Exercise and lactate levels while taking metformin?

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Boelkowj - 31 Jan 2004 16:57 GMT

Just wondering if anyone has noticed any night time symptoms (ie. sleeping
problems/restless leg syndrome/slightly sore muscles ?) which could be due to
elevated lactate levels. I am aware that lactate levels normally go up with
exercise and it would be nice to know if metformin potentiates that effect. I
believe this would be unrelated to a more serious issue concerning another
subject Re: lactate acidosis which I have already read about. I did a
literature search on "pubmed" and found no association to date. Maybe it would
be a good research project for somebody.

Larry

Larry

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Frank Roy - 31 Jan 2004 19:57 GMT

Larry:

Lactate can be the byproduct of breakdown of muscle tissue. It is also a
source (feedstock) for gluconeogenesis which produces glucose which is
termed hepatic (liver) glucose production (HPG).

"As fasting progresses, there is a slow increase in the relative
contribution of gluconeogenesis to HGP, which probably explains this
small rise."
Small Increases in Insulin Inhibit Hepatic Glucose Production Solely
Caused by an Effect on Glycogen Metabolism
http://diabetes.diabetesjournals.org/cgi/content/full/50/8/1872

Search in the journal Diabetes for the terms lactate+gluconeogenesis
resulted in about 450 finds.
http://tinyurl.com/252ha

Metformin is known to suppress HGP as well as to increase the
sensitivity of the peripheral muscles to insulin an thereby increase
glucose uptake.

> Just wondering if anyone has noticed any night time symptoms (ie. sleeping
> problems/restless leg syndrome/slightly sore muscles ?) which could be due to
> elevated lactate levels. I am aware that lactate levels normally go up with
> exercise and it would be nice to know if metformin potentiates that effect.

I think your search terms should have been lactate+"lactic acidosis".
Diabetes journal search for lactic+acidosis resulted in 16 finds.
http://tinyurl.com/2e6ex

"CONCLUSIONS: Given the low interobserver agreement and the lack of any
relationship between metformin levels and outcome parameters, the
concept that there is a simple, causal relationship between metformin
use and lactic acidosis in diabetic patients has to be reconsidered."
Source:
Metformin and lactic acidosis: cause or coincidence? A review of case
reports
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uid
s=14746555&dopt=Abstract

"RESULTS: Pooled data from 194 studies revealed no cases of fatal or
nonfatal lactic acidosis in 36893 patient-years in the metformin group
or in 30109 patients-years in the nonmetformin group. ... There was no
difference in lactate levels for metformin compared with placebo or
other nonbiguanide therapies. CONCLUSION: There is no evidence to date
that metformin therapy is associated with an increased risk of lactic
acidosis or with increased levels of lactate compared with other
antihyperglycemic treatments if the drugs are prescribed under study
conditions, taking into
account contraindications." Source: Risk of fatal and nonfatal lactic
acidosis with metformin use in type 2 diabetes mellitus: systematic
review and meta-analysis
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uid
s=14638559&dopt=Abstract

> I believe this would be unrelated to a more serious issue concerning
> another subject Re: lactate acidosis which I have already read about. I did a
> literature search on "pubmed" and found no association to date. Maybe it would
> be a good research project for somebody.

I was curious about this topic before but never got around to checking
it out.

Frank

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