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When this initially hit the newswire back in December 2019, I was skeptical.

This is for several reasons, notwithstanding the FDA saying it didn’t contain dangerous amounts of the same chemical found in Zantac, a drug used for heartburn (which led to Zantac being discontinued). This chemical is called NDMA (ready for this long name? it’s N-nitrosodimethylamine). And according to the FDA, low doses of NDMA are not dangerous.

I also recalled reading how metformin actually helps to reduce cancer in those who take it. And how some oncologists prescribe it for people undergoing cancer treatment because of metformin’s anti-inflammatory properties and ability to help starve cancer cells of glucose (and thus limit their growth and help chemotherapy work better).

For years, other diabetes care and education specialists like myself would share how metformin lowers glucose, helps you to lose about 5 pounds and has protective qualities against cancer. And just last week, an article came out about how metformin reduces damage in the brains of people with Parkinson’s disease via a neuroprotection pathway.

It’s been around for decades, is cheap and used as a front-line medication for people with type 2 and some providers prescribe it off-label for prediabetes as well. Finally, a cheap drug that addresses some of the body’s deficiencies associated with type 2 and prediabetes, and has other benefits. 

That was until now, with a particular type of metformin.

A version of metformin, called extended release (ER) may have more than acceptable limits of NDMA which is what prompted the FDA to ask 5 pharmaceutical firms to recall metformin. (As of publication, the FDA has named only 1 of the 5 companies identifies – Apotex Corp. who has issued a voluntary recall. You can check with your pharmacy if your metformin batch or manufacturer has been recalled.)

Does this mean you should toss your metformin out? No. It could be dangerous to suddenly stop it. But do check with your provider or pharmacist about your options if you take an extended-release form of metformin. It might turn out that your provider prescribes a combo pill instead (like metformin combined with another diabetes medication). That could save the number of pills you take in a day and save you money via less copays. 

For those of you who have started metformin in the past, you may have experienced what many do – that for the first week it usually causes loose stools which is why it’s best to not take on an empty stomach. It’s best to take with a meal and to gradually ramp up to the dose prescribed to allow your body to get used to it. But for folks who still had loose stools, the extended release option usually got rid of that side effect. Now it looks like that won’t be an option.

If we were having this conversation a couple decades ago when I got into the diabetes field, I would have told you your choices (outside of insulin) were 2 other types of pills. But now? There are sooooooo many new types of medications that can help you get your sugars to a safe level. (And yes, of course by doing your best with what you eat and drink and how much intentional exercise you get.)

Things do change over time, so stay connected to keep up with it all. Do you belong to an organization or subscribe to free diabetes-related newsletters that help you to keep up to date? I’m a particular fan of diatribe.org as it has cutting edge info on news, and there’s the Sweet People Club that helps you figure out the best way to live with high sugar (so that it’s not high)!

And finally, please remember that when you start a new medication, ask whomever is prescribing it to you what side effects to watch out for and report. And do you take it with food. And if they can write a prescription for a 3-month supply to save you some co-pays. Or if a cheaper alternative is available with a similar effect.

You can lean on your pharmacist as well. And of course, the diabetes nurses and dietitians answer these questions all the time in the Sweet People Club. So please ask.

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