Fibromyalgia, Pre-Diabetes and Metformin: Can Diabetes Drug Help Help FM?

Fibromyalgia, Pre-Diabetes and Metformin: Can Diabetes Drug Help Help FM?

Re-printed with permission from Cort Johnson and

It says precisely in the title – "Is insulin resistance fibromyalgia? A preliminary report – it's a preliminary report, but definitely fascinating.

The truth is, authors have said that if the findings are validated, they will result in" revolutionary change "fibromyalgia and related Forms of Persistent Pain (which incorporates Persistent Fatigue Syndrome (ME / CFS)) are being handled. They said that the New Strategy "has the potential to save billions of dollars in the healthcare system and reduce the dependency of many people on opiates" (not to mention the well being and well-being of many people :)) Someone is happy…

The research outcomes are mainly because of the incapability to interpret a fairly widespread laboratory check, and the results recommend that fibromyalgia is usually a precursor of diabetes, which in some instances may be treated with readily available diabetes. (No marvel they’re excited.)


Is insulin resistance fibromyalgia? Preliminary report. Miguel A. Pappo, Laxmaiah Manchikant, Clark R. Andersen, Nigel H. Greig, Fawad Ahmed, Xiang Fang, Michael A. Seffinger, Andrea M. Trescot, Launched: Might 6, 2019, /journal.pone.0216079 [19659002] This small, pretty simple retrospective research analyzes insulin resistance (HbA1c check), metformin use – a drug used to treat insulin resistance (IR) and pain degree in 23 sufferers who had been referred to the ache clinic for widespread myofacial pain ( and met the standards for fibromyalgia).

(Because this was a retrospective research, not a wholesome control group. As an alternative, the researchers used two unbiased wholesome control groups to acquire normative values ​​within the HbA1c check.)

Diabetes happens when the body is unable to metabolize carbohydrates (glucose) properly, resulting in excessive blood glucose ranges. Insulin, hormone, allows glucose to enter cells and produce power. It additionally helps to break down fats and proteins for power. If there’s too little insulin or if the insulin receptors within the cells do not respond to it, glucose is produced in the blood, inflicting problems.

Over time, insulin resistance and excessive glucose ranges in diabetes can have disagreeable results reminiscent of eye (retinopathy), kidney (nephropathy), and neuropathy. These neuropathy issues embrace low-fiber neuropathy (found in fibromyalgia), ME / CFS, GWI, POTS, and diabetes.

The authors said that as a result of their clinic is aggressively treating pre-diabetic circumstances (HbA1c values ​​of 5.7 or greater), that they had info on using metformin (500 mg twice every day). In reality, that they had little info because many individuals with fibromyalgia have been categorised as having pre-diabetes. They used the NPS worth to evaluate the pain degree every time the affected person visited the clinic.


HbA1c ranges elevated considerably after the age of FM patients (green).

The research discovered very vital associations between fibromyalgia and elevated HbA1c check leads to relation to two check populations (p <0.0001 and p <0.0002). This advised that, no less than in this group, elevated HbA1c findings in FM have been real and that insulin resistance or pre-diabetes was current.

The group receiving normal remedies but not metformin improved – indicating that the clinic's pain protocol (usually consisting of norepinephrine reuptake inhibitors (amitriptyline, duloxetine or milnacipran) and / or film stabilizing agents (gabapentin or pregabalin) helped. Nevertheless, sufferers receiving metformin have been a lot better. The truth is, metformin utterly solved half (eight/16) of FM patients, and some sufferers responded only to metformin.

Incorrect interpretation of HbA1c – a standard mistake?

Why has this easy, relatively common check not been combined with fibromyalgia before? Probably because of an error, the authors recommend laboratories and docs do it recurrently: don’t take note of the age when evaluating HbA1c ranges. They found that HbA1c values ​​in lots of their FM sufferers can be thought-about a traditional area.

Nevertheless, HbA1c ranges also improve over time in wholesome individuals. Since the usual HbA1c requirements apparently mirror an older inhabitants, the upper the values ​​might underestimate the extent of pre-diabetes in younger patients. The age distribution of medical FM sufferers showed that lots of them had certainly excessive ranges of HbA1c. (This wasn't a particularly young group: solely three have been in the mid 30s and most have been in the 40s and 50s.) This can be a fairly necessary distinction that doesn't need to be left as a result of the danger of diabetes is larger:) diabetes; b) peripheral neuropathies; c) cardiovascular issues; d) neurological illnesses and their onset; e) All-cause mortality…


Metformin is a first-class drug for sort II diabetes. FM has been steered earlier but with its mitochondrial enhancement results, not its effect on glucose. Quite a few research recommend that there are mitochondrial issues with FM, and several animal research recommend that metformin can scale back pain by growing the activity of mitochondria and antioxidants. One research exhibits that FM sufferers with mitochondrial problems may be properly on metformin. Canadian metformin FM research accomplished.

”Patients with Low Phosphorylated AMPK and Inflammation Activation in BMC Teams. metformin remedy improved both ache and FM signs. “Bullon

This similar inflammation, by the best way, occurs in sort 2 diabetes. (Inflammomas are intracellular immune complexes that react to pathogens and other stressors by producing inflammatory cytokines.)

Pre-diabetes, fibromyalgia and persistent fatigue symptom (ME / CFS) (???)

that insulin resistance might occur in FM and / or ME / CFS. A 2003 research found that fibromyalgia of diabetes was excessive. A high-cognitive insulin resistance was also observed within the 2013 FM research

The link between diabetes will not be as far as suspected. Neil McGregor in Australia and Chris Armstrong of the Open Drugs Basis have instructed that insulin resistance may be current in ME / CFS. Ron Davis has advised that, depending on the result of science, ME / CFS might find yourself in a national diabetes and digestive and kidney illness facility at NIH (NIDDK). If these scientists are proper, fibromyalgia will in all probability come first.

Marco, affected person, locked in a diabetes query in his 2014 Well being Schooling blog: “Power Issues: Diabetes, ME / CFS and FM – Can Diabetes Tell Us About Any Continual Fatigue Syndrome And Fibromyalgia?

He pointed out that untreated diabetes is by definition a "state of energy shortage" and that diabetes is a frequency dysfunction of six varieties. He joined several fascinating potential connections with fibromyalgia, ME / CFS and diabetes:

  • Individuals with sort II diabetes additionally endure from fatigue, early onset of muscle pain, intolerance to train and delayed restoration. Oxygen uptake throughout train has been observed in ME / CFS sufferers and Sort II diabetics
  • Low coronary heart fee variability (elevated sympathetic nervous system activity) has been noticed in all three illnesses
  • .
  • Cognitively comparable enforcement issues are present
  • Small fiber neuropathy is present in FM, ME / CFS, POTS and diabetes.

Plus, We will now add two more attainable matches:

  • Poor microcirculation – because insulin interacts with arterioles and precapillary arterioles to extend blood movement to tissues, insulin resistance can weaken microcirculation, which h studies recommend that FM and ME / CFS might weaken
  • Poor purple blood cell deformation – insulin resistance can also be related to pink blood cell deformation issues and elevated blood viscosity (thickness), both of which can be present in ME / CFS. To ensure that pink blood cells to cross by way of small capillaries and give oxygen to tissues, they need to have the ability to change. If they are unable to take action and / or the blood is just too thick, microcirculation might endure, leading to hypoxia (low oxygen ranges), high lactate ranges (lactic acidosis) and low power production.

Neil McGregor, Australian Metabolic Researcher, stated that though his information suggests that a third ME / CFS patient has insulin resistance, they often have some form of hyperinsulinemia that refers to an extra of insulin. Although hyperinsulinemia typically occurs in sort II diabetes, it does not trigger it, and is extra widespread in metabolic syndrome. It is clear that much stays to be discovered concerning the position of insulin in ME / CFS

A kind II diabetes (and Alzheimer's disease)?

Making One Potential Connection: A number of research have linked Sort II diabetes with (ouch) Alzheimer's disease. In reality, some name Alzheimer's "brain diabetes" or sort III for diabetes.

The 2017 paper assumed that the issues of pink blood cell morphology, deformability and perform, in addition to high oxidative stress, which assist to supply insulin resistance in the brain. It’s fascinating for Trifecta, provided that purple blood cell issues and oxidative stress have already been detected in ME / CFS and FM, and insulin resistance may be added to the listing. (One research means that the speed of dementia may be considerably increased within the FM.)

An intranasal insulin (spray) pumping insulin levels within the mind is another risk. The researchers earned $ 1.7 million to see if intranasal insulin may also help cognitive and different “multi-symptom” problems in Gulf Warfare disease. Intranasal insulin can also be being studied in Alzheimer's and Parkinson's disease


This was a fairly small research and especially individuals with ME / CFS are accustomed to these dangers. Far more in depth analysis is required to determine whether there are giant age-based HbA1c ranges in FM (or ME / CFS). Giant placebo-controlled, double-blind studies are wanted to guage the effectiveness of metformin in decreasing pain.

Physical inactivity and obesity – both of which can happen in FM and ME / CFS – can result in insulin resistance. (The authors may need, however did not consider whether or not BMI has made a difference.) Exercise if FM sufferers can deal with it is extremely really helpful for IR and can enhance it.


In a small retrospective research, the College of Texas researchers found excessive aged HbA1c levels in fibromyalgia, which signifies that pre-diabetes could be widespread, and if their sample inhabitants displays the population to a large extent, probably massively underestimated FM. The authors noted that if HbA1c values ​​in patients were not tailored to their age, most would have been regular.

Remedy with metformin – a first-line drug for sort II diabetes – led to vital and extended pain aid. Half of the cohort (n = 16) has been absolutely reported. As a result of metformin also will increase the production of mitochondria and antioxidants, it may be helpful in many ways

Diabetes, FM and ME / CFS share some fascinating hyperlinks, akin to power issues, low-fiber neuropathy, fatigue, intolerance to exercise, cognitive problems, purple blood cell malformation, and probably microscopy.

The outcomes are engaging, but a lot bigger research are needed to guage the prevalence of altered HbA1c levels, the consequences of metformin on pain and the position of bodily inactivity and / or obesity

Have you ever tried metformin?

Concerning the Writer: ProHealth likes to share info with Cort Johnson. For more than 30 years, Cortilla has had myalgic encephalomyelitis / continual fatigue syndrome. Phoenix Rising and founder of Well being Rising, he has promoted lots of of blogs of persistent fatigue syndrome, fibromyalgia and their allied issues over the past 10 years. Discover extra about Cort and different bloggers in Health Rising.