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.
Lactic acidosis is a rare but serious metabolic complication which can occur due to metformin accumulation during treatment. When it occurs, it is fatal in more than 25% of cases. Lactic acidosis is a medical emergency and must be treated in hospital immediately.
Nausea, vomiting, stomach upset, diarrhea, gas, weakness, or a metallic taste in the mouth may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly. If stomach symptoms return later (after taking the same dose for several days or weeks), tell your doctor right away.
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.
Metformin may have an adverse effect on renal function in patients with type 2 DM and moderate CKD.
Despite being a rare occurrence, metformin use carries the risk of fatal lactic acidosis, particularly in patients with liver and kidney impairment, with an incidence of 1 in 30,000 patients [4].
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.
Clinically apparent liver injury from metformin is very rare, fewer than a dozen cases having been described in the literature despite widespread use of this agent for several decades. The liver injury usually appears after 1 to 8 weeks, typically with symptoms of weakness and fatigue followed by jaundice.
Drinking excessive amounts of alcohol while taking metformin is not safe. It can raise your risk of experiencing lactic acidosis. This is because metformin and alcohol both cause lactic acid to build up in the blood. As discussed above, too much lactic acid in the body can make you very sick.
Metformin doesn't cause kidney damage. The kidneys process and clear the medication out of your system through your urine.
Metformin's side effects usually appear quickly after your first dose and while they can improve for some after a few weeks, others may find they persist. That being said, some people may not experience uncomfortable side effects until they've been taking the drug for months or a year.
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.
Another type of drug, called salicylate, works in a similar way to metformin and scientists think it could be a good alternative for people with type 2 diabetes who can't take metformin. Salicylate is already used to treat other health problems, like pain and inflammation.
Risks of stopping metformin
If you stop taking metformin abruptly, your health may suffer. You may experience side effects such as higher blood sugars, an increased A1c, and even weight gain. Over time, higher blood sugar levels can lead to diabetes complications, including: Retinopathy and blindness.
Symptoms of lactic acidosis are nonspecific and may include anorexia, nausea, vomiting, abdominal pain, lethargy, hyperventilation, and hypotension [11]. Five of our patients (71%) complained of diarrhea, which can be an adverse effect of metformin and can aggravate hypovolemia.
As stated, metformin is contraindicated in patients with GFRs <30 mL/minute. Additionally, metformin is inappropriate for patients at risk of developing lactic acidosis from another cause, as this can lead to diagnostic ambiguity.
It is estimated that 20-25% of patients taking metformin have heart failure.
Official answer. 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).
If your diabetes remains hard to manage even after you begin taking metformin, or you cannot tolerate metformin or do not want to take it, that's when a GLP-1RA or SGLT2i might come in. Studies have shown that both medications are safe and effective at lowering blood glucose when compared to a placebo.
As a result, cinnamon seems to be as effective as metformin in increasing the Insulin sensitivity. In line with this study, Maleki et al. showed that HDL and insulin sensitivity were increased by the cinnamon supplementation while LDL, TG, and blood glucose were decreased in patients with PCOS (17).
If you eat a lot of sugar while taking Metformin, your body will have to work harder to keep your blood sugar levels within a healthy range, and the Metformin will not be as effective for weight loss. However, if it happens infrequently, you should not suffer too many negative side effects. The key is moderation.
Severe Side Effects of Metformin
Anemia: Metformin can interfere with the body's ability to absorb vitamin B12, which plays an important role in healthy red blood cells. If this happens, it can lead to anemia, which may cause symptoms like extreme tiredness, feeling cold all the time, and dizziness.