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 an unacceptable level of a probable carcinogen (cancer-causing agent) was found in some extended-release metformin tablets. If you currently take this drug, call your healthcare provider. They will advise whether you should continue to take your 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. 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. Low blood glucose is called hypoglycemia. Both can lead to serious complications.

A variety of 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 has stopped making insulin.

Some people with type 2 diabetes can benefit from using both medication and insulin. Some pills to treat diabetes include:


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 a little weight.

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

Potential side effects include:

  • upset stomach
  • nausea
  • bloating
  • gas
  • diarrhea
  • temporary loss of appetite

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

Talk to your doctor if you are concerned about side effects for any prescribed medicine 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:

  • nausea
  • diarrhea
  • headache
  • dizziness
  • irritability
  • low blood glucose
  • upset stomach
  • skin rash
  • weight gain


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

Potential side effects include:

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


Rosiglitazone (Avandia) and pioglitazone (Actos) are thiazolidinediones. Taken at the same time each day, they make your body more sensitive to insulin. It may also increase your HDL (good) cholesterol.

Potential side effects include:

  • headache
  • muscle pain
  • sore throat
  • fluid retention
  • swelling
  • fractures

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

Dipeptidyl-peptidase 4 (DPP-4) inhibitors

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

They include:

  • linagliptin (Tradjenta)
  • saxagliptin (Onglyza)
  • sitagliptin (Januvia)
  • alogliptin (Nesina)

Potential side effects include:

  • sore throat
  • stuffy nose
  • headache
  • upper respiratory tract infection
  • upset stomach
  • diarrhea

Alpha-glucosidase inhibitors

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

Potential side effects include:

  • upset stomach
  • gas
  • diarrhea
  • abdominal pain

Sodium-glucose cotransporter-2 (SGLT2) inhibitors

SGLT2 inhibitors work by stopping the kidneys from reabsorbing glucose. They may also help lower blood pressure and help you lose weight.

Some of these medications are combined into a single pill.

These include:

Potential side effects may include:

  • urinary tract infection
  • yeast infections
  • thirst
  • headache
  • sore throat

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 keep your blood glucose under control.

You can take insulin 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 you’re making 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 use 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 already know you’ll have to monitor your blood glucose levels carefully and adjust your insulin accordingly.

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

If your doctor is prescribing a pill, here are a few questions you might want to ask:

  • What is the purpose of this medication?
  • How should I store it?
  • How should I take 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 is working?

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