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GrammaBear

Metformin - electrolyte imbalance

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GrammaBear

I've taken Metformin ER (500 mg) three times a day with meals for a number of years.  I also take two diuretic meds for help in controlling my high blood pressure.  Before recent minor surgery my blood sodium level was 130 and lab values for this lab are 135-154.  Now several weeks after this minor surgery my blood sodium level is even lower at 125 and the symptoms associated with that number are muscle pain and a burning sensation in the muscles in addition to an ongoing nagging headache.  I called the PCPs office and my doctor's nurse advised me to stop the Metformin ER until further notice and to "salt heavily" until labs are drawn again at the end of the month.  How does Metformin contribute to electrolyte imbalance?  I've never heard of the possibility before and I'm not sure I believe it now.  I am finding I require more and more and more insulin to control my blood glucose.

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Kit

I've not researched the subject, but I've never heard of that issue with metformin either.  Unless maybe they are mixing the gastric issues some people can have with this?

 

Honestly, I would be more likely to suspect the diuretics you're on.  The likelihood that they could cause an issue like this seems a lot higher.

 

Oh, I should add

 

Is there a reason you're on Metformin as a type 1?  Are you also dealing with insulin resistance?

Not questions so much of you being on it as I just can't remember the reasoning.  :)

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GrammaBear

I've not researched the subject, but I've never heard of that issue with metformin either.  Unless maybe they are mixing the gastric issues some people can have with this?

 

Honestly, I would be more likely to suspect the diuretics you're on.  The likelihood that they could cause an issue like this seems a lot higher.

 

Oh, I should add

 

Is there a reason you're on Metformin as a type 1?  Are you also dealing with insulin resistance?

Not questions so much of you being on it as I just can't remember the reasoning.  :)

 

I've been on Metformin since 2003, it was the first oral medication the PCP I had at that time prescribed for me.  He originally diagnosed me as T2 and then when oral meds did not work, accused me of NOT taking them, so told me "Well - guess I will have to put you in insulin since you are non-compliant with the pills."  Shortly after that interchange with him I sought the opinion of an Endocrinologist who ran the c-peptide test which came back 0.1.  By then it was too late to run the GAD65 test (he said).  The Endo rediagnosed me as T1 and I've been on insulin ever since.  I have major insulin resistance in the evening hours until around 2 a.m. when my insulin requirements are almost cut in half.  This seems to be the opposite of many people, so really don't know why.  Just know that Metformin seems to help with that resistance.

 

I agree the diuretics are likely responsible for the electrolyte imbalance, my main desire right now is to get rid of the muscle pain and to control the blood sugars.  Just really a struggle at the moment and I've become discouraged a lot.

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Kit

Ah, makes sense to keep you on it then.

I can understand the frustration.  Hope you get things figured out soon.  *hugs*

 

How's your blood pressure been?  The advice you were given makes no sense to me.  The point of diuretics to lower blood pressure is to reduce the amount of fluid you are carrying.  That will flush electrolytes out of your body.

 

Heavily salting your food for a while, however, will have the exact opposite affect.  It will keep fluid in your body (because the salt holds onto it).  In other words, nulling the effect of the diuretics on your blood pressure.

 

Would make more sense to drop one of the diuretics and keep an eye on your blood pressure.  or maybe switch to a different kind of blood pressure medicine.

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macksvicky

I have to agree with the others...it's not the met. I take a diuretic for fluid retention but for blood pressure lowering I take Cozaar (the generic is losartan) they counter balance each other so I don't lose potassium or electrolytes, etc.

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GrammaBear

Ah, makes sense to keep you on it then.

I can understand the frustration.  Hope you get things figured out soon.  *hugs*

 

How's your blood pressure been?  The advice you were given makes no sense to me.  The point of diuretics to lower blood pressure is to reduce the amount of fluid you are carrying.  That will flush electrolytes out of your body.

 

Heavily salting your food for a while, however, will have the exact opposite affect.  It will keep fluid in your body (because the salt holds onto it).  In other words, nulling the effect of the diuretics on your blood pressure.

 

Would make more sense to drop one of the diuretics and keep an eye on your blood pressure.  or maybe switch to a different kind of blood pressure medicine.

 

The only problem with trying to find a different blood pressure medicine is that I am already on 3 others, Micardis, Metoprolol and Amlodipine.  Right now I am so sick of doctors in general, I could scream.  They are a necessary evil.

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TX_Clint

High doses of metformin may cause lactic acidosis, which is a rare but serious side effect, according to Drugs.com. Lactic acidosis is the elevation of lactic acid, which can cause a serious electrolyte imbalance. It is fatal in 50 percent of cases. The risk of lactic acidosis increases in patients with kidney disease and in older patients. Sign of lactic acidosis include malaise, myalgia, respiratory distress, somnolence and abdominal distress

I doubt this is your case but there is the possibility.. 

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GrammaBear

High doses of metformin may cause lactic acidosis, which is a rare but serious side effect, according to Drugs.com. Lactic acidosis is the elevation of lactic acid, which can cause a serious electrolyte imbalance. It is fatal in 50 percent of cases. The risk of lactic acidosis increases in patients with kidney disease and in older patients. Sign of lactic acidosis include malaise, myalgia, respiratory distress, somnolence and abdominal distress

I doubt this is your case but there is the possibility.. 

 

I've been told since my 'minor' surgery that I probably should have stopped the Metformin a week before the surgery, but I did not because the surgery nurse did not mention it when she called with my "surgery instructions".  I do have stage 2-3 kidney disease and I guess I qualify as being 'old' at age 70.  I have an appointment with my CDE this afternoon and hopefully she can be helpful as she is also a type 1 and an RN.

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GrammaBear

High doses of metformin may cause lactic acidosis, which is a rare but serious side effect, according to Drugs.com. Lactic acidosis is the elevation of lactic acid, which can cause a serious electrolyte imbalance. It is fatal in 50 percent of cases. The risk of lactic acidosis increases in patients with kidney disease and in older patients. Sign of lactic acidosis include malaise, myalgia, respiratory distress, somnolence and abdominal distress

I doubt this is your case but there is the possibility.. 

 

You should hang out your 'shingle' for helping people with making a possible diagnosis for their conditions.  It turns out that lactic acidosis is what my doctor suspects with my electrolyte imbalance issues of late.  I would never have guessed that Metformin could perhaps be the cause of my problems.  And yet I've had it too many times in the last few years to have it be a coincidence.  Thank you for bringing this to my attention.  Diabetes is never boring !!!

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Kit

Ah, they took my brother off Metformin once he started having kidney issues due to the risk of lactic acidosis.

 

The advice makes much more sense now.  :)

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ronmesnard

I concur with jwags.  That is the most likely cause from the information you have given us.  Usually, even they do not cause low sodium because your kidneys recover the salt unless you are taking a new diabetes drug that allows you to pee sugar.  You may need a very smart doc to figure this one out.  Hopefully, this will correct itself without help.  

 

You aren't sweating more than usual?  Sweat is the easiest way to lose salt.  You don't have excessive diarrhea?   Are you drinking more water than normal?  More water in more sodium goes out.  More water plus your BP meds could lower your sodium even without sweating.

 

It is unlikely metformin is the cause.  If you can, I would shop for a new doctor or at least a second opinion. Maybe see that Endo again they are usually pretty smart.  Yours was smart enough to properly diagnose what disease you have. Did the nurse ask about drinking more liquids, sweating and  diarrhea?  Any one of these might cause low sodium.  Are you scheduled for a sodium in the urine test?  If you have more sodium in your urine than is normal that could be a sign your kidneys are malfunctioning.  Otherwise it may be just a combination of the normal ways to lose salt.  

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GrammaBear

It turns out that Metformin was not the cause of my electrolyte imbalance.  Before I had surgery 11th August my sodium level was 130, two weeks after it was 125 at the post surgery check.  Last Thursday 17th September I went to the ER because it hurt just to move either my legs or my arms.  They checked the sodium among other things and my sodium level was 122.  My PCP ordered me to be admitted to the hospital where they did what seemed like a million sodium level, urine level and blood sugar checks.  There was a kidney doctor on call and he took over the management of the situation.  So far I like him and will see him in a week or so.  I'm hoping he can tell me then what precipitated this latest bout of hyponatremia and why.  In the meantime he stopped both diuretic pills and my BP has stayed stable if not even better w/o the water pills.  My blood sugar went absolutely nuts in the hospital because as part of the treatment they gave me D5W dextrose/saline solution.  I am glad things have calmed down some and I got to come home.  Home isn't perfect, but it beats being in the hospital.  :)

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