![]() National Library of Medicine, the symptoms of MALA can include 3: The signs and symptoms are often nonspecific and can appear to be symptoms of a number of medical conditions. According to a study published in the February 2016 Metabolism, it occurs in fewer than 10 patients out of every 100,000 per year. But if too much lactic acid builds up in the blood, it can result in lactic acidosis, a condition that can be fatal if left untreated. Normally, the body is able to safely clear lactic acid. Metformin causes the body to produce more lactate, which is the compound that makes lactic acid. When the body uses glucose as energy, it creates lactic acid as a byproduct. ![]() ![]() Metformin-Associated Lactic Acidosis (MALA) According to an ADA study published in February 2012, long-term use of both types of metformin can lead to a decrease in serum B12 concentrations, causing vitamin B12 deficiency over time.6) By limiting the amount of glucose released by the liver, both types of metformin lower blood sugar levels around the clock. They also reduce the amount of glucose produced by the liver. They increase the muscle cells' insulin sensitivity, which enables more glucose to get into the cells where it belongs. Regular metformin and metformin HCL both lower blood sugar through the same mechanism, as described by a study published in the November 2013 Pharmacogenet Genomics. Read More: Normal Blood Sugar Range After Meals This leads to a buildup of glucose in the bloodstream, aka high blood sugar. People with type 2 diabetes, however, are less sensitive to the effects of insulin their cells can't use it properly, which is a condition called insulin resistance. Through this process, insulin lowers blood sugar levels. The body converts the carbohydrates in food into glucose, and the hormone insulin helps move the glucose from the blood into the cells. Glucose, aka blood sugar, is the body's main source of energy.
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