Starting ~ above metformin? mine journey as a form 2 that learning just how to deal with side effects, “faux lows,” and also learning much more about this therapy.

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Editor’s note: this write-up is in Marcia’s view of life with type 2 diabetes, as composed by Timothy Hayin January 2019. It was updated by Eliza Skoler in march 2021.

When i was first diagnosed with type 2 diabetes at the period of 58, my doctor immediately put me on metformin, a medication i didn’t recognize much about.

I shortly learned why metformin is considered the an initial line that defense for civilization with the condition, together it is safe, effective, and affordable. That not attached to weight gain and also it put very little stress top top the inner organs. I also read the metformin has actually side impacts for some people.

I expected it to work like insulin in pill type and drop mine blood street (around 180 mg/dl at the time) appropriate away. Yet metformin doesn’t occupational like that. Not at all.

I learned – together millions of people with kind 2 diabetes have actually – the metformin doesn’t automatically lower her blood sugar. It deserve to take four or five days to endure the full benefit, depending on your dosage.

It could not settle all your problems in the blink of one eye. Yet it is an effective medicine, and its communication with the human body is facility and interesting.

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What we Know about Metformin

Metformin, which is also sold under the trade names Glucophage, Fortamet, Glumetza, and Riomet, is the the class of drugs referred to as biguanides, which inhibit the manufacturing of glucose in the liver.

How does metformin work?

The medication does not increase insulin levels in the body, but instead lessens the amount of street the body produces and also absorbs. As it lowers glucose production in the liver, metformin likewise lowers blood sugar by increasing the body sensitivity come insulin. It additionally decreases the amount of glucose the our bodies absorb from the foods we eat.

What is metformin used for?

Metformin is commonly used to help people with kind 2 diabetes control their blood sugar levels.For most, metformin functions to bring down blood sugar slowly when combined with a healthy diet and exercise (I discovered Adam Brown’s book, Bright clues & Landmines: The Diabetes overview I wish Someone had actually Handed Me to be helpful, an especially in deciding what to eat and not to eat). It’s no so much a quick fix v overnight outcomes as that is crucial component the a larger health and wellness regimen that keeps the condition manageable.

Is metformin safe?

Metformin is taken into consideration a safe, cheap, and effective medication worldwide, and is widely accessible in most countries.

What are the most usual side effects of metformin?

Metformin does cause side results in some people, yet many that these room mild, and also are associated with acquisition the medication for the very first time. Nausea and gastric distress such together stomach pain, gas, bloating, and also diarrhea are somewhat common amongst people starting up ~ above metformin.

For some people, taking huge doses of metformin ideal away causes gastric distress, so it’s typical for physicians to start small and develop the dosage up end time. Many civilization start v a tiny metformin dose – 500 milligrams once a day – and also build up end a couple of weeks until the dosage reaches least 1,500 milligrams daily. This way there’s much less chance of getting an uncomfortable stomach native the medicine, but also way it might take a bit longer to endure the full benefit when gaining started on metformin.

I knowledgeable some mild side results when I began taking metformin, and I discovered that the symptoms associated with how numerous carbs I had in mine diet. Once I to reduce my carbohydrate to 30-50 grams per day – something the took me mainly to perform – any kind of symptoms of gastric uncomfortable went away.

Asking your medical professional for the extended-release version of metformin can keep this symptoms at bay, and also so have the right to tracking your diet.

What is the finest time to take it metformin?

Standard metformin is taken two or three times every day. Be certain to take it it with meals to alleviate the stomach and bowel side effects that can take place – most people take metformin v breakfast and dinner.

Extended-release metformin is taken as soon as a day and should it is in taken in ~ night, v dinner. This can help to law high glucose levels overnight.

What are less typical side effects of metformin?

The medication deserve to cause much more serious side effects, though these space rare. The many serious of these is lactic acidosis, a problem caused through buildup of lactic mountain in the blood. This can take place if too lot metformin accumulation in the blood due to chronic or acute (e.g. Dehydration) kidney problems. Major acute heart failure, or severe liver troubles can also result in a lactate imbalance.

Metformin can also increase the threat of hypoglycemia (low blood sugar), specifically for those who take insulin and drugs which boost insulin secretion (such together sulfonylureas), but also when merged with too much alcohol intake. Also though I’m not on insulin, I began on constant glucose surveillance (CGM) to be able to keep a closer eye on my blood sugar levels. Of course, regular checking v a blood glucose meter is also helpful in preventing low blood sugar episodes.

Because permanent use that metformin deserve to block absorption of vitamin B12, resulting in anemia, sometimes human being need to complement vitamin B12 through their diet as well.

For most people who take it metformin, side results are soft and fairly short in duration.


The “Faux Low”

There is an additional common side impact often knowledgeable by human being taking metformin for the first time. It’s something called a “faux low.”

A faux short happens as soon as you drop your blood sugars to a “normal” range after running consistently high (i.e. Over 180 mg/dl), even if it is by starting on a therapy favor metformin or going on a low-carb diet, or both! your body responds come this readjust as if that in real hypoglycemia (below 70 mg/dl).

Although every human being with diabetes has actually a various blood-sugar threshold and different symptoms, civilization often feeling irritable, tired, shaky, and dizzy once their blood sugar is 70 mg/dl or lower. As soon as I skilled faux lows, ns felt likewise dizzy, lightheaded, nauseous, and also extremely hungry.

If you suffer symptoms choose these and also have evidenced with a glucose meter the short you are feeling is indeed false (i.e. Her meter says you’re in ~ 96 mg/dl), keep taking her metformin as directed. Don’t begin carb-loading (eating carb-rich foods like orange juice to carry sugars earlier up).

If ns indeed having a faux low and also not a real one, I found that drink water and taking a high-sodium, non-carbohydrate snack (nuts are good for this, especially macadamia nuts which space high in fat) nips the symptoms in the bud, permitting me to move on v my life.

Note that specifically for form 2 folks the end there top top metformin and insulin or sulfonylureas, hypoglycemia is a actual risk. If you’re emotion low, check your blood street – there will certainly be times once you do need to treat hypoglycemia with glucose tablets or orange juice or the like.

Metformin interactions: what have to I prevent while acquisition metformin?

When taken in ~ the very same time, part drugs may interfere through metformin. Make certain your medical care team is aware of any medications that you take prior to you start on metformin, particularly certain species of diuretics and antibiotics. Remember, insulin and insulin release medications have the right to increase your hazard of hypoglycemia, so it is specifically important to closely monitor your glucose levels.

You should additionally avoid drink excessive quantities of alcohol while acquisition metformin – aim for no more than one glass every day because that women, and two per day because that men. Alcohol can add to lactic acidosis.

Does metformin cause cancer?

In 2019 the FDA investigated whethersome creates of metformincontain high level of a carcinogenic (cancer-causing) chemical dubbed N-nitrosodimethylamine (NDMA).In 2020, the FDA encourage the recall of several versions the extended-release metformin, and an ext than a dozen providers have due to the fact that voluntarily recalled specific lots that the medication. While low levels of NDMA are typically found in foods and also drinking water, high levels of the substance room toxic and can cause cancer.

You can check to see if her metformin has been recalledhere. For world taking extended-release metformin, the FDA recommends that you continue to take your medication until you speak to your health care professional.

Other feasible Metformin Benefits

Most human being with form 2 diabetes pardon metformin well and also are happy it’s available in generic form, i beg your pardon keeps the price low. The medicine is so reliable as a first-line therapy the American Diabetes Association contains it in the diabetes requirements of Care.

But metformin might have extr uses and benefits external of treating form 2 diabetes.

Researchers are currently studying even if it is the medication can help in the fight against cancer, neurodegenerative conditions, vision problems like macular degeneration, and also even aging. It will certainly be a while, however, before uses other than blood-glucose lowering are proven to it is in effective.

At the same time, metformin is also used in the treatment of gestational diabetes and polycystic ovary syndrome.

The American Diabetes Association has actually said an ext doctors should be prescribing metformin come treat prediabetes (a state that higher-than-normal blood glucose levels that doesn’t accomplish the diagnostic criteria because that diabetes), specifically for civilization under the age of 60, although the FDA has actually yet come bless metformin’s usage for the condition.

Can metformin cause weight loss?

The FDA has additionally not officially approved metformin as an assist in losing weight. Many civilization with type 2 diabetes have lost weight after acquisition the drug, together researchers are still take it over exactly how metformin affect the weight. Some believe it decreases appetite, while others say the affects the means the body stores and uses fat.

Scientists are also examining metformin’s potential to protect against heart disease in world with form 2 diabetes – part older data support this. While durable heart outcome trials v metformin are yet to be conducted, an ext attention is being payment to this research area.

Metformin and kind 1 diabetes

It will certainly be an exciting development if metformin is advantageous in the therapy of cancer or neurodegenerative conditions like Huntington’s. But what if that is found to aid people managing type 1 diabetes?

Metformin is not at this time approved by united state or european regulatory organ for use in form 1s, however people have been known to take it the medication anyway, and also many physicians prescribe the if someone with form 1 diabetes is overweight. There are actually several factors metformin is one attractive choice for many kind 1s. One, metformin has actually been uncovered to assist reduce glucose manufacturing in the liver, i beg your pardon is a problem in type 1 diabetes. Two, people often kind resistance to the insulin lock take, and also metformin can assist improve insulin sensitivity.

And, metformin might support load loss and protection versus heart disease. A study released in the Lancet following form 1 participants for three years uncovered that compared to placebo, participants taking metformin lost weight. Specifically because insulin often causes weight gain, health care providers prescribe metformin “off-label” (not because that intended usage approved by regulation agencies) to their type 1 patients. If the examine didn’t find that metformin definitively protects against heart disease, based upon observed patterns in the data, the authors concluded that it may have actually a function in heart an illness risk management.

The Bottom Line?


If you room a human with kind 2 diabetes, there are plenty of services to acquisition metformin because that its original, to plan purpose.

Its side impacts are minimal for many people. It’s affordable and also covered through Medicare and also most insurance allowance plans. Speaking because that myself: metformin doesn’t need to cure aging or cancer to be immensely valuable. It help me process insulin and go on with my life. Because that me, it is enough.

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About Marcia Kadanoff

MarciaKadanoff is an advisor to The Foundation.She was diagnosed with type 2 diabetes in June 2017 in ~ the age of 50-something, and both her parents and also grandparents passed away of diabetes-related complications. With the aid of and also Adam Brown"s book, Bright spot & Landmines, Marciadiscovered that type 2 diabetes can be put right into remissionwith way of living changes.Over the following 7 months,Marciaworked to reverse her diabetes v a LCHF (low-carb, healthy fat) means of eating and also regular exercise.Along the way, she lost 45 lbs (!) and found the she no longer suffered native sleep apnea and fibromyalgia.Marciahas kept her weight loss for a year and also had a4.9% A1Cat her last checkup.She desires other civilization with kind 2 to recognize that lock too have the right to put your diabetes right into remission.