Not for the faint of heart or delicate of stomach

Lora A commented in yesterday’s post about just starting metformin and wondering about some of it’s less pleasant side effects.

Yeah, met sucks and there’s really no polite way to discuss it. So, for those visitors who don’t deal with metformin and would rather not read a discussion of gastro-intestinal symptoms, now’s the time to go to another blog. Sorry!

I’ve been taking it for a little over a year now. I took the extended release version for part of that and had fewer side effects, but there is some question apparently about whether or not the extended release form is as effective. So, I switched back for the time being. We’ll see how long I stick it out.

On most days, I don’t have any side effects, but probably once a week I get hit with it all at once. There’s the abdominal pain that’s hard to describe. Sort of like an upset, acidy stomach, but not quite. There’s the gas pain. There’s the nausea, but I rarely feel like I’m going to throw up or that throwing up will make me feel better. It just makes me feel gross…clammy and hot and cold all at once. And then there’s the big D. The diarrhea hits almost without warning. It starts with some menacing gurgling noises in my intestines, then there’s a feeling of urgency. If I’m at home, that’s usually when I try to remember where my book is, because I’ll be in and out of the bathroom quite a bit for the next couple of hours. It’s accompanied by painful cramping. I’ve found that baby wipes for sensitive skin are a life saver because that’s some very tender skin being exposed to some acidy stuff there. Vaseline is also helpful for protecting your skin. After about two-three hours, once everything I’ve ever consumed has been purged, I’m usually fine. Again, I apologize for being so graphic, but this is the sort of information and warning I wish I’d had. It took me months to figure out the baby wipe trick. One last trick that is going to sound a little strange…but trust me on this one. Get a small footstool, like the kind they make for children to use to reach the bathroom counter, and keep it near the toilet. Putting your feet up places your knees higher and can make you more comfortable and strain less. There’s no polite way to put this…basically, it puts you in more of a squatting position instead of a sitting position which is a little more natural.

Nothing really seems to help once it reaches this point. I’ve tried taking something like immodium or pepto, but I don’t notice that it passes any sooner and since I have other intestinal issues that make getting constipated a bad thing, I am reluctant to take anything that might “slow me down” once this bout passes. I do make sure to keep my fluid intake up.

I’ve tried keeping a food diary to see if anything in particular sets me off. Some met patients find that particularly fatty foods, or foods high in simple carbs do it for them. Others have complained that salads, for whatever reason, set off the great purge. I haven’t found any pattern between what I eat and what causes it. It does happen within an hour or so of eating a meal, usually dinner for me, but one night it might be sesame crusted seared ahi tuna with a side of quinoa and asparagus, the next time it might be black beans and rice or grilled chicken and sweet potatoes. I can gorge myself on pasta with marinara sauce and not feel a single bubble in my tummy one night, then I can have a bowl of lentil soup and a salad and be miserable, or vice versa. I’m starting to figure out, though, that MOST of my attacks occur on Mondays. On the weekends, I’m not as good about taking my full met dose and I certainly don’t take it at the same times. Our eating schedule on the weekends is very fluid, while during the week, I eat at the exact same times, three times a day and rarely forget one of my three doses. I suspect that I suffer a sort of rebound effect on Mondays and really need to tighten up my regime for the weekends. If you find that you are having attacks pretty regularly, you might want to keep a diary for a couple of weeks. Write down everything you eat and when you eat it and note any distress you feel afterwards. If there’s a pattern, it shouldn’t take too long to figure it out. Hopefully, you’ll be lucky enough to find just one or two things that cause you the most problems.

I’m sure you’ve already found this out, but things like Tums and Rolaids don’t help much, at least they don’t for me. I’m guessing the pain isn’t really in the stomach, but in the intestines. Even though what we feel seems like an upset, acidy stomach, I don’t really think it is. Sometimes a small snack helps with the nausea. I go for things like a banana or apple sauce or yogurt…easy on the stomach. I avoid artificial sweeteners, and anything with too many words I can’t pronounce in the ingredients list.

Hope that helps. I’m by no means a metformin expert, and I’m sure others out there have tips and tricks. If you haven’t checked it out already, Soul Cysters is a helpful website with lots of information about PCOS. They have a nice forum and, if I remember correctly, an entire section of it devoted to metformin. Pretty much any symptom you’ve suffered through, someone has discussed there and lots of people have posted tips and tricks, or at the very least, sympathy and “been there, done that” companionship.