Can Metformin Cause Diarrhea?

Metformin is a well known, reasonably priced, and extensively used drug to assist handle sort 2 diabetes. 

It helps decrease blood sugar ranges, improves HbA1c readings (a measure of glucose management over the earlier 2 to three months), and will help individuals with diabetes reduce weight. 

But can metformin trigger diarrhea? And in that case, what’s the answer? This article will examine this frequent aspect impact of metformin, the dangers related to power diarrhea after metformin use, and what to do about it. 

Key Points:

  • Diarrhea is the commonest aspect impact of metformin. It sometimes goes away inside a couple of weeks of beginning remedy.
  • Taking the drugs with a meal and switching to the extended-release (ER or XR) model of the drug will help cut back the possibilities of experiencing diarrhea from metformin.

Metformin for diabetes 

Metformin is an oral drug that was accredited by the U.S. Food and Drug Administration (FDA) for treating sort 2 diabetes in 1994. It is likely one of the hottest diabetes medicine on the planet, with physicians writing over 120 million metformin prescriptions yearly worldwide. 

Metformin is reasonably priced within the United States, and just about all medical health insurance plans cowl the drug. It is normally taken a few times per day with meals and is really helpful for use together with a healthful weight loss plan and bodily exercise. 

Metformin is assumed to work by lowering the discharge of glucose from the liver and rising insulin sensitivity within the muscle tissue. Most individuals discover the drug tolerable and simple to suit into their life to enhance well being outcomes, however some do expertise unintended effects. 

Common metformin unintended effects

Common, and normally delicate, unintended effects of metformin might embrace: 

  • Stomach cramps
  • Nausea
  • Vomiting
  • Diarrhea
  • Stomachache
  • Suppressed urge for food 
  • Weight loss 
  • Low blood sugar (in people who find themselves additionally being handled with insulin)

Most unintended effects go away inside a couple of weeks of beginning the drugs.

More data on unintended effects could be present in our article: Metformin Side Effects: What You Need to Know.

Does metformin trigger diarrhea? 

A examine out of the American College of Clinical Pharmacy discovered that, sure, metformin could cause diarrhea, and it’s truly extra frequent than one would assume. In truth, diarrhea is the commonest aspect impact of metformin, with roughly 53% of people that take the drugs experiencing this difficulty.

Those who’re taking a number of medicines may additionally be at elevated threat for power diarrhea from metformin use, on account of interactions between their several types of medicine. 

What’s extra, though unintended effects similar to nausea, vomiting, and diarrhea sometimes fade away after an preliminary adjustment interval, typically, after years of secure metformin remedy, the physique might begin to reply negatively to the drugs as soon as once more. 

In one case, a examine topic began producing what the researchers describe as, “nausea, abdominal cramping, and explosive, watery diarrhea that occasionally caused incontinence,” after a number of years of constant metformin remedy. The affected person’s gastrointestinal signs went away as soon as remedy was stopped.

Another examine, within the Journal of Endocrinology and Metabolism, discovered that late-onset, power diarrhea occurred in somebody who had been taking metformin for over 5 years, with no earlier problems or unintended effects. The diarrhea was painless, however extreme, with no different underlying trigger. In this case as effectively, the diarrhea utterly went away after the metformin remedy was stopped. 

In each of those instances, the precise set off of the sudden diarrhea was unknown; metformin appears to be well-tolerated in some individuals till it’s not. 

How lengthy does metformin offer you diarrhea?

According to the journal Diabetes, Obesity, and Metabolism, most of the preliminary gastrointestinal unintended effects that individuals taking metformin expertise can seem instantly after the primary dose, with most going away after the physique adjusts to the drugs inside a couple of weeks. 

However, not all unintended effects might go away, which contributes to the big proportion of people that don’t take the drugs as prescribed. 

Chronic diarrhea could be a type of unintended effects — at greatest pesky, and, at worst harmful — that won’t go away whereas somebody is on a metformin routine. 

Foods that trigger diarrhea with metformin

Experts don’t particularly suggest avoiding any explicit meals whereas taking metformin to forestall diarrhea. That stated, there are particular meals and drinks that may improve the danger of diarrhea generally, so you might need to cut back your consumption of them in case you are experiencing diarrhea with metformin. These embrace:

  • Sugar
  • Artificial sweeteners
  • Dairy merchandise 
  • Garlic, onions, and different meals excessive in FODMAPs (sure sugars which can be poorly absorbed and will trigger intestinal misery)
  • Fructose (a pure sugar present in fruit)
  • Gluten (a protein present in wheat, rye, barley, and their hybrids)
  • Fried or fatty meals 
  • Spicy meals
  • Alcohol 
  • Caffeine

These modifications would possibly assist handle diarrhea signs whereas taking metformin.

Other diabetes-related causes of diarrhea

Metformin isn’t the one diabetes-related reason behind diarrhea. It’s vital to work along with your healthcare supplier to rule out different causes of diarrhea earlier than altering your diabetes treatment

Diabetic neuropathy from persistent excessive blood glucose ranges

Diabetic neuropathy that impacts the digestive system is named diabetic enteropathy. This type of nerve injury to the digestive tract can impression not solely the frequency of bowel actions, however the consistency as effectively, typically inflicting diarrhea. 

Bacterial overgrowth

Diabetes problems similar to gastroparesis can gradual the motion of meals and drinks by the digestive system, which creates the best setting for micro organism to develop.

This slowing of the digestive system could cause every little thing from constipation to diarrhea. (Speak along with your physician when you assume you’ll have gastroparesis.) 

Excessive use of synthetic sweeteners

Artificial sweeteners could make having fun with sweeter treats simpler in your blood sugar ranges, however they will doubtlessly wreak havoc on the digestive system, typically inflicting diarrhea. 

This is as a result of synthetic sweeteners are poorly digested by the gastrointestinal tract. If you embrace synthetic sweeteners as a part of your meal plan, ensure to make use of them sparingly. 

The risks of power diarrhea 

Persistent diarrhea can merely trigger a gentle inconvenience, or it may possibly go away an individual utterly housebound, unable to train, work, or perform in society. 

And past the life-style impression, power diarrhea could be extraordinarily detrimental to well being, too. Some problems of power diarrhea embrace:

  • Malnutrition/malabsorption of vitamins 
  • Dehydration
  • Excessive thirst 
  • Excessive weight reduction 
  • Fatigue
  • Dizziness
  • Lethargy 
  • Dark urine
  • Low blood sugar 
  • Inability to train
  • Social isolation
  • Embarrassment
  • Skin irritation 

If you’re experiencing power diarrhea and have any of those well being problems, contact your physician straight away to get assist. 

How to cease metformin diarrhea

Extended-release tablets

Studies have proven that individuals who develop diarrhea utilizing immediate-release metformin might be able to preserve experiencing the advantages of the drugs and discover reduction by switching to extended-release metformin tablets. 

These variations of the drugs are designed to be absorbed slowly all through the digestive system, which implies there’s much less of the drug in anyone place at a time, making it gentler on the abdomen. 

Take your metformin with meals

Taking metformin with meals has been proven to scale back the danger of diarrhea. Try to take it with a higher-protein meal or snack, and by no means take metformin on an empty abdomen. The drugs is normally higher tolerated within the night, so taking it with dinner is greatest. 

Never take extra metformin than is prescribed 

Start your metformin on a low dose, and don’t improve your dose with out the steering of your physician. If you begin to really feel nauseous or expertise diarrhea, contact your physician about reducing your dose till you construct tolerance once more. 

You can learn extra about how a lot metformin to absorb our metformin dosage information.

Stop taking metformin for a couple of weeks 

Giving your intestine time to heal with a couple of weeks’ break free from the drugs will help cease diarrhea and stop it from coming again. (Be certain to speak to your physician earlier than you cease taking metformin.)

Studies have proven that stopping metformin remedy nearly instantly alleviates late-onset, power diarrhea. 

Look into alternate remedy choices 

If not one of the beforehand talked about methods assist alleviate your diarrhea, and it’s negatively affecting your high quality of life, discuss to your physician about stopping metformin and attempting alternate remedies to handle your diabetes as an alternative. 

Read extra: The Best Alternatives to Metformin for Type 2 Diabetes Management

Treating power diarrhea 

People experiencing long-term diarrhea ought to search skilled medical consideration, particularly if they’ve diabetes. 

If your signs aren’t extreme and also you want to strive treating it at house first, a few of the following remedies might supply non permanent reduction:

  • Drinking loads of water and getting electrolytes (current in drinks similar to Gatorade or coconut water) to forestall dehydration and replenish misplaced salts. 
  • Taking an over-the-counter bismuth-based product to cease the diarrhea, similar to Pepto Bismol. 
  • Eating a higher-fiber weight loss plan to agency up stools (slowly improve your fiber consumption to keep away from gasoline, bloating, and cramps).
  • Taking a every day fiber complement.
  • Taking antidiarrheal drugs, similar to loperamide (Imodium). (Be certain by no means to take greater than the really helpful dose, as exceeding that has been linked to severe coronary heart problems in some individuals.)

Final ideas

Always work along with your diabetes group to evaluate the proper remedy choices to your way of life. With cautious coordination and suggestions out of your care group, you will discover the proper method for you, decreasing your threat of diarrhea from metformin whereas retaining your diabetes well-managed.

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