Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
DRUG CLASS AND MECHANISM: Metformin is an oral medication that lowers blood
glucose (sugar) and is used for treating type 2 diabetes. Insulin is a hormone
produced by the pancreas that controls glucose levels in blood by reducing the
amount of glucose made by the liver and by increasing the removal of glucose
from the blood by muscle and fat tissues. As a result, blood glucose levels
fall. Diabetes caused by a decrease in production of insulin that causes
increased production of glucose by the liver, and reduced uptake (and effects)
of insulin on fat and muscle tissues. Metformin acts by increasing the
sensitivity of liver, muscle, fat, and other tissues to the uptake and effects
of insulin. These actions lower the level of sugar in the blood.
Unlike
glucose-lowering drugs of the sulfonylurea class, for example glyburide (Micronase;
DiaBeta) or glipizide (Glucotrol), metformin does not increase the concentration
of insulin in the blood and, therefore, does not cause excessively low blood
glucose levels (hypoglycemia) when used alone. In scientific studies, metformin
reduced the complications of diabetes such as heart disease, blindness and
kidney disease. Metformin was approved by the FDA in December 1994.
PRESCRIPTION: Yes
GENERIC AVAILABLE: Yes
PREPARATIONS: Tablets: 500, 850, and 1000 mg. Tablets (extended release):
500, 750, and 1000 mg. Solution: 500 mg/5 ml
STORAGE: Metformin should be stored at room temperature between 20-25°C
(68-77°F).
PRESCRIBED FOR: Metformin is used for treating type 2 diabetes in adults and
children. It may be used alone or in combination with other diabetic
medications. Metformin also has been used to prevent the development of diabetes
in people at risk for diabetes, treatment of
polycystic ovaries, and weight gain
due to medications used for treating psychoses.
DOSING: For treating type 2 diabetes in adults, metformin (immediate release)
usually is begun at a dose of 500 mg twice a day or 850 mg once daily. The dose
is gradually increased by 500 mg weekly or 850 mg every two weeks as tolerated
and based on the response of the levels of glucose in the blood. The maximum
daily dose is 2550 mg given in three divided doses. If extended tablets are
used, the starting dose is 500 mg or 1000 mg daily with the evening meal. The
dose can be increased by 500 mg weekly up to a maximum dose of 2000 mg (2500 mg
of Fortamet) once daily or in two divided doses. Glumetza tablets are given once
daily. Metformin should be taken with meals.
For pediatric patients 10-16 years of age, the starting dose is 500 mg twice
a day. The dose can be increased by 500 mg weekly up to a maximum dose of 2000
mg. Glucophage XR has not been studied in children.
DRUG INTERACTIONS:Cimetidine (Tagamet), by decreasing the elimination of
metformin from the body, can increase the amount of metformin in the blood by
40%. This may increase the frequency of side effects from metformin.
PREGNANCY: There are no adequate studies in
pregnant women. Most experts
agree that insulin is the best treatment for pregnant women with diabetes.
NURSING MOTHERS: Metformin is excreted into
breast milk and can therefore be
transferred to the nursing infant. Nursing mothers should not use metformin.
SIDE EFFECTS: The most common side effects with metformin are
nausea,
vomiting,
gas,
bloating, diarrhea and loss of appetite. These symptoms occur in
one out of every three patients. These side effects may be severe enough to
cause therapy to be discontinued in one out of every 20 patients. These side
effects are related to the dose of the medication and may decrease if the dose
is reduced.
A serious but rare side effect of metformin is
lactic acidosis. Lactic
acidosis occurs in one out of every 30,000 patients and is fatal in 50% of
cases. The symptoms of lactic acidosis are weakness, trouble breathing, abnormal
heartbeats, unusual muscle pain, stomach discomfort, light-headedness and
feeling cold. Patients at risk for lactic acidosis include those with reduced
function of the kidneys or liver, congestive heart failure, severe acute
illnesses, and dehydration.
Diabetes mellitus is a chronic condition characterized by high levels of sugar (glucose) in the blood. The two types of diabetes are referred to as type 1 (insulin dependent) and type 2 (non-insulin dependent). Symptoms of diabetes include increased urine output, thirst, hunger, and fatigue. Treatment of diabetes depends on the type.
Polycystic ovarian syndrome (PCOS), also known by the name Stein-Leventhal syndrome, is a hormonal problem that causes women to have a variety of symptoms including irregular or no menstrual periods, acne, obesity, and excess hair growth. Treatment of PCOS depends partially on the woman's stage of life and the symptoms of PCOS.
Insulin resistance is the diminished ability of cells to respond to the action of insulin in transporting glucose (sugar) from the bloodstream into muscle and other tissues. Causes of insulin can include conditions such as stress, obesity, metabolic syndrome, and steroid use. Some of the risk factors for insulin resistance include fatty liver, heart disease, strokes, peripheral vascular disease, high cholesterol, and smoking. Treatment for insulin resistance are lifestyle changes and if necessary, medication.
The major goal in treating diabetes is controlling elevated blood sugar without causing abnormally low levels of blood sugar. Treatment for type 1 diabetes is with insulin, exercise, and a diabetic diet. Treatment for type 2 diabetes is first treated with weight reduction, a diabetic diet, and exercise. When these measures fail to control the elevated blood sugar, oral medications are used. If oral medications are still insufficient, insulin medications are considered.
The main features of metabolic syndrome include insulin resistance, hypertension (high blood pressure), cholesterol abnormalities, and an increased risk for clotting. Patients are most often overweight or obese. Lifestyle modification such as the Mediterranean diet, exercise, and quitting smoking are the preferred treatment of metabolic syndrome.
Managing your diabetes is important. The goal of diabetic therapy is to control blood glucose levels and prevent the complications of diabetes. Information about exercise, diet diet, and medication will help you manage your diabetes better. Blood glucose reagent strips, blood glucose meters, urine glucose tests, tests for urinary ketones, continuous glucose sensors, and Hemoglobin A1C testing information is also provided in this article.
Polycystic ovarian syndrome (PCOS), also known by the name Stein-Leventhal syndrome, is a hormonal problem that causes women to have a variety of symptoms. It should be noted that most women with the condition have a number of small cysts in the ovaries. However, women may have cysts in the ovaries for a number of reasons, and it is the characteristic constellation of symptoms, rather than the presence of the cysts themselves, that is important in establishing the diagnosis of PCOS.
PCOS occurs in 5% to 10% of women and is the most common cause of
infertility in women. The symptoms of PCOS may begin in adolescence with
menstrual irregularities, or a woman may not know she has PCOS until later in life when symptoms and/or infertility occur. Women of all ethnicities may be affected.
What are the symptoms of polycystic ovarian syndrome (PCOS)?
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