Diabetes Talking

Question:

Do you smoke? Even if you don’t, your problem could be intermitant claudication. Check back with your vascular surgeon. Sleepy – Hide quoted text — Show quoted text – I saw an article in the February 2003 issue of ‘Diabetes Forecast’ (page 21) that talked about lactic acidosis caused by the use of metformin.   My question is could it be possible for metformin to cause enough additional lactic acid to cause additional pain in my legs and calves when walking for some distance?   I have been diagnosed with peripheral vascular disease and know that the pain and burning from walking some distance is due to lactic acid not being moved out of the muscles quick enough. Is there any kind of test that can be ran to see if I have an abnormal amount of lactic acid already? Thanks, Jimmy

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Response:

I saw an article in the February 2003 issue of ‘Diabetes Forecast’ (page 21) that talked about lactic acidosis caused by the use of metformin.   My question is could it be possible for metformin to cause enough additional lactic acid to cause additional pain in my legs and calves when walking for some distance?   I have been diagnosed with peripheral vascular disease and know that the pain and burning from walking some distance is due to lactic acid not being moved out of the muscles quick enough. Is there any kind of test that can be ran to see if I have an abnormal amount of lactic acid already? Thanks, Jimmy

Response:

I saw an article in the February 2003 issue of ‘Diabetes Forecast’ (page 21) that talked about lactic acidosis caused by the use of metformin.   My question is could it be possible for metformin to cause enough additional lactic acid to cause additional pain in my legs and calves when walking for some distance?  

During anaerobic muscle activity glucose cannot be changed to pyruvic acid in glycolysis.This may lead to lactic acid accumulation contributing to muscle aches and fatigue. Don’t run, walk like me at the pace of a quarter of a  mile per hour. And don’t walk too far either. We are not as young as we used to. Ask your wife to do the walking for you (grocery shopping). I saw a patient yesterday who sprained her ankle just from walking. PVD (peripheral vascular disease) is a condition that causes partial or complete obstruction of the flow of blood to or from the arteries or veins, in this case in your legs. You can have leg pain with claudication. Metformin is an oral antidiabetic agent used to normalize blood sugar levels by reducing the production of glucose by the liver and by increasing sensitivity of peripheral tissues to the effects of insulin. Glycolysis is the series of reactions that convert a molecule of glucose into two molecules of pyruvic acid. Metformin is mainly excreted in urine. Therefore, the risk of metformin accumulation and lactic acidosis increases with the degree of renal function. Check serum creatinine. Aging associated with reduced renal function increases the risk of lactic acid accumulation. Also the risk increases wherever there is significant tissue hypoperfusion and hypoxemia. Before starting on Metformin check renal function and verified as normal. If renal function is normal for your age, start looking for other causes of your problem as well. Make sure that you know Metformin’s drug interactions. Finally, do not take anything that can potentiate the effect of Metformin on lactate metabolism, like a six-pack of Budweizer. You want to know your lactate level (lactic acid salt) ? What is your question? I can tell you a lot about Tempeh if you want to know….no kidding! – Hide quoted text — Show quoted text -I have been diagnosed with peripheral vascular disease and know that the pain and burning from walking some distance is due to lactic acid not being moved out of the muscles quick enough. Is there any kind of test that can be ran to see if I have an abnormal amount of lactic acid already? Thanks, Jimmy

Response:

My question is could it be possible for metformin to cause enough additional lactic acid to cause additional pain in my legs and calves when walking for some distance?  

Very doubtful. I have been diagnosed with peripheral vascular disease and know that the pain and burning from walking some distance is due to lactic acid not being moved out of the muscles quick enough.

Lactic acid that builds up in the muscles is eventually metabolized (back to pyruvate) in the muscles themselves, not the liver.  Metformin acts on the liver to reduce gluconeogenesis (creation of glucose from non-glucose substrates).  One of those substrates is lactic acid, and in fact gluconeogenesis is the liver’s way of clearing lactic acid from the bloodstream.  But lactic acid buildup in the muscles isn’t caused by lactic acid in the bloodstream, and the muscles don’t metabolize it by gluconeogenesis.

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