Metformin is one of the most popular prescription drugs in the world and is often used as a first-line treatment for type 2 diabetes.
Despite the common association with type 2 diabetes, you may have heard of people with type 1 diabetes who have been prescribed metformin off-label and are wondering about its safety and how the prescription drug works for people with type 1.
In this article, we will explore the use of metformin in the treatment of type 1 diabetes and answer some frequently asked questions about the use of metformin in people with type 1 diabetes.
Why would someone with type 1 diabetes want to take metformin?
People with type 1 diabetes may be prescribed off-label metformin (not approved by the FDA) to help treat insulin resistance, to better control blood sugar, and in some cases to lose weight (usually as a result of insulin resistance as Well).
Several clinical trials and meta-analyses have found that taking metformin can lead to modest weight loss. While it’s not the most common reason people prescribe metformin, the drug is known to reduce appetite and help the body be a little more metabolically efficient, which can lead to weight loss over time.
While studies have shown that A1c levels do not change significantly in people with type 1 diabetes who start taking metformin, studies have shown that adding metformin to an existing insulin regimen reduces the amount of insulin people need to take each day.
In people with type 1 diabetes, metformin is always used in combination with insulin therapy.
Can metformin replace insulin?
This is NO safe for people with insulin dependent diabetes to try to replace insulin with metformin.
Treatment of type 1 diabetes requires insulin therapy. This is because if you have type 1 diabetes, your pancreas does not produce insulin.
Metformin can significantly help lower blood sugar, but it does not increase or restore the body’s ability to produce insulin.
It’s important to check with your doctor about the medications you’re taking to make sure your prescriptions and care plan are up to date and to help prevent unintended interactions – but metformin won’t allow people with type 1 diabetes to stop taking their insulin.
Is taking insulin better than taking metformin?
There is no superiority between insulin and metformin. Rather, they work in different ways, which in some cases may be complementary.
There are many brands of metformin in addition to combination drugs with metformin. Metformin is an oral medication that is taken daily or twice a day in pill form.
There are also many types of insulin, all of which are injected or administered subcutaneously (under the skin) using an insulin pump – or in the case of Afrezza, inhaled.
Basically, insulin helps lower blood sugar faster than metformin.
Metformin helps control blood sugar levels, may fight insulin resistance, and may even help you lose weight.
But there are also downsides to both metformin and insulin.
Metformin can cause stomach discomfort, diarrhea and other digestive problems, especially if the dose is too high or if you take it on an empty stomach.
Insulin is a powerful hormone, and taking too much insulin can cause low blood sugar (hypoglycemia), which can be very dangerous if left untreated.
Many years of clinical research have shown that when metformin alone is insufficient to control blood sugar levels in people with type 2 diabetes, combining it with insulin therapy is an effective way to improve control as measured by A1c.
Again, insulin therapy is necessary for people with type 1 diabetes, while metformin therapy does not.
However, because metformin and insulin work differently, there are reasons why researchers are now exploring the potential usefulness of metformin among people with type 1 diabetes.
What happens when a person with type 1 diabetes takes metformin?
In 2017, the journal published a meta-analysis Diabetology found that over 15% of adults with type 1 diabetes in Scotland were prescribed metformin. In France, metformin has an indication for type 1 diabetes in addition to type 2.
A study titled “Rethinking Metformin Therapy for Type 1 Diabetes” neatly sums it up this way:
“Perhaps because of such compelling evidence for type 2 diabetes, the off-label use of metformin for type 1 diabetes is quite common in clinical practice.”
Studies have shown that people with type 1 diabetes who took metformin in addition to insulin experienced a significant reduction in the amount of insulin they needed to take each day (a reduction of almost 7 units per day) when metformin was added.
Subsequent studies conducted in 2018 confirmed these findings, showing a net benefit for people with type 1 diabetes who add metformin to their existing insulin regimen. Again, adding metformin has been shown to help with weight management, reduce daily insulin needs, and slightly improve blood pressure.
While there was also a slight improvement in average blood sugar levels, these changes were not significantly different from the placebo group.
With the exception of gastrointestinal disorders, no serious adverse effects of metformin were reported in these studies.
Finally, as noted by Dr. Leon Gussow in Emergency medicine newsmetformin has come under the spotlight in recent years for its hypothetical benefits for cardiovascular health, reducing inflammation, and improving all-cause mortality.
But Dr. Gussow is quick to point out that the evidence base is for mice and other test animals – not humans.
Nevertheless, this off-label use for purported overall health benefits appears to be widespread and may be particularly helpful for people living with type 1 diabetes who are already at increased risk of heart disease, stroke and premature death.
As with all prescription medications, metformin should only be taken under the supervision of a physician or other healthcare professional, and your medical history and health goals will play a significant role in whether a metformin prescription can be of help.
Frequently asked questions
There is limited evidence that taking metformin can extend life, but important clinical trials are underway to find out more. One of the largest studies to establish the evidence base on metformin’s effects on aging and longevity is known as TAME (Targeting Aging with Metformin).
For now, there is not enough information about metformin’s effect on life expectancy to judge, and this applies to people with and without type 1 diabetes.
At least until more is known, it’s safe to rely on your doctor’s general advice to improve your health, including keeping your blood sugar in the right range, eating a healthy diet, getting enough exercise, managing stress, and avoiding risky behaviors like smoking cigarettes.
Because insulin therapy is absolutely necessary for people living with type 1 diabetes, metformin is usually considered optional, and its clinical evidence base is not as robust as for the treatment of type 2 diabetes.
No, unlike insulin, which starts to lower blood sugar very quickly, metformin usually takes 2-5 days to lower the average blood sugar level.
Some people will not notice the effects of metformin for up to two weeks after starting the drug, and some people will never notice any effect at all.
If you stop taking metformin, the medicine will stay in your system for about 4 days, so it’s important to be aware that you may need to adjust your insulin doses when you start or stop taking metformin.
Many of these medications have not been thoroughly tested in people with type 1 diabetes, so it’s important to talk to your doctor or other healthcare professional to understand what treatment options are safe and likely to work.
Since the pancreas of a person with type 1 diabetes cannot produce insulin, these drugs are not effective – and therefore combination drugs with metformin would not benefit a person with type 1 diabetes.
There are many conditions and circumstances that may justify taking metformin, even if you don’t have diabetes. These include conditions such as PCOS or a need to lose weight that your doctor thinks metformin can help with.
In addition, many clinical trials are still ongoing to determine whether taking metformin daily has health benefits for healthy individuals.
While animal tests show some improvement in cardiovascular health, inflammation and a reduction in all-cause mortality, these results are so far uncertain and have yet to be widely demonstrated in humans.
While metformin is generally considered quite safe, it’s important to realize that it carries some risk of side effects. Metformin can cause stomach upset, vitamin B12 deficiency, hypoglycemia (low blood sugar) and very rarely – but most seriously – lactic acidosis.
For these reasons, it’s always important to work with your doctor and healthcare team before taking metformin to understand the risks and benefits of metformin.
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