Founder of Goldzone Group and the primary author of Renaissance for Leaders. Harrison’s work focuses on the study of leadership and the conditions that shape human performance and decision-making.
Tag: Diabetes
Summary
Commonly reported side effects of metformin include: lactic acidosis, diarrhea, nausea, nausea and vomiting, vomiting, and flatulence. Other side effects include: asthenia, and decreased vitamin b12 serum concentrate. See below for a comprehensive list of adverse effects.
For the Consumer
Warning
Death, hypothermia, hypotension, and resistant bradyarrhythmias have been reported due to metformin-associated lactic acidosis. Onset may be subtle and include nonspecific symptoms such as malaise, myalgia, respiratory distress, somnolence, and abdominal distress; laboratory abnormalities include low pH, increased anion gap and elevated blood lactate. The risk of lactic acidosis increases with renal or hepatic impairment, aged 65 years or older, having a radiological study with contrast, surgery, or other procedures, hypoxic states, and excessive alcohol intake. If lactic acidosis is suspected, metformin hydrochloride should be discontinued, supportive measures started in a hospital setting. Prompt hemodialysis is recommended.
Along with its needed effects, metformin may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur while taking metformin:
More common
- Abdominal or stomach discomfort
- cough or hoarseness
- decreased appetite
- diarrhea
- fast or shallow breathing
- fever or chills
- general feeling of discomfort
- lower back or side pain
- muscle pain or cramping
- painful or difficult urination
- sleepiness
Less common
- Anxiety
- blurred vision
- chest discomfort
- cold sweats
- coma
- confusion
- cool, pale skin
- depression
- difficult or labored breathing
- dizziness
- fast, irregular, pounding, or racing heartbeat or pulse
- feeling of warmth
- headache
- increased hunger
- increased sweating
- nausea
- nervousness
- nightmares
- redness of the face, neck, arms, and occasionally, upper chest
- seizures
- shakiness
- shortness of breath
- slurred speech
- tightness in the chest
- unusual tiredness or weakness
Rare
- Behavior change similar to being drunk
- difficulty with concentrating
- drowsiness
- lack or loss of strength
- restless sleep
- unusual sleepiness
Some side effects of metformin may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
- Acid or sour stomach
- belching
- bloated
- excess air or gas in the stomach or intestines
- full feeling
- heartburn
- indigestion
- loss of appetite
- metallic taste in the mouth
- passing of gas
- stomachache
- stomach upset or pain
- vomiting
- weight loss
Less common
- Abnormal stools
- bad, unusual, or unpleasant (after) taste
- change in taste
- difficulty with moving
- discoloration of the fingernails or toenails
- flu-like symptoms
- joint pain
- metallic taste in mouth
- rash
- runny nose
- sneezing
- stuffy nose
- swollen joints
For Healthcare Professionals
General
Gastrointestinal events such as nausea, vomiting, diarrhea, abdominal pain, and loss of appetite have been frequently reported during therapy initiation and resolve spontaneously in most cases.
Adverse events in the pediatric population appear to be similar in nature and severity to that published in adults.[Ref]
Metabolic
Common (1% to 10%): Hypoglycemia
Very rare (less than 0.01%): Lactic acidosis[Ref]
Gastrointestinal
Very common (10% or more): Diarrhea (53.2%), nausea/vomiting (25.5%), flatulence (12.1%)
Common (1% to 10%): Indigestion, abdominal discomfort, abnormal stools, dyspepsia, loss of appetite[Ref]
Hematologic
Very rare (less than 0.01%): Subnormal vitamin B12 levels[Ref]
Other
Common (1% to 10%): Asthenia, chills, flu syndrome, accidental injury[Ref]
Hepatic
Very rare (less than 0.01%): Liver function test abnormalities, hepatitis[Ref]
Cardiovascular
Common (1% to 10%): Chest discomfort, flushing, palpitation[Ref]
Dermatologic
Common (1% to 10%): Rash, nail disorder, increased sweating
Very rare (less than 0.01%): Erythema, pruritus, urticaria[Ref]
Endocrine
Frequency not reported: Reduction in thyrotropin (TSH) levels[Ref]
Immunologic
Very common (10% or more): Infection (20.5%)[Ref]
Musculoskeletal
Common (1% to 10%): Myalgia[Ref]
Nervous system
Common (1% to 10%): Lightheadedness, taste disturbances[Ref]
Psychiatric
Common (1% to 10%): Headache[Ref]
Respiratory
Common (1% to 10%): Rhinitis[Ref]
Resources & References
- Detailed information from drugs.com > https://www.drugs.com/sfx/metformin-side-effects.html
- “Product Information. Glucophage (metformin).” Bristol-Myers Squibb, Princeton, NJ.
- “Product Information. Fortamet (metFORMIN).” Physicians Total Care, Tulsa, OK.
- Cerner Multum, Inc. “UK Summary of Product Characteristics.” O 0
- “Product Information. Riomet (metFORMIN).” Ranbaxy Pharmaceuticals, Jacksonville, FL.
- Cerner Multum, Inc. “Australian Product Information.” O 0
- “Product Information. Glumetza (metFORMIN).” Biovail Pharmaceuticals Canada, Mississauga, IA.
Founder of Goldzone Group and the primary author of Renaissance for Leaders. Harrison’s work focuses on the study of leadership and the conditions that shape human performance and decision-making.
Global health regulators are looking into whether widely used diabetes drugs may contain unsafe levels of a carcinogen that has previously been found in heart and gastric medications.
The FDA has begun testing samples of the diabetes drug metformin for the carcinogen N-Nitrosodimethylamine (NDMA), the agency announced Wednesday. Contamination with this same substance led to recalls of blood pressure and heartburn medications within the last 2 years.
Metformin is generally the first medication prescribed for type 2 diabetes, according to Mayo Clinic. It lowers glucose production in the liver and boosts your body’s sensitivity to insulin so that your body uses insulin more effectively. More than 30 million people in the U.S. have diabetes, and 90 to 95% are type 2, the CDC says, and metformin is the fourth-most prescribed drug in the United States.
The FDA’s announcement comes on the heels of a recall of three versions of metformin in Singapore and the European Medicines Agency’s request that manufacturers test for NDMA, according to Bloomberg News.
Singapore health officials recalled three of 46 versions of metformin marketed there after finding NDMA amounts “above the acceptable level.” The recalled drugs had been sold locally for only a short time, and the risk to patients who had taken them is low, Singapore’s Health Sciences Authority said in a statement.
“The agency is in the beginning stages of testing metformin; however, the agency has not confirmed if NDMA in metformin is above the acceptable daily intake (ADI) limit of 96 nanograms in the US,” FDA spokesman Jeremy Kahn says in an emailed statement. “A person taking a drug that contains NDMA at or below the ADI every day for 70 years is not expected to have an increased risk of cancer.”
Valisure, an American online pharmacy that tests every batch of drugs it sells before dispensing them, has rejected 60% of its metformin since it started testing for NDMA in March.
“The public definitely should be concerned about the rapidly growing discovery of carcinogens in medications, especially in those that are taken on a daily basis where even small contaminations can add up over time,” says David Light, CEO of Valisure.
While the FDA investigates, officials urge patients who are taking metformin to continue. “This is a serious condition, and patients should not stop taking their metformin without first talking to their health care professionals,” the statement says.
Resources & References
- Medscape article > https://www.medscape.com/viewarticle/922248?src=soc_fb_191207_mscpedt_news_mdscp_metformin&faf=1
- Diabetes Drugs Latest to Be Targeted for Carcinogen Scrutiny via Bloomberg > https://www.bloomberg.com/news/articles/2019-12-04/diabetes-drugs-latest-to-be-targeted-for-carcinogen-scrutiny
- Metformin description on drugs.com > https://www.drugs.com/metformin.html
Founder of Goldzone Group and the primary author of Renaissance for Leaders. Harrison’s work focuses on the study of leadership and the conditions that shape human performance and decision-making.
A study conducted by Stanford University in California researchers reveals that common foods can cause blood sugar spikes in otherwise healthy people. Paying closer attention to these spikes could prevent diabetes and some of its complications.
Over the course of a day, blood sugar levels may spike to diabetic and prediabetic levels, even in healthy individuals.
Diabetes affects over 30 million people in the United States, which is almost 10 percent of the population. An additional 84 million people have prediabetes.
Abnormal blood sugar levels are a hallmark of this metabolic disease. To measure these levels, physicians use two main methods: they either take fasting blood sugar samples, which informs them of the level of sugar in the blood at that specific point; or they measure levels of glycated hemoglobin (HbA1C).
The glycated hemoglobin test is routinely used to diagnose diabetes, and it relies on the average levels of blood sugar over a period of 3 months.
Despite their widespread use, neither of these methods can say anything about the fluctuations in blood sugar that happen over the course of a day.
So, researchers led by Michael Snyder, who is a professor of genetics at Stanford, set out to monitor these daily fluctuations in otherwise healthy individuals.
They looked at the patterns of blood sugar change after a meal and examined how these patterns vary between different people who have had the same meal.
Prof. Snyder and colleagues published the results of their research in the journal PLOS Biology.
Three types of blood sugar variability
For their study, the researchers recruited 57 adults aged 51 years, on average, who had not been diagnosed with diabetes.
Prof. Snyder and team used novel devices called continuous glucose monitors to assess the blood sugar of the participants in their normal environment. Also, the researchers evaluated the participants’ whole-body insulin resistance and insulin secretion.
The blood sugar and metabolic measurements allowed the researchers to group the participants into three different “glucotypes,” based on the patterns of blood sugar variability.
People whose blood sugar did not vary much were grouped under “low variability;” those whose blood sugar was found to spike quite often were grouped under “severe variability;” and finally, people who fell in between were classified as the “moderate” glucotype.
The findings revealed that “glucose dysregulation, as characterized by [continuous glucose monitoring], is more prevalent and heterogeneous than previously thought and can affect individuals considered normoglycemic by standard measures.”
Glucose often in prediabetic, diabetic range
Next, the researchers wanted to see how people of different glucotypes reacted to the same meal. So, they offered all the participants three types of standard breakfasts: cornflakes with milk, bread with peanut butter, and a protein bar.
Each participant responded uniquely to these breakfasts, which suggests that different people metabolize the same food in different ways.
Additionally, the study revealed that common foods such as corn flakes caused significant blood sugar spikes in most people.
“We were very surprised to see blood sugar in the prediabetic and diabetic range in these people so frequently […] The idea is to try to find out what makes someone a ‘spiker’ and be able to give them actionable advice to shift them into the low glucotype.”
Prof. Michael Snyder
“Our next study will delve into the physiological causes of glucose dysregulation,” continues the senior investigator. “These include not only genetic variation, but also microbiome composition, and pancreas, liver, and digestive organ functions.”
The researchers hope that their recent and future findings will help to prevent diabetes and its complications.
Resources & References
- Glucotypes reveal new patterns of glucose dysregulation study > https://journals.plos.org/plosbiology/article?id=10.1371/journal.pbio.2005143
- Glucotypes reveal new patterns of glucose dysregulation .PDF > https://violetsynergy.box.com/s/k1gk4ep36g0dtzmj1ea6ql11h2i5j1ct
- Original article > https://www.medicalnewstoday.com/articles/322614.php#1
Founder of Goldzone Group and the primary author of Renaissance for Leaders. Harrison’s work focuses on the study of leadership and the conditions that shape human performance and decision-making.
By 2025, a lot more people will be tracking their blood sugar, predicts doctor — here’s why
CNBC > Published Fri, Feb 1 2019 8:00 AM EST Updated Thu, Feb 7 2019 4:42 PM EST Aaron Neinstein, MD
Key Points
- In the future, one doctor suggests that a lot more people without diabetes will dabble in tracking their blood sugar.
- The technology is becoming cheaper and more accessible than ever before, and it will likely get smarter thanks to collaborations between between the device companies and tech companies like Alphabet or Apple.
- Providing consumers with that kind of feedback about their health is powerful.
Aaron Neinstein, MD, is Assistant Professor of Medicine at the University of California, San Francisco, and Director of Clinical Informatics at the UCSF Center for Digital Health Innovation. He’s also a practicing endocrinologist.
Let’s start with a prediction: By 2025, everyone with diabetes will be tracking their blood sugar with devices called continuous glucose monitors, and it will be common for many people without diabetes to dabble in tracking, too.
This may sound like a bold statement coming from an endocrinologist (we’re the specialists who manage diabetes), but hear me out. In my practice, I primarily treat people with diabetes, and over the years, technology to help manage the disease has made remarkable strides.
People with diabetes now have alternatives to pricking their fingers with a sharp needle to measure their blood glucose level multiple times per day. Early continuous glucose monitoring systems — the first was released in 1999 by the medical device maker Medtronic — while helpful in some cases, were not widely used because they were painful to insert, bulky, inaccurate, very expensive and still required many calibrations every day with fingersticks.
The technology has improved dramatically. Two of the newest devices, the Dexcom G6 and Abbott Freestyle Libre , no longer require fingerstick calibrations, are FDA-approved for people to make insulin-dosing decisions, and are much easier to insert.
Anybody who has ever done a fingerstick blood glucose knows that it hurts. Inserting a device instead is much less painful than a fingerstick, and the needlestick happens much less frequently. Both devices transmit glucose levels to a smartphone, either wirelessly and continuously, or with a wave of a smartphone over the sensor. Accordingly, continuous glucose monitoring (CGM) use has increased in Americans with type 1 diabetes, from 6 percent in 2011 to 38 percent in 2018. I expect these technologies to continue to get even better — they will get smaller, more accurate, and even smarter as better algorithms are developed and collaborations from between the device companies and tech companies like Alphabet or Apple.
This is a positive trend. For the approximately 1.5 million Americans with type 1 diabetes, CGM has moved far beyond novelty and should represent standard of care.
But, I believe CGM has much larger potential. That includes people with type 2 diabetes (approximately 30 million American adults), the even larger group with pre-diabetes (approximately 81 million American adults), and potentially almost anybody.
Feedback is powerful
I recently saw a 70-year-old patient with type 2 diabetes and heart disease who takes a medication known as metformin to manage his condition, but he has resisted making any changes to his diet. When he saw his own data from a glucose monitor, with no explanation even needed from me, he immediately identified the daily morning spike in his blood glucose level, and also its source: His daily glass of orange juice and banana.
If he had instead done a fingerprick, he wouldn’t have been aware of these large glucose spikes.
(I shared the data with his permission).
Data that shows blood sugar spikesAaron Neinstein
The patient then cut these items from his diet and reported an immediate improvement in his blood sugar levels.
Another patient case is a 37-year-old man without diabetes. He noticed, by wearing a continuous glucose monitor for a while, that a particular soup from a particular hospital cafe caused a surprisingly sustained elevation in glucose.
I can report that this person has taken this feedback seriously, because this person is… well me. Do I have diabetes? No. But I decided to wear the device to both to help me understand the experiences of my patients (which I embarrassingly chronicled here in 2012), and because I have a history of borderline high cholesterol. Between my cholesterol levels and these data, I decided that my metabolism and insulin resistance levels were likely putting me at higher risk for heart disease, so I immediately made substantial changes in my diet.
Looking at blood sugar trends with a continuous glucose monitor.Aaron Neinstein
These two examples show how immediate feedback is powerful. And this applies even for people who do not have diabetes but may have risk factors for diabetes, such as being overweight, or having a family history of the disease.
There is no proven benefit to everyone using a continuous blood sugar tracker all the time — but, I think we will soon discover that many people can benefit from using it at least for a short period. As in the examples above, people can quickly gain valuable insights on the health impacts of lifestyle choices, including food, stress levels, sleep amounts, and activity levels.
So what do we need next?
We need more scientific studies to prove that monitoring blood glucose levels will help people who haven’t been diagnosed with diabetes to be healthier or live longer. But I expect that the value of using a device to measure it will continue to increase, as our ability to interpret and act on the data improves. In my practice, I have found my patients love being able to do a video visit or email with me about their blood sugar data, and learn from reviewing the data together. We need many more tools that help doctors guide patients to more easily use and interpret that data towards adjusting medications or habits.
Costs will also have to continue to fall for the technology to become ubiquitous. The cheapest option, the Abbott FreeStyle Libre, has arranged deals with most insurance plans to provide two sensors (lasting two weeks each) for $75, but this price will still be out of reach for many people.
Finally, our understanding of diabetes itself will change. A group of researchers at Stanford recently found found that when people without known diabetes put on a continuous glucose monitor and ate different types of meals, the ways their bodies responded varied widely — something they called “glucotypes.” This mirrors my own findings when I wore the device.
Soon, rather than speaking about the two commonly defined categories of diabetes — type 1 or type 2 — there will be dozens of smaller categories representing people who have different genetic profiles, physiological patterns (including those “glucotypes”), and even different behavioral types. We will find that there are no neat categories of people who have diabetes or don’t have diabetes, but rather a continuum of risk. Rather than giving everyone the same pill, or same insulin dose, we will find that each of these different patterns benefit from unique combinations of pills and different behavioral and lifestyle therapies. We will need artificial intelligence to help us determine these different patterns, what they mean, and what we should do with them.
The next five years will be an incredible time, as fingersticks disappear from diabetes, prices fall and the increasing ubiquity of blood sugar tracking opens new opportunities to understand, avoid, or treat disease.
Resources & References
Published by CNBC > https://www.cnbc.com/2019/01/31/blood-sugar-tracking-useful-for-more-than-diabetes-commentary.html
- Stanford Research Glucotypes > https://journals.plos.org/plosbiology/article?id=10.1371/journal.pbio.2005143
- About Dr About Aaron Neinstein > https://aaronneinstein.com/aaron-neinstein-md/
Founder of Goldzone Group and the primary author of Renaissance for Leaders. Harrison’s work focuses on the study of leadership and the conditions that shape human performance and decision-making.