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Why Does Metformin Cause Lactic Acidosis?

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in this videoclip dr. Pietro Addamo and dr Simona Polemi illustrate metabolic and pathophysiological pathways that lead to lactic acidosis caused by metformin. The short video ends with a case report.

Mala: Metformin-associated Lactic Acidosis

By Charles W. O’Connell, MD Introduction Metformin is a first-line agent for type 2 diabetes mellitus often used as monotherapy or in combination with oral diabetic medications. It is a member of the biguanide class and its main intended effect is expressed by the inhibition of hepatic gluconeogenesis. In addition, metformin increases insulin sensitivity, enhances peripheral glucose utilization and decreases glucose uptake in the gastrointestinal tract. Phenformin, a previously used biguanide, as withdrawn from the market in the 1970’s due its association with numerous cases of lactic acidosis. Metformin is currently used extensively in the management of diabetes and is the most commonly prescribed biguanide worldwide. The therapeutic dosage of metformin ranges from 850 mg to a maximum of 3000 mg daily and is typically divided into twice daily dosing. It is primarily used in the treatment of diabetes but has been used in other conditions associated with insulin resistance such as polycystic ovarian syndrome. MALA is a rare but well reported event that occurs with both therapeutic use and overdose states. Case presentation A 22-year-old female presents to the Emergency Departmen Continue reading >>

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  1. 2blessed4stress

    metformin and lactic acidosis

    I am hoping that I can get some guidance from the members here. There are many of you that have a wealth of information on diabetes and things related so please bear with me. I went to the doctor yesterday and finally asked her for metformin er and was all set to try it out. Then I read the paper that came with it from the pharmacy. The warning about lactic acidosis stopped me in my tracks. Now I am afraid to take it. I searched the posts her a DD about lactic acidosis and I also found that some members said it caused them to be really fatigued. Another member posted that she had trouble with exercise because it caused leg cramps. I feel so overwhelmed now. I really wanted to try it out I believe it could help me but I don't want to put my life at risk to try it. I looked up lactic acidosis and I was reading about the bloods ph and acid in your blood. I have a problem with uric acid in my blood but I believe that is not related to lactic acidosis. I have had a problem with kidney infections and a lot of crystals in my urine and kidney stones the past year, but I believe my kidney function is ok. Does metformin cause lactic acidosis very often? Are the symptoms of lactic acidosis easy enough to pick up on so it can be caught early. I am sorry I am such a worry wart. Thank you in advance for any guidance/reassurance from you.

  2. furball64801

    All I can tell you is that millions upon millions take met with 0 issues. You are reading the absolute worst side affects. Have you see tv commericails on meds that is any meds. They say could cause heart attack, fatigue, even death no kidding. I been on met and so has my diabetic family and 0 issues other than a tad of diahrea. To me its extemely rare many here are on met me a very very long time on it. What am I saying to me its about the best D med out there other than exercise its free. It is just my opion for what its worth, I know others might have other ideas and of course its is there opinion also. Some take b-12 if they get fatigued on met, I do not get that way, all I can say is to me its as safe as can be.

  3. coravh

    Every drug has potential side effects. Some more common than others. I'm not sure of the exact specifics, but I believe that for a side effect to be listed, it needs to happen in 1% of the people that take it.
    My husband has been on met with no side effects other than a little bit of tummy trouble. I have a dozen local diabetic friends (through volunteer work) that are also on it, and have no side effects. I do have one friend who reacts to everything and has no issues with it. I think i've only seen people with this issue a couple of times after about 15 years online haunting a variety of message boards.
    Take for example my warfarin. It can cause bleeding. Even a baby aspirin can cause this. And it does happen to some people. But the vast majority of folks don't have issues.
    Do you have some history of lactic acidosis? Or is this simply general anxiety over something new?
    All meds are a cost benefit analysis. Do you want to try the drug to alleviate a serious issue ( like high blood sugar) or do you decide to refuse it on the basis of a rare side effect and maybe get into trouble due to glucose issues? Why not try it? Discuss with your phamacist what to look for if you are worried. But basically it is a safe, effective drug.
    Cora

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https://www.facebook.com/drinkhealthy... - Do you want to learn how to get rid of lactic acid as an athlete, and start recovering quicker with more energy? Learn how to reduce lactic acid symptoms and increase your performance. Getting rid of lactic acid may be easier than you have imagined. Many professional athletes know the importance of eliminating lactic acid so they can recover quicker and perform at an optimal level. Start flushing out that lactic acid today! Many people suffer from lactic acidosis symptoms and are rigorously searching for a lactic acid treatment. More and more athletes are searching for solutions on how to get rid of lactic acid. In this video you will learn what a professional football player from the Seattle Seahawks is using to eliminate lactic acid after his workouts, practices, and NFL games. Learn how to make lactic acid a symptom of the past. Begin your journey to faster recovery today. See what the pro's are using to reduce lactic acid, recover quicker, and have more energy. Uncertain of what lactic is? Here is the definition https://en.wikipedia.org/wiki/Lactic_... Contact me for more information on getting rid of lactic acid FB: http://www.facebook.com/duncan.fraser... IG: http://www.instagram.com/kangendunc [email protected] See a full demonstration of this solution that helps get rid of lactic acid https://www.youtube.com/watch?v=MTxR9... Duncan Fraser 0:00 - 0:13 - Introduction 0:14 - 2:11 - Shan Stratton and Michael Robinson Discuss how to get rid of lactic acid 2:11 - 2:21 - 4 benefits of this incredible technology 2:21 - 2:39 - Conclusion Get in contact with me if you have problems with lactic acid and learn more on my FB page. Visit my Facebook page below. https://www.facebook.com/drinkhealthy...

Lactic Acidosis

The buildup of lactic acid in the bloodstream. This medical emergency most commonly results from oxygen deprivation in the body’s tissues, impaired liver function, respiratory failure, or cardiovascular disease. It can also be caused by a class of oral diabetes drugs called biguanides, which includes metformin (brand name Glucophage). Another biguanide called phenformin was pulled from the market in the United States in 1977 because of an unacceptably high rate of lactic acidosis associated with its use. Concerns about lactic acidosis also delayed the introduction of metformin to the U.S. market until 1995, despite the fact that it had been widely used for years in other countries. There have been reports of lactic acidosis occurring in people taking metformin, and the U.S. Food and Drug Administration estimates that lactic acidosis occurs in 5 out of every 100,000 people who use metformin for any length of time. However, this risk is much lower than it was in people taking phenformin, and it is not clear whether the episodes of lactic acidosis associated with metformin have actually been due to metformin use. In fact, the lactic acidosis could have been explained by the person Continue reading >>

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  1. lorrained8

    Metformin and lactic acidosis

    Has anyone here had lactic acidosis because of taking metformin
    I have leg and muscular pain I feel tired and weak
    I've discontinued my met er
    I will talk to my dr tomorrow

  2. Sweetpoison

    Originally Posted by lorrained8
    I have leg and muscular pain I feel tired and weak
    I have leg pain and bad night cramps but I had that occasionally before I even started Met. I am sorry, Lorraine, this is happening to you!
    How long have you been on the Met ER before you realized this?

  3. Lynnw

    Originally Posted by lorrained8
    Has anyone here had lactic acidosis because of taking metformin
    I have leg and muscular pain I feel tired and weak
    I've discontinued my met er
    I will talk to my dr tomorrow Are you on any other medications that could cause that? How long have you been on the Metformin? Metformin made me incredibly fatigued, to the point where I couldn't do anything but drag myself from my bed to my chair (I'm normally a very active person). I never figured out if that was lactic acidosis, Vit B-12 deficiency (which Metformin can cause), or something else. Others have had the same experience.

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Have you ever stopped and asked yourself why would someone recommend a medication that would potentially harm you? Watch this video to educate yourself about the potential side effects of popular diabetes drug Metformin and natural alternatives available to you.

Metformin-associated Lactic Acidosis

OVERVIEW metformin use is associated with lactic acidosis, but it remians controversial as a disease entity MECHANISM the mechanism of lactic acidosis is uncertain Metabolic effects of metformin include: decreased gluconeogenesis increased peripheral glucose uptake decreased fatty acid oxidation CLINICAL FEATURES presence of risk factors abdominal pain nausea and vomiting fatigue myalgias altered mental status myocardial insufficiency multi-organ failure RISK FACTORS advanced age high dose renal failure (metformin is excreted unchanged in the urine) hypoxia active alcohol intake sepsis dehydration shock acidosis INVESTIGATIONS high anion gap metabolic acidosis (HAGMA) high lactate MANAGEMENT rule out other causes of lactic acidosis (sepsis, cardiogenic shock, hypoperfusion, ischaemic bowel) withdrawal of metformin RRT RRT remove metformin and correct acidosis best performed early due to large volume of distribution of metformin use hemodialysis use HCO3 buffer CONTROVERSY Some argue that metformin itself does not cause lactic acidosis, that it is actually due to the underlying conditions such as renal failure and diabetes mellitus. However, there are definite cases of lactic acidos Continue reading >>

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Popular Questions

  1. 2blessed4stress

    metformin and lactic acidosis

    I am hoping that I can get some guidance from the members here. There are many of you that have a wealth of information on diabetes and things related so please bear with me. I went to the doctor yesterday and finally asked her for metformin er and was all set to try it out. Then I read the paper that came with it from the pharmacy. The warning about lactic acidosis stopped me in my tracks. Now I am afraid to take it. I searched the posts her a DD about lactic acidosis and I also found that some members said it caused them to be really fatigued. Another member posted that she had trouble with exercise because it caused leg cramps. I feel so overwhelmed now. I really wanted to try it out I believe it could help me but I don't want to put my life at risk to try it. I looked up lactic acidosis and I was reading about the bloods ph and acid in your blood. I have a problem with uric acid in my blood but I believe that is not related to lactic acidosis. I have had a problem with kidney infections and a lot of crystals in my urine and kidney stones the past year, but I believe my kidney function is ok. Does metformin cause lactic acidosis very often? Are the symptoms of lactic acidosis easy enough to pick up on so it can be caught early. I am sorry I am such a worry wart. Thank you in advance for any guidance/reassurance from you.

  2. furball64801

    All I can tell you is that millions upon millions take met with 0 issues. You are reading the absolute worst side affects. Have you see tv commericails on meds that is any meds. They say could cause heart attack, fatigue, even death no kidding. I been on met and so has my diabetic family and 0 issues other than a tad of diahrea. To me its extemely rare many here are on met me a very very long time on it. What am I saying to me its about the best D med out there other than exercise its free. It is just my opion for what its worth, I know others might have other ideas and of course its is there opinion also. Some take b-12 if they get fatigued on met, I do not get that way, all I can say is to me its as safe as can be.

  3. coravh

    Every drug has potential side effects. Some more common than others. I'm not sure of the exact specifics, but I believe that for a side effect to be listed, it needs to happen in 1% of the people that take it.
    My husband has been on met with no side effects other than a little bit of tummy trouble. I have a dozen local diabetic friends (through volunteer work) that are also on it, and have no side effects. I do have one friend who reacts to everything and has no issues with it. I think i've only seen people with this issue a couple of times after about 15 years online haunting a variety of message boards.
    Take for example my warfarin. It can cause bleeding. Even a baby aspirin can cause this. And it does happen to some people. But the vast majority of folks don't have issues.
    Do you have some history of lactic acidosis? Or is this simply general anxiety over something new?
    All meds are a cost benefit analysis. Do you want to try the drug to alleviate a serious issue ( like high blood sugar) or do you decide to refuse it on the basis of a rare side effect and maybe get into trouble due to glucose issues? Why not try it? Discuss with your phamacist what to look for if you are worried. But basically it is a safe, effective drug.
    Cora

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