Metformin (Systemic)

Brand Names : Glucophage, Glucophage XR, Apo-Metformin, Gen-Metformin, Glycon, Novo-Metformin, Nu-Metformin

Precautions While Using This Medicine

Your doctor will want to check your progress at regular visits , especially during the first few weeks that you take this medicine.

It is very important to follow carefully any instructions from your health care team about :

• Alcohol - Drinking alcohol may cause very low blood sugar. Discuss this with your health care team.
• Other medicines - Do not take other medicines unless they have been discussed with your doctor. This especially includes nonprescription medicines such as aspirin, and medicines for appetite control, asthma, colds, cough, hay fever, or sinus problems.
• Counseling - Other family members need to learn how to prevent side effects or help with side effects if they occur. Counseling on birth control and pregnancy may be needed because of the problems that can occur in pregnancy for patients with diabetes.
• Travel - Carry a recent prescription and your medical history. Be prepared for an emergency as you would normally. Make allowances for changing time zones, but keep your meal times as close as possible to your usual meal times.

In case of emergency - There may be a time when you need emergency help for a problem caused by your diabetes. You need to be prepared for these emergencies. It is a good idea to:

• Wear a medical identification (I.D.) bracelet or neck chain at all times. Also, carry an I.D. card in your wallet or purse that says that you have diabetes and a list of all of your medicines.
• Have a glucagon kit available in case severe low blood sugar occurs. Check and replace any expired kits regularly.
• Keep some kind of quick-acting sugar handy to treat low blood sugar.

If you are scheduled to have surgery or medical tests that involve x-rays, you should tell your doctor that you are taking metformin . Your doctor will instruct you to stop taking metformin until at least 2 days after the surgery or medical tests. During this time, if your blood sugar cannot be controlled by diet and exercise, you may be advised to take insulin.

Too much metformin, under certain conditions, can cause lactic acidosis. Symptoms of lactic acidosis are severe and quick to appear and usually occur when other health problems not related to the medicine are present and are very severe, such as a heart attack or kidney failure. Symptoms include diarrhea, fast and shallow breathing, severe muscle pain or cramping, unusual sleepiness, and unusual tiredness or weakness.

If symptoms of lactic acidosis occur, you should check your blood sugar and get immediate emergency medical help . Also, tell your doctor if severe vomiting occurs .

Too much metformin also can cause low blood sugar (hypoglycemia) when it is used under certain conditions. Symptoms of low blood sugar must be treated before they lead to unconsciousness (passing out) . Different people may feel different symptoms of low blood sugar. It is important that you learn which symptoms of low blood sugar you usually have so that you can treat it quickly and call someone on your health care team right away when you need advice .

• Symptoms of low blood sugar can include: anxious feeling, behavior change similar to being drunk, blurred vision, cold sweats, confusion, cool pale skin, difficulty in concentrating, drowsiness, excessive hunger, fast heartbeat, headache, nausea, nervousness, nightmares, restless sleep, shakiness, slurred speech, and unusual tiredness or weakness.
• The symptoms of low blood sugar may develop quickly and may result from:
  • delaying or missing a scheduled meal or snack.
  • exercising more than usual.
  • drinking a large amount of alcohol.
  • taking certain medicines.
  • if also using insulin or a sulfonylurea, using too much of these medicines.
  • sickness (especially with vomiting or diarrhea).
• Know what to do if symptoms of low blood sugar occur . Eating some form of quick-acting sugar when symptoms of low blood sugar first appear will usually prevent them from getting worse.
• Good ways to increase your blood sugar include:
  • Using glucagon injections in emergency situations such as unconsciousness. Have a glucagon kit available and know how to prepare and use it. Members of your household also should know how and when to use it.
  • Eating glucose tablets or gel or sugar cubes (6 one-half-inch size). Or drinking fruit juice or nondiet soft drink (4 to 6 ounces [one-half cup]), corn syrup or honey (1 tablespoon), or table sugar (dissolved in water).
    • Do not use chocolate. The sugar in chocolate may not enter into your blood stream fast enough. This is because the fat in chocolate slows down the sugar entering into the blood stream.
    • If a meal is not scheduled for an hour or more, you should also eat a light snack, such as crackers or half a sandwich.

High blood sugar (hyperglycemia) is another problem related to uncontrolled diabetes. Symptoms of mild high blood sugar appear more slowly than those of low blood sugar.

• Check with your health care team as soon as possible if you notice any of the following symptoms : Blurred vision, drowsiness, dry mouth, increased frequency and volume of urination, loss of appetite, nausea or vomiting, stomachache, tiredness, or unusual thirst.
• Get emergency help right away if you notice any of the following symptoms : Flushed dry skin, fruit-like breath odor, ketones in urine, passing out, or troubled breathing (rapid and deep). If high blood sugar is not treated, severe hyperglycemia can occur, leading to ketoacidosis (diabetic coma) and death.
• It is important to recognize what can cause the loss of blood glucose control . Calling your doctor early may be important to prevent problems from developing when the following occur. High blood sugar symptoms may occur if you:
  • have a fever or an infection.
  • are using insulin, sulfonylurea, or metformin and do not take enough of these medicines or skip a dose.
  • do not exercise as much as usual.
  • take certain medicines to treat conditions other than diabetes that change the amount of sugar in your blood.
  • overeat or do not follow your meal plan.
• Know what to do if high blood sugar occurs. Your doctor may recommend changes in your antidiabetic medicine dose(s) or meal plan to avoid high blood sugar. Symptoms of high blood sugar must be corrected before they progress to more serious conditions. Check with your doctor often to make sure you are controlling your blood sugar, but do not change your dose without checking with your doctor . Your doctor might discuss the following with you:
  • Delaying a meal if your blood glucose is over 200 mg/dL to allow time for your blood sugar to go down. An extra dose of metformin or an injection of insulin may be needed if your blood sugar does not come down shortly.
  • Not exercising if your blood glucose is over 240 mg/dL and reporting this to your doctor immediately.
  • Being hospitalized if ketoacidosis or diabetic coma occurs.