From lacrossetribune.com
By Dr. Frank Bures
Metformin as a medicine for diabetes came up in a discussion with someone who recently found out that their test for blood sugar over three months, A1c, was just in the diabetic range. The doc suggested metformin as a medicinal treatment. But there was concern over the most common adverse effect of digestive upset, either or both ends. Not being completely familiar with the drug, I did what we always told our kids to do if they asked a question: look it up.
Metformin has become, worldwide, the preferred first-line oral blood glucose/sugar lowering agent to manage Type 2 diabetes mellitus. The word diabetes comes from Greek, meaning to walk or stand with legs apart. Mellitus means honey sweet. It was coined because the urine of diabetics has lots of sugar in it. Type 1 diabetes occurs when pancreatic cells don’t make enough insulin, which keeps blood glucose under control. Type 2 is when cells can’t utilize insulin correctly and sugar levels escalate.
Metformin’s history is linked to the plant French lilac or goat’s rue, a traditional herbal medicine in Europe, found to be rich in guanidine, which in 1918 was shown to lower blood sugar. Guanidine derivatives, including metformin, were synthesized, and some were used (not metformin) to treat diabetes in the 1920s and 1930s, but were discontinued because of toxicities and the increased availability of insulin.
Metformin was rediscovered in the search for antimalarial drugs in the 1940s. It proved useful to treat influenza, but it was found to lower blood sugar. This was pursued by the French physician Jean Sterne, who introduced it to treat diabetes in 1957. He proposed its brand name Glucophage because it “ate” glucose. It was less potent than other biguanide drugs, phenformin and buformin, which were discontinued in the 1970s due to a high risk of lactic acidosis, a serious fatal reaction. Metformin was late to be introduced into the U.S. in 1994-95 because of that biguanide chemical association.
Metformin is prescribed with diet and exercise, the toughest treatments to get many folks to use faithfully. It inhibits liver glucose production by about 1/3. It increases the insulin sensitivity of body tissues, which are called “insulin resistant” when sugar and insulin are both high. It also increases secretion of a protein called GDF15, which reduces appetite and caloric intake. It can foster some moderate weight loss, always helpful in overweight diabetics.
It can’t be given to everyone, especially those with compromised kidney function. When it is given with other antidiabetic meds, especially insulin, caution has to be taken not to make blood sugar too low, called hypoglycemia. Another pretty rare complication is the development of lactic acidosis, where too much lactic acid builds up. This produces a systemic acid metabolism, which is damaging to all tissues and seems to happen related to impaired liver or kidney function. There are several drug interactions. You and your doc duke that out.
It can be used in polycystic ovary syndrome, a complicated genetic condition with infertility and some insulin resistance. That’s too much to discuss now. Happily, it can be given during pregnancy with no real risk. Dosing and continued management is an entirely personal medical issue.
It has been studied to a degree in several other conditions including cardiovascular disease, cancers, premature puberty, aging (slowing it — good luck) and non-alcoholic fatty liver disease. Results are mixed in most cases.
If it can benefit your blood sugar in conjunction with other tools to decrease all the damage that diabetes can do, it is worth it, and at not too bad a cost. When you can get your blood sugar and A1c down, then you can say “how sweet it isn’t.”
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