Metformin side effects

[JimBear]

Hi folks!
Can I pick your brains about Metformin please?
I have been on and off Metformin several times throughout the treatment of my diabetes. At one time I was taking Bolamyn SR 1000mg twice a day but felt so terrible I insisted I came off them as I had no energy and felt really unwell, depressed and irritable. Before the week was out I felt amazingly better - better than I had done in a long time even though my glucose numbers were sky high.

Since then I was prescribed 500mg to take once a day (for a week), along with various other drugs, and then increase to two a day. Before I got to taking two a day, the old feeling of feeling like the walking dead returned after a few days and so I came off them.

I am now on insulin (great stuff!) and the nurse encouraged me to re-try Metformin because of the beneficial side effect of reducing the risk of heart attack, but a different brand as people can react differently to different brands. Apparently.

So now I am on Glucophage SR 500mg and have been taking one a day for the past two weeks, and am now on twice a day.

For the two weeks of one per day I seem to be :
Very tired, lethargic
Irritable
Depressed, with little interest in anything
Blurry vision (even though numbers have dropped. This has come on quite suddenly and am now using cheapy reading glasses to get by).
Struggling to concentrate on anything.

Since taking two per day (for just one day so far) I am experiencing:
Light headedness and dizziness

None of these side effects, if indeed they are side effects, are listed in either of the leaflets. Does this mean these are not side effects, or are they so ultra rare that they don't list them?

The good thing out of all this is I don't have stomach/bowel problems I experienced on the Bolamyn metformin.

Thanks in advance for any light that can be shed on this!
Jim 🙂

 

[grovesy]

I would say if they make you feel that bad then they are side effects in you!

 

[pippaandben]

How have your blood glucose levels been? Blurred vision is very often the result of high levels and the vision gradually improves as your numbers come down. Also your mood changes could also be because your levels are changing from what your body had been taking as the norm.

 

[JimBear]

My blood glucose levels have been slowly coming down. Typically they are between 14-20 now. Before I started this particular course of treatment my eyesight was dreadful. Both far and near were blurred. I haven't been driving since being on insulin (awaiting DVLA), but I wouldn't have been able to safely drive because of this. Within 36 hours of starting insulin, my vision was improving noticeably, and within a week had returned to normal - both far and near. I continued for some time on just insulin before starting to include this additional treatment of Metformin. It was about a week and a half into this that I noticed my vision was deteriorating and now it is so bad I have to use glasses to read and type. My numbers have come down more since using the Metformin, as was to be expected. I can't be totally sure it isn't because my numbers are still high - it seems a little coincidental it has become this bad since starting the Metformin.
If you look at the side effects for Metformin listed on Drugs.com, there are many, many more than are listed in the leaflet which came with them, and I can appreciate some of them may so very ultra rare as to not be included. However, a lot of the symptoms I mention, including blurry vision, are listed on the website.

My nurse was keen to bring my numbers down slowly so as not to shock my body. She told me that the back of my eyes can bleed if I come down too quick. I just wish I could get the numbers to come down a little quicker than they presently are lol.

I am going to try and carry on with the double dose over this coming weekend, if I can. I shall then take a break from them and see if things improve after a few days without. If this is the case, I will have to admit that I can't tolerate Metformin, even though I was keen to use it to help reduce risk of heart attack.

 

[Northerner]

It is sensible of your nurse to recommend not lowering your levels too quickly - this can cause extra stress to the small blood vessels of the eyes and kidneys in particular. I hope that things improve, it may just be a period of adjustment for your body and hopefully things will improve and you'll be feeling good again! 🙂

 

[JimBear]

Hi folks
I came across and interesting article online yesterday, which may go some way towards explaining why I feel unwell. I have pasted the extracts below and included a link to the full article. I would be interested to hear your comments on this:

Q. I have read that metformin can cause a deficiency of Vitamin B12. I have not been able to find again the source of this information and would like your input.

A. This is from the prescribing information at DailyMed, identical to what is published in the PDR:

“Vitamin B12 Levels: In controlled clinical trials of metformin of 29 weeks duration, a decrease to subnormal levels of previously normal serum Vitamin B12 levels, without clinical manifestations, was observed in approximately 7% of patients. Such decrease, possibly due to interference with B12 absorption from the B12-intrinsic factor complex, is, however, very rarely associated with anemia and appears to be rapidly reversible with discontinuation of metformin or Vitamin B12 supplementation. Measurement of hematologic parameters on an annual basis is advised in patients on metformin and any apparent abnormalities should be appropriately investigated and managed (see PRECAUTIONS: Laboratory Tests).
Certain individuals (those with inadequate Vitamin B12 or calcium intake or absorption) appear to be predisposed to developing subnormal Vitamin B12 levels. In these patients, routine serum Vitamin B12 measurements at two- to three-year intervals may be useful.”​

Q. I am suffering from such severe diarrhea I am sometimes afraid to leave the house. I also have bad gas and bouts of abdominal pain. I suspect the metformin I take for diabetes, but my doctor says my symptoms are not from my medicine.
The Prevacid I take for my heartburn isn’t helping enough to justify the expense. I am also experiencing pain and tingling in my toes.

A. Metformin (Glucophage) can cause diarrhea, nausea, heartburn, flatulence and stomachache. Acid-suppressing drugs like lansoprazole (Prevacid), omeprazole (Prilosec) or esomeprazole (Nexium) won’t solve the problem completely and may interfere with absorption of vitamin B12.
Metformin is also linked to reduced levels of vitamin B12. Because this vitamin is crucial for nerve function, deficiency can contribute to numbness, tingling or pain of the toes, feet or fingers, trouble walking, memory problems, depression, confusion and burning tongue.​

Thankfully, the Glucophage I am taking doesn't seem to have caused me any digestive problems as the generic metformin did. However, I am taking omprazole for acid reflux and have done for years. Since starting the Glucophage I have had pins and needles in my fingers which sometimes last an hour or so or sometimes all day. I have mentioned this to my nurse who dismissed it as sleeping awkwardly. Admittedly I haven't had it for the past week. I have also been having memory problems, often forgetting what I was doing mid-way through it. I am currently being treated for depression, and since starting this it feels like I am no longer being treated... This happened on the old metformin too and I felpt positively euphoric when I stopped taking them. Again I have mentioned this to the nurse who just said it was because my sugars were high. They were high when I stopped the treatment last time, higher in fact, so that theory doesn't hold.
The full article is here: http://www.peoplespharmacy.com/2012/10/21/metformin-glucophage-side-effects-complications/

I have looked up Vitamin B12 deficiency and found this on the NHS website:

Symptoms of vitamin B12 or folate deficiency
Vitamin B12 and folate perform several important functions in the body, including keeping the nervous system healthy.

A deficiency in either of these vitamins can cause a wide range of problems, including:

• extreme tiredness
• a lack of energy
• pins and needles (paraesthesia)
• a sore and red tongue
• mouth ulcers
• muscle weakness
• disturbed vision
• psychological problems, which may include depression and confusion
• problems with memory, understanding and judgement

Some of these problems can also occur if you have a deficiency in vitamin B12 or folate, but don't have anaemia.
​

The full article is here: http://www.nhs.uk/Conditions/Anaemia-vitamin-B12-and-folate-deficiency/Pages/Introduction.aspx
Note the listing for disturbed vision along with extreme tiredness, lack of energy. This is exactly what I have been experiencing (though thankfully I have not had a sore red tongue or mouth ulcers).

Do you think it is likely that I have the problem between Glucophage and Omeprazole leading to Vitamin B12 deficiency? I am going to call the doctors tomorrow and ask how to go about a blood test for this. I don't particularly want to add injections to replace the loss and I don't want to come off the Omeprazole as it took several experiments to find a medication which worked this well. I already take a multi vitamin supplement daily which is supposed to include 100% of the daily requirements for Vit B12 so am surprised that this may be the problem.

Many thanks for your time and comments
Jim 🙂

 

[Robin]

If Metformin depletes vitamin B12 by blocking absorption, ( which i suspect it does, this is what happens when people develop pernicious anaemia without any help from their medications) then eating a bucket load of the stuff isn't going to help you! This is why the treatment is vitamin B12 injections, rather than tablets.

 

[Northerner]

I would definitely raise the B12 issue with your GP, Jim - I've heard it reported quite a few times here on the forum over the years. Sometimes we have to give the medicals a poke in the right direction! 🙂

 

[malturn]

Hi JimBear. I had a similar problem after taking metformin for over 17 years. The doc found that I was becoming aneamic and my B12 was low, in the end I have been put onto Insulin and all the tiredness and lethargy have disappeard and I generally feel heaps better with far more energy and go in me than I have had for years.

 

[JimBear]

I would definitely raise the B12 issue with your GP, Jim - I've heard it reported quite a few times here on the forum over the years. Sometimes we have to give the medicals a poke in the right direction! 🙂

I have called the surgery today with a promise the doctor would phone me back to let me know if I need to see him to discuss this or whether I can just book myself in for the blood test. I have since called twice more with the promise he will call but hasn't I was really hoping I was going to get this resolved this week but the receptionist told me there were no appointments until at least Thursday. By the time I have seen him and then had the blood test - assuming he is willing to agree to this - it'll be next week before I know the results. I feel like cr@p.

 

[JimBear]

Hi JimBear. I had a similar problem after taking metformin for over 17 years. The doc found that I was becoming aneamic and my B12 was low, in the end I have been put onto Insulin and all the tiredness and lethargy have disappeard and I generally feel heaps better with far more energy and go in me than I have had for years.

I have spent almost the last two years feeling like this. I pushed and cajoled the GP to put me on insulin but he was so unwilling to do so. Eventually, after he decided I should try no medication at all for 3 months and I could barely see as a result, I saw a different GP who immediately referred me to the community diabetes nurse with the instructions to put me on insulin. Within 36 hours I felt amazingly better - better than I have felt in a very long time. Even my eyesight improved ever so slightly during that time and then everything returned to a sense of a healthy normality - with energy, zest, happiness etc. Then I was persuaded to try the Metformin again with the insulin and all this nonsense started up again and my nurse made all sorts of excuses as to why I was experiencing these symptoms. *sigh* Sorry to rant, but I am so frustrated right now. And irritable. And that's another side effect of B12 deficiency too...
But anyone who is hesitant for going on insulin, I can't praise it enough compared to the oral meds! 🙂

 

[GA60]

Hi Jim, I too suffer at least 6 of those B12 symptoms on a regular basis, thanks for this post, I'll mention this to my GP next time I visit.

 

[JimBear]

Hi Jim, I too suffer at least 6 of those B12 symptoms on a regular basis, thanks for this post, I'll mention this to my GP next time I visit.

Be prepared to meet some resistance. Both my doctor and my diabetes nurse plus her colleague have pretty much scoffed at the idea it could be so. I was in no mood to accept any waffle when I went to see my doctor yesterday and I am going to have my blood tested tomorrow morning. Once I am tested I am going to reduce the metformin to one per day until the results come through, probably early next week. My doctor did say that between 10-20% of people simply cannot tolerate metformin. Everyone seems to agree that B12 deficiency only occurs in those who have used it for a very long time. However, unless it is some other complication which is creating these effects, I can only assume at present, that I am more susceptible to B12 deficiency caused by Metformin than most.

The good news of this is, if the results prove I do have B12 deficiency then the injections which are needed to replace it are only required once every 4 months after the initial 4 weekly injections have been given. Although oral meds are available, apparently they are not very effective.

I think these feelings of depression, irritability and extreme tiredness aren't easy to appreciate unless you've experienced them. If you can recall what it felt like when you were first diagnosed - the tiredness etc and then double it, you'll get some idea how I've been feeling these past few weeks and most of the time I was on Metformin alone for 2 years!

I will let you know what happens once my results are back. I really do hope this will lead to the end of these symptoms.

 

[Northerner]

I really do hope this will lead to the end of these symptoms.

Hope so Jim, fingers crossed for you! 🙂

 

[JimBear]

Hello again people!
I had my blood samples taken on Thursday and have just received the results back today with regard to the possibility of being B12 deficient.

It came back negative

I admit I am a bit upset about this as I was hoping that it was a 'simple' case of administering the B12 to make me feel well again. So it would appear that perhaps I just can't tolerate Metformin after all. However, as soon as the samples were taken, I stopped the evening dose of Metformin and I think I have noticed some slight improvements, particularly with my eyes (but only very slightly). I am now stopping the morning dose as well and see how I go over the next few days. If I don't feel a heck of a lot better (as I did when I last stopped the Metformin), then I will be at a loss!

 

[mikeyB]

This is a long shot suggestion, but you have been taking omeprazole for a prolonged period, as I did. A couple of years ago, I was feeling constantly tired, with muscle weakness and irritability. My GP decided to check my magnesium levels, which turned out to be dangerously low, and this was due to the omeprazole. Stopping the Omeprazole and taking a magnesium supplement turned me back into a human being. In fact, I was astonished at the change.

Now as I say, this is a long shot suggestion, but it just might be worthwhile asking the doc to check. I know this will only be a partial answer even if it turns out you are magnesium deficient, but it's worth a punt.

 

[Northerner]

Given that the B12 looks OK, did your GP not offer any other explanation or further tests Jim? If not, why not? Clearly, you still have a problem and it shouldn't be down to you to try and find out things that might be causing it! 🙄 However, if cutting out the metformin helps alleviate it, then it would seem to be the root of the problem.

 

[JimBear]

This is a long shot suggestion, but you have been taking omeprazole for a prolonged period, as I did. A couple of years ago, I was feeling constantly tired, with muscle weakness and irritability. My GP decided to check my magnesium levels, which turned out to be dangerously low, and this was due to the omeprazole. Stopping the Omeprazole and taking a magnesium supplement turned me back into a human being. In fact, I was astonished at the change.

Now as I say, this is a long shot suggestion, but it just might be worthwhile asking the doc to check. I know this will only be a partial answer even if it turns out you are magnesium deficient, but it's worth a punt.

I have been taking Omeprazole 20mg for the past 4 or 5 years - is that considered a long time? I have tried two or three other drugs which either didn't work or were unpleasant. If I don't improve over the course of this week then I will press for further tests.

Northerner - I only spoke to the nurse on the phone who wanted to drag me in to see the GP about my HbA1c levels being high, but considering they are looking back over the past 3 months, and I have only been on insulin for the past 2 months and only in the last week have my numbers been dipping into single figures, I am not surprised it was high. Now I have a specialist nurse to talk to I declined their invitation to see the GP. I had to press to get the B12 tested. Personally I think my GP doesn't like fat people and dislikes the fact I am happy with my weight and my body. I pretty much pleaded with him to put me on insulin and he refused. In fact it was he who took me off all meds of a while where I became so full of sugar I couldn't see and my test meter went off the scale. Only by chance did I see a different doctor who said it was about time I was put on insulin and referred me to the specialist nurse. I think that has also ruffled him a bit. Rant over.