Metformin and Reactive Hypoglycemia

Metformin (brand names Fortamet, Glucophage, Glumetza, Riomet) is a popular medication used to treat type 2 diabetes, and sometimes reactive hypoglycemia. The drug controls the amount of glucose in your blood by performing two actions: decreasing the amount of glucose absorbed from your food and decreasing the amount of glucose made by your liver. It does carry the risk of serious side effects.

Metformin and Reactive Hypoglycemia: Some points to consider

  • Keep an eye on your blood sugar reading using an ambulatory glucose meter. This will tell you if your glucose levels are improving, or not
  • Keep a diary of your readings to show to your doctor, just in case you suspect metformin is making your symptoms worse
  • Metformin carries the risk of serious side effects, including kidney failure and a life-threatening condition calles lactic acidosis — where lactic acid builds up in the bloodstream, Because of these risks, you should probably only be on metformin if other treatments (i.e. diet and exercise) have not helped your reactive hypoglycemia
  • Metformin can cause hypoglycemia in some patients (usually those patients taking combination pills like Metaglip or Glucovance), so always have an emergency glucose supply on hand. It can also cause hyperglycemia (high blood sugar)

Metformin and Reactive Hypoglycemia

Metformin and Reactive Hypoglycemia: a good combination?

Although metformin has been shown to improve blood sugar control for insulin-resistant pre-diabetic reactive hypoglycemia, it has never been tested clinically for insulin-sensitive reactive hypoglycemia (non-diabetic reactive hypoglycemia). Why? Most likely because non-diabetic reactive hypoglycemia is — in the vast majority of cases — not life-threatening or disabling (other than the experience of unpleasant symptoms). Therefore, the drug companies aren’t interested in testing it for that purpose — there simply isn’t enough money in it to make it worth their while.

Metformin and Reactive Hypoglycemia: Some questions you may want to ask your doctor:

  1. Why am I being prescribed this drug?
  2. Am I insulin-resistant or insulin-sensitive? (If he doesn’t know — find another doctor!)
  3. Can my symptoms be controlled with diet and lifestyle changes? (In other words, is this medication absolutely necessary?

Metformin and Hypoglycemia: Final note on side effects

Finally, make sure you read the patient information that comes with metformin. There’s an extensive list of side effect information. Make sure you’re aware of symptoms of these side effects, including hyperglycemia and hypoglycemia.

Metformin and reactive hypoglycemia
NCBI: Oral diabetes medications

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