Metformin 101?

[LittleGreyCat]

New posters to this forum get a potted 'how to help yourself'.

I think there may be scope for a similar 'new to Metformin' block of advice.

I have looked at the details on the website including the FAQ, and trawled through several pages of recent posts (search tool won't let me look for just 'Metformin' in post titles) but haven't found quite what I was looking for.

The kind of things I would like to know:

(1) How long after taking a pill will you know if you are going to have side effects from that pill?
* A few hours, in my case *
(2) How long after your first pill will you know if you are going to have side effects (1st pill, 5th pill, 10th pill)?
* After the first pill in my case *
(3) If you do start to have side effects, over a period of days do they start bad and get better, start mild and get worse, stay the same?
(4) If you do have side effects how long before you know if they are going to wear off or if your should consider SR?
(5) How common are side effects related to alchohol?
* Reportedly very rare *
(6) How common is loss of appetite?
(7) How long does the effect of one dose last? For example with statins Simvastatin is supposed to be effective over several hours, but Pravastatin is supposed to be effective over 24 hours or more. If you are one one dose a day you need to know this to plan the best time of day to take the dose, based on when your meals are and what your general blood sugar looks like throughout the day. Or split the dose in two or more over the day.
* In my case, so far looks as though the effects last a full 24 hours *
(8) How long before you see a noticeable change in your BG? {Assuming you already have a reasonably stable BG.] Immediate, a week, a month?

I am sure you get the idea - a guide to what it might feel like starting Metformin so that you have some idea if you are having the usual response or if you are doing better or worse than usual.

It is always the unknown which causes the most anxiety.

Cheers

LGC

 

[Grazer]

Think it's a good idea LGC. Obviously you'd include SR versus normal Met, being tough with doc about it, etc. Regarding your point 5, I've tried to answer that on your other thread on this.

 

[Sid Bonkers]

To try to answer a coupler of your questions LGC:

(1 to 5) (Side effects) Side effects can affect different people in different ways, some will see very little if anything in the way of side effects while others will can be affected quite badly. Stomach cramps and diarrhoea seem to to be the most common side effects and will often start within a very short time of starting the drug but can come on at any stage, sometimes they can start and then ease off and sometimes they can stay with some people. For people that get side effects with standard metformin there is the slow release (SR) version which many who get side effects with standard met find better.

The main problem with a help page is side effects can and do come in so many different colours that everyone seems to have a different experience, I personally had some stomach cramps that came and went for the first few months but not that bad.

(6) (How common is loss of appetite?) Very, one way in which metformin works is as an appetite suppressant, like side effects though it will have a different effect on different people.

(7) (How long does the effect of one dose last?) and (8) (How long before you see a noticeable change in your BG?)
I'm not sure about this but it takes time to work it is not a drug that will have an instant affect but rather is slow to start working and builds up gradually thus it needs to be taken regularly. It is usual to start on 1 X 500mg tablet taken with food and build up 1 tablet at a time maybe a week apart which will often soften the side effect blow, the current maximum dose is 2 X 500mg tablets taken twice a day and will have the effect of lowering bg by between 1 and 2 mmol/L.

Some people are offered tablets of 750mg instead of 500mg which may be a throw back to when the maximum dose was higher, but I'm unsure of this so dont quote me

Dont know if any of this is of any use to you

 

[Unbeliever]

I am not sure if there will be ANY standard answers to questions about metformin effects. They will always differ from one individual to another.

I can see that it might be very useful if there were some guidance but there are too many variables,
From previous discussions it appears that those with a lot of weight to lose suffer fewer side effects and find it to be more effecive, more quickly than others,
There is also he question of wheher other meds begun at the same time may also cause side effects by themselves or in conjunction with the metformin. there are many other factors too.

Some guidance would be an excellent idea but it has to be fairly generalised or it would risk being counter productive.

perhaps some of the good people who put a great deal of time and effort into helping the newly dianosed could put their heads together and come up with something based on FAQs ?

 

[ButtterflyLady]

I am not sure if there will be ANY standard answers to questions about metformin effects. They will always differ from one individual to another.

I can see that it might be very useful if there were some guidance but there are too many variables,
From previous discussions it appears that those with a lot of weight to lose suffer fewer side effects and find it to be more effecive, more quickly than others,
There is also he question of wheher other meds begun at the same time may also cause side effects by themselves or in conjunction with the metformin. there are many other factors too.

Some guidance would be an excellent idea but it has to be fairly generalised or it would risk being counter productive.

perhaps some of the good people who put a great deal of time and effort into helping the newly dianosed could put their heads together and come up with something based on FAQs ?

I agree with these points. I'm a relatively new Metformin user and I got some useful info from the posts above. My approach was so ask the doctor a few questions before I started taking it. I started on 250mg a day for 4 days, then 500mg for 4, then 1000mg a day ongoing. I watched for any nausea and had pills ready for that. I don't think I had any side effects at all (I'm overweight so apparently am the ideal candidate for this drug).

I always ask the doctor about a drug before I start it. And if I'm not happy with the answers I ask the pharmacist and/or look up the patient information factsheets online. Often it's been my pharmacist who gives me the best info. I've been known to not take a med if my own research raises significant concerns - I thinks that's why my GP knows to answer my questions ;-)

 

[LittleGreyCat]

Just noted
http://www.diabetes.co.uk/diabetes-forum/viewtopic.php?f=25&t=27851
which suggests that in some people the side effects go on for months

Also that the bowel related problems may be tied to sugary or carby foods, which would make sense.

 

[ButtterflyLady]

I was thinking that too - that unusual bowel habits can be caused by virtually anything.

Irritable bowel syndrome (IBS) is very common. It's a diagnosis of exclusion - so the only way to diagnose it is to rule out several other causes.

If someone who had never had any significant diarrhoea or constipation issues started on metformin and had diarrhoea early on then it might be easy to ascribe it to metformin. But my bet is that many people who have a tendency towards IBS could have a worsening of symptoms on metformin. It wouldn't necessarily mean metformin was wrong for them.

It comes down to the trade-off of pros and cons - if metformin helps manage diabetes and prevent complications then the occasional mild diarrhoea might be liveable (especially if it happen with at least a few minutes warning). If diarrhoea is moderate-severe and can't be managed with meds or dietary changes then it would make sense to try a different drug to metformin or none at all.

 

[Unbeliever]

I had symtoms for three years , wind diaryears rheoa ec even afer switching to SR, As there is a family history of stroke and heart disease i persitsed. Even now after 5 I will occasionally have symptoms.

I don't say this to depress anyone but merely to pont out that it can take some time To be perfectly honest here are much worse things. the side effects of metformin can be difficul for many people . To pretend that they will wear ff withinn a few weeks for everyone is o deceive them.

 

[purplekat]

Hi, I've answered your questions below, although I do also agree it will vary very much from individual to individual.

(1) How long after taking a pill will you know if you are going to have side effects from that pill? - I think it was around day 2 or 3 of taking 1 pill a day. Although, on an ongoing basis, how likely side effects are is tied to what I've been eating more than anything else!

(2) How long after your first pill will you know if you are going to have side effects (1st pill, 5th pill, 10th pill)? Same as above.

(3) If you do start to have side effects, over a period of days do they start bad and get better, start mild and get worse, stay the same? I worked up gradually from 1 pill a day to 2 twice a day. For the first three pills the side effects started bad, then got better. 1 & 2 pills I was close to normal, 3 pills left my gut more sensitive, and 4 pills I didn't manage to get used to at all.

(4) If you do have side effects how long before you know if they are going to wear off or if your should consider SR? I gave the 4 pill doseage 2 months to improve before I discussed it with the doctor. I made the decision based on the fact I was actually scared to eat certain foods, and it was leaving me feeling reluctant to go visit friends, go on nights out etc.

(5) How common are side effects related to alchohol? Not drunk on them (except a half glass of beer) so can't comment.
(6) How common is loss of appetite? Form me, it's standard. And the best side effect ever when you need to lose weight I'd say my appetite was roughly halfed, and I choose to eat less carbs overall as they make me feel bloated.

(7) How long does the effect of one dose last? For example with statins Simvastatin is supposed to be effective over several hours, but Pravastatin is supposed to be effective over 24 hours or more. If you are one one dose a day you need to know this to plan the best time of day to take the dose, based on when your meals are and what your general blood sugar looks like throughout the day. Or split the dose in two or more over the day. - Not sure

(8) How long before you see a noticeable change in your BG? {Assuming you already have a reasonably stable BG.] Immediate, a week, a month? - I wasn't able to test myself, but the nurse reported improvements from the 3 month check onwards. A friend who was told to monitor saw results within a week, but his was a really high blood sugar.

Another thing that might be worth mentioning (in case I'm not the only one who doesn't work this out for themselves!) - if you are on too much metformin, you can end up having a hypo. It wasn't until after the doctor said she thought she could reduce my dose that I realised the reason I was getting wobbly, light-headed and confused if I didn't eat at a set time was because I was having a hypo. I assumed my dose was correct, because that's what the doctor had put me on!

 

[Patch]

Absolutely brilliant idea. In fact - there should be sub-forums for the most popular oral drugs.

 

[LittleGreyCat]

As noted elsewhere I've been feeling knackered all this week and with a tickly chest.
If I hadn't just started Metformin I would just put this down to an infection, but I am wondering if this might be related.
According to the sleeve notes acute tiredness is one of the rare symptoms which requires you to run screaming to your doctor a.s.a.p.
However the tiredness isn't acute, just a bit irritating as is the low level indigestion/nausea.
Does raise the question, though, of how severe the rare symptoms have to be to justify going back to the doctor.
http://www.diabetes.co.uk/insulin/diabetes-and-metformin-FAQs.html

What are symptoms of lactic acidosis?

Lactic acidosis symptoms include feeling weak or tired, muscle pains, breathing trouble, stomach discomfort, feeling cold or dizzy, developing a slow/irregular heartbeat. Any sudden changes should be reported to your doctor instantly.

Well, I feel tired and I have stomach discomfort, I have muscle pain (but this due to foolishly trying to run off muscle stiffness instead of stopping immediately and walking back) so only in one location. No breathing troubles (in fact my yoga breathing is coming on well), not cold or dizzy, heartbeat seems fine on a quick check.

Obviously I need to be aware, but the warnings make it easy to talk yourself into having the symptoms.

Cheers

LGC

 

[LittleGreyCat]

Just an update to say the tiredness and chestiness seem to have been due to a bug going round which lays you out for a couple of weeks.

My side effects seem to have cleared in a couple of weeks.

 

[LittleGreyCat]

No side effects to notice since the first couple of weeks.

I have occasionally run out of pills or forgotten to take them and I see no difference on the days when I don't take them.

Looking back, I've been off running mainly since my post about the muscle pain - tore a muscle (idiot) and then we had a load of building work and I couldn't risk laying myself up again.

Ho hum!

LGC

 

[Lina333]

I'm a pretty new Metformin user and I've found some useful information from the posts above. So, thanks for sharing! Also I want to add that recently I've discovered a Canada drug store that allows to find out all necessary information about the needed pills. I think it is very convenient, especially if you forget how to use meds and don't have time to visit a doctor. Maybe this info will be useful for someone!