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What are the three major Hazards of Metformin can be fatal if you ignore any of these?
Metformin is the first-line medication recommended in the guidelines for the prevention and treatment of type 2 diabetes. Not only can it improve insulin resistance and lower blood sugar, it can also prevent macrovascular and microvascular disease caused by diabetes, improve blood lipid metabolism, and reduce the chance of cardiovascular complications. Most people with diabetes need to take it for a long time. However, there are three issues that Metformin must pay attention to, otherwise it may cause harm or even threaten life at any time.
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The 3 Issues are:
1. Long-term use of metformin will cause the loss of Vitamin B12 and accelerate the occurrence of diabetic neuropathy
Vitamin B12 is an important substance that maintains the normal state of the body's hematopoietic function and can effectively prevent pernicious anemia.
It can also exist in the form of coenzymes to regulate sugar metabolism. At the same time, it is also an essential vitamin for the nervous system.
For diabetics, the lack of vitamin B12 will not only affect
the regulation of blood sugar, but also accelerate neuropathy and cause a
variety of diabetic complications early. For example, diabetic peripheral
neuropathy (lower limb numbness, pain, itching, etc.), diabetic cardiovascular
disease (painless myocardial ischemia, painless myocardial infarction, etc.),
diabetic foot (old rotten foot), etc.
Therefore, patients taking Metformin for a long time should add vitamin B12 appropriately.
Vitamin B12 is abundant in meat, animal liver, fish, shellfish and eggs.
2. Very few patients taking metformin will induce Lactic Acidosis
Lactic acidosis is a very rare but very dangerous complication of diabetic patients.
The clinical manifestations are vomiting, abdominal pain, and mental disorder. Once it occurs, the mortality rate is as high as 50%.
Lactic acid is a substance produced when glucose is
metabolized under anaerobic conditions in cells. Under normal circumstances,
most of the lactic acid can be converted into glucose again by the liver's
xenobiosis, providing energy for the human body.
A small amount of lactic acid can be excreted by the kidney through metabolism.
Metformin itself has the
effect of inhibiting gluconeogenesis to glucose. It will cause the increase of
lactic acid content in the body.
If the patient has a serious loss of kidney function and lactic acid is difficult to metabolize through urination. It will accumulate too much in the human body and cause lactic acidosis. Therefore, patients with severe liver and kidney dysfunction are clinically prohibited from using metformin to prevent lactic acidosis.
3. Taking Metformin under three circumstances can easily cause Hypoglycemia
Metformin itself does not cause hypoglycemia, but it can induce hypoglycemia in three situations, causing the patient's life to be dangerous.
1) After a lot of exercise, did not add enough calories in time;
2) Combination with sulfonylurea drugs or insulin may cause hypoglycemia;
3) After drinking alcohol, alcohol can stimulate insulin secretion, and it will reach a peak in 2-3 hours, which is the same as the peak period of the effect of hypoglycemic drugs.
The two peaks are superimposed, which can easily cause hypoglycemia coma. This situation is often most easily overlooked by patients, and should be paid more attention to.
Although there may be the above risks, a large number of studies have shown that metformin is generally well tolerated, has high safety, and does not damage the liver and kidneys.
It is still the drug of choice for diabetes control worldwide.
Patients should be taken reasonably under the guidance of a doctor to obtain better treatment results.
There are 7 special effects of metformin that diabetic people often face
At the end of 2019, the American Diabetes Association (ADA) released the Diabetes Diagnosis and Treatment Guidelines 2020, and jointly released the updated version of the Consensus 2019 for Type 2 Diabetes Hyperglycemia Management with the European Diabetes Research Society (EASD). Metformin, as a first-line medication, is recommended if there are no contraindications or intolerance, metformin should be preferred. Prior to this, due to the excellent performance of some new drugs in experimental studies, there was a tendency to replace metformin as the first choice.
It now appears that metformin is still the drug of choice.
Crucial Effects of Metformin on Diabetic people
Many doctors and patients have concerns when using metformin, especially after seeing a lot of contraindications listed in the instructions. In fact, in many special cases, metformin can still be used.
1. Senior
If there is no kidney disease, even if there is a physiological decline in renal function in elderly patients, it is safe to take metformin, and the low risk of hypoglycemia is particularly valuable for elderly patients.
Older patients only need to monitor kidney function regularly (once every 3 to 6 months), and they need to stop metformin when severe renal insufficiency occurs.
2. Young age
Many children and adolescents are now suffering from type 2 diabetes.
If simple lifestyle interventions are ineffective and blood glucose
levels do not need to start insulin therapy, children 10 years of age and older
may consider using metformin, which is currently not recommended for children
under 10 years of age.
3. Heart failure
Heart failure can cause tissue hypoxia, and the use of
metformin may be a potential risk. In fact, metformin itself does not cause or
exacerbate heart failure.
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| Adjust Metformin per the diabetes Risk |
On the contrary, it may be related to the reduced risk of heart failure and death in patients with diabetes. Therefore, metformin can be used in patients with stable heart failure, but only for patients with acute and unstable heart failure.
4. Liver disease
Metformin is not metabolized by the liver and has no liver
toxicity. Studies have also shown that metformin is beneficial for the
treatment of liver diseases, especially in the presence of insulin resistance
and inflammation.
However, when the liver function is seriously impaired, the body's ability to clear lactic acid decreases significantly, so it is recommended that patients with serum transaminase exceeding 3 times the upper limit of normal or with severe liver dysfunction should avoid using metformin.
5. Nephropathy
Metformin itself has no damage to the kidneys, and more studies have shown that metformin may have kidney protective effects. However, in order to avoid lactic acidosis, it is recommended that metformin need to be reduced when the renal function is mild-moderately decreased G3a phase, and metformin is disabled when the renal function is moderately-severely decreased (G3b phase) or worse.
The ADA guidelines are broader, and it is considered safe to use metformin in the G3b phase.
6. Anemia
Although studies have shown that long-term use of metformin can cause vitamin B12 to decline, there are also studies that have found that metformin can improve vitamin B12 metabolism in cells. Therefore, long-term use of metformin does not require routine supplementation of vitamin B12.
Vitamin B12 levels can be measured once a year, if lack of replenishment, even anemia patients do not have to refuse metformin for this reason.
7. Gastroenterology
Studies have shown that gastrointestinal reactions caused by
metformin mostly appear in the early stage of treatment (the vast majority
occur in the first 10 weeks), and most patients can gradually tolerate or
disappear as the treatment time prolongs.
Recent domestic studies also found
that the incidence of gastrointestinal adverse events did not increase with
dose.
Therefore, patients with gastrointestinal diseases can also try to start with small doses and gradually increase the dosage, as well as choose enteric-coated capsules (such as Junlida), sustained release and other dosage forms to reduce gastrointestinal adverse reactions.
Author's Bio
Education: MBBS, MD
Occupation: Medical Doctor
Specialization: Community Medicine, General Surgery, Natural Treatment
Experience: 18 Years as a Medical Practitioner
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