Biguanides, as a class of diabetic medication, got off to a bad start back in the 1950s. Phenformin, the first of the biguanides, was implicated in a number of deaths from lactic acidosis and was taken off the market. As a result, metformin, a much less risky form of biguanide medication, wasn’t approved for use until 1979 in Europe, and 1997 in the US.

Glucophage, Glucophage XR and Glucovance (which is actually a combination of metformin and glyburide) are three brand-name metformin biguanides available today. Generic metformin is also available at less cost. These drugs work by reducing the liver’s production of glucose which, like the AG inhibitors which act in the intestines rather than the liver, prevents high blood sugar rather than acting to reduce blood sugar after it is produced.

Metformin is chemically similar to French lilac, which in the early 1900s, showed marked ability to lower blood sugar. However, French lilac was even more toxic than phenformin. Metformin, since it is shorter-acting than phenformin, has much less potential for the toxic build-up in the body which leads to lactic acidosis. Metformin is also the only oral diabetes medication that has shown ailbity to reduce diabetic-related heart attacks, strokes and overall death rates. One study showed a 30%+ reduction in heart attacks among diabetics who were prescribed metformin. Biguanides can reduce the need for insulin in both Type 1 and Type 2 diabetes, as well as reducing the need for blood sugar-combating medications such as the meglitinides and sulfonylureas for Type 2 diabetics.

Lactic acidosis, the most dangerous side effect of metformin, occurs when the body is unable to clear the medication from the body effectively. Most at risk are people with significant lung disease, congestive heart failure, or kidney disease, as well as individuals who drink more than two servings of alcohol per day. If you are not in one of these risk groups, biguanides may be an especially effective diabetic medication for you to consider. Talk to your doctor and find out!

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