Jump to content

Photo

Metformin affecting the liver

- - - - -

  • Please log in to reply
63 replies to this topic

#1
nisthana

nisthana

    Junior Member

  • 500 plus
  • PipPip
  • 15 posts
Hi,
I stumbled upon this board searching for my answer about Metformin 500mg. I was on 3 mets (morning, noon, night), + 4 glyburide (5mg each) per day and my sugar levels were contained. Then I had my labs done and my doc found out that my ALT levels, which measures damage to the liver, had shot up to 111. Normally it should be < 34. My doctor asked me to stop Metformin immediately and I have a liver untrasound scheduled next week to look at the damage if any. Now i am on Glyburide (20mg total) alone and its not helping my sugar levels. My fasting remains at 200+. Just wanted to make you aware of Metformin's liver effects and to seek advice if any.

#2
4519

4519

    Member

  • 500 plus
  • 286 posts
It does happen - sorry to hear that it actually does happen these days. Metformin does have a pretty good record - you have reason to doubt that though.

With fasting numbers at 200+ why have you not considered insulin? Insulin is as natural as you can get. Yes, there are hazards there also. Just look around and you will see how people handle them - and pretty well too. I am not on insulin but if it is a question between insulin and medications I would pick insulin. Of course, with a type 2 it is more a case of insulin and medications.

#3
DonnieD

DonnieD

    Member

  • 500 plus
  • 149 posts
Hi nisthana,

I give you and your doctor credit for doing the lab work .... some doctors aren't so rigorous to follow-up. More and more prescription drugs can adversly affect liver and muscle enzymes (I'm on Lipitor Gemfibrozil, and Lamisol) and routine and periodic bloodwork is a MUST. The benefits of these drugs far outweigh the risks, which as you have witnessed, need to be closely monitored.
diagnosed 4/06
Metformin 1500 mg
April 06 A1c 9.9
July 06 A1c 7.3
Oct 06 A1c 6.5
Jan 07 A1c 6.4
Apr 07 A1c 6.3
Jul 07 A1c 6.2
Oct 07 A1c 6.2
Jan 08 A1c 6.5
April 08 A1c 6.3
July 08 A1c 6.1
Oct 08 A1c 6.1
Jan 08 A1c 6.4
April 09 A1c 6.4
July 09 A1c 6.1
Oct 09 A1c 6.1
Jan 10 A1c 6.1
Apr 10 A1c 6.1
Jully 10 A1c 6.1
Oct 10 A1c 6.2

#4
4519

4519

    Member

  • 500 plus
  • 286 posts
I forgot to add What DonnieD said. My doctor has not ever told me to come back in for a blood test. Not one time. I have to call them and then ask for a blood test. I too take Lipitor sometimes. I closely monitor it myself.

#5
nisthana

nisthana

    Junior Member

  • 500 plus
  • PipPip
  • 15 posts
My doctor has been pretty good at checking my blood for various things every so often. I have to go for another blood test in 2 weeks to see if stopping Metformin brought down my ALT levels.

For taking Insulin, I just can't stand needles. I freak out when I have to go for blood tests. My wife has to hold me tight when they are on the verge of inserting that needle. Insulin is out, unless its in form other than injections. I am doing Yoga these days. I am from India and there Yoga is very prevelant means of controlling diabetes. I also walk. I have not worked out for a while. However I dont understand how exercises control diabetes, i mean scientifically ? And what kind of exercises are good for diabetes ? If anyone can answer that for me, I'll really appreciate.

If anyone has had this issue with Metformin, please let me know.

#6
4519

4519

    Member

  • 500 plus
  • 286 posts
As far as the needles - ask any insulin diabetic how to handle that. I know it is not at all like getting blood drawn. That needle you could drink through.....

I cannot give you the scientific explanation for the exercise part of it. I do know that using your muscles directly assists with the use of your own insulin.

The best exercises are one that run your heart rate up to the top of the safe range. I don't remember the range right this second. It is something like 220-(your age) times 75%. I could be off a little. Bring your heart rate up to this range and exercise 30 minutes a day for at least 3 - 5 days a week. It is a direct realationship for diabetics. Exercise for a type 2 is just as important as diet and medications(if you are on meds)

#7
JasonSmithMT

JasonSmithMT

    Member

  • 500 plus
  • 381 posts

Hi,
I stumbled upon this board searching for my answer about Metformin 500mg. I was on 3 mets (morning, noon, night), + 4 glyburide (5mg each) per day and my sugar levels were contained. Then I had my labs done and my doc found out that my ALT levels, which measures damage to the liver, had shot up to 111. Normally it should be < 34. My doctor asked me to stop Metformin immediately and I have a liver untrasound scheduled next week to look at the damage if any. Now i am on Glyburide (20mg total) alone and its not helping my sugar levels. My fasting remains at 200+. Just wanted to make you aware of Metformin's liver effects and to seek advice if any.


A general rule of medicine is that anything is possible. That being said this sounds strange to me as glyburide which is metabolized by the liver is much more common to cause an increase in liver enzymes than metformin which is metabolized by the kidneys. If metformin is the only medication you are taking then I would have definitely stopped it had I seen the same results. Are you on any other medications, prescriptions or over the counter medications? Was your AST also elevated?

Jason

#8
DonnieD

DonnieD

    Member

  • 500 plus
  • 149 posts
Stress can definitely increase blood glucose, so I would speculate that yoga would help to reduce bg.

As far as excercise, I benefit with aerobic activities (brisk walking, biking, swimming) about 60 - 90 minutes each day. Enough to raise my heart rate, but not over-strenuous.
diagnosed 4/06
Metformin 1500 mg
April 06 A1c 9.9
July 06 A1c 7.3
Oct 06 A1c 6.5
Jan 07 A1c 6.4
Apr 07 A1c 6.3
Jul 07 A1c 6.2
Oct 07 A1c 6.2
Jan 08 A1c 6.5
April 08 A1c 6.3
July 08 A1c 6.1
Oct 08 A1c 6.1
Jan 08 A1c 6.4
April 09 A1c 6.4
July 09 A1c 6.1
Oct 09 A1c 6.1
Jan 10 A1c 6.1
Apr 10 A1c 6.1
Jully 10 A1c 6.1
Oct 10 A1c 6.2

#9
nisthana

nisthana

    Junior Member

  • 500 plus
  • PipPip
  • 15 posts

A general rule of medicine is that anything is possible. That being said this sounds strange to me as glyburide which is metabolized by the liver is much more common to cause an increase in liver enzymes than metformin which is metabolized by the kidneys. If metformin is the only medication you are taking then I would have definitely stopped it had I seen the same results. Are you on any other medications, prescriptions or over the counter medications? Was your AST also elevated?

Jason


My AST levels are fine. Initially I was only on Glyburide, when I had first started. After few weeks of monitoring, doctor increased my Glyburide and also started Metformin. I checked the ALT level when I was just diaganosed and it was normal. Then after few months of taking Metformin+Glyburide, my labs indicated 99 for ALT. My doctor asked me to reduce to two Metformin instead of 3 and then did the labs after 2 months. The ALT level had increased to 111. So he figured that Metformin is causing the damage and asked me to stop it right away (and also ordered liver ultrasound). However, I am still on Glyburide, he didnt tell me that Glyburide might also affect it. Do you think I should ask him about it ? I bet being the doc, he would know what meds affect what part of the body. Apart from the diabetes Rx, I dont take any other meds, except for occasionaly advil or allergy meds.

#10
JasonSmithMT

JasonSmithMT

    Member

  • 500 plus
  • 381 posts
Makes more sense now, I read it as you started both at the same time. Giving the medication history you described the logic does seem to point to metformin being the biggest suspect in the ALT increase. If you had been on the glyburide for awhile and the liver function tests (AST/ALT) have always been normal during that time all indications would seem to implicate the new medicine. Sounds like your physician is following that reasoning.

Good luck on the follow up and ultrasound. Let us know how it goes.

Jason

#11
nisthana

nisthana

    Junior Member

  • 500 plus
  • PipPip
  • 15 posts
My ultra sound results came in and Dr called me saying that I had "fatty liver" (but the liver is not damaged) which is caused by Diabetes, and Metformin is not causing it. I dont clearly understand what is meaning of fatty liver and how Dr is so sure that Metformin is not the cause. I have another blood test tomorrow to re-check ALT levels and if my levels are lowered, he said he will put me back on Metformin. Lets see what happens. I have sent him a mail with my questions about fatty liver, but if someone has some experience here to share, please do so.
Thanks

#12
Harold

Harold

    Super Moderator

  • Moderators
  • 6,169 posts
The two most common causes of fatty liver that I have heard of were excessive alcohol intake and excessive weight. One of the ways metformin helps to control blood glucose is by inhibiting glucose release from the liver. So metformin does directly affect the liver. Elevated liver enzymes AST/ALT are an indication of the liver repairing itself. An ALT of 111 does indicate your liver is trying to repair itself. Which may be because it has time to repair since it's not releasing glucose and making more constantly as an affect of the metformin on it. Might be a good thing, but will require monitoring over time to determine what exactly is going on. Not sure why just your ALT was elevated, but a 111 is not enough to freak over. Your probably thinking fine thing to say it's not your ALT. Well I seen my doctor freak when he found both my AST/ALT over 200, and sent me to a Gastrointerologist. Took me nearly a year and a half to get them under 60 and another ten years into the normal range. Figure on it's going to take time for your liver to heal. I hear Milk Thistle is good for the liver and helps with the healing.

#13
JasonSmithMT

JasonSmithMT

    Member

  • 500 plus
  • 381 posts

Elevated liver enzymes AST/ALT are an indication of the liver repairing itself. An ALT of 111 does indicate your liver is trying to repair itself.


Not quite Harold. ALT is released as a result of hepatocellular (liver cells) damage. It doesn't indicate any kind of active healing process. However the liver does have a remarkable ability to repair itself.

Jason

#14
Harold

Harold

    Super Moderator

  • Moderators
  • 6,169 posts

Not quite Harold. ALT is released as a result of hepatocellular (liver cells) damage. It doesn't indicate any kind of active healing process. However the liver does have a remarkable ability to repair itself.

Jason

Had both enzymes elevated myself and that was how it was explained to me. Which makes me wonder what the AST signifies.

#15
JasonSmithMT

JasonSmithMT

    Member

  • 500 plus
  • 381 posts

Had both enzymes elevated myself and that was how it was explained to me. Which makes me wonder what the AST signifies.


AST is also primarily used to monitor and detect liver disease but an increase can also be seen in many other conditions because AST is found in many other tissues (cardiac, skeletal, red blood cells, etc). What is commonly said about AST is "AST is more sensitive but less specific in detecting liver disease." ALT is rarely increased in conditions other than parenchymal liver disease. Also ALT activity persist longer than AST activity making AST not as useful in detecting and monitoring chronic liver conditions.

Jason

#16
butterflykisses

butterflykisses

    Senior Member

  • 500 plus
  • 601 posts

My doctor has been pretty good at checking my blood for various things every so often. I have to go for another blood test in 2 weeks to see if stopping Metformin brought down my ALT levels.

For taking Insulin, I just can't stand needles. I freak out when I have to go for blood tests. My wife has to hold me tight when they are on the verge of inserting that needle. Insulin is out, unless its in form other than injections. I am doing Yoga these days. I am from India and there Yoga is very prevelant means of controlling diabetes. I also walk. I have not worked out for a while. However I dont understand how exercises control diabetes, i mean scientifically ? And what kind of exercises are good for diabetes ? If anyone can answer that for me, I'll really appreciate.

If anyone has had this issue with Metformin, please let me know.

Exercise reduces insulin resistance, which is the cause of type 2 diabetes. It also helps you lose weight...excess weight makes insulin resistance worse. The best medication for type 2 diabetes in exercise. Medication is a very small part of treating diabetes and many people would not need medications if they were to lose to and maintain their ideal weight, exercise and eat right. Aerobic exercise is great. Building muscles is great too. The more muscle mass you have the more glucose is needed to work them which means less glucose in your blood.
Katherine
type 1 (1.5) 12 years, Pumper 6 1/2 years? or so.

#17
Brenda A

Brenda A

    Junior Member

  • 500 plus
  • PipPipPip
  • 98 posts

A general rule of medicine is that anything is possible. That being said this sounds strange to me as glyburide which is metabolized by the liver is much more common to cause an increase in liver enzymes than metformin which is metabolized by the kidneys. If metformin is the only medication you are taking then I would have definitely stopped it had I seen the same results. Are you on any other medications, prescriptions or over the counter medications? Was your AST also elevated?

Jason


When I was on metformin my endo said it was vital to check liver function every 3 months because althought it was a very good drug, it was hard on the liver. My son is on it now and his doc said the same to him. My sister is on it and her doc told her the same also. We were all told do not drink alcohol at all while taking it as it would be a double shot to your liver. Most meds do affect liver and kidneys. I think when taking any med you should monitor your blood levels to prevent surprizes later on.

#18
jolo

jolo

    Junior Member

  • Members
  • Pip
  • 5 posts
I am a diabetic that also has Hepatitis C. I have been watching liver counts for years.

The first thing is that a liver count of 111 is something I would just dream of. It is NOT at a level that could create liver damage. IKt is something to watch, but not be overly concerned about.

Liver counts are just like blood pressure readings or glucose tests, they can flucuate dramtically day by day. It is possible that the day after a count of 111 is there, that it would be a count of 50.

The truth is that the regular taking of any prescription medication can have a negative effect on your liver and liver count. They are never a good thing for the liver, but a potential side effect. I think it is adviable for you to get your liver counts taken on a regular basis when you have a doctor visit.
Just look at the find print of about liver damage warning about the liver.

For example, check the Avandia web site. You can read what it says about people with liver damage, etc. Here is the page:
[URL="http://www.avandia.com/avandia_side_effects.html"]http://www.avandia.com/avandia_side_effects.html[/URL]

Metformin seems to be as safer to the liver than most others. But, if liver damage is already there, thern there seems to be the possibility of side effects.

Good luck with the use your medication and your diabetes. We are all individuals and all react differerntly ot medications.

There are some nice simple things to do that are kind to the liver. I am NOT a doctor, so I will mention a couple of items that i have heard helped som,e people with their liver count. I would not have any clue if they would help you or anyone else.

  • A simple starting the morning with a glass of clean water with squuzed lemon in it.
  • Water filters and drinking lots of water.
  • I have heard of some people who take the herb Milk Thistle that I have heard helps to protect the liver.
  • Some people like Green Tea. I have no idea about any clinical good this does, but I have found, for me, that chinese green tea make my tummy feel calm and help me with some stomach irritation that I feel from the Metformin. That doesn't mean that it will help you as well?

Jon

Hi,
I stumbled upon this board searching for my answer about Metformin 500mg. I was on 3 mets (morning, noon, night), + 4 glyburide (5mg each) per day and my sugar levels were contained. Then I had my labs done and my doc found out that my ALT levels, which measures damage to the liver, had shot up to 111. Normally it should be < 34. My doctor asked me to stop Metformin immediately and I have a liver untrasound scheduled next week to look at the damage if any. Now i am on Glyburide (20mg total) alone and its not helping my sugar levels. My fasting remains at 200+. Just wanted to make you aware of Metformin's liver effects and to seek advice if any.



#19
JasonSmithMT

JasonSmithMT

    Member

  • 500 plus
  • 381 posts

When I was on metformin my endo said it was vital to check liver function every 3 months because althought it was a very good drug, it was hard on the liver. My son is on it now and his doc said the same to him. My sister is on it and her doc told her the same also. We were all told do not drink alcohol at all while taking it as it would be a double shot to your liver. Most meds do affect liver and kidneys. I think when taking any med you should monitor your blood levels to prevent surprizes later on.


I'm not sure what your endo is trying to say about metformin but it doesn't sound right to me. Metformin, relatively speaking, is not that hard on the liver since it is metabolized mainly in the kidneys. I don't believe the manfuactures of metformin recommend periodic liver function testing in the package insert. It is recommended that metformin users have annual hematologic and renal function tests. There are a lot of medications commonly used in diabetics that do require periodic liver testing such as HMG-CoA reductase inhibitors (aka the statins), thiazolidinediones (Avandia,Actos,Avandamet), and the alpha-glucosidase inhibitor acarbose (Precose) for example. Maybe your endo was referring to one of those.

Jason

#20
jolo

jolo

    Junior Member

  • Members
  • Pip
  • 5 posts
JasonSmithMT

I am sorry for stumbling through my message. With the Hep C and the Diabetes, the ole brain fog comes in and sometimes my mind does wonder.

JasonSmithMT, I totally agree with you about Metformin.It is as about as safe on the liver as any medication that is around. Even when I asked my Hepatologist about it, he told me that he would have prescribed the same thing for my diabetes.

Here is the exact warning about Metformin with regards to the liver:
LIVER OR KIDNEY PROBLEMS. If you have liver or kidney problems of any kind, metformin could pose a problem, because it alters liver function and is excreted through the kidneys. A healthy liver and kidneys will improve your outcome with metformin. Liver and kidney function should be assessed before starting metformin and rechecked at least once a year while taking it. A blood chemistry screen and a complete blood count will tell your physician how well your system is doing with this drug.

I then gave an example of how the regular use of many, many medications can effect the liver enzyme rate and I think it is something to watch when someone has a general blood test, etc. I also mentioned specifically about Avandia, which the FDA has recently approved as a first choice drug, like metformin, has some serious warnings about potential liver problems.

I am not at all saying that people shouldn't take medications , or implying anything like that. My point is that some minor elevations of liver enzyme counts can occur when several medications are taken on a regular basis. We all are individuals and react to different medication differently. That I believe that if anyone is taking medications regularly, that testing for liver enzymes whenever a general blood screen is being done. I think it is important to watch.

There also are millions walking around with Hepatitis C (like I was), and have no idea that they have it. I found out about mine when I got rejected for life insurance.

Thanks,


Jon




0 user(s) are reading this topic

0 members, 0 guests, 0 anonymous users