Tag Archives: Metformin

new study: Metformin safer than other diabetes drugs

16 Apr

A new study in the European Heart Journal, by Tina Ken Schramm et al, found that metformin had the best outcomes out of a group of diabetes drugs: metformin, tolbutamide (Orinase), glipizide (Glucatrol), glibenclamide (Diabeta, Micronase, or Glynase), and glimepiride (Amaryl or GLIMY). The other drugs are known as sulfonylureas, whereas metformin is a biguanide.

The study, which compared metformin against available insulin secretogogues (ISs) found that the risks of “monotherapy with the most used ISs, including glimepiride, glibenclamide, glipizide, and tolbutamide, seems to be associated with increased mortality and cardiovascular risk compared with metformin. Gliclazide and repaglinide appear to be associated with a lower risk than other ISs.”

In other words, Met is safer. The American Diabetes Association recommends that sulfonylureas be used as a second-step treatment.

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research: Metformin useful even for non-obese PCOS patients

14 Apr

A recent meta-analysis (which, for those of you who don’t read a lot of academic jargon, means that it’s a piece that examines a bunch of clinical studies and draws conclusions) has concluded that Metformin is a good first-line treatment for women with PCOS, regardless of whether or not they are obese. The studies–which looked for successful pregnancy and live births–found that both Met and clomiphene (Clomid) were good treatments for anovulation.

This is interesting because Metformin is usually used for women in the “obese” category on the BMI chart. In my view, this is further evidence that PCOS is associated with insulin problems, regardless of how heavy the patient is.

This could affect you if you are a relatively thin PCOS patient and you’re trying to induce ovulation: Metformin is worth a try!

Metformin: basic information

18 Mar

Many PCOS patients are prescribed Metformin for the treatment of their condition. It can be a bit confusing, because it is only FDA approved for treatment of diabetes; however, there are a lot of good reasons for using this drug to treat PCOS. Here’s a general overview of some things you should know.

How It Works

Metformin improves your body’s sensitivity to insulin. If you read my post about insulin resistance, you’ll remember that an insulin resistant person produces a lot of insulin, and her body is not very good at recognizing and using it to control blood sugar. Metformin improves the body’s ability to do this; it resensitizes the cells to insulin, so that your body doesn’t have to produce as much.

What It Does
From your perspective, you might see the following results from Metformin:
* Lower risk of developing diabetes.
* Easier weight loss (this varies from woman to woman, but many feel that Metformin makes it easier to drop pounds).
* Drop in testosterone production–this is directly related to the drop in insulin production. This can also mean less hirsutism, acne, and hair loss.
* Improved menstrual cycle regularity. Many women on Metformin have more consistent or frequent cycles. That is why it is often prescribed for women who are trying to get pregnant. (I took Met when I was trying to conceive my second child, and it did regulate my cycle very well.)
* Reduced risk of miscarriage. This is why many reproductive endocrinologists recommend that PCOS patients continue to take Metformin through the 12th week of pregnancy or later.

Side Effects
Metformin can have some major side effects for some women. These include GI symptoms (nausea, diarrhea), which can be bothersome, but not usually dangerous, at least in the short term (see below for suggestions on minimizing these problems). However, Metformin is also associated with liver and kidney problems; usually, this won’t be an issue for you unless you have a liver or kidney function problem already.

Metformin can also cause (or contribute to) a problem called lactic acidosis. This is rare (3 in 100,000 Metformin users), but it is a serious problem, so you should be aware of the symptoms: weakness, slow pulse, muscle pain, deeper and more labored breathing, and sleepiness. This is more common if you have liver/kidney problems, dehydration, diabetes, or a great deal of chronic stress. It is very important that you NOT take Metformin while fasting (for example, before a medical procedure) or if you are dehydrated, for this reason.

How to Minimize Side Effects
If you do have unpleasant GI symptoms while taking this medicine, there are a few things you can do to try to make them less severe. Make sure that you eat when you take your medication; break up your dose over the course of the day; and, at least at first, avoid very fibrous foods such as salads. Some people also find that the name brand (Glucophage) causes them fewer side effects.

The Bottom Line
Should you take Metformin? That’s a question you’ll want to discuss with your doctor. It’s worth considering, though, if you have many symptoms of insulin resistance. The side effects (which, by the way, I never experienced) are manageable for most people who use it, and it may be protective against diabetes over the long term.

Metformin for low milk supply in PCOS mothers

3 Jul

Lisa Marasco–the ICBLC who is possibly the first researcher to examine the role of PCOS in low milk supply–has found evidence that Metformin can help with low milk supply in mothers with PCOS. The La Leche League has an excellent article by Marasco available on their web site (Marasco is an LLLI leader, as well as a lactation consultant).

Marasco suggests that anecdotal evidence shows a boost in milk production for low-supply moms with PCOS. She acknowledges that large-scale studies and high-quality research on this do not yet exist; however, in the absence of other good options, it may be worth trying. Marasco advocates using Metformin throughout the pregnancy and during breastfeeding.

Thomas Hale, the leading authority on the safety of drugs in breastfeeding mothers, has studied Metformin and concluded that it is quite safe. His assessment can be found here (warning: it’s pretty technical). Essentially, Hale found that the levels of Metformin in breastmilk were low, and that no adverse effects on the infants were reported.

He does point out, however, that “since metformin is largely excreted via the kidneys, particular caution should be exercised where the infant renal function is low or compromised (e.g. in premature neonates, or in rare cases of renal failure).” This doesn’t mean that no breastfeeding mother of a preemie should take Metformin; rather, it means that your doctor should consult with your child’s pediatrician and make the decision carefully. Since breastfeeding is beneficial, especially for premature babies, being able to produce more milk may benefit the infant enough to be worth the risk. Kidney function should be carefully monitored, though.

You may also be interested in this study, which examined infants whose mothers took Metformin over the course of their first six months of life. No differences in development or illnesses were found.

Finally, this page from Kellymom has a good list of links about PCOS and breastfeeding, including links to info about Metformin. (How much do I love Kellymom? A whole lot, that’s how much.)

Ultimately, my feeling on this matter is that it’s worth a shot. Metformin, which is a first-line treatment for PCOS, has a lot of benefits for PCOS sufferers; it can improve regularity of cycles and reduce other symptoms. I find it plausible that Met might make some differences to the hormonal balance that promote milk supply. Of course, not all patients find Metformin easy to tolerate; it often has significant GI side effects. Talk to your doctor about prescribing you the name brand (Glucophage) if that is true for you and adjusting your diet doesn’t help. Some PCOS ladies have reported that the generic has more side effects for them than the name brand.

That said, I took Met before I got pregnant with my son (and for the first trimester), and I had almost zero side effects. It regulated my cycle almost immediately and I conceived my son in the second month of trying. As a result, I’m a believer in Met’s ability to affect hormones for the better, which means that if I were going to have more children, I’d be taking it throughout the pregnancy and while breastfeeding.

research! Take folate with your Met.

7 Mar

If you’re on Metformin, or considering it, check out this research–it recommends taking b-vitamins and folate with your Metformin, because Met can elevate levels of homocysteine [a risk factor for heart disease] and reduce levels of b-vitamins. This study found that taking folate can help with both.