DIABETES - WHAT YOU NEED TO KNOW !! (PART II)

Hi again!

So continuing with the series of   Diabetes – What You Need to Know!!

Today I am going to talk about Oral medicines.

When we think of Diabetes the name which comes along with Diabetes is the wonder drug called METFORMIN.

Metformin has been a cornerstone in Diabetes Management for decades now. A small group of old time physicians are still apprehensive of using this drug. The reason is not Metformin but its predecessor PHENFORMIN. This phenformin which was used during our grandpa’s time had its own side effects. This drug was withdrawn from the market long back. Metformin is devoid of most of the unwanted and dangerous side effects. Metformin comes under the class of BIGUANIDES.

Apart from its major role in the treatment of Diabetes Metformin is used in Conditions like Polycystic ovarian syndrome, weight management and where ever there is a need to combat insulin resistance Metformin is the drug of choice. Recent studies also indicate that this drug is useful in Breast Cancer. There are some studies which talk about the benefits of metformin in Rheumatiod Arthritis as well.

How does this drug work?

Well to understand this you need to know the very basic principle of Diabetes. Diabetes is a result of two processes. First one is the reduced insulin production by the pancreas and secondly the Insulin resistance. This means already the pancreas is producing little insulin and the body is not ready to take up the insulin in a normal way. Now this doesn’t happen overnight...  It takes years before you actually develop Diabetes. This stage where the body is trying to help you by overworking is called PREDIABETES. This is the only stage where the pathological process of progression from Normal to Diabetes can be STOPPED! ( I will write about Prediabetes in a later post )  When the body doesn’t utilize insulin in the normal way the Pancreas tries to compensate by producing much more insulin than required. This phase goes on for a few years. Slowly the pancreas also gets tired and Beta cells (Insulin producing cells in the Pancreas) start failing. Only when a considerable amount of Beta cells fail Diabetes develops. Metformin acts at the level of insulin resistance. The cells of our body act like locks and insulin acts like a key. Insulin opens up the receptors (the lock in the cells of our body) so that GLUCOSE can get inside the cells for a normal function and extra glucose can be converted to glycogen which is the storage form of glucose. In Diabetes, the number of receptors readily accepting insulin are less. With addition of metformin glucose uptake is better thereby reducing the level of glucose in blood.

How to take Metformin?

Metfomin is available commercially in many forms. It comes as

• Plain metformin
• A combination of Metformin & Acarbose.
• Combination of Metformin & Voglibose
• Combination of Metformin & Sulphonylureas (Glimipride, Glipizide, Gliclazide & Glibenclamide)
• Combination with Pioglitazone
• Metformin with the latest DPP IV inhibitors (Sitagliptin, Vildagliptin)
• Combination of Metformin , Sulphonylurea & Pioglitazone.

When you are prescribed a plain tablet it is better to be taken after food. If you have been asked to take a combination generally the 2^nd member in the combination is important to decide the timing of tablet. This holds true for combination of Metformin and sulphonylureas. So whenever you visit your Diabetologist or Physician never forget to ask in detail regarding timing of tablets.

Strengths & Potency

Metformin comes in various strengths. In India its is available as 250mg, 500mg, 500mg SR, 850mg , 1gm and 1gm SR. Although the number looks big compared to other tablets used in the treatment of Diabetes it is relatively a mild tablet. As it acts peripherally in reducing Insulin Resistance it can be used as the sole drug in treatment of diabetes or as an adjuvant to Sulphonylureas or Insulin.

Drawbacks....

Patients during initial course of treatment with metformin can experience Gastritis (Ask your Doctor about side effects and report to your Doctor if you are uncomfortable after starting Metformin)

Some patients lose weight ( Not exactly a drawback.... right??)

This drug should not be used when the Kidney function tests are abnormal..

Before closing......

Metformin is a Wonder Drug in the management of Diabetes. It works exceptionally well and its efficacy has been proven beyond doubts over the decades.. Several hundreds of research papers have been published proving that metformin works well in different settings. Now like any other drug we use, this drug also has side effect but MINIMAL. It is only prudent to say that Metformin is a tool which works well in the hands of the Doctor who knows to use it well......

So, Till we meet next.....

Take care... Stay healthy...

Dr.Riyaz Sheriff

Consultant Diabetologist..