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Metformin

Metformin stands alone in a class of medications called biguanides. Available under the brand name Glucophage and as a generic, it works by decreasing the over production of glucose in your liver, improving the uptake of glucose by your muscles, and improving your insulin sensitivity.

Perhaps metformin's most alluring quality, particularly back when it was first approved by FDA in 1995, is its ability to help you control your blood glucose without gaining weight. In fact, you may even lose a pound or two. You can take this relatively safe and versatile drug either alone or in combination with other blood glucose lowering medications, such as insulin, TZDs, sulfonylureas, or exenatide.

Metformin lowers blood glucose in three ways:

1. First, it suppresses the liver's over production of glucose -- your liver releases glucose when your body is in need of energy. In a person with type 2 diabetes, the liver's rate of glucose formation is two to three times greater than normal due in part to insulin resistance.
2. Second, metformin helps your body more efficiently use the insulin it makes by increasing the sensitivity of your liver, muscle, fat, and other tissue cells.
3. Third, it decreases the intestinal absorption of the carbohydrates you consume.

Metformin doesn't increase insulin production, so when taking metformin, you're unlikely to become hypoglycemic unless you are also taking a blood glucose lowering medication that can cause hypoglycemia, such as a sulfonylurea or insulin.