Kathryn Jean Lucas, MD 611 N 35th St Morehead City, North Carolina 28557

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INFORMATION FOR PATIENTS ON GLUCOPHAGE

By: K. Jean Lucas, M.D.

Glucophage (metformin) works by increasing the body’s sensitivity to insulin.  Since Type II diabetes is a result of longstanding insulin resistance, Glucophage should improve blood sugar control people who have type 2 diabetes.  

Other groups of people that Glucophage may help are those who do not have diabetes yet but who have insulin resistance.  Insulin resistance is inherited and may lead to obesity, diabetes, high blood pressure, high fats in the blood, irregular periods and excessive hair growth in women, and early puberty in girls and delayed puberty in boys. Since Glucophage improves insulin sensitivity, people taking this medication may find it easier to lose weight, control their blood pressure, and lower their cholesterol and triglycerides.  Those with a history of gestational diabetes, a family history of diabetes, an elevated triglyceride level, a history of polycystic ovary syndrome, or upper body obesity may benefit from being on this medication.

If you fit into any of the above categories, you may find yourself on this medication.  To improve success with Glucophage and to minimize side-effects, you should take the medication as instructed and follow precautions given to you by your physician. 

The most common side-effects of Glucophage are diarrhea and nausea.  Do not take the medication on an empty stomach.  You should take the medication during the meal rather than before the meal.  If you are not eating for any reason, the medication should not be taken since it may cause more side-effects. The medication is usually begun gradually to minimize side-effects.  Usually, the medication is started at one pill per day for the first week and the dose is increased by one pill per week until the maximum dose is reached.

If you are fasting, on clear liquids, or undergoing a test in which contrast material (dye) is used, you should avoid taking the Glucophage the day of the procedure and for 2 days following the procedure or x-ray.  Examples of such tests are: CT scans with contrast, IVPs (kidney x-rays), arteriograms, or cardiac catherizations.   When you stop the Glucophage, your blood sugar may increase.  You may need to adjust your other medication for diabetes or take supplemental insulin until two days after the test is completed. Ask your physician if you are unsure of what to do. Be sure to monitor your blood sugar frequently during this time.

Glucophage aids in weight reduction because it decreases insulin resistance and decreases levels of insulin in the body.  Insulin causes storage of calories as fat primarily in the fat above the waist.  If the insulin level is high, there is a drive by the body to store calories as fat.  High insulin levels may also increase one’s appetite leading to increased weight and increased blood sugar.

The following instructions have been customized for you by your physician.  If you have any problems with the medication, please call.

Start taking Glucophage (1 tablet equals 1 tsp if you are taking the liquid preparation) as follows:

First week:     one daily with a meal

Second week: one with breakfast and supper OR 2 at one meal

Third week: 1 at breakfast, 2 at supper OR 3 at one meal

Fourth week: 2 at breakfast and 2 at supper OR 4 at one meal

If you are on Lantus insulin and your blood sugar drops below 100, you should lower your Lantus by 5 units and continue to lower the Lantus until the blood sugar no longer drops too low.

If you are on a premixed insulin (70/30 or 75/25), lower the morning insulin by 5 units if your blood sugar drops below 100 during the day and lower the evening insulin by 5 units if you blood sugar goes below 100 overnight or before breakfast.        

If you are on Amaryl, glyburide or glipizide, you should only adjust them after you are already off insulin.  If the blood sugar goes below 100, you should decrease any of those medications by 50% of your current dose.  If you are on two per day, lower dose to one.  If you are on one per day, lower dose to ½.  If you are not sure what to do, notify your physician.

If you have side-effects from the medication, please follow the instructions below:

If you have nausea, try taking the medication after a full meal.  If this does not work, decrease the dose by one-half.  For example, if you are on 500mg twice a day, you would take 500mg once a day.  If still nauseated, stop the medication for three days and restart one-half a tablet.  You will need to use a pill cutter since the tablet is not marked for cutting.

If you have diarrhea, try avoiding fats and excess sugars during the meals when you are taking the Glucophage.  If this does not work, stop the medication for three days.  When you restart the medication, restart one-half of the previous dose (see above example).

If you feel fatigued or achy, stop the medication for three days or until the symptoms improve and restart it at one-half the previous dosage per day.

If you have any problems with low blood sugars, please use the information listed above for reduction of other oral agents or insulin. If all these measures fail, call your physician to ask what further steps you should try or if there are any medications to help the side-effects until your body is more accustomed to the medication.