Metformin is a well-liked prescription drug that’s used as a first-line therapy for sort 2 diabetes.
For almost all of customers, metformin is efficient and well-tolerated. However if you’re experiencing extreme or persistent negative effects when taking this drugs, or if it merely isn’t working, you could surprise if there are some other choices.
The reply is sure. This text will examine the very best alternate options to metformin for individuals with sort 2 diabetes.
Key Factors:
- Whereas an efficient therapy for a lot of, metformin could cause vital negative effects akin to gastrointestinal points, and it might have adverse interactions with different widespread medicines.
- In some circumstances, metformin just isn’t efficient in managing blood glucose ranges or just isn’t suggested due to well being situations or insurance coverage protection limitations.
- A number of lessons of diabetes medicines supply totally different mechanisms of motion and advantages for managing sort 2 diabetes. These alternate options could also be extra appropriate for individuals who can not tolerate metformin or discover it ineffective.
- Every various class of remedy comes with its personal set of potential negative effects, starting from gastrointestinal points to dangers of hypoglycemia and weight acquire. Understanding these results is significant for choosing essentially the most acceptable therapy choice.
- Together with remedy, life-style modifications akin to elevated bodily exercise and dietary adjustments may be efficient in managing sort 2 diabetes. Though tough to take care of, these measures can considerably enhance blood sugar administration and general well being.
Why would you not take metformin?
Metformin helps higher handle blood sugar ranges, struggle insulin resistance (a situation wherein the physique doesn’t use insulin effectively), and might even assist with weight reduction. Most tips advocate it because the first-line therapy for sort 2 diabetes.
It’s also very reasonably priced and customarily efficient, however that effectiveness can include a value: negative effects.
Unwanted effects
Metformin could cause quite a lot of doubtlessly detrimental negative effects, together with:
For some individuals who have strict work or college schedules, enduring a few of these negative effects is probably not doable.
Moreover, experiencing these negative effects may also impression different areas of your life. Coping with persistent gastrointestinal points, for instance, can turn into an impediment to consuming effectively or forestall you from sustaining an everyday train behavior.
Contraindications
In different circumstances, individuals might keep away from taking metformin as a result of it’s contraindicated (not suggested) to take with many different widespread pharmaceuticals. (Right here is an summary of the medication which will work together with metformin.)
Generally it’s unimaginable to cease taking one other drugs that negatively interacts with metformin, and due to this fact, a substitute is important.
Ineffectiveness
And for some individuals, metformin merely just isn’t efficient. It doesn’t assist everybody higher handle their blood sugars, decrease their HbA1c ranges (a measure of glucose management over the earlier 2 to three months), or shed some pounds. Actually, some individuals even acquire weight when taking metformin.
Insurance coverage or life-style concerns
Lastly, some individuals might choose to not take metformin as a result of their medical insurance doesn’t cowl it, or they want to handle their diabetes with out the usage of prescription drugs.
What are alternate options to metformin?
The next are some alternate options which you can talk about together with your physician.
(Bear in mind to at all times work together with your healthcare supplier earlier than making any adjustments to your diabetes administration.)
Sulfonylureas
Sulfonylureas are oral diabetes medicines which might be usually taken with or earlier than a meal. They work to decrease blood sugar by rising the manufacturing of insulin from the beta cells within the pancreas. These drugs are normally both taken as soon as a day earlier than breakfast or twice each day, earlier than each breakfast and dinner.
Sulfonylureas embody:
- Glipizide (model identify Glucotrol)
- Glimepiride (Amaryl)
- Glyburide (Diabeta, Glynase)
Sulfonylurea negative effects
Some doable negative effects embody:
Thiazolidinediones (TZDs)
TZDs are an oral class of sort 2 diabetes remedy that will increase insulin sensitivity and helps lower glucose manufacturing by the liver.
They’re simply accessible and reasonably priced and should not have a excessive danger of inflicting hypoglycemia.
Thiazolidinediones embody:
- Pioglitazone (Actos)
- Rosiglitazone (Avandia)
Thiazolidinedione negative effects
Some doable negative effects embody:
- Weight acquire
- Elevated danger for coronary heart illness
- Edema (swelling) of ft, legs, arms, and fingers
- Elevated danger for bone fracture
DPP-4 inhibitors
DPP-4 inhibitors decrease blood sugar and HbA1c ranges with out inflicting low blood glucose (except taken with different medicines that may trigger hypoglycemia, akin to insulin or sulfonylureas).
They operate by interfering with the breakdown of two hormones within the physique, GLP-1 and GIP, that cut back blood glucose ranges.
These hormones are sometimes damaged down in a short time. By serving to sluggish this course of, DPP-4 inhibitors enable the hormones to operate for longer, decreasing blood sugar ranges solely when they’re elevated.
These medication are taken orally, usually together with metformin, however they are often taken with out metformin as effectively.
DPP-4 inhibitors embody:
- Sitagliptin (Januvia)
- Saxagliptin (Onglyza)
- Linagliptin (Tradjenta)
- Alogliptin (Nesina)
DPP-4 inhibitor negative effects
Potential negative effects embody:
- Low blood sugar, if taken together with insulin or sulfonylureas
- Gastrointestinal points like upset abdomen
- Elevated danger for pancreatitis (irritation of the pancreas)
- Fever, physique aches, and different flu-like signs
GLP-1 receptor agonists
GLP-1 receptor agonists can both be taken orally or by way of an injection (both as soon as a day or as soon as weekly), relying on the particular drugs used. They operate equally to the GLP-1 and GIP hormones within the physique that decrease insulin ranges however are extra proof against being damaged down.
Along with decreasing blood sugar and HbA1c ranges, a few of these medicines additionally shield in opposition to coronary heart illness.
Notably, though they don’t seem to be weight-loss medication, GLP-1 receptor agonists can help with weight reduction. In accordance with the Mayo Clinic, research point out that each one GLP-1 medication can result in a complete weight lack of between 10.5 and 15.8 kilos.
GLP-1 receptor agonists embody:
GLP-1 receptor agonist negative effects
Potential negative effects embody:
- Nausea
- Vomiting
- Low blood sugar ranges (if taken together with insulin)
- Decreased want for insulin, if on insulin remedy
- Diarrhea
- Weight reduction
SGLT-2 inhibitors
SGLT-2 inhibitors are a category of oral remedy, usually taken each day, used to decrease blood sugar ranges and HbA1c ranges by inflicting the discharge of extra glucose within the urine. They hardly ever trigger low blood sugar.
These medicines can shield in opposition to coronary heart failure and enhance outcomes in individuals who have coronary heart illness, kidney illness, or coronary heart failure.
SGLT-2 inhibitors embody:
SGLT-2 inhibitor negative effects
Potential negative effects embody:
- Frequent urination
- Elevated frequency of urinary tract infections (UTIs)
- Elevated danger for kidney injury
- Elevated danger for diabetic ketoacidosis (DKA)
- Dehydration
- Thirst
- Low blood stress
- For Invokana, particularly, elevated danger of amputations
GIP/GLP-1 receptor agonists
The primary drugs on this class was accredited in 2022. It’s an injectable drug taken as soon as weekly, and it features by mimicking the actions of each GLP-1 and GIP to assist decrease blood sugar ranges.
Analysis signifies that this remedy results in a median weight lack of about 15 % to twenty %.
GIP/GLP-1 receptor agonists embody:
GIP/GLP-1 receptor agonist negative effects
Potential negative effects embody:
- Gastrointestinal points
- Hypoglycemia, notably when used with one other drugs that may trigger low blood sugar akin to a sulfonylurea or insulin
- Weight reduction
- Pancreatitis
- Adjustments in ldl cholesterol and triglyceride ranges
- Kidney points
- Fatigue and dizziness
Insulin
Insulin has been a cornerstone in diabetes remedy since its discovery in 1921. In sort 2 diabetes, it’s usually used when different medicines don’t present ample blood sugar management.
The aim of insulin therapy is to imitate the physique’s pure insulin manufacturing. It’s administered by way of injection, infusion (from an insulin pump), or inhalation. The various kinds of insulin fluctuate in onset, peak instances, and length of motion.
A number of the extra widespread insulins utilized in the USA embody:
Speedy-acting insulin
- Insulin lispro (Humalog, Admelog)
- Insulin aspart (NovoLog, Fiasp)
- Insulin glulisine (Apidra)
Brief-acting insulin
- Common human insulin (Humulin R, Novolin R)
Intermediate-acting insulin
- NPH (isophane) insulin (Humulin N, Novolin N)
Lengthy-acting insulin
- Insulin glargine (Lantus, Basaglar, Toujeo)
- Insulin detemir (Levemir)
- Insulin degludec (Tresiba)
Potential negative effects
- Hypoglycemia, notably if the insulin dose just isn’t balanced with meals consumption and bodily exercise
- Weight acquire
- Adjustments in fats tissue at injection websites
- Allergic reactions, starting from native injection web site reactions to systemic ones
- Swelling of legs and arms
- Insulin resistance, particularly with increased doses over time
Much less-commonly used alternate options
Alpha-glucosidase inhibitors
The starches you eat are damaged down into sugars by your physique. Alpha-glucosidase inhibitors assist decrease blood sugar ranges by blocking the digestion of starches. They’re taken with the primary chew of every meal.
Alpha-glucosidase inhibitors embody:
- Precose (generic solely)
- Miglitol (Glyset)
Alpha-glucosidase inhibitor negative effects
Frequent negative effects embody:
- Gastrointestinal points akin to fuel and diarrhea
Meglitinides
Meglitinides are a kind of oral remedy that stimulates the insulin-producing beta cells of the pancreas to launch insulin. They’re taken earlier than every meal to assist decrease after-meal blood glucose ranges.
Meglitinides embody:
- Repaglinide (Prandin)
- Nateglinide (Starlix)
Meglitinide negative effects
Frequent negative effects embody:
Way of life adjustments
Lastly, adopting wholesome life-style adjustments is at all times an excellent method, whether or not or not you’re taking remedy. Partaking in common bodily exercise and consuming a balanced, nutritious weight loss program will help handle blood sugar ranges, decrease your HbA1c, and doubtlessly result in weight reduction as effectively.
This can be the most affordable choice, however it may be laborious to take care of. And it’s additionally not assured that life-style adjustments will will let you cease taking medicines.
Different components, akin to a genetic predisposition for diabetes, could make remedy obligatory, even if you’re in nice bodily situation and in any other case wholesome.
Speak together with your physician and meet with a registered dietitian (RD) to develop an train and consuming plan that may work to your life-style and well being targets.
Ultimate ideas
Whereas metformin is a particularly fashionable, reasonably priced, and accessible drug for sort 2 diabetes administration, it isn’t for everybody.
Some individuals expertise debilitating negative effects that make taking this drug over the long run unimaginable. Others might not have insurance coverage protection for metformin or might not want to take extra medicines, or metformin might merely not be working for them.
Thankfully, different choices can be found. Drug lessons together with sulfonylureas, thiazolidinediones, DPP-4 inhibitors, GLP-1 receptor agonists, SGLT-2 inhibitors, GIP/GLP-1 receptor agonists, and fewer widespread alternate options like alpha-glucosidase inhibitors and meglitinides can be utilized to deal with sort 2 diabetes.
Adopting wholesome life-style approaches akin to elevated bodily exercise and a nutritious weight loss program may also assist, whether or not or not you’re taking drugs.
Do a little analysis to see what your medical insurance will cowl to guarantee that any adjustments in your diabetes medicines are financially sustainable over the long run.
If metformin just isn’t working effectively and also you need to make a swap, converse together with your physician about doable alternate options, and talk about what is going to work greatest for you, your life-style, and your well being targets.
