Metformin Increasing Insulin Sensitivity

The standard practice in mainstream medicine is to try to medicate. Medications are sometimes required but I believe they should be initially used in crisis situations and later, only if proper diet and exercise are not getting the desired results. Metformin is one of the more popular drugs of choice. In addition to diet and exercise, the prescription drug Metformin has been proven to increase insulin sensitivity in people with mild to moderate hyperglycemia but the main mechanism of action is to suppress glucose production by the liver, thus decreasing the glucose load on the body by decreasing the amount of glucose that the liver makes.

Metformin is now the most commonly prescribed oral anti-diabetic drug in the world. It works by increasing insulin sensitivity in the liver (Joshi SR 2005). It also has a number of other beneficial effects, including weight loss, reduced cholesterol-triglyceride levels, and improved endothelial function. Metformin is tolerated better than many other anti-diabetic prescription drugs, but people with congestive heart failure or kidney or liver disease are not candidates for metformin therapy. Neither are people who use alcohol to excess. A benchmark assessment of kidney function, followed by an annual renal evaluation, is essential. Vitamin B12 levels should also be checked regularly because chronic use of metformin could cause a deficiency in both folic acid and vitamin B12, resulting in neurological impairment and disruption in homocysteine clearance. Also, metformin should not be used for two days before or after having an x-ray procedure with an injectable contrast agent because of the rare risk of lactic acidosis.

Metformin is effective on its own, but it may also be prescribed in combination with another class of insulin sensitizers called thiazolidinediones (TZDs; e.g., pioglitazone, or Actos®, and rosiglitazone, or Avandia®). TZDs increase insulin sensitivity and stimulate release of insulin from beta cells in the pancreas. TZD treatment also improves blood pressure and relieves vascular and lipid defects (Meriden T 2004). However, TZDs have potentially serious side effects, including liver toxicity, which requires regular monitoring of liver function (Isley WL 2003; Marcy TR et al 2004). Late in 2007 warnings were raised that Avandia®, one of these TZDs was causing increased risks of heart attacks.

In addition to these two prescription drugs, many nutrients have been shown to increase insulin sensitivity, protect vulnerable cell membranes, and reduce the damaging effects of elevated glucose.

Ideally, a combination of improved diet, exercise, supplementation, and insulin-sensitizing prescription drugs can reverse mild to moderate hyperglycemia before stronger drugs are needed and permanent damage is done. All drug therapies have potential adverse side effects and studies have shown a good regimen of diet and exercise can be more beneficial than the medications.

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