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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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Julie
Metformin can cause stomach upset, but if you start is with a low dose and increase “as tolerated” your stomach will get used to it.
Focus on the benefits! Metformin will improve your liver function. When you improve your liver by just 20% , your blood sugar will improve by 80%!
In other words, if you are prediabetic, you will save your beta cells!
If you have polycystic ovaries, it will absolutely improve this condition.
Focus on the benefits!
Start slow and increase slowly.
Jedha
Yes, it definitely has it’s benefits!
Claire
My doctor prescribed Metformin ER 2 months ago. I haven’t taken it because of the terrible side effects people have reported. I also have stage 2 chronic kidney disease and am very allergic to sulfa drugs which my doctor is aware of. I am confused as to why she would prescribe this drug. All the newer drugs are VERY expensive and I can’t afford them. Any suggestions?
Elizabeth: Dietitian (MS, RD, CDE)
What a bummer–I would ask your doctor since she is the one who prescribed it and knows your treatment options. I’m assuming by “sulfa” you mean sulfonylureas? Like glipizide, glyburide, glyimipiride? If so, Metformin is the only other ‘inexpensive’ option. The other meds will be more costly. Remember that the majority people have absolutely no side effects when taking Metformin. If someone has a great or mediocre experience with something (medicine, a restaurant, a purchased item), they usually won’t say anything, but if someone has an awful experience, they tell everyone. CKD stage 2 is not contraindicated with Metformin so if your doctor prescribed it, I’d give it a shot before you knock it. Also, the ER is less likely to cause side effects than the regular.
Claire
My A1C went to 7 3 months ago and my fasting blood sugar was 125. My doctor decided to put me on 750mg er Metformin to take with dinner. I had resisted taking this medication because of the side effects I had heard about. So, I haven’t taken it yet. I am trying to eat better. I need to lose a lot of weight. Unfortunately I have some severe orthopedic problems that prevent me from exercising. What I am puzzled about is that my doctor knows that I have stage 2 chronic kidney disease plus I am very allergic to sulfa drugs. After reading the comments I am very afraid to take this drug. All the newer drugs are VERY expensive. I am very confused as to why my doctor would prescribe this drug knowing my medical history
Kathy
When I fast my level is between 104 112 my dr put me on 500 once a day do you think I need it
Kim
Hi….
Can i take metformin and cinnamon capsules?
Thanks
Kim
Elizabeth: Dietitian (MS, RD, CDE)
Hi Kim,
No contraindication with metformin and cinnamon. Remember that dietary supplements aren’t regulated like drugs are so just exercise caution and be a wise consumer as you choose!
Lynelle
I have a disorder of my spinal cord/nerves called arachnoiditis that causes severe pain. It’s hard for me to exercise at all because of it. I have been diabetic for the past 11 years, and last year had to start insulin therapy for it. I am still on 1000 mg Metformin twice a day. Are there perhaps forms of exercise that you know of that would not put any stress on my lower spine to help me control my blood sugar and weight?
Jedha
Sorry to hear of your pain and struggle Lynelle. Are you able to do things like chair leg lifts, swimming, or upper body exercises with some weights? That’s the direction I’d be trying.
Lynelle
I can’t be in a swimming pool due to the pain or I might drown. I can and have been doing some exercises with my arms and some 5lb weights, it just doesn’t feel like it is enough. It doesn’t seem to have any effect on my blood sugar readings. I’d be interested in anything you have regarding using arm weights. And no, I can’t do anything in a sitting position, so no chair leg lifts. The arm exercises I do while lying flat on my back with my knees bent, feet on the floor.
Jedha
This is a difficult on Lynelle. It’s a case of where you just have to do what you can. I’d recommend seeing a physical therapist. They may be able to design a more specific program for you.
lynda settles
I have t2 and was taking 1000 mg metformin daily my side effects was dry mouth to the point I could not speak and diarrhea so severe I had to wear a diaper I lost control of my bowels the diaper could not hold it. I was to the point of giving up. Thank God I stopped taking it no dry mouth or any diarrhea now.
Carol
I had very similar reaction to you with Metformin. The relief Dr at the clinic told me I probably had IBS which was a common side in Diabetics..the Specialist laughed when I told him ! Anyway I went about 4 months with constant and severe debilitating diarrhoea which was so bad I hardly dared go to the shops in case I was in sudden need of a toilet. Anyway a change in medication has made a massive difference, although it is more expensive, to me it is worth it.
Geoff
Had double pnuemonia last Xmas, lost a bit of weight now lost two stone, can a traumatic event like that trigger diabetes.
Elizabeth
Absolutely, infections or anything which trigger the immune system can cause an elevation in blood sugar. Double pneumonia sounds awful.
Randy Davis
which is best, er metformin or immediate release?
Elizabeth
It just depends on the person and their condition. Metformin is fine for most people, the ER will release slower and sometimes easier on the gut for some people. I’d encourage you to discuss with your physician based on your health history and blood sugar readings.
Zella Overstreet
I started taking Metformin 500mg w/breakfast two days ago. One of my kidneys is covered with cysts.I forgot to mention this to my pcp. The Dr at the time I was told about the cysts I was and am not having any issues with the cysts (no pain or anything). Do you know if Metformin will affect my kidneys? The cysts were discovered while being checked for rapid heart beat (heart rate was 150). I am 77, have family history, overweight. However, I’ve started an excersize once a week and I plan to increase to at least 3 times a week. I am concern about the cysts that surround one of my kidneys.
Elizabeth
Zella,
Please discuss this with you doctor asap to help make an informed decision. Even if you don’t go in, call to leave a message so they are aware of the issue with your kidneys. Whenever a doctor is prescribing a medication, they need to be fully informed of your medical conditions and medications. Metformin is cleared by the kidneys and so if you have issues with your kidneys the medication may not clear as it should. Check with your doctor before making any changes!
Barney
I just got diagnosed yesterday and will start 500mg of metformin tonight. Is having a couple of beers completely out of the question? Just curious.
Elizabeth
Barney, that’s up to you. Metformin doesn’t have a direct contraindication with alcohol. However, alcohol is empty calories and toxic–as compared with food which is nutritious. Additionally, keep in mind that beer is extra carbs and often alcohol lowers inhibition resulting in poor dietary choices later. I’d try to keep it minimal if it were me.
KarlavWolfinger
I won”t go on Mediform. It can made your diabetes get bad and can cause cancer which is bad in my family. I am on raw vegetables and fruit. have got my blood sugars down from 197 on may 2 to 109 on June 5. Have my smoothie of spinach and Kale with Bee Pollen and squirt of Honey with strawberries and bananas or blueberries in morning. Plus a organic vegetable powder which I don’ have the name with me now. Then lunch I’ll have a green salad with carrots celery broccoli, cauliflower,onions and any other kind of vegetable I have. With Hemp oil for dressing will also put in flax seed , raw nuts and fruits.I can have my smoothie a couple times a day. eat the raw vegetable thru out the day and fruit also raw nuts as much as I want. Most of all the strength of God to help as I know I could not do it without Him, Will power bad when I see dessert but now a fruit helps,cut the want. I’m on supplement which has help get things back to the way they should be. Many good things out there that will help your body too heal. God made my body healthy my way of eating hurt me or should I say my choices of eating. There also is other things I have done but these are the biggest.
Elizabeth
Great job being proactive and making lifestyle changes! Some people are able to maintain control without needing metformin or other medications and it seems this is working well for you. Keep up the good work!
Ruth Ann
Metformin’ was my biggest night mare.
It cost me a lot of diarrhea specially when I got in the middle of the store and couldn’t get to the bathroom and I was so embarrassed. Never will I take metfomin ever again.
Elizabeth
Unfortunately, it does have that effect on some people…in most, it resolves over time, but in some it does not. Thankfully there are other options available!
Jim Flynn
I was diagnosed with T-2 within the past year. I have been on Metformin 750mg 1 x in the evening after meal. Have not experienced any side effects. I can relate to many of the comments posted here and truly appreciate the information within your response to them. Thank you.
Jim
Elizabeth
You’re welcome–so glad you find our site a helpful resource. That’s our goal!
Vicky
I was diagnosed T2 less than a month ago. My Dr. put me on MetforminER, once a day (in the morning). I’ve noticed – unbelievable – that I am getting WOLFISHLY hungry after taking Metformin. However, several times I had forgot to take it and did not want to eat at all, almost all day. Is it possible that Metforming causes the feeling of hunger instead of expected loss of desire to eat?
Elizabeth
That is a side effect I’ve never seen in practice, nor read about. Everyone responds to medication differently, so I can’t rule it out..however, pretty unlikely. Most often, Metformin helps curb appetite if anything. I’d mention it to your physician next time you have an appointment and maybe try to think if there were any other variables at that time (other meds, skipping a meal, etc) that could have factored into the increase in hunger.