Let's learn about Metformin, which is used for diabetes? (Biguanides)

When your doctor tells you that you have diabetes, the first medication you will probably be prescribed is Metformin. This is a very popular and safe medication for diabetes, not only in Sri Lanka, but all over the world. However, it is normal for all of us to have a few questions and a little fear when starting a new medication. You may also be wondering things like, "What will happen with this?", "Is this good for the body?", "Are there any side effects?" Don't worry, today we will talk about this class of medication called Metformin, that is, Biguanides, in a very simple way that you can understand.

Simply put, what are these Biguanides?

Biguanides are a class of medications used to control diabetes. They are taken in pill form. They are mainly used to treat people with Type 2 Diabetes . The main function of these medications is to lower and control the level of sugar, or glucose, in your blood.

Now you may be thinking, "Are there many drugs in the Biguanides group?" Not really. Currently, in most countries of the world, including Sri Lanka, there is only one drug under this group. That is the Metformin that we all know. However, you may see the drug Metformin under different brand names. For example:

• Glucophage®
• Glucophage XR®
• Glumetza®
• Fortamet®
• Riomet®

No matter what name it has, the active ingredient inside is the same, which is Metformin.

Is metformin only given for diabetes?

Metformin is primarily approved for type 2 diabetes. In fact, it is considered a first-line therapy for that. That is, it is the first drug that a doctor will start with as soon as diabetes is diagnosed.

However, doctors are prescribing this drug for several other conditions, not just diabetes. We call this "off-label" use. That is, doctors are prescribing the drug for other conditions besides the one for which it is officially approved, because of its effectiveness.

In addition, researchers are now investigating whether metformin has anti-cancer properties. Some studies have shown that people who take metformin for diabetes have a reduced risk of developing cancer. However, these are still in the research stage.

How does this Metformin pill actually work inside our body?

This is a very important question. There are two main ways this medicine works. Let's understand it with a simple example.

Imagine that you have a big factory inside your body that makes sugar (glucose). That's your liver . In a person with diabetes, this factory is overworked, constantly pumping sugar into the blood.

1. Reducing sugar production by the liver: The first thing that Metformin does is to reduce the production of sugar in the sugar factory (the liver). In other words, this medicine controls the unnecessary addition of sugar to the blood from the liver.

2. Muscles become more sensitive to insulin: The second thing is to help the hormone insulin in our body work properly. Insulin is like a key to the doors of our body's cells. This key opens the door so that the sugar in the blood can enter the cells and create energy. People with diabetes have a hard time opening this key. We call it insulin resistance . Metformin makes the doors of cells like muscles more sensitive to this key (insulin). Then the sugar in the blood can easily enter the cells and become energy. Then the blood sugar level decreases.

In women with PCOS, Metformin lowers insulin levels, which in turn reduces levels of hormones like androgens, helping to restore regular menstrual cycles.

What are the benefits of this medicine?

Metformin is a very effective medicine.

• Lowering A1C levels: For someone with diabetes, metformin can lower their A1C level (a test that shows average blood sugar levels over the past 2-3 months) by about 1%. This is a major breakthrough in diabetes management.
• Preventing diabetes: Studies have shown that this medicine can help delay or completely prevent the development of full-blown diabetes in people with prediabetes.
• Reducing the risk of heart disease: Some studies have shown that metformin can also reduce the risk of cardiovascular disease.

The most important thing is that since this medication is a lifelong condition, it is essential to stay in touch with your doctor and take your medication and lifestyle changes (diet, exercise) as directed. Medication alone cannot control diabetes.

Let's also be aware of side effects and risks.

Like any medicine, Metformin can cause some side effects. But most of these are not serious and not everyone gets them.

Common side effects

These may occur in the first few days or weeks after starting the medication. They usually go away over time as the body adjusts to the medication.

• Stomach upset: Bloating, nausea, vomiting, and especially diarrhea are the most common side effects. This condition can occur in about 30% of people taking metformin.
• Taking the medicine after meals: The best way to reduce stomach discomfort like this is to take the medicine with a meal or immediately after a meal. Do not take it on an empty stomach.

Rare side effects

• Chest discomfort
• Headache
• Excessive sweating (diaphoresis)
• Low blood sugar (hypoglycemia) - (This is very rare with metformin alone, but can happen when taken with other diabetes medications)
• Weakness

If these persist or if you are experiencing discomfort, talk to your doctor.

Risks that require special attention

Metformin is generally a very safe medication, but it is important to be aware of some serious complications that can occur very rarely.

1. Vitamin B12 Deficiency

When you take Metformin for a long time, your body may absorb vitamin B12 a little less. Therefore, your doctor may check your vitamin B12 levels, especially if you have anemia or peripheral neuropathy. If necessary, he or she may recommend taking a vitamin B12 supplement.

2. Lactic Acidosis

Lactic acidosis is a condition in which the body builds up too much lactic acid, which causes the blood to become too acidic. This condition affects about 1 in 30,000 people taking metformin. This is very rare. However, it can be life-threatening, so it's important to be aware of the symptoms.

People at higher risk of developing lactic acidosis:

• People with kidney or liver disease
• People over 65 years of age
• People who have recently undergone surgery
• People with hypoxia (lack of oxygen in the body)
• People who drink alcohol excessively

Your doctor will regularly check your kidney function when prescribing Metformin to account for this risk.

Symptoms of lactic acidosis:

If one or more of these symptoms suddenly occur, stop taking the medicine immediately and go to the nearest hospital emergency room (ETU).

• Extreme fatigue and weakness
• Nausea and vomiting
• Stomach ache
• Rapid or long, deep breathing

This condition can even lead to death if not treated quickly, so be aware of these symptoms.

3. Problems with other medications (Drug Interactions)

If you are taking metformin and are taking other medications for another condition, it is important to tell your doctor. Some medications can interact with metformin and increase the risk of lactic acidosis. Some medications can also cause low blood sugar (hypoglycemia). Be sure to tell your doctor about all the medications you are taking (including vitamins, supplements, and herbal remedies).

When should I see the doctor?

When taking metformin, you should go to the clinics at the scheduled times as prescribed by your doctor. That way, he or she can see if the medication is working, if the dosage needs to be changed, and if there are any side effects.

In addition, talk to your doctor in the following situations:

• If the side effects bother you or are difficult to tolerate.
• If you feel that your diabetes or PCOS condition is not being properly controlled by medication.
• If you feel you need to stop taking the medication for any reason, never stop taking the medication without consulting your doctor.

Metformin is a very safe and effective drug that has been used by millions of people around the world for decades, has been well-researched, and is well-tolerated. So don't be afraid to ask questions. Feel free to talk to your doctor about any questions or concerns you may have. He or she is always ready to help you.