People with type 2 diabetes are often given medications including insulin to help control their blood glucose levels. Most of these medications are in the form of tablets, but some are given by injection. Tablets or injections are intended to be used in conjunction with healthy eating and regular physical activity, not as a substitute. Diabetes tablets are not an oral form of insulin.Speak with your doctor or pharmacist if you experience any problems. An alternative medication is usually available. All people with diabetes need to check their glucose levels on a regular basis. When taking medication, you may need to check your glucose levels more often to keep you safe and to ensure the medication is having the desired effect. In Australia there are seven classes of medicines used to treat type 2 diabetes: Biguanides Sulphonylureas Thiazolidinediones (Glitazones) Alpha-glucosidase Inhibitors. Dipeptidyl peptidase 4 (DPP4) inhibitors Incretin mimetics Sodium-glucose transporter (SGLT2) inhibitors Your doctor will talk to you about which tablets are right for you, when to take your tablets and how much to take. Your doctor can also tell you about any possible side effects. You should speak to your doctor or pharmacist if you experience any problems. Chemical name: METFORMIN , METFORMIN ER Points to remember about biguanides This group of insulin tablets helps to lower blood glucose levels by reducing the amount of stored glucose released by the liver, slowing the absorption of glucose from the intestine, and helping the body to become more sensitive to insulin so that your own insulin works better They need to be started at a low dose and increased slowly Metformin is often prescribed as the first diabetes tablet for people with type 2 diabetes who are overweight. It gene Continue reading >>

Metformin: The Good, The Bad, The Benefits

Metformin: The Good, The Bad, The Benefits

If you’ve read anything at all about type 2 diabetes, you probably know that the primary treatment is a carb-controlled diet plus healthy moving. Beyond this cornerstone, medications are often needed to keep the A1C (or average 3 month glucose level) under control. There are at least 7 different classes of oral drugs to treat diabetes, plus injectables, plus insulin. How does your doctor know which one to choose? Is metformin really better than any of the other options? Yes, this drug is clearly the front-runner when we’re talking about oral diabetes medication and which one to use first. The Good How does metformin work and why is it recommended? Going back to the basics of understanding diabetes, it is a condition where there is either not enough insulin made by the pancreas, or the body can’t use the insulin that is produced (known as insulin resistance). Because of insulin resistance, the liver thinks that there isn’t enough glucose in the cells, so it produces more to overcome the resistance. Metfomin then comes in to tell the liver to chill out and stop making so much glucose. When that happens, the overall result is a lower blood sugar level. But wait…that’s not all! Many drugs have a secondary action, and this is the case for metformin. It is also able to improve the way the muscles utilize insulin. This is known as improving insulin sensitivity. With these two actions combined, metformin (at full dose) can decrease an A1C level up to 2% over a 3 month period. That all sounds good, so what’s the downside? The Bad Metformin is famous for causing stomach upset, diarrhea, nausea and bloating. These side effects can be miserable and will make you hate metformin. The good news is, most people develop tolerance to the gastrointestinal (GI) symptoms and t Continue reading >>

What Next When Metformin Isn't Enough For Type 2 Diabetes?

What Next When Metformin Isn't Enough For Type 2 Diabetes?

› Turn first to metformin for pharmacologic treatment of type 2 diabetes. A › Add a second oral agent (such as a sulfonylurea, thiazolidinedione, sodium-glucose cotransporter-2 inhibitor, or dipeptidyl peptidase 4 inhibitor), a glucagon-like peptide-1 (GLP-1) receptor agonist, or basal insulin if metformin at a maximum tolerated dose does not achieve the HbA1c target over 3 months. A › Progress to bolus mealtime insulin or a GLP-1 agonist to cover postprandial glycemic excursions if HbA1c remains above goal despite an adequate trial of basal insulin. A Strength of recommendation (SOR) A Good-quality patient-oriented evidence B Inconsistent or limited-quality patient-oriented evidence C Consensus, usual practice, opinion, disease-oriented evidence, case series The "Standards of Medical Care in Diabetes" guidelines published in 2015 by the American Diabetes Association (ADA) state that metformin is the preferred initial pharmacotherapy for managing type 2 diabetes.1 Metformin, a biguanide, enhances insulin sensitivity in muscle and fat tissue and inhibits hepatic glucose production. Advantages of metformin include the longstanding research supporting its efficacy and safety, an expected decrease in the glycated hemoglobin (HbA1c) level of 1% to 1.5%, low cost, minimal hypoglycemic risk, and potential reductions in cardiovascular (CV) events due to decreased low-density lipoprotein (LDL) cholesterol.1,2 To minimize adverse gastrointestinal effects, start metformin at 500 mg once or twice a day and titrate upward every one to 2 weeks to the target dose.3 To help guide dosing decisions, use the estimated glomerular filtration rate (eGFR) instead of the serum creatinine (SCr) level, because the SCr can translate into a variable range of eGFRs (TABLE 1).4,5 What if metfo Continue reading >>

Metformin Weight Loss – Does It Work?

Metformin Weight Loss – Does It Work?

Metformin weight loss claims are something that are often talked about by health professionals to be one of the benefits of commencing metformin therapy, but are they true? At myheart.net we’ve helped millions of people through our articles and answers. Now our authors are keeping readers up to date with cutting edge heart disease information through twitter. Follow Dr Ahmed on Twitter @MustafaAhmedMD Metformin is possibly one of the most important treatments in Type II Diabetes, so the question of metformin weight loss is of the utmost importance, as if true it could provide a means to lose weight as well as control high sugar levels found in diabetes. What is Metformin? Metformin is an oral hypoglycemic medication – meaning it reduces levels of sugar, or more specifically glucose in the blood. It is so effective that the American Diabetes Association says that unless there is a strong reason not to, metformin should be commenced at the onset of Type II Diabetes. Metformin comes in tablet form and the dose is gradually increased until the maximum dose required is achieved. How Does Metformin Work & Why Would it Cause Weight Loss? Metformin works by three major mechanisms – each of which could explain the “metformin weight loss” claims. These are: Decrease sugar production by the liver – the liver can actually make sugars from other substances, but metformin inhibits an enzyme in the pathway resulting in less sugar being released into the blood. Increase in the amount of sugar utilization in the muscles and the liver – Given that the muscles are a major “sink” for excess sugar, by driving sugar into them metformin is able to reduce the amount of sugar in the blood. Preventing the breakdown of fats (lipolysis) – this in turn reduces the amount of fatt Continue reading >>

Unlocking The Secrets Of Type 2 Diabetes Drug

Unlocking The Secrets Of Type 2 Diabetes Drug

In a joint effort, Melbourne researchers with a team from Canada have described for the first time the action of the type 2 diabetes drug metformin. This research answers decade-long questions about how metformin works and may help develop more effective therapies for the more than 1 million Australians currently living with type 2 diabetes. Despite its front-line role in the treatment of type 2 diabetes, until now no-one has been able to explain how the drug lowers blood sugar for those patients living with the condition. Researchers at St Vincent’s Institute of Medical Research, in collaboration with colleagues at McMaster University in Canada, are the first to solve that mystery, with their discovery that metformin works by reducing fat in the liver. Their research is published in today’s issue of the prestigious journal Nature Medicine. Professor Bruce Kemp from St Vincent’s Institute who has worked closely on the project said, “This work, the result of a great international collaboration, has the potential to help develop more effective treatments for type 2 diabetes, which currently affects 4% of Australians and represents an ever growing burden on our health system.” Senior author on the study, Associate Professor Greg Steinberg from McMaster University and former researcher from St Vincent’s Institute said, “The key is that metformin doesn’t work to lower blood glucose by directly working on the glucose. It works on reducing harmful fat molecules in the liver, which then allows insulin to work better and lower blood sugar levels.” Dr Sandra Galic from St Vincent’s Institute and co-lead author on the study, was keen to work out the mechanism of action of metformin. “We knew that metformin activates the metabolic sensor AMP-activated protein Continue reading >>

Diabetes Type 2

Diabetes Type 2

Many people with type 2 diabetes are prescribed tablets to help control their blood glucose levels. Metformin is the first-line medication for diabetes in the UK but there are many more types of medication for type 2 diabetes discussed below. Most people had tried initially to control their blood glucose with a regimen of diet and exercise before being given oral medication. Many people took metformin alone to control blood glucose, and some were taking metformin and gliclazide. Both medications help to reduce blood glucose but work differently. Metformin reduces the amount of glucose produced in the liver, and also makes muscle tissue absorb more glucose; gliclazide increases the amount of insulin produced by the pancreas. While people found that the medication they took had helped reduce and control their blood glucose, many had experienced side effects. Metformin can cause diarrhoea and other digestive problems and many people went back to their GPs for advice. Some people felt concerned about the risks they might face from certain drugs after reading negative reports in the media (see 'Misunderstandings about diabetes'). Rosiglitazone has been linked to an increased risk of heart attack and stroke. Since these interviews were conducted in 2008, there has been growing concern about the potential harmful effects of rosiglitazone (Avandia, but also contained in Avandamet and Avaglim) and from September 2010 in the UK and Europe, new prescribing of this drug has stopped, and most people who were taking the drug have been changed to alternative medication. Most people we interviewed had been prescribed higher dosages of medication to control their blood glucose as their diabetes got worse over time. Some people had transferred to insulin while continuing on metformin (se Continue reading >>

Metformin And Other Medications For Type 2 Diabetes

Metformin And Other Medications For Type 2 Diabetes

Developed by the Washington University/St. Louis Children’s Hospital Diabetes Team 2015 In type 2 diabetes, the pancreas doesn’t make enough insulin (keys) AND the insulin doesn’t work as well as normal (insulin resistance). Insulin is the KEY to let sugar into your cells and bring down your blood sugar. There are only a few medications used for type 2 diabetes in children and adolescents. These are metformin and insulin. There are other medications that are used more often in adults with type 2 diabetes. Insulin is always given by shots. If you need insulin, your diabetes team will teach you how to use it. Metformin A pill that is taken 1- 2 times every day. Other Common Names: Glucophage, Glucophage XR How does it work? Metformin brings down blood sugar by making insulin work better (decreasing insulin resistance) and causing the liver to make less sugar. It can take several days or even weeks before metformin works well. What if I miss a dose? Take your dose as soon as you remember. If it is more than 2 hours from your missed dose, then skip the missed dose. DO NOT take 2 doses at the same time. Common Side Effects: Loose stools/diarrhea, upset stomach, and gas. These USUALLY GET BETTER if you keep taking your metformin. Try taking it with food. If the symptoms bother you a lot, ask about an extended release form. Serious Side Effects: Rare risk of lactic acidosis – a form of too much acid in your blood. DON’T TAKE YOUR METFORMIN if you have VOMITING/DIARRHEA, are having SURGERY, or are having CT SCAN with CONTRAST. If it is a scheduled procedure, stop metformin 24-48 hours before it is scheduled. You can restart metformin 24 hours after you recover. Call your doctor right away if you have fast breathing, fast heartbeat, shortness o Continue reading >>

Metformin + Pcos

Metformin + Pcos

“But I don’t have high blood sugar? Why am I on the diabetes drug Metformin?” Metformin, aka Glucophage, is a common treatment option for PCOS and many wonder why it is chosen. {Side note: in order to understand the role of Metformin, you might want to review the previous post on PCOS and insulin.} The state of insulin resistance so common with PCOS promotes an environment where extra glucose and lots of insulin hang out in the bloodstream. That glucose wants to get in your cells to give you energy (and that’s why you are so tired all the time!). Those very high insulin levels seen in PCOS drain you even more and are behind the acanthosis nigricans, carb cravings, irregular periods, and even affects your sleep. Want to find a way to treat your PCOS without dieting? Get Julie’s FREE Road Map: Your First 3 Steps Toward Food Peace with PCOS. Metformin steps in making your cells more sensitive to insulin: that’s why it’s referred to as an insulin sensitizer. It helps the glucose actually get in your cells, giving you the energy you need. Many report having more energy and less carb cravings after starting metformin. Metformin has another job: it stops the liver from making and sending out so much glucose. Most people connect Metformin with blood sugar since it is a common diabetes drug. Although it affects blood sugar, most people with PCOS on metformin have normal blood sugar levels. Also, insulin levels are MUCH higher in PCOS than diabetes so more Metformin is necessary compared to people with diabetes. Metformin affects more than just insulin and glucose. In addition to reducing blood glucose and insulin levels, Metformin has been shown to improve menstrual irregularities, fertility, and ovulation rates. Metformin may also slow the progression of type 2 Di Continue reading >>

“why Insulin Therapy Doesn’t Work,” Transcript: Israel Hodish, Md, Phd

“why Insulin Therapy Doesn’t Work,” Transcript: Israel Hodish, Md, Phd

To view the full video, click here. Steve Freed: Tell us a little about yourself and why you are attending the ADA Scientific session. Dr. Hodish: I’m an endocrinologist and my main focus is the management of patients with diabetes, especially adult ones with diabetes. I’m here to learn about development in the field, to offer my help. Steve: Are you presenting here? Dr. Hodish: We are presenting a poster that describes the outcome for almost full year worth of new surveys that have been available in Northern Ireland and has considerably changed the standard of care in a large center over there. It shows the outcome of patients using insulin. Steve: I know one of the topics that came up and the title that you gave to us was “Why insulin therapy doesn’t work and what we can do about it.” That’s a pretty bold statement to say that insulin doesn’t work. If we had the manufacturers outside this door, they’d probably be throwing tomatoes at you. Dr. Hodish: Oh, they probably would. Well, I’m just looking at data and I’m trying to analyze it. So insulin is one of these medications that we have been using for a long time. In fact, almost a century. We know how to use it, we know what the side effects are, and we know that there is one main facet of toxicity which is hypoglycemia. There are a lot of formulations available nowadays to make the therapy as sophisticated, or as flexible as we can. And still epidemiology shows us that over the past 30 years we have not been able to make insulin therapy better. The data is the same, it’s the same in the U.S.A as it is the same in Europe. The majority of the patients I would like to say about 2/3rds of them, have an A1C above 7%, above the goal. The average is about 8.5% in terms of A1C. A 1/3 of the patients hav Continue reading >>

Metformin Doesn’t Affect Fat Distribution In Mother Or Baby

Metformin Doesn’t Affect Fat Distribution In Mother Or Baby

This study was part of the EMPOWaR study, which looked at whether taking a drug called metformin during pregnancy makes it less likely for obese women to have babies with a very high birth weight. Tommy's researchers used magnetic resonance imaging (MRI) to look at the effect of metformin on the body composition and fat distribution of mothers during pregnancy, and the fat distribution in the newborn baby. In total, 37 women had MRI scans at both 28 and 36 weeks of pregnancy, and another 20 women had one or the other of these scans. Half of the women took metformin during pregnancy, while the other half took a placebo. We found that the distribution of fat in mothers and babies was similar regardless of whether they took metformin. Metformin also didn't lower the amount of harmful fat in liver and muscle. This means that there may be no benefit to giving metformin to severely obese women during pregnancy. It is important to show this, so that these women are not given metformin in the belief that it may help. In the future we hope to follow up the babies, to see whether metformin during pregnancy has any long-term benefits on the babies' health. Continue reading >>

Metformin For Type 1 Diabetes - Really? Why?

Metformin For Type 1 Diabetes - Really? Why?

You've heard it before: someone with type 2 diabetes goes on insulin. That's no surprise. But how often have you heard the reverse — someone with type 1 going on Metformin? Since the launch of Symlin in 2005, it's not uncommon for people to treat their type 1 diabetes with a supplemental injectable medication. But hang around long enough, and you too might get to know someone with type 1 who takes insulin and oral meds, those formerly known as "type 2 only" drugs. Really? Type 1's taking oral meds alongside insulin? To clarify this, I just had to query some experts. Just like in type 2 diabetes, people with type 1 diabetes can sometimes suffer from insulin resistance (when the insulin that's present can't perform it's work properly), and Metformin can lower your insulin requirements by helping the body make better use of the stuff — in this case coming from an injection or insulin pump. Gary Scheiner, CDE, author, and head of Integrated Diabetes Services in Wynnewood, PA, explained it this way: "Some of the more creative and aggressive endos are prescribing Metformin for type 1's, particularly if they are overweight or requiring very large basal insulin doses. In addition to having some mild appetite-suppression effects, it will enhance insulin sensitivity by hepatic cells (in the liver) and limit the amount of glucose secreted by the liver. Personally, I think it can be helpful during adolescence as well. As long as the patient has good liver and kidney function, the side effects and risks are negligible." I also learned this: a couple of other uses of Metformin for women to consider are PCOS (ovary disease) and pregnancy. Kelley Champ Crumpler, RN, who is a diabetes nurse educator and a type 1 diabetic married to an endocrinologist with type 1 diabetes (how's that Continue reading >>

Does Metformin Work In The Gut?

Does Metformin Work In The Gut?

The drug metformin is one of the most common drugs prescribed to treat type 2 diabetes. When you’re diagnosed, most physicians prescribe metformin as well as suggesting diet and exercise changes. But not everyone can tolerate metformin. Some people get diarrhea and nausea, sometimes so severe they stop taking the drug. Starting the drug slowly and then increasing the dosage helps. Taking metformin with meals helps. But sometimes that’s not enough and you decide to try something else. Metformin should also not be used if you have impaired kidney function, because the kidney is where the drug is removed, and if your kidneys are impaired, the metformin concentrations might rise too high and cause a serious, sometimes life-threatening, complication called lactic acidosis. Now a group of researchers have found that they can give metformin in a form that has the same benefits but doesn’t have the same side effects. What they do is coat the metformin with a covering that only dissolves in the lower intestine. This approach is like that of enteric aspirin, which doesn’t dissolve in the stomach and hence doesn’t trigger stomach bleeding, a common side effect of aspirin. With this form of metformin, which they call metformin DR for “delayed release,” the drug levels in the blood are about half as low as those of regular metformin, but the blood-glucose-lowering effects are the same. What is interesting about this research is that it suggests that the primary site of action of metformin is in the gut, and not in the liver as has been claimed for some years. Researchers have said that metformin keeps the liver from producing and releasing a lot of glucose, through stimulating a molecule called AMPK. But the metformin worked even when researchers knocked out the AMPK, Continue reading >>

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