METFORMIN. What do you need to know?

What is type 2 diabetes?

People with diabetes are not able to make enough insulin and/or respond normally to the insulin their body does make. When this happens, sugar (glucose) builds up in the blood. This can lead to serious medical problems including kidney damage, amputations and blindness. Diabetes is also closely linked to heart disease. The main goal of treating diabetes is to lower the level of your blood sugar as close to normal as possible.

How is type 2 diabetes usually controlled?

High blood sugar can be lowered by diet and exercise, by a number of oral medications and by insulin injections. Before taking biguanidas (metformin hydrochloride tablets) you should first try to control your diabetes by exercise and weight loss. Even if you are taking biguanidas, you should still exercise and follow the diet recommended for your diabetes.

Does Metformin work differently from other glucose-control medications?

Yes it does. Until Metformin was introduced, al¡ the available oral glucose-control medications were from the same chemical group called sulfonylureas. These drugs lower blood sugar primarily by causing more of the body's own insulin to be released. Metformin lowers the amount of sugar in your blood by helping your body respond better to its own insulin. Metformin (metformin hydrochloride tablets) does not cause your body to produce more insulin. Therefore, Metformin rarely causes hypoglycemia (low blood sugar) and it doesn't usually cause weight gain.

What happens if my blood sugar is still too high?

When blood sugar cannot be lowered enough by either Metformin or a sulfonylurea, the two medications may be effective taken together. However, if you are unable to maintain your blood sugar with diet, exercise and glucose-control medication taken orally, then your doctor may prescribe injectable insulin to control your diabetes.

Can Metformin cause side effects?

Metformin, Iike all blood-sugar lowering medications, can cause side effects in some patients. Most of these side effects are minor and will go away after you've taken Metformin for a while. However, there are also serious, but rare side effects related to Metformin.

What kind of side effects can Metformin cause?

If side effects occur, they usually occur during the first few weeks of therapy. They are normally minor ones such as diarrhea, nausea and upset stomach. Taking your Metformin with meals can help reduce these side effects. Although these side effects are likely to go away, call your doctor if you have severe discomfort or if these effects last for more than a few weeks. Some patients may need to have their dose lowered or stop taking Metformin (metformin hydrochloride tablets), either temporarily or permanently. Although these problems occur in up to one-third of patients when they first start taking Metformin, you should tell your doctor if the problems come back or start later on during the therapy.

About three out of one hundred people report having a temporary unpleasant or metallic taste when they start taking Metformin.

Are there any serious side effects that Metformin can cause?

Metformin rarely causes serious side effects. The most serious side effect that Metformin can cause is called lactic acidosis.

What is lactic acidosis and can it happen to me?

Lactic acidosis is caused by a buildup of lactic acid in the blood. Lactic acidosis associated with Metformin (metformin hydrochloride tablets) is rare and has occurred mostly in people whose kidneys were not working normally. Lactic acidosis has been reported in about one in 33,000 patients taking Metformin over the course of a year. Although rare, if lactic acidosis does occur, it can be fatal in up to half the cases. It's also important for your ¡¡ver to be working normally when you take Metformin. Your liver helps remove lactic acid from your bloodstream. Your doctor will monitor your diabetes and may perform blood tests on you from time to time to make sure your kidneys and your liver are functioning normally.

Are there other risk factors for lactic acidosis?

Your risk of developing lactic acidosis from taking Metformin (metformin hydrochloride tablets) is very low as long as your kidneys and liver are healthy. However, some factors can increase your risk because they can affect kidney and liver function.

You should not take Metformin if:

• You have chronic kidney or liver problems.
• You drink alcohol excessively (all the time or short-term "binge" drinking).
• You are seriously dehydrated (have lost a large amount of body fluids).
• You are going to have certain x-ray procedures with injectable contrast agents.
• You are going to have surger.
• You develop a serious condition such as a heart attack, severe infection, or a stroke.

What are the symptoms of lactic acidosis?

Some of the symptoms include: feeling very weak, tired or uncomfortable; unusual muscle pain, trouble breathing, unusual or unexpected stomach discomfort, feeling cold, feeling dizzy or lightheaded, or suddenly developing a slow or irregular heartbeat.

If you notice these symptoms or if your medical condition has suddenly changed, stop taking Metformin (metformin hydrochloride tablets) and cal¡ your doctor right away. Lactic acidosis is a medical emergency that must be treated in a hospital.

What does my doctor need to known to decrease my risk of lactic acidosis?

Tell your doctor if you have an illness that results in severe vomiting, diarrhea and/or fever, or if your intake of fluids is significantly reduced. These situations can lead to severe dehydration, and it May be necessary to stop taking Metformin (metformin hydrochloride tablets) temporarily.

You should let your doctor know if you are going to have any surgery or specialized x-ray procedures that require injection of contrast agents. Metformin therapy will need to be stopped temporarily in such instances.

Can I take Metformin with other medications?

Remind your doctor that you are taking Metformin when any new drug is prescribed or a change is made in how you take a drug already prescribed.
Metformin (metformin hydrochloride tablets) may interfere with the way some drugs work and some drugs may interfere with the action of Metformin.

What if I become pregnant while taking Metformin?

TeII your doctor if you plan to become pregnant or have become pregnant. As with other oral glucose-control medications, you should not take Metformin during pregnancy.

Usually your doctor will prescribe insulin while you are pregnant. As with all medications, you and your doctor should discuss the use of Metformin if you are nursing a child.

How do I take Metformin?

Your doctor will te¡¡ you how Metformin tablets to take and often. This should also be printed on the label of your prescription.You will probably be started on a low dose of Metformin and your dosage will be increased gradually until your blood sugar is controlled.
Ramiro Antuña de Alaiz
Educational Treatment Unit
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