Metformin is one of the most commonly used hypoglycemic drugs for diabetic patients, and the 2016 Expert Consensus on the Clinical Application of Metformin states that metformin is the first choice and the whole course of medication for type 2 diabetes, unless there is a contraindication or intolerance, so you can see how important metformin is in diabetes medication.

Metformin is currently marketed in regular tablets, capsules, and extended-release dosage forms. The regular dosage form usually requires 2-3 times per day and the extended release dosage form is usually taken once per day or twice per day for those who are not as effective. For patients taking 3 times daily, if they skip dinner, can they skip metformin as well?

We begin with the mechanism of action of metformin.

(1) Acts on the liver to inhibit gluconeogenesis and reduce hepatic glucose output.

(2) Acts on peripheral tissues (muscle, fat) to improve muscle glycogen synthesis and increase glucose uptake and utilization.

(3) Acts in the intestinal tract to inhibit glucose uptake by cells of the intestinal wall.

Take your medication even if you don't eat

it can clearly be seen (that this is the case)metforminAlthough it also lowers postprandial blood glucose, thePrimarily reduces basal blood glucose in patients with type 2 diabetes ((fasting blood sugar). AndMetformin alone rarely causes hypoglycemia. Therefore, for patients who need to take metformin 3 times a day, the medication should be taken even if they do not eat dinner. Unlike acarbose, which simply lowers postprandial glucose, and short-acting sulfonylurea hypoglycemics (glipizide, gliquidone, etc.), if you don't eat a meal, you don't need to take the medication.

Can be switched to extended-release dosage forms to improve adherence

In addition, if adherence is not good because metformin regular dosage needs to be taken three times a day, you can avoid forgetting to take your medication by choosing metformin extended-release tablets and taking them with dinner.

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There are many people who take it for granted that if their blood sugar is high and they don't eat or eat one less meal, their blood sugar will not be high and they will be able to take less medication. Is this really true?

Metformin should be taken sparingly if an occasional meal is skipped. But the general diet for diabetes calls for this: eating less at every meal, not skipping them.

First of all, when a diabetic takes only one glucose-lowering medication, metformin can be taken with or without food, and generally does not trigger hypoglycemia.

Under normal circumstances, metformin should be taken at mealtimes and immediately after meals, once in the morning and once in the evening, or once before each of the three meals. ① Regardless of whether meals are eaten or not, taking only metformin will not cause hypoglycemia. ② Taking metformin on an empty stomach is more irritating to the gastrointestinal tract.

Therefore, metformin should be discontinued when an occasional meal is skipped.

Second, the vast majority of diabetic patients may be on two to three medications, especially those applying long-acting insulin and insulinotropic agents (known as glargine), and are prone to hypoglycemia.

Insulinotropic agents stimulate insulin secretion directly; insulin injections are direct insulin supplements. When irregular meals are not eaten, which is primarily the case, both drugs may induce hypoglycemia by themselves, and are more likely to do so when combined with metformin.

In short, people with diabetes eat three regular meals: each meal should be eaten regularly, but the amount of each meal should be controlled. This reduces the incidence of hypoglycemia and ensures adequate nutrition.

Diabetic patients should be under the guidance of the doctor reasonable diet, reasonable medication, in order to achieve twice the result with half the effort to lower sugar effect.

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It's best not to do this, and for diabetics, we can explain this in two ways!

First of all, the role of dinner is not only to satisfy people's appetite, not only to replenish the human body, it also has a more "great" mission, that is, to maintain the stability of the body's hormone levels, especially for diabetic patients with pancreatic islet secretion regulation, good eating habits is to ensure that the normal secretion of insulin necessary conditions; diabetic patients already exist pancreatic function is impaired and abnormal insulin secretion defects. Good eating habits are necessary to ensure the normal secretion of insulin; diabetic patients already have impaired pancreatic function and abnormal insulin secretion, if you do not eat dinner, or irregular meal habits, will only lead to the instability of insulin levels, which will aggravate the condition!

And dinner is responsible for replenishing people's consumption throughout the day, if you don't eat dinner, your blood glucose level may drop for a short period of time, but the feedback mechanism that exists in the body reactively increases the secretion of glucagon, which in turn promotes an increase in the level of blood glucose, and such a drastic fluctuation of blood glucose is not good for diabetics!

Secondly, some diabetic patients have poor control of blood glucose levels, even if you do not eat dinner, the blood glucose value will remain at a higher level, in the long run, the damage to the body is very great, so, for this type of patient glucose-lowering drugs can not be arbitrarily discontinued, even if for some reason did not eat dinner, you still need to take the drug, only that you need to monitor the blood glucose at night in order to avoid the emergence of hypoglycemic symptoms;

Finally, metformin is a safer type of glucose-lowering drug, even if normal people take the drug will not lead to obvious symptoms of hypoglycemia, but several other types of glucose-lowering drugs need special attention, such as sulfonylurea glibenclamide and so on, can not not eat meals only to take the drug, it is very easy to lead to severe hypoglycemia endangering the safety of life!

The above is purely personal and for reference only!

Currently, there are more dosage forms of metformin, including regular tablets, enteric-coated tablets, enteric-coated capsules, and extended-release tablets. The common sizes are 0.25 and 0.5. The recommended dosage is 1.5~2.0 per day, and the maximum dosage can be 2.5~3.0. The dosage time is more flexible, which can be taken before or after meals, and in order to minimize the gastrointestinal reaction, it is preferable to take the dosage during or after meals. In terms of dosage frequency, the extended-release dosage form can be taken once a day, and other dosage forms can be divided into 2~3 times.

Metformin primarily promotes glucose utilization by peripheral tissues and has a good insulin sensitizing effect; the drug alone does not usually produce hypoglycemia. It has a good effect on fasting blood glucose and a poor effect on postprandial blood glucose.

This is a very good question! By metformin, I generally mean metformin hydrochloride tablets, which belong to the biguanide class of hypoglycemic drugs.

The glucose-lowering mechanism of metformin is that it reduces hepatic glucose production, as well as intestinal absorption of glucose, and lowers basal and postprandial glucose by increasing peripheral glucose uptake and utilization, and improving insulin sensitivity.

Metformin hydrochloride tablets, preferred for use in patients with type 2 diabetes mellitus who are ineffective in controlling blood glucose with diet and physical exercise alone, especially those who are obese and with hyperinsulinemia.

Metformin hydrochloride tablets can be used alone or in combination with sulfonylureas or insulin.

In the market, metformin hydrochloride tablets are available in 3 main sizes, namely 0.25 g/tablet; 0.5 g/tablet; and 0.85 g/tablet.

Metformin hydrochloride tablets should be taken with meals and started with a small dose, gradually increasing the dose according to the patient's condition, which will improve the tolerance of the gastrointestinal tract to metformin hydrochloride tablets.

Special attention should be paid to.If you are using other medications, it is important to consult with your doctor and fully inform him or her of all your diagnosed conditions and the treatment regimen you are undergoing before taking the medication.

So, how do you take metformin hydrochloride tablets? What dose to take? Can I take it less than once if I don't eat dinner?

I'm going to join you guys and gals and talk about this, just FYI.

Metformin Hydrochloride Tablets Individual Dosage

If metformin hydrochloride tablets are taken alone for the treatment of type 2 diabetes, then the dosage is as follows.

1. If the initial dose is 0.25 grams at a time, 2-3 times a day, after 10-15 days according to the efficacy of the gradual increase, the recommended maximum daily dose is 2 grams.

2. If the initial dose is 0.5 grams at one time, twice daily, or 0.85 grams at one time, once daily, followed by weekly increases of 0.5 grams or biweekly increases of 0.85 grams until 2 grams daily.

If further glycemic control is needed, the dose may be increased to 2.55 grams a day, or 0.85 grams once, three times a day.

The above is for reference only, the specific use of drugs must follow the doctor's instructions.

Metformin Hydrochloride Tablets Combination Dosage

If Metformin Hydrochloride tablets are used in combination with other medications for the treatment of type 2 diabetes, then the dosage is as follows.

1. If, in combination with a sulfonylurea, a patient remains unresponsive after several weeks of using the recommended maximum dose of metformin hydrochloride tablets, then consideration should be given to the gradual addition of a sulfonylurea while maintaining treatment at the maximum dose.

If satisfactory glycemic control is not achieved after 1-3 months of medication, a change in therapy should be considered, including metformin hydrochloride tablets in combination with insulin or insulin alone.

The above is for reference only, the specific use of drugs must follow the doctor's instructions.

2. Metformin hydrochloride tablets are used in combination with insulin to maintain the insulin dose when metformin hydrochloride tablets are started to be added; for patients using insulin, the initial dose of metformin hydrochloride tablets is 0.5 grams once a day, once daily.

If efficacy is unsatisfactory, increase by 0.5 grams after 1 week, and thereafter may increase by 0.5 grams per week until satisfactory glycemic control is achieved, with a recommended maximum daily dose of 2 grams.

The above is for reference only, the specific use of drugs must follow the doctor's instructions.

Summary:Metformin hydrochloride tablets are taken three times a day, never less than once if you don't eat dinner.

Reason:Metformin hydrochloride tablets belong to the prescription drugs, need to follow the doctor's instructions, under the guidance of the doctor to take, since the doctor's instructions are metformin hydrochloride tablets three times a day, this is the doctor according to your condition, combined with metformin hydrochloride tablets specifications, to give you to determine the dosage, can not be changed without authorization.

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Metformin three times a day definitely means regular tablets. Skipping dinner doesn't reduce the number of doses.

Why? This is because metformin is a sensitizer among glucose-lowering drugs, which means that it increases the body's sensitivity to insulin and decreases tissue resistance to insulin. It is not directly related to the number of meals, unlike insulin, especially short-acting insulin, where you have to eat 15 - 30 minutes after the injection, or else hypoglycemia will occur.

The person who inquired about this was a little concerned about whether not eating dinner and then taking the pill would result in low blood sugar? No, it won't!

Metformin has been used clinically for many years, it does not cause hypoglycemia, does not increase weight also reduces cardiovascular events.

I hope this helps.

Metformin has been in clinical use for more than 50 years and is one of the most widely used oral hypoglycemic agents worldwide.

The main mechanisms of metformin hypoglycemia include: 1) acting in the liver, reducing hepatic glucose output and inhibiting gluconeogenesis; 2) acting in muscle, fat and other peripheral tissues, improving muscle glycogen synthesis and increasing glucose utilization and uptake; and 3) acting in the intestinal tract, inhibiting glucose uptake by the cells of the intestinal wall, and increasing the level of GLP-1. As you can see from the glucose-lowering mechanism of metformin, it does not lower postprandial blood glucose by slowing down the absorption of carbohydrates as does acarbose, which must be taken with a meal. Although metformin also lowers postprandial blood glucose, it mainly reduces the patient's basal blood glucose and rarely causes hypoglycemia when used alone.consequentlywith regards toneed(soup etc) of the daytake (medicine)tertiaryPatients with metformin，The medication should be taken on time and without dinner。

Metformin regular tablets are usually taken with or after meals, mainly because of its adverse effects gastrointestinal discomfort, which can be alleviated by mixing with gastrointestinal food with meals. If the adverse effects are not tolerated, you can switch to metformin extended-release or enteric-coated tablets.

References:

[1] Mu Yiming, Ji Linong et al. Expert consensus on the clinical application of metformin (2016 edition)[J]. Chinese Journal of Diabetes Mellitus, 2016, 24(10):871-884.

[3] Li M, Ji LN. Safety of metformin in patients with type 2 diabetes mellitus[J]. Chinese journal of diabetes mellitus, 2014, 22(10):289 -292.

Author：Li Chunyu Unit：Clinical Pharmacy Department, Fengtai Hospital, Beijing, China, Member of Pharmaceutical Affairs Network

Drugs.com authoritative interpretation, unauthorized reproduction, plagiarism will be prosecuted

Thank you. Don't ask me why. People's trouble comes out of the mouth, illness enters by the mouth. Which have eaten five grains do not have disaster, sick and take medicine everything according to the instructions to take. Or follow the doctor's instructions. Your body is your own. Don't take it blindly, take it indiscriminately. If something happens, don't ask me why. That's because you're not careful.

For diabetic patients, it is very important to maintain stable blood glucose, diabetic diet should follow a small amount of food to reduce the fluctuation of blood glucose, if the long term not to eat dinner will lead to excessive fluctuations in the patient's blood glucose, is not conducive to blood glucose control, and therefore is not recommended. Patients with diabetes should eat at least 3 meals a day, which can reduce the amount of food at each meal.

If for special reasons the patient temporarily skips dinner, it is not recommended to stop taking Metformin, by monitoring blood sugar, if the blood sugar control is normal, you can continue to take Metformin. The number of times metformin should be taken is 2-3 times according to the patient's specific situation, not strictly 3 times, so for special cases, it can be reduced by one dose under the advice of the doctor.

Metformin has been recommended as the first-line glucose-lowering drug by major guidelines, and its effect is very remarkable, both in monotherapy and in combination with other drugs. The mechanism of action of metformin is to reduce blood glucose by inhibiting the output of glucose, improving the sensitivity of peripheral tissues to insulin, increasing the uptake and utilization of glucose, and decreasing glucose absorption in the small intestine, as well as having the effect of weight loss, making it an ideal choice for obese and overweight patients with type 2 diabetes mellitus.

But note: Clinical studies have shown that metformin has a limited effect on reducing weight in normal people, so it is not recommended to take metformin for weight loss, and it is better to use nationally-approved weight-loss medications for weight loss.

Be careful while taking metformin：

1. Selection of suitable dosage form: Metformin is available in regular, extended-release and enteric-coated tablets. Regular tablets need to be taken 2-3 times a day with meals, which can effectively reduce the irritating effect of metformin on the gastrointestinal tract. Extended-release tablets are a new dosage form to control the slow release of metformin, and can be taken 1-2 times a day. Enterosolvents need to be taken on an empty stomach half an hour before meals, which can effectively relieve stomach discomfort, and can be taken 2-3 times a day.

2. Metformin does not cause much damage to the liver or kidneys: The main reason why many people don't want to take medication is that they are worried about the burden on the liver and kidneys caused by taking medication for a long period of time. Metformin is not metabolized by the liver, and is excreted as a prototype through the kidneys, which hardly affects the function of the liver and kidneys, and is therefore safe and reliable for long-term use.

3. Adverse effects of metformin: The most common adverse reactions to metformin are gastrointestinal adverse reactions, such as stomach upset, abdominal pain, abdominal distension, nausea, etc. They are generally mild and can be tolerated by most patients. The treatment can be a low-dose starting dose, starting from 500mg, gradually increasing the dose of the drug, for patients with severe gastrointestinal reactions, need to choose the appropriate dose according to the patient's specific situation.

4. Medications for the elderly: There is no strict age limit for taking metformin, and even older people over the age of 80 can get a better glucose-lowering effect by taking metformin. However, long-term use of metformin in the elderly need to monitor renal function, renal function is impaired, i.e., glomerular filtration rate is less than 45, it is not recommended to continue to take metformin.

I am pharmacist Li, every day and you talk about health, welcome to pay attention! If you still have questions about health, welcome to leave a message to consult, after seeing will be the first time to respond.

Metformin is the most widely used oral hypoglycemic agent in clinical practice, which acts not by promoting insulin release, but by reducing hepatic glucose output, inhibiting glycogen isomerization, increasing the sensitivity of muscle, fat and other peripheral tissues to insulin, increasing glucose uptake and utilization, promoting anaerobic fermentation of sugar, inhibiting cholesterol biosynthesis and storage, and inhibiting glucose uptake by the cells of the intestinal wall to reduce fasting and Postprandial hyperglycemia, can reduce glycated hemoglobin by 1%-2%, suitable for type 2 diabetes mellitus, especially obese and patients with hyperinsulinemia. For patients with poor efficacy of metformin monotherapy, combining with other oral hypoglycemic agents or insulin can further improve glycemic control. In addition, metformin has a well-defined cardiovascular protective effect and may reduce the risk of cardiovascular events in patients with type 2 diabetes mellitus. Metformin is safe and well-tolerated for long-term use, and can be used as the first-line first choice and the whole course of treatment for type 2 diabetes mellitus.

Common adverse reactions to metformin include nausea, vomiting, gastric distension, abdominal discomfort, dyspepsia and other gastrointestinal symptoms, the vast majority of which occur in the first 10 weeks of starting treatment, and most patients can gradually tolerate or disappear their symptoms with the prolongation of treatment, starting with a small dose and gradually increasing the dosage or switching to extended-release or enteric-coated formulations of metformin is an effective method of reducing gastrointestinal adverse reactions, and it is recommended that metformin's The starting dose of metformin is 500mg twice daily, if there is no obvious gastrointestinal symptoms, it can be gradually increased to 1,000mg twice daily, and the general one-day dose is 1,500-2,000mg, divided into 2-3 times. In addition, choosing the correct time to take the medication is also an effective strategy to prevent or minimize gastrointestinal adverse effects, so it is recommended that metformin be taken at mealtime or immediately after a meal.

The minimum recommended dose of metformin is 500mg/day, the optimal effective dose is 2000mg/day, and the maximum dose is 2550mg/day. 2000mg/day of metformin, divided into 2-3 times, can maintain the effective blood concentration for 24 hours. The therapeutic effect of metformin is only related to the dosage of metformin, but not the number of times of dosing and the time of dosing, and the divided dosage, choosing to take it during meal time or after meals, is only to reduce gastrointestinal adverse effects and improve tolerance. Split dosage, choosing meal time or after meal, is only to reduce gastrointestinal adverse reactions and improve drug tolerance, so as long as the optimal dosage of 2000mg per day can be achieved, 3 times a day or twice a day is feasible, the key also depends on the patient's gastrointestinal tolerance, and eating or not eating dinner has no effect on the efficacy of the treatment.

In conclusion, metformin is currently the first-line first choice and the whole course of clinical treatment of type 2 diabetes mellitus, and its efficacy depends on the dosage, independent of the dosage form, dosage frequency and dosage time, the optimal effective dosage of metformin is 2,000 mg/day, which can be divided into 2-3 times to improve the gastrointestinal tract tolerance of the patient and medication adherence, so as long as you can achieve the optimal effective dosage of the daily dose, take it 2 times or 3 times is acceptable as long as the optimal effective daily dose can be achieved, independent of whether or not dinner is taken.