Welcome to the Metformin Forum!
When considering or starting Met, there are always lots of questions. So to try and eliminate multiple postings asking the same thing, I have compiled a list of answers to the most FAQ's regarding Met on this forum, along with relevant links to the sources of the info.
Please keep in mind, that I am *not* a Dr, just a reading junkie and
no articles should replace the advice of your doctor. All questions about taking Metformin should be discussed with your prescribing physician.
Also, if you have any other FAQ that you'd like to see added, let me know. Hope it helps!
1. Why am I on a diabetic drug?
Met is an insulin regulator. A large number of PCOS women (although not all...we’ll discuss that later) have insulin resistance, where their bodies do not use the insulin their body produces efficiently. As a result, the body over-produces insulin to get their blood sugar down. So the diabetic drug Metformin/Glucophage works well with Insulin Resistant (IR) women because it opens the cell doors and helps your body use insulin more efficiently. There are other insulin regulating drugs such as Avandia & Actos, which are less prescribed, but effectively treat the same problem.
IR, hyper-androgenism and Metformin:
http://www.eje.org/eje/138/eje1380269.htm
Metformin therapy in polycystic ovary syndrome reduces hyperinsulinemia, insulin resistance, hyperandrogenemia, and systolic blood pressure, while facilitating normal menses and pregnancy:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=94231979&dopt=Citation
Effect of Long-Term Treatment with Metformin Added to Hypocaloric Diet on Body Composition, Fat Distribution, and Androgen and Insulin Levels in Abdominally Obese Women with and without the Polycystic Ovary Syndrome:
http://jcem.endojournals.org/cgi/content/abstract/85/8/2767 2. How does Met help IR?
As mentioned above, Metformin re-sensitizes the cells so that your body doesn’t have to crank out massive amounts of insulin to lower your blood sugar. That constant over-production of insulin can cause many health problems over the long-term:
a) Weight gain/obesity: Excess insulin is stored on the body as fat . And the nasty thing is, many women, until their insulin is under control, have a terrible time losing weight. That’s because enlarged fat cells make a hormone called TNF. If a woman has polycystic ovaries, insulin resistance and high levels of insulin in the blood, she puts on weight, she enlarges her fat cells. The fat cells then secrete this TNFߨormone, which acts on the muscles to stop the muscles being sensitive to insulin, makes the muscles more resistant to insulin, so the woman has to make more insulin, and then further stimulates her fat cells to get bigger. It’s nasty vicious cycle. So that’s why PCOS ladies are at higher risk for any weight-related health risks such as high blood pressure, high cholesterol, sleep apnea, stroke & heart disease.
IR, Obesity & Heart Attack risk:
http://www.ncbi.nlm.nih.gov/entrez/q...&dopt=Abstract
Study on Mice; Obesity-Induced insulin resistance:
http://www.nature.com/cgi-taf/DynaPa...89610a0_r.html
b) Diabetes: The over-production of insulin damages the pancreas. So much so, that your pancreas can quit working properly after time goes on, and this is why PCOS women have a higher risk for diabetes later on in life.
Diseases linked to IR and obesity:
http://www.diabetesincontrol.com/Pescatore/i148.shtml
c) Other hormone imbalances: Insulin is a significant hormone, so when it is out of whack, there can be all kinds of other hormonal imbalances that occur. Many IR women have infrequent periods, making conception difficult and increasing the risk of endometrial cancer.
Endometrial cancer and PCOS:
http://www.medscape.com/viewarticle/410791_3
Additonal reading: See IR, hyper-androgenism and Met article above.
How does Met Affect Insulin Resistance:
http://www.medscape.com/viewarticle/...gimMwwOm2TD0FW|-7825318128910303436/184161394/6/7001/7001/7002/7002/7001/-1
Met hampers progression to IR in teens:
http://www.lef.org/newsarchive/disea...704645857.html 3. What If I'm not IR or obese. Can I still take Met?
New studies are showing new results for non-IR or obese women on Metformin. Their testosterone levels and other hormones are improving significantly.
Metformin is at least as efficacious in the nonobese as it is in the obese with Type 2 Diabetes:
http://www.medscape.com/viewarticle/549150?src=mp
OB GYN advocates for metformin use as first-line therapy in all women with confirmed PCOS, regardless of fertility:
http://www.obgmanagement.com/article...?AID=3849&UID=
For more information, see:
http://www.pslgroup.com/dg/21642a.htm &
Making a case for metformin. (Controlling PCOS: Part 2)
Criteria for entry into studies where met shown effective did not include elevated insulin levels, but rather hyperandrogenemia and anovulation:
http://www.ivf.com/faqs/pcos3.html
Lean women and effects of Met on testosterone, insulin:
http://www.ncbi.nlm.nih.gov/entrez/q...&dopt=Abstract
Metformin appears to do the same for non-obese PCOS women, according to a study from the University of Medical Sciences in Poznan, Poland. Thirty nine PCOS women were given metformin for 12 weeks. They had improvements in insulin, testosterone, hirsutism and acne. (Kolodziejezyk, B et al):
http://www.ovarian-cysts-pcos.com/gl...rmin-pcos.html
Italian Study - Ovarian activity in non-obese patients on metformin:
http://www.ncbi.nlm.nih.gov/entrez/q...tool=iconabstr
Metformin Therapy Is Effective in Nonobese Patients With Type 2 Diabetes:
http://www.medscape.com/viewarticle/546864
Insulin sensitizing drugs help thin women as well overweight women with polycystic ovary syndrome:
http://www.news-medical.net/?id=5605
Metformin's benefit not limited to obese patients
http://www.soulcysters.net/showthread.php?t=47429
Viewpoints on Polycystic Ovary Syndrome - the case for Metformin for all PCOSers
http://www.soulcysters.net/showthread.php?t=118693
Assessing insulin sensitivity. (Controlling PCOS, part 1)
http://www.soulcysters.net/showthread.php?t=47430&
Making a case for metformin. (Controlling PCOS: Part 2)
http://www.soulcysters.net/showthread.php?t=47425
Metformin May Be Only Drug Needed for Ovulation in PCOS
http://www.soulcysters.net/showthread.php?t=6999
Should we use insulin sensitizers to treat infertility in women with refractory PCOS?
http://www.soulcysters.net/showthread.php?t=6983
PCOS Treatment with Insulin Lowering Medications
http://www.soulcysters.net/showthread.php?t=4413 4. How long will it take to get my period?
Some women with easily moved hormones or hormones that are pretty close to normal can see signs of menstruation fairly quickly. Others have to be more patient with their hormones while they get realigned.
In my practice, about 50% of women begin having regular ovulatory menses after 6 months of treatment. For women with PCOS treated with metformin alone, about 25% begin regular menses within 3 months,and about 50% to 95% begin regular menses within 6 months.
Metformin highly effective in normalizing menstrual cyclicity in women with polycystic ovary syndrome, especially with a treatment duration of 6 months or longer:
http://www.sciencedirect.com/science...6f4b20c6bbfee4 http://scholar.google.com/scholar?hl=en&lr=&c2coff=1&q=cache:6SkR0mkf6NwJ:www.obgmanagement.com/redir.asp%3Ffilename%3Dobg_1003_00018.xml+less+wei ght+loss+benefit+with+metformin+extended+release
5. What is the difference between Metformin /Glucophage and Gluc XR/ER?
Metformin and Glucophage are the same drug…Met is just the generic version of Glucophage, so it is the identical drug but the generic is generally cheaper to make so it costs less. Gluc XR is a specially formulated product that releases slowly into the body, meaning women can take their entire dosage ONCE a day, rather than spreading their pills out over the whole day. Which people prefer is a very personal thing. Some ladies get less side effects with the XR product, some find it similar in that regard. Some studies claim that XR absorbs better, some indicate the opposite. So which product you use is between you and your doctor, depending on which works better for your individual body. Gluc XR is not available at this time in Canada.
Drug Comparison:
http://www.drugdigest.org/DD/Compari...,20-12,00.html
FDA on ingredients of gluc vs glu xr:
http://www.fda.gov/cder/foi/label/2000/21202lbl.pdf 6. I am trying to have a baby. Can Met help me ovulate?
Met is NOT a fertility drug, but due to it's ability to restore hormone function, it can help with fertility and ovulation. No one drug has a written guarantee to help every woman, but Met has been showing great results in the area of ovulation, both on it’s own and in combination with other drugs:
Met and ovulation in Clomid resistant patients:
http://www.shadygrovefertility.com/cevents.cfm
Met, Ovulation & pregnancy rates:
http://www.medscape.com/viewarticle/...nSUM9vXeWt2uKA|6497932300131838355/184161394/6/7001/7001/7002/7002/7001/-1
Met and menstrual cycles:
http://www.ncbi.nlm.nih.gov/entrez/q...&dopt=Abstract
Menses resumption and Met:
http://www.ncbi.nlm.nih.gov/entrez/q...&dopt=Abstract
Metformin & Ovarian stimulation and in vitro patients:
http://www.ncbi.nlm.nih.gov/entrez/q...&dopt=Abstract
13 trials, Ovulation & Met:
http://www.docguide.com/news/content...Other&count=10
In nonobese women with PCOS, metformin is more effective than clomiphene for improving the rate of conception:
http://www.aafp.org/afp/20051215/tips/7.html
Metformin improved ovulation rate 3.9-fold over placebo, and the combination of metformin and clomiphene improved both ovulation and pregnancy rates 4.4-fold over clomiphene alone:
http://www.medscape.com/viewarticle/467200_7
Metformin Often Helpful in Clomiphene Citrate-Resistant Women With Polycystic Ovary Syndrome:
http://www.medscape.com/viewarticle/492185 7. Should I stop Met or stay on it when I get pregnant?
This is a personal decision that needs to be made in conjunction with one’s own doctor. It also helps to do lots of reading on the human studies with Met and Pregnancy.
Current studies surrounding Met are showing it as safe to a fetus, but has had few long term studies, so some are understandably hesitant to continue it during pregnancy. The most recent human studies are showing taking Met during pregnancy decreases the high miscarriage rate of PCOS women (
http://www.fertilityplus.org/faq/metformin.html#pg) It is also showing a decrease in the incidence of gestational diabetes in PCOS ladies: (
http://www.medscape.com/viewarticle/432639_3).
Women with previous gestational diabetes are at increased risk of subsequent type 2 diabetes:
http://www.medscape.com/viewarticle/...HV47DW6girtEx4|5317142672560534711/184161395/6/7001/7001/7002/7002/7001/-1
Metformin & Gestational Diabetes:
http://www.health-alliance.com/hospi...n_diabetes.htm
Metformin not associated with Pre-eclampsia, Metformin reduces GD & birthweight greater than 4500 g, and several other great articles on PCOS & pregnancy:
http://www.health-alliance.com/hospi...dates.htm#met1
Insulin resistance and its potential role in pregnancy-induced hypertension:
http://www.thewomenshealthsite.org/a...?ArticleID=463
A comparison of 68 women treated with metformin during pregnancy vs 31 not treated with metformin showed early pregnancy loss in 9% vs 42%:
http://www.medscape.com/viewarticle/467200_7
Prior reports have established that gestational diabetes occurs in 25%-45% of women with PCOS. In contrast, the risk of gestational diabetes among the general population in the United States is 1%-4%:
http://www.findarticles.com/cf_dls/.../article.jhtml
April 2006 study on outcomes of 50 metformin-induced pregnancies:
http://taylorandfrancis.metapress.co...lts,1:100389,1 8. What about taking Met while breastfeeding?
Once again this decision needs to be made at the discretion of each woman. The studies I have seen to date indicate that about 0.28-.4 % of the drug passes to the infant, leaving it well within the acceptable limits. You can read articles/studies on this here:
Metformin Use by Nursing Mothers Does Not Affect Infants:
http://www.medscape.com/viewarticle/537186 http://www.ncbi.nlm.nih.gov/entrez/q..._uids=12436333 http://www.mja.com.au/public/issues/...0804_fm-6.html 9.How long will the side effects last? Can I make them better?
Generally, side effects lessen over time, and go away when you are on the same dose for several weeks. It seems to help nausea or diarrhea to take it in the middle of a meal. Also if you havenÂ’t already, consider altering your dietÂ…Side effects are prolonged by high carb or high fat diet. Also, keep in mind that the higher the dosage, the more people tend to have side effects. If you are just starting Met, it helps to increase your dose gradually over a period of weeks to help side effects too. One more tip: Make sure that if you have diarrhea or vomiting, you drink lots of water to stay hydrated.
Insulin Sensitizers and Diet:
http://www.inciid.org/faq/pcos4.html#4.15
Side effects:
http://www.inciid.org/faq/pcos4.html#4.14
You can read the tips of this forum’s ladies on dealing with side effects here:
post your tips on dealing with gluc/met side effects 10. Will Met help me lose weight? Do I still need to low carb or exercise on Met?
Met’s primary purpose is to regulate your insulin, so anyone claiming it is a weight loss drug is inaccurate. Having said that, as we discussed above, insulin resistance and weight tend to be directly proportional in many women. So as the IR is corrected, it is easier for them to lose weight. It puts us on a level playing field with normal women, who can exercise and diet and see results. Diet and exercise are proven to help lower hormone levels faster, and by doing this, we help Met work harder for us.
Study: Diet & Exercise dramatically decrease Type 2 diabetes:
http://www.niddk.nih.gov/welcome/releases/8_8_01.htm
Study: Exercise and diet nearly twice as effective in preventing diabetes for people at risk than meds alone:
http://www.fi.edu/brain/carbs.htm
Lifestyle changes more effective than Met alone:
http://www.ncbi.nlm.nih.gov/entrez/q...&dopt=Abstract
Comparing the effects of metformin and lifestyle changes on menstrual frequency in women with polycystic ovary syndrome:
http://www.orgyn.com/en/news/2005/We...fails_to_i.asp
Exercise's effect on insulin:
http://www.faqs.org/faqs/diabetes/fa...ection-15.html :
Study - Metformin & Carbohydrate modified diet:
http://www.soulcysters.net/showthrea...post1886467384
Effects of exercise on glucose tolerance and insulin resistance:
http://www.ncbi.nlm.nih.gov/entrez/q...&dopt=Abstract
Intensity and amount of physical activity in relation to insulin sensitivity:
http://www.ncbi.nlm.nih.gov/entrez/q...&dopt=Abstract
Intensive lifestyle intervention for more than three years is more effective at reducing the prevalence and preventing the onset of the MS than metformin or placebo:
http://www.medscape.com/viewarticle/503419
Dietary Guidelines for Diabetes and IR (Metformin mentioned):
http://www.endocrinetoday.com/200509/frameset.asp?article=guested.asp
How Exercise Effects Hormones:
http://64.233.187.104/search?q=cache:Wbs2FECKoYYJ:www.sideroad.com/Weight_Loss/hormones-weight-loss.html+glucagon+and+weight+loss&hl=en
Metformin and Weight Loss in obese women with PCOS - comparison of doses:
http://jcem.endojournals.org/cgi/rap...004-2283v1.pdf
Any Exercise can improve Insulin Control - Meds, Diet and Exercise work well together:
http://www.nlm.nih.gov/medlineplus/n...ory_41279.html 11. How do I know if Met is working?
One way: Bloodwork. Weight loss alone is often the gauge with which women determine success. But weight is only a part of the picture of metformin. If insulin, blood sugar, testosterone and androgen levels were elevated and are being regulated on Met, then the drug is doing itÂ’s job. If you have elevated blood sugars, another sign the drug is working is control of your sugars, but other factors like diet can influence this as well, which is why hormone labs are the strongest indicator.
It does take some time for Met to start working...it isn’t instant. Generally it is a matter of weeks to months before the levels drop, and it may be a year or more before our stubborn hormones get where they need to be. Time is of the essence with Met, and it’s hard to be patient with our stubborn hormones.
It is also worth considering that many medical professionals consider 1500 mg per day to be the minimum effective dose. If you are on a less significant dose, you will want to discuss this with your physician.
Metformin Dosage:
http://www.lef.org/featured-articles...in_dosage.html
Maximum Dosage for Gluc vs XR - 2550 mg in adults and 2000 mg in pediatric patients, maximum recommended daily dose of GLUCOPHAGE XR in adults is 2000 mg:
http://www.rxlist.com/cgi/generic/metformi_ids.htm 12. Can I take Met with other drugs (Provera, BCP etc)
A lot of Dr’s are prescribing Met along with other ovulatory drugs. The thing to keep in mind when deciding which drugs to be on, is that having a lot of drugs in your body can cause more hormone fluctuations for Met to regulate. All the surging of your hormones, can send confusing signals to your body. For example, progestin-only BCP make IR worse, and Met is supposed to make it better, so they counter each other regarding insulin in some women. Speak to your physican about combining any medications with Metformin.
For more informaton on BCP & insulin resistance:
http://www.diabetesforum.net/cgi-bin...category_id=12
Oral contraceptives improved features of PCOS in adolescent girls but have an unfavorable impact on insulin resistance:
Oral contraceptives increase insulin resistance in adolescent PCOS
Low dosage BCP's have less effect on IR and Blood Glucose levels and the pill:
http://www.tinman.com/diabetes/diabsex/birthcon.htm
Oral Contraceptives Increase Insulin Resistance in Teenagers:
http://www.ovarian-cysts-pcos.com/news35.html#sec1
One more interaction women should know of as well. If you are on the gastrointestinal drug Tagamet, it can increase the amount of Met in your body by about 50%. So if you are on a dosage of 2000 mg of met, you will be getting the dose and side effects as if you were taking 3000 mg. Talk to your Dr about dosing while on Tagamet. See:
http://www.medicinenet.com/metformin/article.htm
Interaction- Devil's Claw & Metformin:
http://altmedicine.about.com/od/drug...s_claw_int.htm 13. What happens if I miss a dose?
Take it as soon as you remember. If it is getting close to the time for your next dose, then skip the dose and just take your next one. DONÂ’T take 2 pills at once.
http://um-jmh.org/HealthLibrary/meds/Metformin.html 14. When should I take my Metformin?
To help the side effects, it is most beneficial to take Met with food and at more or less the same time each day. When you are on Gluc XR, you can take your entire day’s dose at once, because it releases slowly into your system.
If you are on regular Met, spread your doses up over the course of the day when you eat the most, as this is when insulin fluctuates the most...after meals. Met takes about 2 hours to show up in your system and it peaks 4 hours after you take your dose. It is out of your system about 2 hours after that (except at night when insulin doesn’t fluctuate as much). So it is most beneficial to your hormones to take Met about 4 or 5 hours apart during the day to keep from having long periods of unregulated insulin. Most women find it beneficial to take Met with food to quell the side effects too.
Ultimately though these are merely suggestions. Your physican will outline the dosing regime that is right for you. Consult with your physician regarding questions concerning dosage.
Onset of effect of Metformin in this article:
http://www.diabetes-normalsugars.com...pter14-2.shtml
Dosing of Regular Met and Gluc XR:
http://www.drugdigest.org/DD/Compari...,20-12,00.html 15. Will I get Lactic Acidosis?
Although most every piece of literature on Met mentions it, LA is actually very uncommon. Documented cases of a normally healthy person without risk factors developing LA, are very rare, and the FDA is actually revising labels to reflect the rarity. And a large majority of people who develop it had specific risk factors for LA.
Stats vary, but the *highest* stat I have read on the subject is that 3 out of every 100,000 people perscribed Met develops a case of LA. So that's .003% of patients on Metformin...a very low number. And half of those cases are NOT fatal. So only .0015% of people on met for any period of time will die of LA.
LA is SIGNIFICANTLY more common in people with certain risk factors. These include:
A) Pre-existing cardiac disease
B) chronic pulmonary disease
C) severe liver disease
D) acute asthmatic attack
E) Patient over 80 years of age
F) Renal insufficency. *This risk factor is one of the biggest. Ninety percent of metformin is excreted unchanged by the kidneys and lactic acidosis typically occurs in patients with renal (kidney) insufficiency. So if you have had any degree of kidney problems in the past, you need to have liver tests done by your Dr before beginning metformin therapy.
G) patients on extremely high doses (higher than 2550 mg per day)
H) Patients severely dehydrated. Speak to your Dr if you are on a dieuretic.
I) Rapid ascent to high altitude can also be a risk factor.
J) LA is more common after certain surgeries. If you are having surgery involving iodinated contrast media or any other condition in which an acute decline in kidney function might occur (aggressive diuresis, excessive fluid loss from gastroenteritise etc) you can lower your risk significantly by discontinuing the drug a 24 hours to a week before your surgery. Speak with your surgeon about this if you are undergoing any procedures that may require discontinuing the drug.
K) LA is more common in people who drink moderate to heavy amounts of alcohol on Met.
If you are concerned about your risk factors or have concerns regarding LA, speak with your Dr.
Metformin-Associated Lactic Acidosis:
http://www.medscape.com/viewarticle/417792_1
Searching for a Link - Met & LA:
http://www.ncbi.nlm.nih.gov/entrez/q...&dopt=Abstract
Study: Metformin patients had no higher incidence of LA than non-Met patients:
http://www.diabetesincontrol.com/rosen/i186.shtml
Report: FDA revising Metformin labels to reflect that there were NO reports of lactic acidosis during more than 20,000 patient-years of exposure to metformin in clinical trials.
http://www.medscape.com/viewarticle/474836 16. What do symptoms of LA look like?
Symptoms of Lactic Acidosis (which can also be symptoms of other health issues): nausea, vomiting, altered level of consciousness, abdominal pain, severe thirst, severe lethargy and an increase in the depth and rate of your breathing.
http://www.psycheducation.org/hormon...icacidosis.htm 17. Can Met give me low blood sugar?
Some ladies start to have signs of hypoglycemia after going on Metformin, so they assume that Met causes low blood sugar. But this hypoglycemic episode is not due to the drug, but rather due to the fact that their bodies are working better and they are often not taking in enough calories to compensate for this new, more efficient body. Met opens the cells so that the cells use the insulin that our body produces more efficiently, and as a result the amount of insulin being produced by the body is actually less. If you make sure to eat small, high protein meals every few hours, you should not have frequent sugar problems on Met alone. It is advisable to talk to your Dr if you have concerns about your blood sugar.
See: “Why it’s Used” section of this article:
http://yalenewhavenhealth.org/librar...sp?hwid=tw9315 18. What blood tests do I need to have done when my Dr monitors me?
After determining which hormones are out of sync and placing you on Met treatment, the Dr should continue to monitor those hormones to ensure they are regulating. As well, the Dr should run regular liver enzymes, kidney tests and tests to determine your vitamin B 12 level. This is because people at higher risk for Lactic Acidosis have elevated liver/kidney enzymes and vitamin B12 can be depleted with long term Met use. He should also repeat your fasting glucose/insulin. These labs should be performed at least once per year and preferably twice per year to determine if your dose is adequate to control your IR. These Bloodwork suggestions are not tailored to your individual needs, but are intended as a guideline. Results and the neccessity of specific tests should always be discussed with your Dr.
Vitamin B12 info & possible reduction of B12 on Met:
http://www.usadrug.com/IMCAccess/Con...alamincs.shtml
Increased intake of calcium reverses vitamin B12 malabsorption induced by metformin:
http://www.ncbi.nlm.nih.gov/entrez/q...&dopt=Abstract
Lab tests & insulin sensitizing agents:
http://www.inciid.org/faq/pcos4.html#4.11 19. Can I still have alcohol while taking Met?
Yes! Guidelines are strict, but data suggests a couple of drinks per week is perfectly fine on Metformin. But studies suggest some concerns with moderate to heavy drinking on metformin. This level of alcohol can actually delay a period due to itÂ’s effect on hormones:
http://www.ncbi.nlm.nih.gov/entrez/...1&dopt=Abstract
Excessive amounts of alcohol can increase the effect of met resulting higher chances of hypoglycemia and lactic acidosis:
http://webmd.lycos.com/content/drugs/4/4052_143.htm http://www.diabetesmonitor.com/metf-qa.htm
Drinking while on Met often causes increased nausea, abdominal discomfort and other side effects. So to counter this, some ladies discontinue Met when they are planning to drink in excess. By doing this, you increase your chances of hypoglycemia even further by leaving your insulin unregulated completely.
Many women on Met also find they get a ‘buzz’ a lot faster, so bear this in mind. This is because the liver is overworked due to the Met and processing the alcohol, so the alcohol moves through your bloodstream to other parts of your body..the alcohol moves to the brain because the liver can't process it. Symptoms of hypo look like those of drunkenness: confusion, slurred speech, dizziness, nausea and headache.
If you plan to drink, try to eat prior to (and while) drinking to keep your blood sugar up, limit your number of drinks, drink low sugar drinks if possible and drink as slowly as you can to keep from your liver being over-worked. If you use mixers in your drinks, choose ones that are sugar free, like diet soft drinks, diet tonic, club soda, seltzer, or water. This will help keep your blood sugar levels in your target range. Light beer and dry wines are good choices. They have less alcohol and carbohydrates and fewer calories. To make drinks last longer, try a "spritzer." Mix wine with sparkling water, club soda, or diet soda.
ANY consumption of alcohol should be discussed with your physican.
Diabetes Medication, blood sugar and alcohol:
https://secure.lillydiabetes.com/Foo...ls/alcohol.cfm 20. I just went to the bathroom and saw a tablet in my stool! Is this normal?
If you’re taking Gluc XR, it can be unsettling! It may appear that you are passing the pill, but not to worryÂ…the drug has been absorbed into your body. It’s just that sometimes the exterior capsule doesn’t dissolve completely and it is discarded as waste in your stool when you defecate. This is totally normal and indicates that the tablet was released into your system exactly the way it should have been.
To read more about the gelshield diffusal system, see the FDA's info on Gluc XR at:
www.fda.gov/cder/foi/label/2001/20357s22lbl.pdf 21. How long do I have to stay on Met?
Your physican will help you determine the duration of your metformin therapy. Usually, this decision is based on the severity of your hormonal imbalance and whether or not it can be controlled with diet & exercise alone. Some people can take Met to reduce their hormone levels and then once their insulin is under control, maintain that through low carb diet and exercise. Others will be right back where they began with their hormones going right back out of sync again.
Once your labs are within normal limits (provided they ever get there), many physicians will taper off the dosage and see if hormones remain regulated. This process of trial and error will show you if your body can stay balanced on itÂ’s own or if you require metformin to do so.
If you do end up having to stay on Met long-term, keep in mind that Met is a drug many diabetics are already on, presumably safely, for life. While long-term studies are still underway, there donÂ’t appear to be any emerging health risks at this time. At this time, Doctors are assuming that the long term cumulative effects of unregulated insulin pose a greater risk than the long term cumulative effects of metformin therapy.
Long term Met benefits for PCOSers:
http://www.pslgroup.com/dg/25c402.htm
Effect of long-term treatment with metformin added to hypocaloric diet on body composition, fat distribution, and androgen and insulin levels in abdominally obese women with and without the polycystic ovary syndrome:
http://www.ncbi.nlm.nih.gov/entrez/q...&dopt=Abstract 22. Can Met help my hirsutism (excess hair)?
It may. Study results differ and ladies have varying degrees of success.
The effect of Met on hirsutism:
http://www.eje.org/eje/147/eje1470217.htm
Pilot Study of Metformin for the treatment of hirsutism in non-diabetics:
http://www.endocrine-abstracts.org/e...ea0003p116.htm
Metformin or antiandrogen in the treatment of hirsutism in polycystic ovary syndrome:
http://www.ncbi.nlm.nih.gov/entrez/q...&dopt=Abstract
Metformin more effective than Dianette in treating hirsutism:
http://www.endocrine-abstracts.org/e.../ea0005oc7.htm
The effect of metformin on hirsutism in polycystic ovary syndrome:
http://www.ncbi.nlm.nih.gov/entrez/q...tool=iconabstr
Some ladies find little improvement in this area and others are greatly aided. Speak with your Doctor about this and other remedies available to help you conquer hirsutism.
23. What can I do if my medical insurance won't cover this?
Pharmaceutical Company Bristol-Myers Squibb has a patient assistance foundation, for patients on Glucophage.
Contact info:
PO Box 2118
Lakewood NJ 08701
Toll Free 800-736-0003
Fax 800-736-1611
Call Monday through Friday 9-6PM Eastern Time. Doctor completes physician section which includes DEA# and signs form including the RX section which takes the place of a prescription. There is a list of drugs and the "NDC Number" for the drug must be on the form as well as the name of the drug. Patient must provide basic information including gross monthly income and size of household, and whether or not patient has public/private prescription insurance and sign form. If approved, Medication sent to the prescriber. Once approved, patient can get up to a 1 year supply of medication.
A new form can be used to change the dosage for an existing patient; the physician would indicate that on the prescription section of the form.
Other links:
http://www.helpingpatients.org/scree...?program_id=19https://www.pparx.org/Intro.php
Another option for those who can't afford the medication is to participate in a clinical trial involving Metformin. Not only are you helping research on the drug, all participants recieve their meds free of charge if they fit the criteria for the study.
The Effects of Metformin on Blood Vessel Structure and Function:
http://www.clinicaltrials.gov/show/NCT00105066
This study was accepting applicants in November 2005.
24. I'm having an HSG (hysterosalpingogram). Do I need to discontinue the drug?
Patients should go off metformin for several days prior to any x-ray procedure in which iodinated compounds will be used, including the hysterosalpingogram where contrast dye is injected into the uterus (note: this is a different procedure than a sonohystogram where saline is injected into the uterus before an ultrasound).
The reason for this recommendation is that the kidneys clear both the dye and metformin. It should not be a problem if renal function judged by creatinine and blood urea nitrogen (BUN) tests is normal. Renal function testing should be performed before metformin is started, and periodic screening is prudent. Many of the users of metformin are older diabetics with altered kidney function, and this is added precaution.
http://www.inciid.org/faq.php?cat=in...ty101&id=2#134 Further Reading on Met:
http://www.ovarian-cysts-pcos.com/g...ormin-pcos.html
Metformin needs to be the first treatment after diet and physical activity for Type 2 diabetes:
http://my.webmd.com/content/Article/111/109922.htm
Metformin May Help Diabetics with Heart Failure:
http://www.nlm.nih.gov/medlineplus/news/fullstory_27427.html
Study looks at Metformin and Lifestyle Therapy in PCOS:
Study looks at Metformin and Lifestyle Therapy in PCOS