Metformin also lowers risk factors for cardiovascular disease such as blood fats [13,14,15], body weight and blood pressure.
It is estimated that 20-25% of patients taking metformin have heart failure.
Metformin may positively influence the development and progression of atherosclerotic disease, and therefore of CAD-related HF, in people with or without T2DM, including subjects with type 1 diabetes [58]. Merely, the drug is able to correct some atherosclerotic risk factors.
Metformin may have an adverse effect on renal function in patients with type 2 DM and moderate CKD.
Recent studies have also found that metformin can reduce plaque formation in a high cholesterol diet-induced atherosclerotic Apolipoprotein E knockout (ApoE−/−) murine model [31].
Long-term side effects
Taking metformin can cause vitamin B12 deficiency if you take it for a long time. This can make you feel very tired, breathless and faint, so your doctor may check the vitamin B12 level in your blood. If your vitamin B12 levels become too low, vitamin B12 supplements will help.
have liver or kidney problems. have a severe infection. are being treated for heart failure or have recently had a heart attack. have severe problems with your circulation or breathing difficulties.
More serious side effects are rare. They include severe allergic reactions and a condition called lactic acidosis, a buildup of lactic acid in the bloodstream. The risk for this is higher among people with significant kidney disease, so doctors tend to avoid prescribing metformin for them.
Metformin is an oral medication used to treat type 2 diabetes that is generally well tolerated. GI upset, especially diarrhea, is the most common side effect. This typically decreases over time. Although rare, lactic acidosis, hypoglycemia, and vitamin B12 deficiency can occur.
An effective substitute for Metformin is a compound known as berberine or berberine hydrochloride, which is obtained from many plant species, including goldenseal, barberry, Oregon grape, and turmeric.
A lower prevalence of lipid plaque was observed in patients treated with metformin (66.2% vs. 77.9%, P=0.03).
Rare Side Effects of Metformin
Up to 12% of people on the regular formula had those side effects. They also reported flu-like symptoms, sweating, flushing, heart palpitations, rashes, and nail problems.
Metformin overdose associated with lactic acidosis presents with nonspecific symptoms and includes severe nausea, vomiting, diarrhea, epigastric pain, thirstiness, lost appetite, lethargy and hyperpnoea. Hypotension, hypothermia, acute renal failure, coma and cardiac arrest also represent significant clinical features.
Metformin associated lactic acidosis (MALA) was the most commonly reported adverse effect present in 224 (92.6%) patients. Most of the patients presented with gastrointestinal and neurological symptoms and a significant number of patients had severe metabolic acidosis and hyperlactatemia.
Metformin may protect against ischemic injury and significant cardiovascular stress, as demonstrated by improved mortality in the setting of coronary artery disease,9 congestive heart failure,10 acute kidney injury,11 chronic kidney disease,10 septic shock,12., 13.
As much as possible, avoid white bread, white rice, white pasta, candy, soda, desserts, and snacks like chips or crackers. Eating foods that can spike your blood sugar will not necessarily make the metformin not work, however, it will increase the burden it has to work against.
The current drug labeling strongly recommends against metformin use in some patients whose kidneys do not work normally because use of metformin in these patients can increase the risk of developing a serious and potentially deadly condition called lactic acidosis, in which too much lactic acid builds up in the blood.
Dosage and strength
The maximum daily dose is 2,000mg a day. This can be taken as four 500mg tablets a day. Liquid metformin should be taken in 5ml doses of 500mg, 850mg or 1,000mg.
The American Diabetes Association (ADA) also recommends metformin for some people with prediabetes. Generally, if you're prescribed metformin, you'll be on it long term. That could be many decades, unless you experience complications or changes to your health that require you to stop taking it.
Under certain conditions, too much metformin can cause lactic acidosis. The symptoms of lactic acidosis are severe and quick to appear, and usually occur when other health problems not related to the medicine are present and are very severe, such as a heart attack or kidney failure.
Metformin has a black box warning for lactic acidosis — a condition where too much lactic acid builds up in the blood. It's a serious problem and can lead to death. If you experience these symptoms, seek medical attention right away.
Most experts consider metformin to be the safest medicine for type 2 diabetes because it has been used for many decades, is effective, affordable, and safe. Metformin is recommended as a first-line treatment for type 2 diabetes by the American Diabetes Association (ADA).
GLP-1 receptor agonists are another option if Metformin isn't working for you. These can either be taken orally or through an injection (either once a day or once weekly). They are proven to lower blood sugar levels and HbA1c levels, as well as protect against kidney disease and heart disease as well.