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Taking METFORMIN/Glucophage? You MUST Take This Vitamin!Metformin and digestive health -
Do not take any other medicines to treat vomiting without speaking to a pharmacist or doctor. If you take contraceptive pills and you're being sick , your contraception may not protect you from pregnancy. Check the pill packet to find out what to do. Drink lots of fluids, such as water or squash, to avoid dehydration.
Signs of dehydration include peeing less than usual or having dark, strong-smelling pee. Do not take any other medicines to treat diarrhoea without speaking to a pharmacist or doctor.
If you take contraceptive pills and you have severe diarrhoea for more than 24 hours, your contraception may not protect you from pregnancy. Check the pill packet for advice. Try to rest and relax. It can help to eat and drink slowly and have smaller and more frequent meals. Putting a heat pad or covered hot water bottle on your stomach may also help.
Eat when you'd usually expect to be hungry. If it helps, eat smaller meals more often than usual. If this advice does not help and any of these side effects continue to bother you, tell your doctor or pharmacist.
Taking metformin can cause vitamin B12 deficiency. Call your doctor or call straight away if you:. Your doctor can check your vitamin B12 serum levels. If they are too low, they may prescribe B12 vitamin supplements.
Metformin does not usually cause low blood sugar known as hypoglycaemia, or "hypos" when taken on its own. The data of physiologic and metabolic measures, gene expression, microbiome alpha-diversity indices, bacterial abundance, and other measures were compared using a two-tailed unpaired student t -test when comparing two groups or Kruskal—Wallis test followed by pair-wise post hoc comparison for comparing more than two groups.
Unless otherwise stated, all the values presented herein are means ± SEM. Supplementary data are available at The Journals of Gerontology, Series A: Biological Sciences and Medical Sciences online.
Supplementary Figure S1. a-c Insulin tolerance test, a , the area under curve AUC b , and percentage change in blood glucose during ITT of older mice treated with metformin and fed with LFD and HFD compared to their controls.
d-g Food intake d , water intake e , fat mass f , lean mass g , fasting blood glucose h , total energy expenditure i , and RER j were not significantly impacted by metformin treatment in the older mice fed with LFD and HFD compared to their nontreated controls.
Supplementary Figure S2. Metformin modulated gut microbiome composition. e The abundance of microbial composition was significantly distinct in metformin-treated versus untreated, as well as mice fed with LFD and HFD.
Supplementary Figure S3. FMT of metformin-treated microbiome transfer significantly microbiome signature in the gut of recipient mice. a-f Transplantation of the microbiome from metformin-treated mice to recipient mice show significantly different microbiome signature in terms of α-diversity PD whole tree, Chao1, Observed OTUs and Shannon index , major phyla e and genera f compared to their controls.
g The differential abundance of microbiome signature f and microbial genera g was changed in metformin-treated compared to untreated controls. This study was supported by the National Institutes of Health—K01AG J. and the Pepper Older Americans for Independence Center P30AG , and the Department of Defense—W81XWH and W81XWH H.
Author Contributions: S. conducted majority of the experiments, A. performed western blot and histology analyses, R. performed microbiome analyses, S. performed metabolic measurements and tissues histology analyses, B.
performed global metabolomics, B. and S. performed metabolomics data analyses and S. helped during animal experiments and data analyses. All the authors who performed experiments, complied their data and performed preliminary analyses, and contributed in writing first draft of manuscript.
significantly gave intellectual feedbacks in the study. conceived the original project idea, supervised the study, compiled and interpreted data, and wrote and revised the manuscript the manuscript.
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Because of a concern of autonomic neuropathy, she was evaluated. Her electrocardiogram showed a sinus rhythm, there was no postural drop in blood pressure, and heart rate variability with deep breathing was normal.
A trial of metformin withdrawal was initiated. Within 1 week, she got better. At her last follow-up, she had gained weight, the diarrhea had stopped, and the dyspepsia had reduced.
She was not achieving glycemic control with increasing doses of a sulfonylurea or a sodium—glucose cotransporter 2 SGLT2 inhibitor and so was switched to a coformulation of insulin degludec and insulin aspart. A year-old woman with longstanding diabetes presented for management of type 2 diabetes.
She had been having episodes of food-induced, mild, watery, solid, and unformed diarrhea with fecal incontinence for 1. She was evaluated thoroughly by a gastroenterologist, diagnosed with irritable bowel syndrome, and prescribed an antidepressant for its treatment.
On examination, she was lean and normotensive and had no features of malabsorption. Her autonomic function tests were normal, as was her anal tone. It was recommended that she withhold metformin for a few weeks.
A small dose of sulfonylurea was added in its place. She showed dramatic improvement in her diarrhea and had gained weight when seen at her last visit.
A year-old man who was a nonsmoker with longstanding diabetes, was concerned about progressive, unintentional weight loss without any constitutional symptoms despite adequate caloric intake.
He was evaluated by a gastroenterologist for this complaint, but no reason could be found. On examination, he was afebrile and had no lymphadenopathy or organomegaly. He was started on a trial of withholding metformin, and after a few weeks, he started showing improvement.
What are the reasons for insidious-onset diarrhea and weight loss in otherwise normal patients with type 2 diabetes?
Chronic diarrhea can occur in people with type 2 diabetes because of numerous reasons including medications i. Unintentional weight loss in type 2 diabetes can occur, apart from systemic causes, as a result of uncontrolled diabetes per se, medications i.
Metformin-induced diarrhea developing in individuals starting the medication has been attributed to changes in the gut microbiome, increased intestinal glucose and bile acid turnover, and increasing GLP-1 concentration 3.
The diarrhea usually reduces with time or after dose reduction, which may be followed by gradual up-titration. Metformin-induced weight loss has been hypothesized to result from appetite-modulating effects in central nervous system, reduction in leptin production from adipose tissues, reduced carbohydrate absorption from the gut, and increased GLP-1 levels 5.
Both of these side effects most commonly occur either immediately after the introduction of the drug or after a delay of a few weeks. However, the patients in all three cases presented here were on stable doses of metformin for several years before these effects developed.
Case reports of late-onset diarrhea in type 2 diabetes and in those with stable doses of metformin therapy for several years are scarce 6 , 7. In one report, there was no obvious precipitant factor, whereas in the other, polypharmacy with ranitidine and digoxin and nephropathy were attributed to increased metformin levels causing diarrhea.
In our case series, there were no obvious precipitating factors such as autonomic neuropathy or drug interactions causing increased levels of metformin and renal dysfunction. Recently, epigenetic factors causing metformin intolerance in drug-naive patients were identified 8.
With age, even the gut microbiota changes dramatically, but its role in causing diarrhea has not been studied.
As detailed in Table 1 , all three of these patients underwent unnecessary biochemical testing, imaging, and endoscopy studies.
Additionally, all had suffered mental anguish of worrying about potentially having a serious and life-threatening illness. Hence, educating treating physicians about this condition could reduce both patient stress and health care costs.
This complication must be recognized early to save patients from unnecessary invasive investigations and psychological distress. In patients with type 2 diabetes who take metformin, chronic diarrhea and weight loss may ensue at any time—even after several years of stable dosing.
Withholding metformin may be the first prudent step before subjecting patients to detailed, invasive, and expensive investigations. Each of the authors contributed a case for this series, collected the necessary patient data, and drafted the manuscript.
edited the manuscript and discussion. is the guarantor of this work and takes responsibility for its integrity. Sign In or Create an Account.
Noel T. MetformknMoira K. DifferdingMingyu ZhangNisa Metformin and digestive health. MaruthurStephen P. JuraschekEdgar R. MillerLawrence J. AppelHsin-Chieh Yeh; Metformin Affects Gut Microbiome Composition and Function and Circulating Short-Chain Fatty Acids: A Randomized Trial. Aim: Gastrointestinal discomfort Metforrmin the most common adverse event in metformin treatment for type 2 diabetes. The mechanism of action of metformin is Metformin and digestive health Alpha-lipoic acid and antioxidant defense gut digeestive. However, Metfoormin gut snd community hfalth related to metformin-induced gastrointestinal adverse events remains unclear. This study aimed to investigate it. The patients were divided into two groups according to whether gastrointestinal adverse events occurred group B or did not occur group A after treatment. The fecal bacterial communities and short-chain fatty acids SCFAs were sequenced and compared. After 4 weeks of metformin treatment, blood glucose, food intake, fecal SCFAs, gut microbiota and gut hormones were measured.
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