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what is Metformin ?

Metformin is the most widely prescribed oral anti-diabetic medicine used to treat Type 2 Diabetes Mellitus (T2DM) — a condition where the body becomes resistant to insulin or fails to produce enough of it. It belongs to a class of drugs known as biguanides and helps control blood sugar levels without causing weight gain or significant hypoglycemia (low blood sugar). It is often the first-line medication prescribed after lifestyle changes like diet and exercise.

How Metformin Works (Mechanism of Action)

Metformin primarily lowers blood glucose levels through three synergistic mechanisms:

  • Reduces Glucose Production by the Liver
    The liver continuously releases glucose into the blood. Metformin inhibits this process (known as hepatic gluconeogenesis), leading to reduced fasting blood sugar.
  • Increases Insulin Sensitivity
    Metformin helps muscle and fat cells respond better to insulin, allowing more glucose to enter cells for energy — thus lowering post-meal sugar levels.
  • Delays Glucose Absorption in the Intestine
    It slows down carbohydrate breakdown and glucose absorption from the gut after meals, reducing spikes in blood sugar.
  •  Metformin does not stimulate insulin secretion, which is why it rarely causes hypoglycemia (low blood sugar).

Indications / Uses of Metformin

  • Metformin is used to treat and manage several metabolic and hormonal disorders:
  • 🔹 Primary Use

  • Type 2 Diabetes Mellitus (T2DM)
    Controls high blood sugar and reduces long-term complications like nerve damage, kidney failure, and blindness.

  • 🔹 Other Medical Uses (Off-label)

  1. Prediabetes: Prevents progression to full diabetes in at-risk patients.

  2. Polycystic Ovary Syndrome (PCOS): Improves insulin resistance, ovulation, and fertility in women.

  3. Metabolic Syndrome: Helps manage obesity and abnormal cholesterol.

  4. Gestational Diabetes (in select cases): Used as an alternative to insulin under medical supervision.

  5. Weight Management (off-label): May help with mild weight loss in overweight diabetics.

Benefits of Metformin

  •  Controls blood sugar levels effectively

  •  Improves body’s sensitivity to insulin

  •  Promotes mild weight loss (or weight neutrality)

  •  Lowers bad cholesterol (LDL) and triglycerides

  •  Reduces cardiovascular risk in diabetics

  • Delays diabetes complications (neuropathy, nephropathy, retinopathy)

  •  Improves fertility outcomes in PCOS

Side Effects

Metformin is usually well-tolerated. Most side effects occur early in treatment and improve over time.

Common (Mild) Side Effects:

  • Nausea or vomiting
  • Diarrhea
  • Stomach discomfort or bloating
  • Loss of appetite
  • Metallic taste in mouth
    Rare (Serious) Side Effects:
    Lactic Acidosis
  • A very rare but serious condition due to lactic acid buildup.
  • More likely in people with kidney/liver problems, alcohol use, or dehydration.
  • Symptoms: Weakness, muscle pain, trouble breathing, dizziness, or irregular heartbeat.
    Seek immediate medical help if these occur.
    Vitamin B12 Deficiency (Long-term use):
  • Can cause anemia, tiredness, or numbness.
  • Prevent with yearly B12 blood tests and supplementation if required.