“Are there side effects of Metformin therapy for children?”
My daughter has type 1 diabetes, and her doctor recommended for us to include Metformin therapy in her treatment. We aren't sure though if this is a good idea. Are there risks, or side effects of Metformin that are dangerous for children?
5 Answers
Depends on the age of your daughter. It is not common to use metformin in the management of type 1 diabetes, but sometimes we do. Generally, it's very safe and the benefits overweigh the risks. The most common adverse reactions are abdominal distention, abdominal distress, abdominal pain, abnormal stools, constipation, diarrhea, dyspepsia, flatulence, heartburn, nausea, and vomiting.
Metformjn is usually not indicated for Type 1 diabetes. Type 1 diabetes requires insulin. If your daughter is truly a Type 1 diabetic, meaning she had positive antibodies such as anti GAD and anti islet cell antibodies then metformin won’t help her. Unless the metformin was recommended for a superimposed health problem such as PCOS then metformin can help for the PCOS but not type 1 diabetes.
There are two major classes of diabetes. Most patients have type 2 diabetes (90%) and about 5% have Type 1 diabetes. Besides type 1 and type 2 diabetes, there are other forms of diabetes such as gestational diabetes, cystic fibrosis-related diabetes, congenital diabetes and steroid induced diabetes.
Both type 2 diabetes and type 1 diabetes are based on genetic and environmental factors. Type 1 diabetes results from pancreatic islet beta cell destruction by an autoimmune disease. Once more than 80% of islet cells are destroyed by this process the insulin production is insufficient to control blood sugars.
Type 1 diabetes is mainly treated with insulin. With out insulin type 1 diabetes patients will not survive. A good insulin regiment, frequent blood glucose testing and a healthy diet will achieve a tie glycemic control of HbA1c of <7.5%.
Type 2 diabetes is treated with diet, physical activity and/or oral medications, though as time goes by, many of these type 2 diabetic patients will require insulin to control their blood sugars. Metformin is the first line therapy for type 2 diabetic patients.
Metformin (Glucophage) is the commonest drug prescribed to treat type 2 diabetes. Unless there is contraindication metformin is recommended for almost all new onset type 2 diabetes in addition to diet and exercise. Other oral antidiabetes medications may also be indicated depending on their situation.
Metformin is the 6th most prescribed medication in America (about 80 million prescriptions per year), Vicodin being the number one prescribed drug in America. It is one of the safest and cheapest medications available.
It was isolated from lilac plant in France in the early 1920's by a French scientist. It was not used as antidiabetes medication for 35 years since its use for other purposes.. It was approved as atidiabetes medication in 1957 in France. It took another 35 years (1995) to be approved in the united states.
Metformin comes from a class of atidiabets medication called "The Biguanids". There were three biguanides in use. Bufermin, Phenfermin. Bufermin and Phenfermin were abandoned due to their toxicity.
Unlike the oral hypoglycemic agents metformin does not involve in increase insulin production. It involves in improving insulin sensitivity by insulin responsive tissues. It increases tissue glucose uptake and utilization. It decreases glucose production (gluconeogenesis) by the liver as diabetics have 3-4 times glucose production in the liver than non diabetic patients. It also decrease glucose absorption in the gastrointestinal tract.
Metformin can be combined with different medication to treat type 2 diabetes. There double and triple combinations with metformin in various doses. Such examples from each class are as follows: Janumet, Avandamet, Actoplus Met, Glucovance, Prandimet, Triformin and many other combinations.
Side effects of metformin: Metformin has side effects which are mostly tolerated. The most common side effect is gastrointestinal complaints such as diarrhea, flatulence, abdominal pain, nausea, vomiting, distention, heart burn and constipation. Most of these symptoms would be tolerated if metformin can be started in a lower dose and gradual increase it to the desired range. It should be taken consistently with food. If symptoms persist a long acting form of metformin would easy the symptoms on the gastrointestinal tract.
Other none Gastrointestinal side effects would include: weakness, muscle pain, chest pain, low levels of vitamin B-12, dizziness and rarely low blood glucose levels.
There is also a risk of lactic acidosis. But this is very rare. It occurs probably 1 in 30,000 cases. It is mostly with patients with renal insufficiency, liver disease, contrast medium, or patients with keto-acidosis. The effect of metformin on lactic acidosis is probably similar to the background population.
Under normal condition the body needs to get sugar at all times to do its function. The brain solely depends on glucose for energy, though other tissue can utilize non sugar substrates for energy. The body gets glucose from food and glycogen storage in the liver and muscle. If it does not get glucose from theses sources, it makes itself in abundance through a process called gluconeogenesis from the liver. Diabetics make 3-4 times sugar through these process than the general population in their liver. Liver is the biggest machine that makes sugar and lipids from non sugar sources.
Lactate is a major source of gluconeogenesis in the liver. Metformin inhibits this gluconeogenesis path way and diminishes glucose production. Therefore metformin increase lactate in the body. In a healthy person this lactate is excreted by a healthy kidney and no significant lactate build up takes place. But in conditions that impair lactate excretion, lactate build up can happen leading to lactic acidosis. These conditions include, impaired kidney function, liver disease or use of contrast media.
Overdose of metformin is very rare. The usual dose of metformin is 2,000-2,500 mg per day divided in to two or thee doses. Dose exceeding of 5,000 mg may lead to some form of toxicity. An ingestion of about 60,000 mg may still not kill some one.
Metformin is therefore one of the most prescribed, reasonably priced, and safest medications used as a first line therapy for type 2 diabetes. Though its approved use is for type 2 diabetes it is being used off label for many medical conditions.
Some of the list of the medical conditions are as follow:
1) in insulin resistance (metabolic syndrome). Metabolic syndrome is a constellation of conditions consisting of central obesity, abnormal blood sugar, dyslipidemia, hypertension, fatty liver etc.
The hallmark of metabolic syndrome is insulin resistance. Though most people with metabolic syndrome are obese a significant population is non obese with metabolic syndrome. But both population have insulin resistance or insulin function abnormality. Of note 20% of obese people are healthy Fat (healthy people) and 40% of thin people may have metabolic syndrome (sick thin). These people probably have fatty liver exporting insulin resistance without being obese. Almost 50% of Americans have some form of metabolic abnormality.
Metformin is a good option for the management of metabolic syndrome besides diet and exercise.
2) Prediabetes: There are about 85 million Americans with these condition. Many of them will develop diabetes in the near future. Most are obese and some are not.
Metformin is a good option to manage these patients besides diet and exercise.
3) PCOS: polycystic Ovarian Syndrome in a condition were there is high male hormones, abnormal period, physical manifestation of excess male hormone such as hirsutism, acne etc with or with out ovarian cysts. These patients are prone to infertility. Many of these women have problems with conceiving children with out the help of fertility drugs. Metformin is in good use in these kind of population.
4) Neuroprotective: metformin have been used to protect the function and integrity of the nervous system in certain risk groups.
5) Antiaging effect; Metformin is being used to slow the aging process. There is ongoing studies on this topic.
6) Cardiovascular protective effect. Metformin is in use to protect the cardiovascular health in certain risk population.
7) Antitumor effect: Metformin is being tested for its anti tumor effects.
8) Acanthuses Nigricans: This is a condition were the skin of the neck, arm pit and other parts of the body becoming dark due to insulin resistance. Insulin stimulates the epidermal growth factor of the skin in those areas and lead to thick velvety or dark skin. Metformin is a good option besides diet and exercise for this population.
9) Obesity; Metformin is believed to suppresses appetite. Metformin has been used in children to treat obesity for many years. Obese children mainly 10 years and above may benefit from metformin therapy as appetite suppressant though younger ones can be tried if there are no other options.
10) Double diabetes: Double diabetes is patients with type 1 diabetes but have additional conditions such as metabolic syndrome. They are mostly obese, showing signs of insulin resistance, Acanthuses Nigricans or are requiring unusually insulin doses. They can also be thin with signs of insulin resistance. These patients with type 1 diabetes who have the above conditions are believed to have double diabetes. For these patients metformin will be a good option besides diet and exercise and their regular insulin regiment.
Metformin will lower their liver glucose production, increase insulin sensitivity and glucose uptake and utilization.
Going back to your daughter: Your daughter has type 1 diabetes. She needs to be on reasonable dose of insulin and maintain a good glycemic control. A customized insulin regimen, regular frequent blood sugar monitoring, healthy diet and regular physical activity will be suffice to achieve a good glycemic control of HbAc1 of <7.5 %.
Double diabetes will develop if she is gaining excessive weight, have abnormal liver fat, dyslipidemias or she is requiring excessive amount of insulin that are not explainable by growth, food intake, activity level or other variables. In this case adding metformin to her insulin regiment may be helpful. metformin will suppress excess production of glucose from the liver and increase sensitivity of the body to insulin. It may also lower the lipid production by the liver which will intern help in the body's insulin sensitivity.
Metformin is one of the safest medications to use for type 2 diabetes. Most of the side effects are gastrointestinal which are tolerated in the long run, if they are started at a lower dose and increase it slowly or change it to the extended release form of metformin, which is tolerated much better.
I encourage you to talk to her doctor and discuss about these issue in detail. If she has the clinical or physical phenotypes that are listed above, it would not be a bad idea to be on metformin as long as she could tolerate the medication and have close monitoring.
Metformin has been used in children as young as 8 years old for many years. It has similar side effects to adults. If a child really needs it, there is no reason why the child (especially teens and adolescent) would not be on it.
The most important thing is to focus on her over all health and good glycemic control. Discuss this with her doctor and take what would be the best treatment options for your daughter.
Good Luck
Both type 2 diabetes and type 1 diabetes are based on genetic and environmental factors. Type 1 diabetes results from pancreatic islet beta cell destruction by an autoimmune disease. Once more than 80% of islet cells are destroyed by this process the insulin production is insufficient to control blood sugars.
Type 1 diabetes is mainly treated with insulin. With out insulin type 1 diabetes patients will not survive. A good insulin regiment, frequent blood glucose testing and a healthy diet will achieve a tie glycemic control of HbA1c of <7.5%.
Type 2 diabetes is treated with diet, physical activity and/or oral medications, though as time goes by, many of these type 2 diabetic patients will require insulin to control their blood sugars. Metformin is the first line therapy for type 2 diabetic patients.
Metformin (Glucophage) is the commonest drug prescribed to treat type 2 diabetes. Unless there is contraindication metformin is recommended for almost all new onset type 2 diabetes in addition to diet and exercise. Other oral antidiabetes medications may also be indicated depending on their situation.
Metformin is the 6th most prescribed medication in America (about 80 million prescriptions per year), Vicodin being the number one prescribed drug in America. It is one of the safest and cheapest medications available.
It was isolated from lilac plant in France in the early 1920's by a French scientist. It was not used as antidiabetes medication for 35 years since its use for other purposes.. It was approved as atidiabetes medication in 1957 in France. It took another 35 years (1995) to be approved in the united states.
Metformin comes from a class of atidiabets medication called "The Biguanids". There were three biguanides in use. Bufermin, Phenfermin. Bufermin and Phenfermin were abandoned due to their toxicity.
Unlike the oral hypoglycemic agents metformin does not involve in increase insulin production. It involves in improving insulin sensitivity by insulin responsive tissues. It increases tissue glucose uptake and utilization. It decreases glucose production (gluconeogenesis) by the liver as diabetics have 3-4 times glucose production in the liver than non diabetic patients. It also decrease glucose absorption in the gastrointestinal tract.
Metformin can be combined with different medication to treat type 2 diabetes. There double and triple combinations with metformin in various doses. Such examples from each class are as follows: Janumet, Avandamet, Actoplus Met, Glucovance, Prandimet, Triformin and many other combinations.
Side effects of metformin: Metformin has side effects which are mostly tolerated. The most common side effect is gastrointestinal complaints such as diarrhea, flatulence, abdominal pain, nausea, vomiting, distention, heart burn and constipation. Most of these symptoms would be tolerated if metformin can be started in a lower dose and gradual increase it to the desired range. It should be taken consistently with food. If symptoms persist a long acting form of metformin would easy the symptoms on the gastrointestinal tract.
Other none Gastrointestinal side effects would include: weakness, muscle pain, chest pain, low levels of vitamin B-12, dizziness and rarely low blood glucose levels.
There is also a risk of lactic acidosis. But this is very rare. It occurs probably 1 in 30,000 cases. It is mostly with patients with renal insufficiency, liver disease, contrast medium, or patients with keto-acidosis. The effect of metformin on lactic acidosis is probably similar to the background population.
Under normal condition the body needs to get sugar at all times to do its function. The brain solely depends on glucose for energy, though other tissue can utilize non sugar substrates for energy. The body gets glucose from food and glycogen storage in the liver and muscle. If it does not get glucose from theses sources, it makes itself in abundance through a process called gluconeogenesis from the liver. Diabetics make 3-4 times sugar through these process than the general population in their liver. Liver is the biggest machine that makes sugar and lipids from non sugar sources.
Lactate is a major source of gluconeogenesis in the liver. Metformin inhibits this gluconeogenesis path way and diminishes glucose production. Therefore metformin increase lactate in the body. In a healthy person this lactate is excreted by a healthy kidney and no significant lactate build up takes place. But in conditions that impair lactate excretion, lactate build up can happen leading to lactic acidosis. These conditions include, impaired kidney function, liver disease or use of contrast media.
Overdose of metformin is very rare. The usual dose of metformin is 2,000-2,500 mg per day divided in to two or thee doses. Dose exceeding of 5,000 mg may lead to some form of toxicity. An ingestion of about 60,000 mg may still not kill some one.
Metformin is therefore one of the most prescribed, reasonably priced, and safest medications used as a first line therapy for type 2 diabetes. Though its approved use is for type 2 diabetes it is being used off label for many medical conditions.
Some of the list of the medical conditions are as follow:
1) in insulin resistance (metabolic syndrome). Metabolic syndrome is a constellation of conditions consisting of central obesity, abnormal blood sugar, dyslipidemia, hypertension, fatty liver etc.
The hallmark of metabolic syndrome is insulin resistance. Though most people with metabolic syndrome are obese a significant population is non obese with metabolic syndrome. But both population have insulin resistance or insulin function abnormality. Of note 20% of obese people are healthy Fat (healthy people) and 40% of thin people may have metabolic syndrome (sick thin). These people probably have fatty liver exporting insulin resistance without being obese. Almost 50% of Americans have some form of metabolic abnormality.
Metformin is a good option for the management of metabolic syndrome besides diet and exercise.
2) Prediabetes: There are about 85 million Americans with these condition. Many of them will develop diabetes in the near future. Most are obese and some are not.
Metformin is a good option to manage these patients besides diet and exercise.
3) PCOS: polycystic Ovarian Syndrome in a condition were there is high male hormones, abnormal period, physical manifestation of excess male hormone such as hirsutism, acne etc with or with out ovarian cysts. These patients are prone to infertility. Many of these women have problems with conceiving children with out the help of fertility drugs. Metformin is in good use in these kind of population.
4) Neuroprotective: metformin have been used to protect the function and integrity of the nervous system in certain risk groups.
5) Antiaging effect; Metformin is being used to slow the aging process. There is ongoing studies on this topic.
6) Cardiovascular protective effect. Metformin is in use to protect the cardiovascular health in certain risk population.
7) Antitumor effect: Metformin is being tested for its anti tumor effects.
8) Acanthuses Nigricans: This is a condition were the skin of the neck, arm pit and other parts of the body becoming dark due to insulin resistance. Insulin stimulates the epidermal growth factor of the skin in those areas and lead to thick velvety or dark skin. Metformin is a good option besides diet and exercise for this population.
9) Obesity; Metformin is believed to suppresses appetite. Metformin has been used in children to treat obesity for many years. Obese children mainly 10 years and above may benefit from metformin therapy as appetite suppressant though younger ones can be tried if there are no other options.
10) Double diabetes: Double diabetes is patients with type 1 diabetes but have additional conditions such as metabolic syndrome. They are mostly obese, showing signs of insulin resistance, Acanthuses Nigricans or are requiring unusually insulin doses. They can also be thin with signs of insulin resistance. These patients with type 1 diabetes who have the above conditions are believed to have double diabetes. For these patients metformin will be a good option besides diet and exercise and their regular insulin regiment.
Metformin will lower their liver glucose production, increase insulin sensitivity and glucose uptake and utilization.
Going back to your daughter: Your daughter has type 1 diabetes. She needs to be on reasonable dose of insulin and maintain a good glycemic control. A customized insulin regimen, regular frequent blood sugar monitoring, healthy diet and regular physical activity will be suffice to achieve a good glycemic control of HbAc1 of <7.5 %.
Double diabetes will develop if she is gaining excessive weight, have abnormal liver fat, dyslipidemias or she is requiring excessive amount of insulin that are not explainable by growth, food intake, activity level or other variables. In this case adding metformin to her insulin regiment may be helpful. metformin will suppress excess production of glucose from the liver and increase sensitivity of the body to insulin. It may also lower the lipid production by the liver which will intern help in the body's insulin sensitivity.
Metformin is one of the safest medications to use for type 2 diabetes. Most of the side effects are gastrointestinal which are tolerated in the long run, if they are started at a lower dose and increase it slowly or change it to the extended release form of metformin, which is tolerated much better.
I encourage you to talk to her doctor and discuss about these issue in detail. If she has the clinical or physical phenotypes that are listed above, it would not be a bad idea to be on metformin as long as she could tolerate the medication and have close monitoring.
Metformin has been used in children as young as 8 years old for many years. It has similar side effects to adults. If a child really needs it, there is no reason why the child (especially teens and adolescent) would not be on it.
The most important thing is to focus on her over all health and good glycemic control. Discuss this with her doctor and take what would be the best treatment options for your daughter.
Good Luck
Yes there are side effects of Metformin therapy that would be undesirable and would need to be monitored if experienced. However, metformin is not the ideal medication for Type 1 Diabetes. If anything, your daughter should have been recommended insulin therapy.
There are few risks with metformin but there are side effects. The most common one is irritation of the GI tract with cramping, bloating & loose stools. These are common but are short lived on most people. GI symptoms can be minimized by taking the med. with food or using a long acting metformin with supper. The other side effect is called Lactic Acidosis but this occurs in only about 1/4,000,000 people Mainly in people with failing kidneys. What I am puzzled about is Why the DR. is wanting to use this in a child. That is an off-label use & subject to FDA penalty. Is your child overwt? This would be the only reason I would use metformin in children. I have used it in a lot of children who were overwt. & had metabolic syndrome and in children with Type 2 diabetes but never in a child with Type 1 disease. I did research on it in children with T2DM several years ago & it didn't do ant thing for them so it is a waste of money. I recommend you ask the Dr Why he or she wants to use & what is the expected result. Be careful.
