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Metformin ER (or XR) is generally easier on the GI tract. Symptoms vary widely and can change over time...your body has adapted to the condition and tries to regulate itself. I have a healthy diet and exercise regularly and when I first started, I hated Metformin. However, after about 4-5 weeks of taking it, my system settled down and now I only have trouble if my meal prior to taking the dose is too high in fat or carbs. I don't have to to a low fat or low carb diet, but do need to make sure that everything is balanced.
Melissa Nestor, MS, CSCS
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I'm not sure either, but I do know that it was the basic generic glucophage from CVS both times. No XR or anything. It *was* the same dosage both times, as well. About the exercise/diet keeping insulin levels down - speaking for myself, the endocrinologist and i have determined that that does little to no good in bringing my insulin levels down and can even *cause* hypoglycemic episodes. One nice thing about Actos - it doesn't cause your sugar to drop. It sensitizes your body to your insulin production, unlike Metformin. Hell, the generic for Metformin - glucophage - means sugar eater! The one and only side effect i've noticed with the Actos is a vastly increased appetite, which isn't such a bad thing for me because I was having difficulty eating because of major depression.
Hi SarielSwish, that's very interesting information ... especially regarding the vastly different responses the different times you took it. You've kind of blown my theory out of the water about met doing you not so much good if you keep your insulin/glucose levels down through exercise/diet. I wonder, was it a different type of Metformin? I've heard that people have different reactions to the XR or extended release version than to the regular. I can't remember which is supposed to be easier to take though.
When I was first diagnosed with PCOS, I was put on a rather high dose of Metformin with little trouble. I'd have a bit of nausea, but nothing too bad. Then I started seeing a psychiatrist who gave me Abilify. That stuff is hell on earth. After taking the Abilify for about two weeks, I had a rather violent and painful reaction to the two - lactic acidosis. My muscles and joints hurt so badly I almost couldn't get out of bed to pee! So, I stopped taking both at the recommendation of my doc, which I didn't want to do because since I'd started taking it, I'd lost almost 100lbs and my periods came back.
Fast forward 3 years - after the surprise birth of my munchkin, Lily, (a whole 'nother story - ask if you'd like) my new doc puts me back on the Metformin - 500mg/3xdaily. I couldn't even take ONE dose without being in the bathroom for an hour or two and fighting nausea the rest of the day. It was coming out both ends (gross, I know.). The doc who gave me the Metformin was uncomfortable with prescribing anything else, as she is an obgyn, so she referred me to an endocrinologist.
After a rather hellish 5 hour fasting glucose tolerance test we determined that I have both severe insulin resistance (levels around 400, when they should be 20-50) and reactive hypoglycemia. Add to that iron-deficiency anemia and I'm having all sorts of fun. So, because of my recent reaction to the Metformin I'm now on Actos. I can't really say I've seen the type of results I did with the Metformin, but I also am not having ANY side effects with the Actos. I'm not dropping weight like I did, but I've stopped gaining and after adjusting to my iron supplements, we're going to try increasing the dose on the Actos and see how that treats me.
Yeah, I got a little off topic there but I guess what I'm trying to get across is that the side effects of Metformin can and do vary depending on your body chemistry at the time, which *does* change.
Hi Sweet Sunshine,
Well, we have something in common then ... I started reading medical textbooks when I was 7 and I did a Remedial Massage Diploma on the way to Naturopathy.
Which PCOS board? I'd love to find a good one. I was on SoulCysters for a while, but it's just so disorganised. There's so much good information there, but it's lost in the bulk.
I know how Metformin works, from insulin receptors to AMP-activated protein kinase, and I know it has a half life of about 6 hours. All drugs have plenty of actions other than their main actions though and our biochemistry is infinitely complex. Just because something is no longer in your bloodstream doesn't mean it may not have triggered a cascade of effects before vacating the scene and that those effects will continue long after the substance is gone.
My blood sugar has always been extremely stable ... 5.2 - 5.5 mmol/L (x18 for g/dL if you are in America) even after a meal or dessert, so I don't have typical IR sx and on top of which I am very strict with carbs (since discovering PCOS), so maybe therein lies the problem. Actually, that could well explain why I didn't get the GI symptoms - my diet was already low in carbs and fats.
A drug doesn't have to stay in your body for a long time to trigger a problem, I suppose much in the same was as all the hormonal and biochemical havoc that a pregnancy causes a body triggering a worsening of PCOS sx.
I suppose I wonder if I, already having stable BSL, an atypical presentation of PCOS (skinny most of my life, only have to look at me for me to get pregnant), in taking the Metformin, upset my pancreas (in the same was as people who inject insulin increase their insulin resistance and eventually need to increase the dose to compensate, and reduce their native insulin production if any still exists).
If you are interested in reading about the lady who tried Metformin 2x that I mentioned with very different results:
Ugh, I am so tired. It's 2.30am I need to learn to go to bed earlier! Goodnight.
Right now, I am a massage therapy student (which is an 18-month, INTENSE program here in Canada and considered a full health profession). On my own, though I have been fascinated with medical stuff since I was 6 years old and knew what the medulla oblongata was about 10. I have been researching everything I can find on PCOS since I was first diagnosed about 13 years ago, including the effects (and side effects) of Metformin. I am a leader on a very good PCOS board, and am always looking information up for people, and relying on scientifically verifiable information as often as possible, but not ignoring obvious trends.
The reason that I don't believe it was the Metformin that triggered the worsening of your condition is this: first of all, the main actions of met is 1) to help the "gates" in your cells that allow glucose/insulin to be transported in work better and for your cells to make more of them. This helps the IR, and is the main effect that we want with IR and PCOS. 2) it has an effect on the liver. Normally, between meals, the liver converts glycogen (temporary sugar storage) back into blood sugar. Met slows this down. This an effect that helps diabetics because their blood sugar is already high, and it can really rise overnight. The main side-effect is the nausea/diarrhea, which is usually caused because Met also blocks the digestion of some carbs and fats - which then, of course, would get flushed out of your system. You can also get mild low blood sugar if you don't eat often enough because of the previously mentioned liver effect.
Now, I have seen many people who get side effects while on Met, and I have yet to see anyone else who has had their PCOS worsen from taking it. I've seen people get severe side effects, and even a few get an extremely rare, life-threatening side effect, but no-one before who's even made a casual connection between met and worsening PCOS - it just doesn't stay in the body long enough. I have, however, come across many people who have had pregnancies and especially miscarriages who have had the PCOS worsen - many times with previous events that did not affect their PCOS at all. Now, you may be the "one in a million" who really did get worse from Met - but everything I've seen suggests to me that that's not what's happening here. I agree that you should probably not take it anymore, though, because you did get a poor reaction from such a small dose.
As for people living a healthy lifestyle getting sx more often - I haven't seen that as a trend before, either, but I will now keep my eyes open for it. In many ways, it works better if you add in diet and exercise, rather than rely on just the Met alone to help in weight loss. I know that I struggled to control my PCOS for years with just diet and exercise, with no success until I added in Met. I haven't had too much of a problem with it, and I found that it did allow me to lose weight, while I still gained without it.
Please don't think that I'm attacking you in any way - you asked what my background was and what my reasoning was, so I'm just answering you. If you have any information for me, I'm always on the lookout for new sources.
Take care, and good luck finding a homeopath or naturopath!
Registered Massage Therapist (2200 hrs training)
Hi there Sweet Sunshine. Thx 4 taking the time to reply. You sound reasonably knowledgeable ... what's ur background? Mine's in nursing, naturopathy and science research. I still do put the Sx down to Met, as I've never had them whilst pregnant (6 x). I also did not have any PCOS Sx escalation after any of the previous 5x pregnancies, so I doubt that that was what triggered the PCOS to get worse. Some of the Sx may have been due to low BSL, but typically I just get a raging migraine, no dizziness, weakness, brain fog etc. I've queried quite a few cysters on their experience with Metformin and have come to the conclusion that it seems to help (often greatly) women whose diet and exercise levels leave a lot to be desired, and seems to make women who exercise regularly and eat a healthy low GI/GL diet very ill. I've even heard from one woman on another forum who tried it 2x, that the first time it helped with no S/Es and after a break of a couple of years when she started exercising and eating well, she went back on Met and found it had horrible S/Es and actually made things worse. I've spoken to quite a few women who have had a similar experience to mine so I wouldn't be so quick to say definitively that it couldn't be Met. We know so little about PCOS and it's effects on the body, I just don't think anyone is qualified to say such a thing. We can't know. The fact remains, I had PCOS for quite some time before I took Met, with no obvious worsening or progression of symptoms, had been pregnant before with no apparent effect on PCOS Sx, then took Met and all hell broke loose for 4 years. I am only just now starting to bring it under control (using natural means).
I only went to a student homoeopathic clinic and unfortunately when I went back, they gave me a different strength of the remedy and it did nothing, so I went back and asked the same one, took it and it didn't do anything (that I noticed) that time.You are right though ... I should go an find myself a good homoeopath and give it another go. It's certainly easier than taking 20 different herbs and vitamins each day!
PS: I wouldn't have been pregnant for long if any amount of time while on Met, as the holiday to NZ was towards the end of the 2 months and I stopped taking it after a few days in NZ because I didn't want to ruin the holiday and I just wasn't up to doing anything whilst on it. Not much fun. There only would have been an overlap of a day or 2 max.
Edited by: BELROSA at: 3/30/2009 (00:01)
Belarosa, you only took Met for a very short period of time, and some of that time, you were pregnant, which could account for some of your symptoms. The spaciness, etc. that you describe sounds almost like low blood sugar, which can happen with Met, but you can manage it if you eat every 2 - 3 hours. The symptoms after the miscarriage are the worsening of your PCOS, and not related to Metformin whatsoever. It's common for the PCOS to get worse after a triggering event such as pregnancy or miscarriage, which I am very sorry that you had to go through.
I agree that Met is not the "be-all and end-all" - no drug is. But it is a medication that generally has milder side effects than any of the other blood sugar/insulin medications, and it is effective for most of us. A low-GI-type diet and exercise can actually do more than Met, but sometimes you need the extra push, too, to get started on an upward spiral instead of downward!
Anyways, take care, and it sounds like the homeopath really helped you - you might want to start seeing him again! The laser probably won't work that well until you get your hormones back under control so you don't get any new hairs "turning" dark.
Registered Massage Therapist (2200 hrs training)
If anyone is interested, there are plenty of natural alternatives to Metformin:
Hyponidd, an ayurvedic herbal formulation has been proven to be as effective as Metformin in clinical studies. www.fixdisease.com/clinical_research
Gymnema Sylvestre a herb which is in Hyponidd but can be taken separately, lowers blood sugar and reduces the cravings for carbs.
Cinnamon, Chromium, Vanadium, Vitamin B Complex and Magnesium also act in different ways to keep blood sugar functioning normally.
Try googling for more info, or find a Naturopathic Physician who specialises in PCOS.
I tried metformin (a quarter of a tablet or 125 mg 2x day, supposed to later work up to higher dose) for 2 months in 2005, but had to discontinue due to how ill it made me feel. Not particularly the GI symptoms, I was expecting those and they weren't that bad. What happened was I felt constantly spacy, dizzy, and as if I was really sick, not nausea but just unwell. It's hard to describe, because it was so wishy washy in specificity, but it was severe.
What I noticed yesterday, after having read a lot on this forum for many months, and thinking about my own progression of symptoms was this:
I had IRREGULAR periods prior to 2005 ... I'd generally get at least 4-6 a year.
I went to a Homoeopath in Feb 2005, took a remedy, then had 3 normal periods roughly a month apart, 3 months in a row. I started taking Metformin (and such a low dose too) for a couple of months in April/May, then felt too ill to continue, then had a miscarriage at about 6 weeks, not even realising I was pregnant until then, in June. This was not my first pregnancy and I had no trouble at all conceiving, so I don't think this can be attributed to the Metformin, more likely related to being on holidays in NZ.
* I did not have a period for 4 years after that. I just had one a week or so ago. First in 4 years.
* I started putting on weight like nobodies business (5kg in April/May, +10kg in September) I had previously always been able to maintain a reasonable weight, albeit with a lot of effort.
* I started growing the most disgusting body and facial hair, now to the point where I sometimes shave like a man ... I've had A LOT of laser, but it doesn't work where I would really like it to.
Well, that's my experience with Metformin. I think it's the work of the Devil (for me anyway).
Metformin has 2 main actions. 1) it helps the "gates" in your cells that allow insulin/glucose in to work better, and encourages the cells to create more "gates" - that helps the IR, and is what most of us want. 2) it also has an effect on the liver. Normally, between meals, the liver takes glycogen (short-term sugar storage) and converts it back into blood sugar. Met slows this down. This is helpful for diabetics because their blood sugar is usually high enough already, and it can make their blood sugar go too high, especially at night. For us, it can give us low blood sugar sometimes, especially when getting used to it. This is easily taken care of, though, by planning snacks so you eat every 2 - 3 hours. The snacks should include a form of carb, as well as fibre or protein to balance it out. So, apple slices spread with some natural peanut butter should be OK. If you need more, then you might want to change things so that you have 5 or 6 mini-meals per day. I'm prone to low blood sugar, and I found it got worse at first, but now it's a lot better and I hardly ever get sugar lows anymore.
As for some of the extreme reactions - the nausea and diarrhea usually goes away after a while. I wouldn't increase dosage until after it settled down. Eating things high in simple carbs and fats does tend to set things off, as does lettuce for some reason.
There are some people who just can't tolerate the normal dosages, but they usually still benefit from a lower dose. Maybe they react to the high one because all they need is a low one? There are also some very rare extreme reactions - I would count the "ringworm"-like rash as one of them, and I would say if you get a strong reaction like that, then don't take it anymore!
Metformin is a drug like any other. It is pretty mild compared to other meds that help blood sugar and insulin issues, although there are some other ones that might help (like Actos, for instance). Some of us are so far out of balance that we CAN'T get a handle on things without a helping hand. Certainly diet and exercise NEED to be a part of your long-term treatment plan as Metformin will only help push things in the right direction - you still need to do the work to get it there.
Take care, and HTH!!!
Registered Massage Therapist (2200 hrs training)
The only side effect I have is some GI upset. Other than that I tolerate it pretty well. Thank goodness.
~Linda (West Chicago, IL)
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Well, oddly enough, I cut back on taking it for a little bit recently because I was really sick (in and out of the hospital for two whole weeks due to an allergic reaction to an antibiotic so I couldn't eat anything and my doctor said to stop taking it until I could have solid food again), and I've been back on it for two weeks now without any of those side effects this time. So huh...
Wow. I had no idea people had such bad reactions to it.
I don't get side effects.
I used to wonder if it worked at all.
I have taken Metformin for almost two years. I did have really bad side effects when I first started taking it. I talked to my doctor and he told me to take it at lunch and dinner. That way I was making sure I ate enough. I think that it just takes a little while for your body to get use to the medicine. I don't have any of the side effects now, unless I eat a meal that is high in fat or real greasy (which I don't need anyway). But, I think that everyone is different, so it will effect everyone differently.
I had been taking Metformin for quite some time and my doctor was changing my dosages due to my vomiting and diarrhia. When I finally just told him to change me to something else, I started to get these spots that look like ringworm all over my legs and arms. They will not go away for 2 to 3 years according to him. It is due to my metformin doing the opposite of what it's supposed to do and my insulin or whatever is trying to escape thru my skin, causing the rings. He wanted me to continue my metformin, but I refused it. I will never again go on this pill in anyways, shape or form.
~*~Anastasia Marie Barajas~*~
I was on Metformin for almost a year. I took it morning and night after slowly working up to that dose. I had violent, painful, emergency bathroom visits everyday at about 2:00pm and 7:00pm. Sometimes I would wake up late at night for a third bathroom visit.
It was HORRIBLE.
Here is my advice. Do not use Metformin as a quick fix for PCOS. Balance your blood sugar naturally by eating right and working out. I was, sick, miserable, and depressed on Metformin, It did not help me at all to loose weight, and after I went off of it I gain wait rapidly.
I recommend trying every last resort possible before going on this medicine. It is terrible.
My doctor told me today about the side effects of metformin being worsened by eating fat. She said the best idea is to meet with a dietician to eliminate fat almost entirely from the diet, as fat, even a salad dressing, can increase the nausea and diarrhea.
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I started on met back in 2003, and until 3 months ago was proty much house bound with the side effects of it
still have issues with the extended release version of it, but at least I know in 12 hours of taking it to be around the loo - a better inprovement over 30 min after taking it and stuck for a good 2 hours till it clears my body.
The side effect you speak of being hungry, have you tested your blood glucose levels to make shure are not having a low, that is triggering your body to tell you to eat because it is in danger of going hypo? which can be a side effect met that it lowers your BG levels to blasted low (its an insulin sensitizing drug, but it has been reproted to lower BGs to low for some people).
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Metformin was a disaster for me. It took a long time to work up to the correct dosage for me, though I would be in the ladies room forever. At the time, I just couldn't handle how sick it made me, especially because of my job. Now I guess I could re try it, but I don't have insurance now & really dread all the extra time in the latrine. I did shed pounds on that pill, probably from the nausea & dysentery. An important side note, my grandmother was on it for 20 years, and her kidneys started to shut down and she almost died from it.
On Metformin, I also got extremely nauseous & nearly lost it at all sorts of familiar smells...like horse droppings....been around barn smells all my life & never affected me unless I was on Metformin, and then I would just gag if I was near horse manure...hard to handle when I have a few horses!!!
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I actually had the SAME exact symptoms. (With the addition of me no longer wanting food I KNEW I loved!) Metformin affects the gastro system, so any of those symptoms can completely be contributed to Met. My dr informed me that if I took the pills at bedtime, then the symptoms I experienced would go away. I did that and it's all better! YAY!
Life is what you make of it! =)
Take your goals inch by inch rather than yard by yard...
I have trouble with Metformin and can not take it anymore...but not for the same reasons. It makes my stomach hurt and I get very bloated when I take it. Maybe you just need more calories when you take more of it. Wouldn't that be nice to know that you could eat more and still lose weight? haha
Three weeks ago, after nearly ten years of struggling with my weight and being diagnosed and treated for hypothyroidism and PCOS, I finally came across a doctor who believe me when I said I was doing everything right but still GAINING weight, and he put me on Metformin right away to see if that would at least help me to maintain my weight. He's having me increase my dosage slowly, by 1/2 a pill a day.
The first week I took 1/2 a pill with breakfast every morning and I felt fine and even saw some changes (I lost 1lb and half an inch off of my waist). The next week I went up to 1/2 a pill at breakfast and 1/2 a pill at dinner, but I started feeling really hungry in between meals. Then this last week I went up to 1 pillat breakfast and 1/2 at dinner, and it was disastrous. I was hungry ALL THE TIME, even immediately after meals, and while I was drinking extra water just in case I was getting dehydrated like one of the side effects warned, it didn't help. I started getting dizzy from hunger if I went more than an hour without eating something, and it had to be something that was really sugary, too, because several nights I'd snack on nuts or eggs or cheese and nothing would work until I grabbed a peanut butter bar or a mini chocolate bar left over from Halloween. I was waking up and feeling sick to my stomach in the morning because of how hungry I was. I immediately dropped back down to the 1/2-1/2 schedule and called my doctor, but he said that this isn't a symptom he's ever heard of with Metformin. He says that if I'm still having trouble to drop down again to the 1/2 pill once a day thing, but he was trying to get me up to at least 2 pills a day, if not 4, so even though I'm still feeling hungry more frequently than I like, I'm going to try and stick with this and maybe go up again in another week and see what happens.
But have any of you have a similar experience with Metformin? And how did you cope with it until you got used to everything? I'm really liking the benefits of it, my hair isn't falling out any more and even though last week I was eating something like 1800 calories a day because of the hunger issues I'm no longer gaining weight so I think it's still working, but these blood sugar crashes are just hell on my system and with school and two jobs, I'm really struggling with them.