Am I Metformin Intolerant?

For many newly diagnosed diabetics, their first line of therapy often focuses on diet and exercise alone.  While that will be enough for some, unfortunately for many, the inevitable first step into a pharmaceutical treatment involves a medicine called metformin.  Metformin has been used since 1995 in the United States to treat Type 2 Diabetes and is preferred by most physicians as the standard of care to treat newly diagnosed diabetes because of minimal associated risks.

Metformin helps manage diabetes through three functions:  (1) by decreasing the amount of glucose produced by the liver, (2) by inhibiting the absorption of glucose in the patient’s stomach, and (3) by enhancing the function of insulin.

Why Is My Metformin So Intolerable?  

Because metformin is absorbed in the small intestine, and eliminated through the kidneys, some patients taking metformin may experience gastrointestinal side effects such as nausea, vomiting, and diarrhea – which usually subsides over the first few weeks after starting the diabetic treatment. Due to these side effects, physicians will often start their patients on a low dose and then gradually increase the metformin.

For many patients however, these side effects become significant even at low doses from 500 mg to 1000 mg a day.   Many patients aren’t aware that their sudden diarrhea or stomach pain is connected to their new diabetic treatment.  They simply call their physician and say that their stomach is hurting for some reason.

What Do I Do If I Think I’m Metformin Intolerant?

If you think you might be metformin intolerant, Dr. Robert Strzinek, one of our principal investigators, suggests that you speak with your physician and ask the following questions:

• Could it be that my metformin is causing my diarrhea or my stomach to hurt?
• Can I adjust my metformin dose to improve my side effects?
• Are there any options available for my diabetes other than metformin?

Based upon your discussion, your physician will make the clinical judgment whether you should continue your metformin therapy or if you are metformin intolerant.  More than likely, this will be determined by assessing whether your symptoms are truly persistent and not the commonly experienced transient (or temporary) symptoms that often occur when you start metformin.

Patients who are metformin intolerant sometimes have better experiences by taking extended-release formulations of metformin.   As always, be sure to first speak with your physician before discontinuing or changing your diabetic therapy.

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