Chances are, if you have Type 2 Diabetes, you've taken Metformin. All the major medical organizations recommend Metformin as the first medication to treat Type 2. There are a few reasons for this:
Metformin is REALLY Cheap. While most Type 2 Diabetes drugs can run $300-$800 or more per month, Metformin is almost always under $10-20 a month. If it's more expensive than that for you, here are a couple tips that might make it a little cheaper:
Metformin works in three ways:
Metformin is really safe for most people. In fact, because it's so safe and effective, I have doctor friend who jokes that he thinks metformin should be added to the municipal water supply. People who should avoid Metformin are people with severe kidney disease or metabolic acidosis (for which they would generally be hospitalized). So, not reasons that would prevent most of us from safely taking Metformin.
Besides effectively lowering blood sugar, many people lose weight and/or see an increase in their energy level. Remember the part above where I said that that it improves insulin resistance? And remember that insulin resistance causes sugar to move to fat storage instead of going to the muscle cells where it's used for energy? Well, Metformin helps redirect the sugar to where it's needed. Now your muscles are getting the energy they need and the sugar isn't going directly to fat storage. Win-Win, right?
Metformin is the most discontinued drug taken by people with Type 2 Diabetes. What's up with that? There are a lot of things the prescriber might not tell you about Metformin that can make your time with Metformin less-than-pleasant. It's not that they're trying to keep things a secret, it's more likely that they don't know that Metformin is a difficult drug to take or, if they do, they forget to mention it, what with all the other things they need to talk to you about in the 10 minutes you have together. So, let's cover some of the basics so you can have an easier time with Metformin and not become a "non-compliant" statistic.
The main reason people stop Metformin is the well-known GI Side Effects. That's the polite term for it. This can range anywhere from a little bit of gas and bloating to REALLY bad stomach cramps and disabling diarrhea. For most people, the severe side effects can be avoided with a few tweaks to the way Metformin is taken. Here are some things you can do to improve your chances of avoiding the nasty side effects (note that some of them require your prescriber to alter their prescription so you need to make sure they're on board):
A note about prescribers and Metformin: Many prescribers have NO IDEA how bad the side effects of Metformin can be. I've been at conferences where I've heard the lines "Some patients will stop taking their Metformin because they have a little bit of diarrhea. It's important that you stress the importance of continuing despite these bothersome side effects."
Um. Hello. Bothersome side effects? I've taken Metformin. When I took it, the side effects severely limited my life. I couldn't go for walks longer than a block because I knew there was a risk I wouldn't make it home in time. I didn't just have "a little bit of diarrhea." I pooped water multiple times per day, leaving me with headaches from dehydration. Based on my own anecdotal surveys of my own patients, I know that my experience isn't typical but it also isn't unusual. Most people who follow the tips above, tolerate Metformin just fine after a 1-2 week period of adjustment with each dose increase.
Metformin can cause B12 Deficiency in some people. You can talk to your healthcare provider about taking an over-the-counter B12 supplement. This is important to note because B12 Deficiency can cause peripheral neuropathy, which is also a complication of Diabetes. B12 neuropathy can be mistaken for Diabetic neuropathy. While this might not seem like a big deal, it is, because B12 neuropathy can be treated with B12 supplementation if caught early enough.
Metformin is probably the best and safest drug available for Type 2 Diabetes but is has some serious drawbacks due to potentially severe stomach side effects. I think it's absolutely worthwhile to try Metformin if it's recommended by your medical provider. It's worth the trouble of sticking it out through the side effects for a few weeks to see if you can make it work and continuing to titrate up to your prescriber's recommend dosage.
It's REALLY IMPORTANT to be open with your prescriber about side effects you have with Metformin or any other drug. I mentioned above that most providers have no idea how bad the side effects can be. I think this is because no one wants to talk about diarrhea. If you're pooping water, tell them that you're pooping water! If you can't go out to dinner because you might not make it through the drive home, tell them! Prescribers keep prescribing Metformin to people who keep not taking it because patients are embarrassed to talk about how bad the diarrhea is. My own patients have told me, "I'm having some stomach trouble" and would have left it there if I didn't prod more to find out how bad it was. Tell them! Severe diarrhea is serious, not a "bothersome side effect." If you're among the small percentage of people for whom Metformin really doesn't work despite trying the measures I listed above, your medical provider needs to know and they need to find an alternative. Metformin may be the first option, but it's not the only option.