Cirrhosis + Metformin?

[jettt]

New user here.  Have had fatty liver for many years.  Recently ALT/AST mildly elevated.
Seen a GI doc and got a liver biopsy.  Biopsy showed cirrhosis.  I have no noticeable symptoms.  Never drank or done drugs.  Anywho, my question is I have read several places that the diabetes medicine Metformin should not be used by people with liver cirrhosis.  I am type 2 diabetic.  I have not discussed this with any of my doctors yet because my appointments are a few weeks away.  Just wondering if anyone on this forum has any insight on metformin + cirrhosis?  Any type 2's with cirrhosis on here who take metformin?  Should an alternative to metformin be used?

Having abdominal MRI in 4 weeks.  Had ultrasound but also wanted MRI for a better.

Thanks for reading......

[flyinlynn]

I did find some info from the American diabetes association basically what they’re saying is as long as you don’t have very advanced liver cirrhosis it should be safe but the best person to answer the question is your personal doctor who is familiar with your specific medical condition

[jettt]

Yes.  But some confusion arises because on many liver disease websites and videos they say it should be avoided.  You are right though and I will know more tomorrow at my hepatologist appointment  This comes at a very bad time for me.

Appreciate it flyinlynn

[flyinlynn]

https://diabetesjournals.org/care/article/35/3/e21/28753/Metformin-Induced-Hepatotoxicity#

[flyinlynn]

Metformin is not considered intrinsically hepatotoxic. In fact, metformin may be beneficial in patients with nonalcoholic fatty liver disease (1) and chronic hepatitis C (3). Metformin is only contraindicated in patients with advanced cirrhosis because it heightens the risk of developing lactic acidosis (4). However, given the increasing prevalence of type 2 diabetes and expanding indications for metformin (5), it is important that clinicians be alert to the occurrence of rare but potentially serious side effects of this drug, such as idiosyncratic hepatotoxicity.

[jettt]

Thanks for the info flyinlynn.  I see a hepatologist tomorrow and will query this.  The package insert for metformin talks about liver disease but not specifically.  To me, cirrhosis is advanced liver disease at whatever level.  But I'll still learning and trying to take things in.
Thanks again!

[flyinlynn]

So basically there is compensated cirrhosis wheee the liver, although damaged, is still able to perform its important functions. Decompensated cirrhosis is where the liver is so very damaged where the liver is no longer able to keep up with its important jobs.

Symptoms of advancing liver cirrhosis in many cases begins with lower leg and foot swelling called edema or putting edema. Another early symptom is a low platelet count. Before my hep c was cured my platelets were around 85 with 150 being low normal. Now 8 years post hep c cure my platelets on last check were 144 just barely below normal.

Other more serious symptoms would be the development of ascities the retaining of fluid in the abdomen which can get to the point where the patient looks like they are pregnant. This can make it difficult to breathe at times and also cause the person to not eat enough. This fluid can become infected (SBP) spontaneous bacterial peritonitis which is one of the ways cirrhosis can shorten your life.

Another serious complication is the development of esophageal varicies which are caused by  portal hypertension where the main vein in the liver the portal vein becomes somewhat blocked causing an increase in the pressure in this vein and backing up pressure in the veins in the esophagus. If not discovered with upper endoscopy the veins can enlarge to the point they can burst and bleed leading to excessive blood loss and death.

Also there is a complication called hepatic encephalopathy where the blood has elevated levels of ammonia because the liver is no longer able to clean the blood. Advanced  hepatic encephalopathy can lead to coma and death.

Also people with cirrhosis are at increased risk of HCC hepatocellular carcinoma liver cancer.

I was diagnosed with early cirrhosis in 2008 I was diagnosed with esophageal varicies in 2012 which I had banded. I also have some lower leg edema. I did have some amount of ascities which have improved  since my hep c was cured and is no longer noted on my ultrasounds which I have every six months.

Yeah I’ve learned way more then I really wanted to know about liver disease.

Best of luck to you

[jettt]

Thanks for further enlightening me flyinlynn.  I seen my new hepatologist today.  She said the metformin would not be an issue for me at this time.   Iam scheduled for an MRI in 4 weeks to check for HCC.  The ultrasound had trouble looking through the nodules/fatty so it was recommended to have.  I have read about varicies banding.  The doc also is going to change the beta blocker I take(selective for cardio/hypertension) to a non-selective one that will help with my hypertension as well as the liver.  I get an endoscope next week for celiac disease investigation/biopsy.  The doc doing it is going to look for esophegeal varicies during the biopsy procedure.  You're a wealth of knowledge flyinlynn.  I'm glad you share it.  I'm still trying to sort everything out cuz I just got hit with a celiac diagnosis the liver cirrhosis.  A dietian is going work with me on diet.

Are you on any meds for your situation now flyinlynn?

Yeah, it seems you are the one keeping some activity in this forum.

toodles for now..

[flyinlynn]

Hi glad your doctor is working with you and you’re making forward progress.

There are no meds to be taking there is no treatment other than time and hopefully some improvement. The best one can do is try to maintain a healthy weight try to eat healthy and get some exercise.

Which I will admit I like most people need to work on all those things :-)

Best of luck to you
Lynn

[jettt]

There are no med for cirrhosis of course, but there are for the many other issues it causes.  I was prescribed a non-selective beta blocker Coreg, Generic name: carvedilol, for reduction of portal hypertension and esophageal varicies.  I am not sure I have varicies.  I will find out next week at my endoscope.  But the beta blockers may help prevent them as well as well as possibly reduce bleeding episodes in those who do.  Other non-selective beta  blockers used similarly are Nadolol and Propranolol.  Then there are the meds to tackle Heptic Encephalopathy if you acquire it.  Then worse case is the threat of Hepatocellular Carcinoma and the reason for screening(Ultra-Sound or MRI) every 6 months.  MRI would provide the most accurate data.

You're right about " maintain a healthy weight try to eat healthy and get some exercise".  My doctor set me up with a nutritionist I see in 1 month but I have started doing this, the best I know of, a month ago.

You take care Lynn.  Thanks for sharing your experience and knowledge.

...........jettt

[flyinlynn]

In my case I cannot take beta blockers as the goal is to lower your heart rate below 60 bpm and my testing hr is in the 50’s that was why I had to have my varicies banded. Took four upper endoscopies over four months to get rid of all the varicies I had. Haven’t had a reoccurrence of them since.

I was having upper EGD’s every year then my doctor reduced to every two years.

I was having abdominal ultrasounds every 6 months but about two years ago there were some masses detected in my liver the concern being HCC (heptocellular carcinoma) so I now have been having CT scans of my liver to more closely the masses. Fortunately so far there has been no changes in the masses so knock on wood they so far don’t seem to be cancer.

Thankfully I’ve had no episodes of HE basically the only symptoms I’ve had have been a small amount of abdominal ascities that have resolved, esophageal varicies that were banded, and a low platelet count that has improved to approaching near normal.

The only med I’m taking is some blood pressure meds as my BP is a little elevated.

Best of luck to you

[jettt]

Holy cow!  You've certainly been through so much!   I've been on high bp beta blocker for a long time.  They are just going to replace that one with the coreg.
On my ultrasound last month, my first one for liver, they said they cannot get a good reading to look for HCC due to the cirrhosis(scaring),  They suggested the MRI.  I don't know if my ultrasound in Jan 2024 will have the same result and suggest MRI.like

It seems like you have great doctors and they are closely monitoring you.  So much scary stuff could happen.  Its a real nightmare.  I worry constantly.

Thanks again for the info.  I'm always grateful to of other peoples experience.  Especially someone like yourself who has first hand knowledge.

Take care............
jettt

[flyinlynn]

I’m really one of the very few here still commenting. My cirrhosis was caused by decades of hep c infection which was finally cured in 2015.

[jettt]

Thats great and I am happy for you.  No doubt you've learned a lot about the disease in your experience.  I was tested by labs for Autoimmune Hepatitis along with the liver biopsy.  No AIH ruled out although I did have a weak positive reaction.

Take care............

[flyinlynn]

Call your doctors office

[jettt]

I will wait until my appointment.  I am asking to see if anyone has any first hand experience about this.  Might that be you?