Recall of metformin extended release

In May 2020, the Food and Drug Administration (FDA) recommended that some makers of metformin extended release remove some of their tablets from the U.S. market. This is because experts found an unacceptable level of a probable cancer-causing agent in some extended-release metformin tablets. If you currently take this drug, call your healthcare professional. They can advise you on whether it’s a good idea to continue taking the medication or if you need a new prescription.

Diabetes affects the way your body uses glucose. Treatment depends on which type of diabetes you have.

In type 1 diabetes, your pancreas stops producing insulin — a hormone that helps regulate glucose, or sugar, in your blood.

Type 2 diabetes starts with insulin resistance. Then, your pancreas no longer produces enough insulin or doesn’t use it efficiently.

Every cell in your body uses glucose for energy. If insulin isn’t doing its job, glucose builds up in your blood. This causes a condition called hyperglycemia, or high blood sugar. Low blood glucose is called hypoglycemia.

Both can lead to serious complications.

Various pills can treat diabetes, but they can’t help everyone.

They only work if your pancreas still produces some insulin, which means they can’t treat type 1 diabetes. Pills aren’t effective in people with type 2 diabetes when the pancreas stops making insulin.

Some people with type 2 diabetes can benefit from taking medication and insulin. Some pills to treat diabetes include the following.


Metformin (Glucophage, Fortamet, Riomet, Glumetza) is a biguanide. It lowers the amount of glucose produced by your liver and boosts insulin sensitivity. It may also improve cholesterol levels and might help you lose weight slightly.

People typically take it twice per day with meals. You can take the extended-release version once per day.

Potential side effects include:

It may also cause lactic acidosis, which is rare but serious.

Talk with your doctor if you are concerned about the side effects of any prescribed medication for diabetes.


Sulfonylureas are fast-acting medications that help the pancreas release insulin after meals. They include:

People usually take these medications once per day with a meal.

Potential side effects include:


Repaglinide (Prandin) and nateglinide (Starlix) are meglitinides. Meglitinides quickly stimulate the pancreas to release insulin after eating. Always take repaglinide with a meal.

Potential side effects include:

  • low blood glucose
  • nausea
  • vomiting
  • headache
  • weight gain


Pioglitazone (Actos) are thiazolidinediones. Doctors recommend that you take them at the same time each day. Thiazolidinediones can make your body more sensitive to insulin. It may also increase your high-density lipoprotein cholesterol.

Potential side effects include:

These drugs also increase your risk of heart attack or heart failure, especially if you’re already at risk.

Dipeptidyl-peptidase 4 inhibitors

Dipeptidyl-peptidase 4 inhibitors help stabilize insulin levels and lower how much glucose your body makes. People take them once per day.

They include:

Potential side effects include:

Alpha-glucosidase inhibitors

Acarbose (Precose) and miglitol (Glyset) are alpha-glucosidase inhibitors. They slow the breakdown of carbohydrates in the bloodstream. People take them at the beginning of a meal.

Potential side effects include:

Sodium-glucose cotransporter-2 inhibitors

Sodium-glucose transport protein 2 inhibitors work by stopping the kidneys from reabsorbing glucose. They may also help with weight loss and lowering blood pressure. Drug manufacturers combine some of these medications into a single pill.

The medications include:

Potential side effects may include:

You need insulin to live. If you have type 1 diabetes, you’ll need to take insulin every day. You’ll also need to take it if you have type 2 diabetes and your body doesn’t produce enough on its own.

Fast- or long-acting insulin is available. It’s likely you’ll need both types to manage your blood glucose.

You can take insulin in several ways.


You can take injections using a standard needle and syringe by loading the insulin into the syringe. Then, you inject it just under your skin, rotating the site each time.


Insulin pens are a bit more convenient than a regular needle. They’re prefilled and less painful to use than a regular needle.

Jet injector

The insulin jet injector looks like a pen. It sends a spray of insulin into your skin using high pressure air instead of a needle.

Insulin infuser or port

An insulin infuser or port is a small tube that you insert just under your skin, held in place with adhesive or dressing, where it can remain for a few days. It’s a good alternative if you want to avoid needles. You inject insulin into the tube instead of directly into your skin.

Insulin pump

An insulin pump is a small, lightweight device that you wear on your belt or carry in your pocket. The insulin in the vial enters your body through a tiny needle just under your skin. You can program it to deliver an insulin surge or a steady dose throughout the day.

It’s usually not a case of either pills or insulin. Your doctor will make a recommendation based on the type of diabetes you have, how long you’ve had it, and how much insulin your body makes naturally.

Pills may be easier to take than insulin, but each kind comes with potential side effects. It may take a little trial and error to find the one that works best for you. Pills can stop working, even if they’ve been effective for some time.

If you start out with only pills and your type 2 diabetes worsens, you may need to take insulin as well.

Insulin also has risks. Too much or too little can cause serious problems. You’ll have to learn how to monitor your diabetes and make adjustments as necessary.

If you have type 1 diabetes or if you must take insulin, you might know you’ll have to monitor your blood glucose levels carefully and adjust your insulin accordingly.

Ask your healthcare professional about the various methods of delivering insulin, and be sure to report lumps, bumps, and rashes on your skin to them.

If your healthcare professional would like to prescribe a pill, here are a few questions you might want to ask:

  • What is the purpose of this medication?
  • How should I take it and store it?
  • What are the potential side effects, and what can be done about them?
  • How often should I check my glucose levels?
  • How will I know if the medication works?

These medications are meant to be part of an overall treatment plan that includes exercise and careful dietary choices.