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What is a substitute for metformin ?

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General & Family Physician
Practicing since : 1995
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I am a diabetic for 4-5 years. Age 52. I take 1000mg Gluformin, 1 No at night after meal. Two years ago I became anaemic and am in a continuous state of fatigue. No amount of vitamin supplementation with B12 either oral or IV has helped. My Vitamin B12 level was on the lower side. I am a vegeterian. Later on I had symptoms of neuropathy. All this time my blood sugar has been under fairly good control. I feel that metaformin is causing B12 neuropathy. I would like to know if a proper substitute for metaformin can be recommended. My last blood sugar reading about month ago was 111/140. A1c tested two months ago was 6.3.
Posted Wed, 11 Apr 2012 in Diabetes
Answered by Dr. Pragnesh Vachharajani 49 minutes later

Thanks for posting your query.

Vitamin B 12 deficiency conditions are increasing now a days,the reasons are not properly known.

Please understand that vegetarians lack vitamin b 12 in their diet, as most of the sources of vitamin b12 are animal in origin.Once you had vitamin b12 deficiency you need to have supplementation for life long to prevent your level to fall again.

Initially if the vitamin b12 level is very low,injections are advised on regular intervals along with oral supplements.With time levels become normal and stores of vitamin b12 in body also gets replenished.After this first phase of treatment you need to take depending upon the level, monthly injection of vitamin b12,may be every month or every 3 months as per the advise given to you.If you do not take this you will have deficiency again and your hemoglobin will fall.

Metformin(gluformin) is a very good and well tolerated drug ,extensively used world vide.It is not related to vitamin b12 deficiency.

Your blood sugar levels are fine with the drug,so I think there is no need to change the drug in the absence of any other side effects.

Long term diabetes it self predisposes to neuropathy.As your diabetes is under control there is no need to worry.

Please continue taking this drug and for vitamin b12 level, continue supplementation as per advise from your physician.

I hope this answers our query,I will be available for follow up.

Above answer was peer-reviewed by
Follow-up: What is a substitute for metformin ? 1 hour later
Thanks, Doctor.

I have this concern about metformin after going thro' a number of "diabetes" websites and support groups. It is reported that metformin prevents absorption of B12 in the body in about 20-30% of the patients while in others it is well tolerated. Vegeterians seem to be more vulnerable to B12 deficiency because there are very few sources of this vitamin in their food. It is possible these few sources are also not getting absorbed. Vitamin B12 apparently could also lead to neuropathy. Therefore while metformin may be good at keeping my blood sugar under control it is the side effect that seems to be causing more trouble to me. I am therefore wondering if it is worthwhile to stay on this drug over my lifetime and keep worrying about the side effect part.
Answered by Dr. Pragnesh Vachharajani 1 hour later
Hi,Good to hear from you again.

First of all I am happy that you are an informed patient ,this makes job of doctor easy most of the times.

A factor called "intrinsic factor" is required for vitamin b12 to get absorbed from the gut.Deficiency of this can lead to improper absorption and its deficiency.

Apart from this there could be several conditions like worm infestation,some drugs taken for acidity,alcohol etc.can lead to B12 deficiency.

Metformin as written earlier is extensively used drug for diabetes.You might have read that it can interfere with absorption of vitamin b12,but you can not blame this drug alone and there could be multiple factors involved.

Still if you are concerned and wanted to stop this drug you can,there are several other good anti diabetic drugs are available today which can effectively control your sugar.Metformin is not must for all.In medical science there is always a choice between risk of complication and benefits that the drug will offer to the patient.

Please get in touch with your physician for this ,who can give alternative medicine to this drug from other class of drugs after examining you and looking at other things like your blood pressure,body mass index and other routine investigations like lipid profile,kidney functions etc.

I hope this clarifies your doubts.

Above answer was peer-reviewed by
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