Doctors typically prescribe metformin for long-term treatment of diabetes (and, in some cases, conditions like PCOS). If you or a loved one have been placed on this medication, you may be wondering whether it’s effective. This article provides clarity on how to know when metformin is working and when it’s not.
Metformin (Glucophage) is an antidiabetic medication, which belongs to the Biguanide class, used mainly for managing type 2 diabetes. According to the American Diabetes Association (ADA), it has been chosen as the first-line drug for the treatment of type 2 diabetes in adults and also in children above the age of 10. Metformin is also used in the management of polycystic ovary syndrome (PCOS).
Metformin reduces blood sugar (glucose) levels by improving the responsiveness of surrounding tissues to insulin (a hormone that enables body cells to utilize glucose for energy), leading to a decrease in circulating insulin levels.
Additionally, this drug suppresses glucose production by the liver while simultaneously promoting glucose uptake by peripheral tissues, thereby leaving less glucose in the blood.
The importance of metformin in PCOS lies in its ability to lower insulin levels, which results in reduced levels of luteinizing hormone and androgen. Normalizing these hormones aids in the regulation of the menstrual cycle in women.
Even though metformin is not a medication that was primarily designed to be used for weight loss, neither has it been approved for weight loss officially, studies have indicated it is effective in weight reduction. Some studies have shown that it is a favorable weight-loss option for people who are overweight and have an increased risk of developing diabetes.
Below are signs and symptoms that indicate metformin is working.
Signs that metformin is working for PCOS include:
Some other signs that metformin is working for PCOS include a reduced risk of heart disease, low cholesterol levels, low insulin and blood sugar levels, and improved fertility.
Signs that metformin is working for diabetes include:
Snacking regularly at night is not ideal for people with diabetes. But, if you must snack at night, choose healthier options like boiled eggs, oats and unsalted nuts.
Metformin usually begins to exert its effects within approximately 3 hours after administration, although the exact timing may vary among individuals.
Metformin's effects persist due to its relatively long half-life of about 20 hours; this allows for sustained regulation of blood sugar levels. The half-life represents the time it takes for half of the drug to be eliminated from the body.
For some people, despite adherence to treatment and lifestyle modifications, metformin may not be the ideal treatment for them and, in such cases, may not effectively manage their condition.
There are several signs that metformin may not be effectively managing a patient's condition, including:
Many people take matters concerning their health into their own hands, and this often leads to adverse consequences. If you find out that your metformin is no longer working for you, you might want to increase the dosage yourself, but you should not do that.
The first thing you should do upon finding out that metformin is not working is to consult your healthcare professional, either a doctor or a pharmacist. The professional may adjust your dose, conduct laboratory tests to determine if there are any problems, or suggest alternative treatments. Also, ensure that you modify your lifestyle to maximize treatment outcomes.
To maximize the benefits of metformin and improve its effectiveness, consider the tips below:
As a result of some side effects of metformin and also the fact that it may not be ideal for patients with kidney and liver problems, doctors may sometimes need to prescribe alternative medications to their patients.
Other alternatives to metformin for the treatment of diabetes, PCOS, and weight loss include:
Sodium-glucose co-transporter 2 inhibitors are medications used to treat high levels of blood glucose in type 2 diabetes. They block glucose and sodium reabsorption in the kidneys.
SGLT-2 inhibitors such as empagliflozin, canagliflozin, and dapagliflozin have been proven to be alternatives to metformin in effectively managing diabetes, PCOS, and its associated obesity.
Glucagon-like peptide-1 receptor agonists are antidiabetic agents that make the muscles and liver more sensitive to insulin sensitivity by directly blocking the infiltration of macrophages, thereby inhibiting inflammation. These are also alternatives to metformin. An example is liraglutide.
Dipeptidyl peptidase-4 inhibitors, commonly referred to as gliptins, are the second or third drug of choice after metformin. They block DPP-4, the enzyme that breaks down GLP-1 (Glucagon-like peptide-1).
Sitagliptin, an example of DPP-4 inhibitors, has been proven to be an alternative for PCOS patients who are intolerant to metformin.
Acarbose slows down the breakdown of food into glucose in the body, helping to prevent blood sugar levels from spiking after meals. It is usually used alone or with other medications and a proper diet to manage type 2 diabetes.
It has been found that acarbose leads to a reduction of about 3 kg/m2 in BMI in PCOS patients, hence a good alternative to metformin.
If you experience inadequate results or adverse effects from metformin, it is essential to consult your healthcare provider promptly. Your doctor can assess your situation, evaluate treatment effectiveness, and recommend appropriate adjustments or alternative treatment strategies based on your specific needs and medical history.
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