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11/14/09
12:25 AM
"My endocrinologist said he would like me to take metformin 2000mg daily for the cardiovascular benefits. My A1c was 5.9"
Asked By:
debbie2507
Category:
Oral Medications
Background Info Hide
I was dx last July and my A1c was 11.7. I have lost 20 lbs. by walking and diet control. my most recent A1c was 5.9. He would like me to switch from the Lantus and work my way up to 2000mg metformin daily. I have controlled hypertension. No cardiac hx. I'm reluctant to change to pill and have possible side effects, especially when the insulin is working well and I don't mind the injections. He said a study from England showed significant benefits for cardiovascular.
Expert Answers (1)
11/18/09
05:24 PM
Hello debbie2507
Thanks for presenting such an interesting question! I think your specialist is refering to a study that shows a decrease in the c-reactive protein in participants that were on Metformin. This marker is an indicator of inflammation in the vascular system. Many newly diagnosed type 2 diabetics start out on insulin to get control of their glucose and can go on oral meds when the glucose levels are more easily controlled. Insulin has it's own set of side effects that come into consideration when the doctor decides how to treat his patient. Insulin can make people to gain weight. Metformin is weight neutral. You have already shown significant weight loss while on insulin so this should not be a factor for you. You are correct that Metformin has side effects contributed to it for some people. I would ask your doctor more about his reason why he wants to change your medications. You are part of the treatment team and your input should be heard. I do not believe Metformin is being prescibed as yet for cardiovascular purposes alone but it is a good medication for glucose control as it decreases insulin resistance and lowers glucose production in the liver. Using Metformin to lower cardiovascular risk would be considered off label ordering. But if your doctor is concerned about cardiovascular risk, ask the doctor what your c-reactive protein level was or have a blood draw for this test. If it is elevated, then maybe that is the reason the doctor wants to try Metformin. Keep asking questions until it makes sense!
Thanks for presenting such an interesting question! I think your specialist is refering to a study that shows a decrease in the c-reactive protein in participants that were on Metformin. This marker is an indicator of inflammation in the vascular system. Many newly diagnosed type 2 diabetics start out on insulin to get control of their glucose and can go on oral meds when the glucose levels are more easily controlled. Insulin has it's own set of side effects that come into consideration when the doctor decides how to treat his patient. Insulin can make people to gain weight. Metformin is weight neutral. You have already shown significant weight loss while on insulin so this should not be a factor for you. You are correct that Metformin has side effects contributed to it for some people. I would ask your doctor more about his reason why he wants to change your medications. You are part of the treatment team and your input should be heard. I do not believe Metformin is being prescibed as yet for cardiovascular purposes alone but it is a good medication for glucose control as it decreases insulin resistance and lowers glucose production in the liver. Using Metformin to lower cardiovascular risk would be considered off label ordering. But if your doctor is concerned about cardiovascular risk, ask the doctor what your c-reactive protein level was or have a blood draw for this test. If it is elevated, then maybe that is the reason the doctor wants to try Metformin. Keep asking questions until it makes sense!
Answered By:
Rita Juray
Accreditations: RN, MLT-ASCP, CCM, CDE
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