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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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Sharie
Dr prescribed me metformin to help with weight loss. I have been unsuccessful in this area. My question is when do I take this med. Presently I take it in the AM when I get up and when I go to bed. Should I be taking it with my meals?
Elizabeth
Yes, definitely always take with meals. It will not affect the potency of the medication, but will help to reduce GI side effects. It should be taken at the same time every day (morning or evening does not matter, but most people take in the morning if only taking once per day).
Melissa
I just started Metformin. Supposed to take a 500mg pill twice a day but most of the time only get the one in at breakfast. In two weeks my fasting has gone down from 250 to 116. I already limit carbs and sugars so I didn’t have much of a GI reaction which I am thankful for due to having IBS-D for so long. I think this is a good start. My problem is I don’t eat enough but need to lose weight. I try and eat proteins and veggies mainly with some carbs. Anything I can do to get more energy want to eat more and be more active? I want to control this but I know mine is hereditary. My back hurts all the time and when I walk it seizes up. I lost 80 pounds over the past four years and 10 in the last 3 months but I need to do more at 231 I gotta get this thing under control. Frustrated but happy with the results so far.
Elizabeth
Melissa,
Sounds like you’re doing a great job taking charge of lifestyle changes like getting your diet and exercise under control. Metformin can also help with weight loss and hopefully that’s the case as well. There can be a lot more factors contributing to weight gain or difficulty with loss including: gut microbiome (have you considered a probiotic supplement?), hormonal disruption (perhaps see endocrinologist to check your thyroid and other potential issues), and as you said genetics. Bariatric surgery–esp gastric sleeve has been shown to be effective in those who have tried everything & still not seeing results. However, it looks like you are still seeing results, just maybe a bit slower than you’d like.
Pam
I was diagnosed with Type II diabetes in May 2016. I never had any symptoms, wasn’t feeling poorly, not overweight and considered myself to be a healthy person. My PCP says it is hereditary; my grandmother had it. I currently take 500mg Metformin 3 x day. My fasting reading in the morning usually runs in the teens (i.e. 115, 117 etc.) and two weeks ago I was even 107. I exercise daily and really watch my diet closely. Here’s my problem. Within 6 weeks Of being diagnosed and starting Metformin, I lost 13 pounds. I’m 5’6″ and weighed 140. I’m now at 128 and hate it. Everyone Tells me how skinny i am. I saw a dietician and she told me to eat More protein and snack alot. I do all this but i never gain an ounce. I hate it. A friend of mine said she was prescribed Metformin strictly to lose weight (she’s not diabetic). What other meds can i take that are not costly and that won’t make me lose weight?
Elizabeth
While the majority of those with Type 2 Diabetes struggle with overweight or obesity, it isn’t uncommon to have the condition at lower weights. Unfortunately, most people with prediabetes and early diabetes do not have any symptoms, but it is very important to take seriously because damage can still occur. Jedha wrote a great article about healthy weight gain and diabetes here: https://diabetesmealplans.com/9664/low-carb-weight-gain-diet-for-diabetes/. I would just reinforce that calories are what matter when it comes to weight gain and thankfully, FAT (which does not significantly increase blood sugar) has the most calories per gram–more than carbs and protein. So amp up your healthy fats: avocado, coconut oil, olive oil, nuts/seeds, nut butters as well as protein/fat foods such as salmon, eggs, chicken etc. Eating small frequent meals throughout the day helps as well. Metformin has a slight weight loss effect, but it isn’t that strong. You should be able to maintain a healthy weight by altering a few things in your diet.
NAG HITTALAMANI
very helpful information ! thank you very much
Elizabeth
I have been type 2 for about 13 years. Sugars have always been pretty good for about the last 10 years. Recently i quit my job and stsrted school to get my LPN at age 46. I have noticed an increase in my morning blood sugars aii the way to 190. I have taken metformin 500mg Twice daily for 13 years.
With school and school work, i do sit a lot.
I am eondering if i need to increase my metformin at this stage.
Elizabeth
Hi Elizabeth. That may be a next possible step, I would recommend scheduling an appt with your pcp to discuss your options and which would be the best. Perhaps trying to figure out how to increase your activity would help as well. One thing I used to do in undergrad and grad school is write out my notes on notecards and ‘quiz’ myself (terms on one side, definitions on the other) which I could take with me on walks or to the gym. Multi-tasking is sometimes a necessary solution when juggling a lot in life. Good luck!
Linda M Hammerberg
Since the day I took my first dose I have had Diarrhea. It has never stopped in 3 years. My A1c is 6.5 and my Doctor is going to let me decrease the dose. The GI upset has been continual. I am sorry but there is a big Side Effect for some of us. The one thing I have done differently is I take my dose at night. That stops some of the GI upset. The diarrhea has never gone away.
Elizabeth
Sorry to hear you’re having such a rough time Linda. Generally the diarrhea goes away in a week or 2 in those who develop it but obviously if the side effects do not improve, it is appropriate to consider medication change. I have run across several patients for whom that is the case. I would encourage you to discuss alternative options with your physician as there are many other medication options available.
Brandy
My mother is currently on metformin, but not sure of her dose. She was diagnosed in august 2016 when she went in for her physical at work & her glucose level was over 500. she still thinks she can eat what she wants now that she’s on this medication. However, when she over does it she tends to get sick. For instance, she went out the other night & I was told she ate flour tortillas, beer, butter, tortilla chips, refried beans, Spanish rice & enchiladas w/cheese sauce. Not even 24hrs later she has been vomiting & has diarrhea. Is this due to the medication? She thinks she has the flu, but this has happened now twice in the last month after her over doing it with her carb & sugar intake & She won’t listen to me.
Elizabeth
Wow–that’s not just a lot of food in general, but quite a lot of refined carbs and high fat. I’m not surprised she got sick–in fact I’d be a bit surprised if someone felt well after all that. Unfortunately, knowledge does not always equate to behavior change. Sometimes ignorance is bliss when it means someone can continue to engage in habits they really like even if they are bad. It would be difficult to tell which is the culprit when you have illness, a new medication and a poor diet all at once. Regardless, it is wise to follow a carb-controlled, balanced diet whether on metformin or not.
Raj Kumar
Hi, Elizabeth. I am a diabetic patient. I am interested to be in touch with latest medications.
Jedha
Hi Raj, Elizabeth wrote a medication guide over here. I’m sure you’ll find some of the answers you’re looking for.
ernesto
What is the metabolical impact of chewing a glucofage XR ” slow release ” tablet if I am unable to swallow it ? The label clearly says ” do not chew ” but the doctor laughed and said it did not matter.
Elizabeth
Hi Ernesto,
I would recommend speaking with a pharmacist about your question. I/we would not advise any patient to take a medication ‘off label’ or contrary to manufacturer specifications. I could speculate, but the pharmacodynamics of medications is way outside my scope. I would discuss your concerns with a pharmacist you trust (they are really knowledgeable!) and/or the manufacturing company itself if you have concerns or want a second opinion to your doctors recommendation. There should be a contact number listed with your Rx.
brenda
I was put on Metformin in June 2016, hands and feet started to peel…alergic reaction to the meds…after a few weeks it Stopped I’m also taking my blood sugar levels and I notice with carbs they spike…low carbs the numbers are good….I’ve lost a total of 25lbs..since june…but now I’m at a stand still…I need to walk more/exercise more…
Karen robison
I was just prescibed metFormin hcl 850mg twice a day for prediabetes with an AC1 of 5.9. No where do i see where its for pre diabetes, is it?
Elizabeth
Hi Karen–yes Metformin is approved for use in Pre-Diabetes, but should multiple factors should be taken into consideration. The Standards of Care (http://care.diabetesjournals.org/content/suppl/2015/12/21/39.Supplement_1.DC2/2016-Standards-of-Care.pdf) see summary on p 36 and following states that metformin should be considered in those with pre-diabetes esp if BMI is high or prior history of GDM. It is a very safe effective medication with few, if any, side effects.
John Medel
We are cleaning our kitchen pantry out, trying to get Healthy food. We have Organic Penne Pasta is this something we can keep having T2 diabetes? Or should I get rid of this?
Jedha
Give it the flick John. Organic Penne Pasta is simply wheat pasta, which is high in refined carbs and will likely send your blood sugar soaring. More info on pasta here and here.
John
Thank you so much for the info, I’ll get rid of It.
John
Jedha
You’re welcome John. Glad the info helps and let us know how you go with your new eating habits!
Letty
Thank you Elizabeth for your Reply. I really appreciate You taking the time to explain this. It makes sense and I will share this info with my Husband so we can make the best decision for our daughter.
Thank you again.
Letty
letty
hello,
my 9 year old was diagnosed with Insulin Resistance and hyperthyroidism. her doctor prescribed metformin. everyone (family) keeps telling me this is bad for her and will damage her organs (kidneys, liver). they tell me she is too young to be taking this type of medication. I am aware that every medication can have bad side effects. but even my husband is against her taking it. has anyone experience any issues with their kidneys or liver while taking metformin?
Elizabeth
Hello Letty,
You pose a good question and your concerns are valid. Metformin is less commonly prescribed, but approved for use in children and sounds like your 9 year old may be an appropriate candidate to give it a shot. While I would certainly advise starting out with the lowest dose possible and being mindful of potential side effects–namely GI effects. There are no contraindications for liver damage–the medication is not cleared by the liver, but by the kidneys. And the medication does not cause kidney damage. Poor blood sugar control causes this. Often people get this confused. People with diabetes are often on metformin and incur kidney damage (at which point they have to stop because with damage, the medication can’t be cleared) and attribute it to the metformin when it’s actually because of ongoing hyperglycemia. So you may want to weigh out the benefits of metformin on improving hormonal control and preserving the pancreas, thereby preventing organ damage against side effects. Does that make sense? The way you pose the question, many people will answer “yes” but the “issues with kidneys or liver” are WHILE taking metformin, but not because of it. I’m not advising you either way, just clarifying how the medication works. More info on how is works is available here and here. Of course, being very diligent with diet, exercise and weight can go a long way and may eliminate the need for medication at all. Best to you!
sheena
I just started victoza today I got told I had type 2 diabetes and they also put me on metformin and a strict diet I will do anything I can to get my a1c down mine is 8 and reading all the things people said really helped me thanks everyone