Metformin

• Metformin may be used to treat Type 2 diabetes. It increases the ability of cells to uptake glucose by improving their sensitivity to insulin. It also decreases the amount of glucose made by the liver and decreases the absorption of glucose from the intestine.  Metformin belongs to the class of drugs known as biguanides.
• Metformin is the preferred therapy for people with Type 2 diabetes without any contraindications. It may be used in combination with other medications for Type 2 diabetes.
• Metformin rarely produces hypoglycemia (low blood sugar levels).
• Metformin does not change how much insulin is secreted and it does not cause hyperinsulinemia (high insulin levels). Fasting insulin levels and the base-line insulin response may actually decrease.
• Take with a meal to reduce the risk of stomach upset. Once-daily dosages should be taken with the evening meal.
• Splitting dosages throughout the day (rather than taking a single dose) may improve gastric side effects such as nausea, diarrhea, and indigestion.
• The peak effects of metformin are seen within 2-3 hours for immediate-release forms or 4 to 8 hours with slow-release forms. May take up to 2 weeks of regular dosing for the maximum effects of metformin to develop.

Common medications that may interact with metformin include:

• antidepressants such as SSRIs (eg, fluoxetine, sertraline), monoamine oxidase inhibitors (MAOI) such as selegiline, isocarboxazid, and phenelzine
• aspirin and other salicylates

Administer immediate-release tablets 2 or 3 times daily. Administer in 2 divided doses if total dosage ≤2 g daily or in 3 divided doses if total dosage is >2 g daily.

Increase daily dosage in increments of 500 mg at weekly intervals to a maximum of 2 g daily given in divided doses.

Immediate-release tablets or oral solution: Initially, 500 mg twice daily or 850 mg once daily with meals.1 257 Increase daily dosage by 500 mg at weekly intervals or by 850 mg at biweekly (every 2 week) intervals up to a maximum of 2 g daily given in divided doses.

May increase dosage from 500 mg twice daily to 850 mg twice daily after 2 weeks.

Clinically important responses generally not observed at dosages <1.5 g daily.

For additional glycemic control, increase dosage (as immediate-release tablets or oral solution) up to a maximum daily dosage of 2.55 g given in divided doses.1 257

Patients with inadequate glycemic control on either a sulfonylurea or metformin alone: Initially, 500 mg of metformin hydrochloride and 2.5 or 5 mg of glipizide twice daily with the morning and evening meals.

 Initial dosage of the fixed combination should not exceed the patient's current daily dosage of metformin hydrochloride or glipizide (or equivalent dosage of another sulfonylurea).

Titrate daily dosage in increments not exceeding 500 mg of metformin hydrochloride and 5 mg of glipizide until adequate glycemic control achieved or maximum daily dosage of 2 g of metformin hydrochloride and 20 mg of glipizide is reached.

Metformin and Vitamin B-12

Vitamin B-12 is a nutrient your body absorbs from food. Clams and beef liver have the highest concentrations of it, but if those aren’t on the menu, you can also get B-12 from fish, meat, poultry, milk, and eggs.

Most people get all the B-12 they need from food, but those who take metformin are at a greater risk of B-12 deficiency.

One study found that over the course of 4 years, metformin reduced people’s B-12 levels by 19 percent. Other studies have found reductions of up to 52 percent.

A B-12 deficiency can cause tiredness, weakness, or a loss of appetite. If left untreated, it can lead to nervous system damage.

What is “moderate” drinking?

For women, moderation is defined as no more than one drink per day. For men, it’s no more than two drinks per day. It’s important to monitor your glucose levels before you drink, while you drink, before bed, and 24 hours later. Alcohol can lower your blood sugar level for up to 24 hours after your first drink. Low blood sugar can make you feel lethargic, so don’t plan on doing anything other than Netflix and chilling after a night of drinking.

You can drink alcohol while taking metformin, but there are side effects. Metformin and alcohol can both lower your blood sugar, putting you at risk for hypoglycemia and life-threatening lactic acidosis.

If your blood sugar levels are very unstable, it’s probably best to hold off on drinking until you get them under control.

Be sure to talk to your doctor about the risks and interactions of any medications you’re taking. While you’re at it, have your B-12 levels checked, since both metformin and alcohol reduce them.

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