Metformin's GUT (not liver) action helps regulate blood sugar

[rcjordan]

https://refractor.io/diabetes/metformin-gut-health-benefits/

[ergophobe]

slows down the cellular machinery powering energy production – the mitochondria – and in turn forces the gut to metabolize excess sugar, regulating glucose levels.

I need a chart of the pathway, because this makes no sense to me. The mitochondria are responsible for aerobic metabolism, of both lipids and carbs. I don't understand how slowing that down helps lower blood sugar.

Claude explains it to me:

So the logic is almost counterintuitive but makes sense once you see it: blocking the mitochondria means the gut cells can no longer meet their energy needs the "easy" way (oxidative phosphorylation). They are then forced to compensate by pulling more glucose in from the bloodstream and processing it through a less efficient, non-mitochondrial pathway (anaerobic glycolysis → lactate). This increased glucose uptake by gut cells directly lowers blood glucose levels.

This makes sense. Oxidative phosphorylation yields (check me) something like 32 ATP per glucose molecule. Anaerobic glycolysis yields just 2. So to meet the energy needs of the gut in absence of oxidative phosphorylation you would need a LOT more glucose, so the gut pulls it from the supply of glucose in the blood.

[rcjordan]

I'm on metformin because transplant steroids gave me T2.  It is a frequent discussion topic in /r/diabetes because it is dirt cheap & works BUT it puts most people in gastric hell until they get acclimated to it.

I posted this because many docs with agree to rx it off-label for weight loss. (A lot of /r diabetics complain of too much weight loss.)