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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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I am 67 and weigh 6.4kg. Recently got a Hb-1Ac of 6.2, which I understand makes me pre-diabetic. Fasting glucose was 4.8. My doctor has said “wait and see” but I have already started adjusting my diet and trying to exercise more. As there is a lot of diabetes2 in my family, I am not surprised. However it’s hard to know how much to cut back on starchy foods etc. do you have any advice? I really hope to control any development by life style changes rather than medication!
Check out our recommended food list here Judith. For best results, we encourage people to cut out all starches such as bread, pasta, rice, noodles, potatoes etc – all the very high carb foods that have a direct impact on blood sugar and A1c levels.
Love this site! Diagnosed last month and initially focused on diet/exercise. Unfortunately I turned to junk food when stress hit. My pre-dinner # was just 344. My question is, should I try the Extended Release 500mg Metformin I was prescribed to get my numbers under control quickly, or start with diet and exercise, which I know will work, but may take longer? Not looking for medical advice, just opinions 🙂 Thanks!
You always need to follow your doctors advice, including taking medication exactly as prescribed.
With that being said, we’ve seen people lower their numbers from the 300s to normal in as little as 30 to 60 days with dietary and lifestyle changes. Stay diligent with your diet and exercise and the results will follow!
Hi. In 3 weeks I went from 319 to 90-109 in the mornings and 120 after meals with a big diet change and no medication at all! With help of a dietitian specialized in Whole Foods and Vegan. In years didn’t feel so great! Right know fighting kidney and liver disease but stil strong and positive with some supplements help. Numbers also went down there!!! Some excerxise of course! Loosing weight! And enjoying life again!!! You can do it! Dr said this most be my life style now on and I love it! Be positive stand up and act!!! And then you will prove it by yourself 😉💪🏼👍🏼
What’s your take on Trulicity? I started it and suffered terrible side effects, but my numbers are significantly better 7 weeks in. I credit this to cutting out carbs significantly. Trulicity curbs your appetite (big time)…to the point that it literally punishes you for overeating and consuming too many carbs.
I checked out some videos from Dr. Jason Fung about intermittant fasting and that seems to be the cure…what is your take on that?
The ADA is absolutely wrong about the recommended carb intake for people with diabetes, and it needs to be addressed….but they know this and take contributions from the food industry and big pharma, all while promoting high carb diets to diabetics…should be criminal.
In our experience fasting isn’t necessary in order to reverse metabolism/ diabetes. Many of our members are doing it through dietary changes alone. According to our research, there are currently 3 methods that can achieve these outcomes.
You may find this article beneficial as well, it includes some more information about common diabetes medications, including Trulicity (GLP-Agonists). Always refer to your doctor for questions about medication and/or side effects.
Hi, i got diagnosed with type2 diabetes 10 days ago. I had a blood glucose of 348 im down to 160 fasting and 197 after dinner im unsure of how long it should take me to get it down to normal
With commitment to diet and lifestyle changes, we have seen people lower levels from the high 300’s to normal in one to two months – Leisa for example. But overall, the amount of time it takes someone is individualized. You’ve certainly had great improvement in a short timeframe – well done! Keep on going!
I dont understand why my bg is getting higher at night before bed, i hardly eat anything in the day salad for dinner i had 176 in the morning199 at night im on day 10 of metformin
Just like Laura said, it will take some time for you to get back to normal!
Do you check your blood sugar during the middle of the day as well, or only morning and evening? For some, it’s necessary to check more often (and track all your readings) so that you can recognize patterns in your daily values and make necessary adjustments with diet, lifestyle, and sometimes medication. Without knowing how your sugar levels are during the day, we don’t know if you are truly “rising” in the evening, versus living with chronically high blood sugar throughout the day.
Hi I am 82 and have had Diabetes for 4 years taking Metformin 2 twice a day. l suffer badly with R A having to take medication for it. I am use to the painful disability of the flare ups I get, sometimes being kept in hospital for a few days. My main problem is the nerve pain in my left leg, and the spongy painful feet from the Diabetes. Most times it’s so heavy and painful, and keeps me awake most of the night.My doctor prescribed Pregabalin, which I have been taking for a few months, but not helping at all.( just another drug). Is there anyone who can give me some help please
For the symptom management of nerve pain (neuropathy), it’s best to work with your doctor, especially if you have questions or concerns over a current medication. It’s crucial to keep your blood sugar within range to help slow the progression of the neuropathy. High blood sugar levels will continue to damage the nerves and cause further pain.
I also recommend checking out these foot tips for diabetic foot treatment to help prevent any further complications. And one supplement that has shown some promising results is alpha lipoic acid. Always consult your doctor before taking supplements.
which herb is Metformin derived from?
The concept behind metformin originates from knowledge about the French lilac (Galega officinalis). However, metformin is not derived from an herb and is not an herbal supplement, it is a prescription medication. You can find more about what the drug contains here.
What should my A1c be? Is it a random number, if not, how is it calculated? I was taking Metformin 1000 ER but asked my doctor to go on insulin because my number was not going down. I need to have knee replacement but she wont sign off
This info on A1c will help Vann. And you might want to read about the difference between A1c and blood sugar here.
I have had type 2 for 5 years. Take metformin and insulin. My problem is unusual. I need to gain 15 – 20 pounds. What can I eat to get there and would it help to stop the metformin. I went from 185 to 150 after contracting diabetes and would like to be at 165 – 170. Help!
We have quite a number of people with this problem Robert, so you’re not that unusual. 😉 You will find this info useful.
How can our Doctors allow us to take medicine for us to take WHICH will cause us harm.
Metformin HDL 500- Unfortunately, no one on this blog discussions mention the dangerous ingredient “Titanium Dioxide” and “Talc” included in the metformin by majority of manufacturers. It is mind boiling why FDA approved it. Both ingredients caused cancer, there are a lot of study done and had been published. Another problem that pharmacies changing manufacturers too often looking for low cost by profiting themselves. It is very hard to find the generic form without these deadly ingredients. Beware, check the inactive ingredients and images of the pill because the different image for the same medication contain different ingredients, perhaps some less costly than others.
I felt very happy reading this article. It felt like all I have been reading about diabetes summed up into one article. Great work! Please keep it up. I have a little question from a site I read something about diabetes. Please what is the difference between sugar and glucose? And my next question is, does a yellowish urine mean I am well hydrated? I hope I am going to get answers from you Jedha? Please clear my confusion. Thanks!
Glucose is a form of sugar so sugar and glucose mean the same thing Clement, the terms are often used interchangeably – blood sugar/ blood glucose. You can find many urine charts around the web, such as this one.
Great information.. Thank you
will try moderation. thankyou
I TAKE METFORMIN TWICE A DAY AT 500 MG EACH. ONE IN THE MORNING AND I AT NIGHT. WILL THIS HELP. WHAT IS THE NORMAL COUNT FOR TYPE 2 DIABETES.
SOMETIMES I EAT SWEETS. IS THIS BAD.
Metformin is one of the most common medications used to help control blood sugar. It is likely helping but diet and lifestyle changes can also help control blood sugar, and reduce the need for medication in many people. However, you should always check with your doctor regarding specific medication questions or if you want to change dosage etc. Your goal with blood sugar is to get to normal ranges, or as close to normal as you can, which is less than 100 mg/dL before meals; and under 140 mg/dL after meals.
As for sweets they do contain sugar, which will raise blood sugar. If you’re struggling to gain good control, you might think about limiting them, or trying some alternative sweets.
Please i need you to answer my question. I am 43, female,diagnosed diabetic in 2016. But I want to ask if being diabetic can make one to experience painful sexual intercourse and dry vaginal? I am currently on metformin 1000mg.and again i want to know if being diabetic can make it difficult to get pregnant even though i have fibroid 6.0 x 4.3cm inside the womb. Thank u
You need to contact your doctor so they can refer you to someone who specializes in this. Diabetes is likely not the cause of your pain nor trouble getting pregnant. Although, I can say that having tight control of your blood sugar leading up to and during pregnancy is crucial for a healthy pregnancy and baby.
I was diagnosed Type 2 ten years ago. I am on metformin 850mg two time a day, and glibenlcamide 5mg once a day. My sugar levels are around 136 and 165. Is the medication doing me good?
Metformin is one of the most common medications prescribed for people with diabetes Fred and it likely is doing you some good. It’s hard to say without knowing your history. But overall, you could get your levels controlled better through diet and lifestyle means as well, that way you may not need the meds. Try looking at your diet and lifestyle to see what you may be able to alter. Also, the best person to discuss medications with is your doctor.
Thank you Jedha for the guidance. Looks like diet and lifestyle is indeed key to better management of diabetes
Yes indeed Fred! Diet and lifestyle changes can help you control diabetes, and perhaps without the need for medications. Though you should always work with your doctor if you’re aiming to reduce them.