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As a type 2 diabetic, you’ve probably heard of Metformin, or you might even be taking it yourself.
Metformin (brand name “Glucophage” aka “glucose-eater”) is the most commonly prescribed medication for type 2 diabetes worldwide…and for good reason. It is one of the safest, most effective, least costly medication available with minimal, if any, side effects.
There are always lots of questions around Metformin – how does metformin lower blood sugar levels, does metformin promote weight loss or weight gain, will it give me side effects – and lots more.
Today we’ll hopefully answer some of those questions.
How Metformin Works
Metformin belongs to a class of medications known as “Biguanides,” which lower blood glucose by decreasing the amount of sugar put out by the liver.
The liver normally produces glucose throughout the day in conjunction with the pancreas’ production of insulin to maintain stable blood sugar.
In many people with diabetes, both mechanisms are altered in that the pancreas puts out less insulin while the liver is unable to shut down production of excess glucose. This means your body is putting out as much as 3 times as much sugar than that of nondiabetic individuals, resulting in high levels of glucose in the bloodstream.
Metformin effectively shuts down this excess production resulting in less insulin required. As a result, less sugar is available for absorption by the muscles and conversion to fat. Additionally, a lower need for insulin slows the progression of insulin resistance and keeps cells sensitive to endogenous insulin (that made by the body).
Since metformin doesn’t cause the body to generate more insulin, it does not cause hypoglycemia unless combined with a sulfonylurea or insulin injection.
Metformin is one of the few oral diabetes medications that does not cause weight gain and often people note a slight weight loss (although this is not its main action and not everyone experiences weight loss).
While the mechanism for this is not clear, it may be the result of less gluconeogenesis (making glucose) in the liver and/or decreased food intake, likely caused by increased satiety (ie. curbing appetite).
The Downside of Metformin
Despite its perks, there are some precautions to take when starting Metformin.
The main side effect is gastrointestinal (GI) upsets.
Unfortunately Metformin can cause nausea, stomach pain, bloating, diarrhea, and other GI upsets in about one third of people. The good news is that this generally goes away within a couple days or 2 weeks at most.
This GI upset is simply the body adjusting to the medication and in most cases, incrementing slowly per physician and pharmacy recommendation will help to minimize upset. It also helps if you take it at the same time daily with meals.
Be aware that poor blood sugar control itself (both high and low) can also cause GI distress, so optimizing your diet is key as well. If symptoms haven’t waned after a week or 2 of taking Metformin, contact your physician’s office to see if there is a better option to consider.
It’s also worth considering that in time, as you get you maintain better blood glucose control through diet and lifestyle, you may be able to reduce or stop taking Metformin altogether – as demonstrated in this case study.
Another thing to note is that Metformin can cause B12 deficiency over time. If you’ve been taking Metformin for several years, it is advisable to get a B12 blood test. This deficiency can easily be corrected through supplementation.
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Metformin’s Effectiveness
Metformin is generally not as effective at lower doses, but starting out with smaller doses (ie. 500 mg/day) and titrating slowly to 1,000 mg twice daily (maintenance) will help avert GI side effects.
It’s also recommended never to exceed 2,500 mg/day (maximum dose).
The effectiveness of Metfomin varies from person to person–with some, the initial dose is sufficient, in others, effect is not seen until the max dose is reached, and still in others it is minimally effective.
For many people, healthy diet and lifestyle are sufficient in controlling blood glucose and in others whose biology or hormonal signaling is altered as described above, medication may be required to achieve control – it’s always an individual thing.
Regardless of whether medication is a part of your healthcare plan, it’s always important to make healthy dietary choices including the restriction of carbohydrates, most especially those in the form of white starches (bread, pasta, potatoes, rice) and simple sugars.
Metformin Perks
In comparison with other diabetes medications, Metformin:
- Is weight neutral (and in some may result in slight loss)
- Does not cause hypoglycemia
- Has a significant glucose lowering effect (preventing onset of diabetes in up to 33% of people enrolled in CDCs DPP)
- No effect on bone loss (as with TZDs and possibly SGLT-2s)
- Protective against cardiovascular disease, cancer, stroke and dementia
- Is non injectable
- Is very cost effective
- Originated from a natural herb and traces its medicinal history back thousands of years
Who should NOT take Metformin
There are a few people for whom Metformin is contraindicated:
- If you are having an X-Ray or CT scan requiring dyes, you will have to temporarily stop taking Metformin
- Because Metformin is cleared by the kidneys, it is contraindicated in kidney disease
- Because Metformin works in the liver, it is contraindicated in liver disease
- In rare cases, Metformin can cause a life threatening condition called lactic acidosis (tell your doctor if you have liver, heart or kidney disease, or drink alcohol)
As with all medications, whether to take metformin should be a shared decision between you and your physician.
Remember to discuss your goals, current blood sugar control (including HbA1c), family history, length of time you have been diagnosed, and any symptoms you may have.
Keeping a diary/log of medications and symptoms along with a food and glucose journal is very helpful in troubleshooting and making informed decisions regarding your health care in the future.
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Pat
I was started on Metfirmin and started having problems with my hands peeling and then my feet started peeling come to find out it contains some sulfer and I am allergic and cannot take! To bad because it controlled my blood sugars great!
Mary
I had an allergy to sulfur drugs also and that’s what put me in the hospital with lactic acidosis. Scary. I take Januvia now and am doing better and am glad to be off the insulin.
Mary
I was put on metformin last August and had the lactic acid reaction that almost took my life. I did not have any existing medical problems at the time. Please put stronger precautions on these medications. I was told if I had taken the fourth pill I would have probably not made it. Thank God my husband was home and rushed me to the hospital where my sugar had sky rocketed to over 1000. I spent a week in a hospital recovering. I am on. Different medication now and I have lost 60 pounds and my A1c is only 5.5.
Tom
What was the different medication that you were prescribed? I currently take 1000mg twice a day. Thanx
Sharon
Good morning. I am currently dealing with psoriatic arthritis and my rhuematologist is closely monitoring various labs, A1C being one of them…and it’s been creeping up. Given family history x 2 of diabetes, I am quite concerned. As if a diabetic diet weren’t bad enough, I am allergic to wheat and soy and almonds. So trying to find anything palatable to eat is looking pretty hopeless right now. Any recommendations…?
Jedha
A diabetic diet is awesome Sharon, it’s super healthy and exactly what our body needs! We don’t recommend wheat and soy anyway, they are too high in carbs for most people to tolerate. And as for almonds, there are plenty of other nuts to choose from. Check out some of our recipes, they are all in line with what you need to eat.
Nicole Lane
Thanks for all the helpful tips. I’ve just started on this medicine two weeks ago. I’ve lost 8lbs so far. I take 2 500mg twice a day. I haven’t had any side effects.
Thanks!
Dehlia
Hi well I took Metformin for about 2 years and it was the worst experience that I had. I had constant diahrrea. I had to finally stop taking it. I am glad that it has helped others. But it just wasn’t meant for me. Good luck to all who are taking it.
Lori
I also couldn’t take it. Caused excruciating pain on my left side. I couldn’t even stand up straight. Tried half a pill, a fourth of a pill, extended release…no matter.
Kris S.
This article might be true if you take Medformin because you are diabetic. I was prescribed Medformin for my Polycystic Ovarian Syndrome (PCOS) and I was not diabetic. I took Medformin for nearly 15 years before I resorted to gastric bypass surgery. Medformin not only caused me gastric pain, discomfort and constant diarrhea for 15 years but contributed to my weight gain. My gastric bypass surgery five years ago put my PCOS in remission immediately after surgery. Since then I’ve discovered I’m hypoglycemic which I probably was before I started taking Medformin.
Jedha
Hi Kris, you’re right, this article is aimed specifically at type 2 diabetics. Thanks for sharing your story and glad you finally found the issue.
steven
The article regarding metformin was interesting and useful. Such information is always appreciated.
Thank you.
Sincerely,
steven
Jedha
Glad you found it helpful Steven. 🙂
Frodosdojo
Very good info and I was happy to see your recommendation to titrate the dosage. I think a lot of people give up on metformin because of the gi problems. I know I did when it was first prescribed for me. Many years later I figured this out: take 250mg for 5 days, then 500mg for 5 days and continue until I’m at the recommended dosage. It really is the best medicine.
Beth
You got it!
Nadene Bishop
I just started today with metformin are there any vitamin supplements that interfere with the metformin?
Elizabeth
There are no supplements that I’m aware of that would interfere with metformin, however it taking it can result in B12 deficiency in some so you may want to get your levels checked and consider taking a B12 supplement to ensure you have adequate levels.
Jennifer
Thank you so much for this article. I just started taking this yesterday and I was wondering about some of the side effects. This explains a lot!
Beth
Great!!! You are more than welcome 🙂 Hopefully if there are any, they will subside very soon–if not, be sure to check in with your physician.
wendy
Very helpful first time I have read this I am a type 2 diabetic and found the information useful .
Jedha
That’s great Wendy and welcome 🙂
Jill Van De Velde
I was diagnosed with Type II diabetes in April 2015. I initially was on Metformin 500mg twice daily. Doctor had me add Magnesium oxide 400mg with each meal and if tolerated to take more than three times per day. I asked to get changed to Metformin 500mg extended release twice daily to cut down on GI effects. I have notice since being on the extended release Metformin that my weight loss has plateaued and I am at a standstill. My weight fluctuates by plus or minus 5lbs. by the scale. I have noticed my energy levels have dropped also…feeling very tired. I am unable to exercise much due to a left hip and knee issue. I am very physically active at my job on my feet for 8 hours with non-stop movement and activity. Any suggestions? I want to take supplements but have occasional issues with GI tract. What recommendations would you make?
Beth
Hi Jill!
A few thoughts-one question is how long did you take the Metformin before switching to the ER? Usually symptoms associated with GI start to wane after a couple of weeks. If it was longer than that and you were still having GI distress, there are a couple of things to ask your physician about (I am not advising you do, but simple discuss with your doctor)–one option would be to cut the Metformin dose in 1/2 (so you would take 250 mg) if you are pretty well controlled and try to gradually increment it upward. I would also ensure you are taking the Metformin with meals. I doubt your plateau is related to the medication switch as it is the same basic formula just a different release time–Metformin is not a weight loss medication itself, that is simply one of it’s effects in some people (and the effect is relatively small) so it may be the case that you would have plateaued regardless. If you are very active at your job, maybe consider counting your calories a few days….sometimes people who start counting carbs ONLY find that they are eating too many high fat foods and end up taking in more calories than they are burning (consider an avocado 240 calories or 2 T peanut butter 190 calories–very healthy options, but can add up quickly). A last consideration would be to discuss a different medication with your doctor. GLP-1s (ie Victoza) are excellent at controlling glucose and very helpful with weight loss. The downside is they are more expensive and injectable (but not insulin). Hope that gives you some things to consider!
Charlene
Thanks for all the good lnformation
Jedha
Glad you found it helpful Charlene 🙂
James Wilson
I appreciate the info. I’ve been on Metrormin 1000mg twice daily for about 20 years. I’m 66 years old weigh 150 lbs. and run 2 to 3 miles outside everyday. My A1c is 7.3. If the newcomers keep their weigh down and take their meds they will enjoy a “normal” life. If I could only grow hair on my head again. Thanks for the encouraging responses. Jim
Jedha
Glad you found it helpful James. 🙂
Beth
Wow….2-3 mile run every day at 66? Kudos!!!!
Becky Oestreich
I also have a hair loss problem. I’m wondering if its the metformin. I’m on 2000mcg. I do wonder…
Elizabeth
It’s very unlikely–I’ve not heard of anyone in my clinical practice or read in any literature of hair loss as being a side effect of metformin and wouldn’t make sense based on the action of the medication (of course it’s always possible you are sensitive to particular ingredients contained). It may be the case that you have some hormonal dysregulation (of which diabetes is one example/type) such as hypothyroidism or PCOS which can cause hair loss. I would recommend discussing with your healthcare practitioner who can do a more thorough assessment.
April
Thank you for sharing thisinformation. I just began taking Metformin about a month ago. Is it imperative to take Metformin before your meal? SometimesI forget and take in the middle of my meal or just after.
Thank you.
Beth
Hi April!!! Great question! The primary reason for taking Metformin with a meal is that the medication can be rough on your GI tract (causing stomach upset). Taking it with food helps minimize or eliminate that. The most important thing is that you are taking it consistently from day to day to get the most benefit. Metformin does not change the amount of insulin you produce or use, so will not (by itself) put you at risk for hypoglycemia (which IS the case in many other medications and insulin in which the timing is more imperative). As long as you are taking it with a meal, you should be just fine (whether that is just before, during, or right after).
MelISsa Coleman
We wete taught in nursing school that to be most effective it should be taken 20-30 min priot to eating.
Elizabeth
The prescription will generally say take with meals. The time it is taken (with regard to meals) will not have an impact on it’s efficacy because it’s action is on the liver and muscle glucose stores and improving insulin sensitivity (not addressing glucose from meals). The purpose of taking at meal times is to reduce GI symptoms, not to make it more or less effective.
James Farnsworth
Most M.D.’s are prescribing Metformin ER which is the extended release version so it’s not that important as to when it is taken.
Gelly
Hi! Im just curious about it!
Should I take metformin always on the same time everyday or it doesn’t matter which time as long as after meal?
The doctor I asked said it has to be on the same time but I can’t commit.
Jedha
If your doctor advised to take it at the same time everyday, then that’s how you should take it. Physicians are the best person to advise about your medication.
Jay
I went in today to review blood work that was perform elsewhere. My fasting glucose last week (day of blood work) was 139, a1c of 6.8. A year ago glucose was 111 with a1c of 6.5. Beginning november up to now i slacked off, and ate bad bc of holidays and birthdays. Today my glucose reading was 113. Doctor prescribed this medication 500mg 2xs a day. I am on edge about this bc i see it as the beginning of never ending medications. I do not want to take medications no matter how low of a dosage it is. Doc claims ppl also take it for losing weight. Reason why i refuse to take medication a few yra back my a1c was 6.0 glucose 111 within 8 months i retest i dropped my a1c down to a 5.3 glucose of 110. Do you think with my numbers today, i can manage to lower my numbers down withOUT taking the medication? Or do you recommend going further with the RX?
Jedha
Sorry, we can’t give you medical advice Jay.
113 isn’t overly high and can probably be brought back under control by diet and exercise, people with much higher readings bring theirs down. I understand how you feel though, and I agree, though meds do work for some people, taking meds can sometimes be a downward spiral. Perhaps you could seek a second opinion or talk to your doctor and tell them you want to try to lower it yourself with lifestyle and ask your doctor to support you by giving you a 3 month leeway to bring it down without the meds?
You might find this case study useful https://diabetesmealplans.com/7145/t2-low-carb-diabetic-diet-case-study/
Jay
Will do, it will take time and adjustment. I have a follow up within a month but that seems too short of a time to show some progress. I greatly appreciate your input I love this site, info and your replies. 🙂
Jedha
Yes Jay, things do take a bit of time but in a month you should see your numbers come down. Focus right in on your carb intake – limit rice, potatoes, pasta, bread etc – all the high carb foods. And get at least 15 minutes a day of exercise, even a walk will do. Another thing that works well post meal are some squats. Just do 10-20 after a meal. Great way to get incremental exercise. 😉
Thanks for the compliments and let me know how you go.
Beth
I can totally understand your concern & frustrations. While this should be a shared decision between you and your physician, remember that lifestyle changes (diet and exercise), while being absolutely crucial, in some people, aren’t sufficient alone to maintain stable blood glucose – everyone is different. Diabetes is a progressive disease, meaning your pancreas function will continue to decline regardless of what you do–our goal with lifestyle changes is to SLOW that decline as much as we can. That said, it can be more difficult for some to control glucose levels with diet and exercise alone the longer they’ve had the condition. I know MANY patients who have been on Metformin alone for well over 10 years and no need for additional meds as well as some who have obtained such tight control that they have gone “off” the Metformin. Regardless of what you decide with your doctor what to do in terms of medication, you can see this as a red flag as to how important it is to avoid slacking off with diet & exercise & how important they are to your health!!!
Jedha
It’s true, everyone is different but there is very strong evidence that eating a low carb diet slows type 2 diabetes right down and even stops it in it’s tracks – this case study last year is a case in point. And a new study by CSIRO released this year showed a 40% reduction of meds in the low carb diet group. Or this research comparing low carb to low fat.
When it comes to the pancreas, the reason why the low carb diet is getting great results is basic biochemistry. Carbohydrate foods cause the pancreas to release insulin, and too much insulin increase insulin resistance. So naturally, when we lower carb intake, we have less glucose in the bloodstream, less insulin production, and insulin sensitivity improves. So all round there can be major changes on a metabolic level.
That’s not to say it works for everyone or that you should feel guilty if you do have to take meds. Everyone is different so although we have research to help guide our choices, we also need to listen to our own bodies and work with our health care team to achieve the best results.
Brewster
I’m on 500mg of Metformin daily and so far no side effects. I have lost about 15lbs since this T2 started last September. Diet changes, daily workouts at the gym and maybe the med’ contribute to the loss. Took a reading yesterday morning and I was at 5.0
Jedha
Awesome work Brewster. Congrats 🙂
Beth
That’s wonderful!!! It really is a great firstline medication–glad to see you aren’t looking at the med as a panacea, but rather using it in combination with smart lifestyle choices. Those will carry you much further than the medication alone!!! Keep up the good work 🙂
Net
Hi, I just started using metformin 500 mg 2x a day for about 4 days now. My blood sugar went down but not in normal range yet especially 2 hours after meal. Is this normal? How long do I have to wait before it normalizes? Now, I’m thinking I am underdose. Thanks
Emily - Dietitian (MS, RD)
Results vary from person to person. It can take anywhere from a few days to a few weeks to notice improvements. Here are 20 Q&As about Metformin that you may find helpful. And lastly, do NOT change your dose of medication without your doctors consent- give your body a bit more time to adjust to the medication and discuss your concerns with him or her at your next appointment.
Risto Rinne
I’ve been taking this medicine over a year now and i have lost weight abot 50 pounds.
Rochelle g
Can you stop taking metformin after reaching your goal?
Jedha
Yes, many people do come off metformin Rochelle. But it is something you should discuss with your doctor.