low blood sugar episodes, measuring blood sugar, Invokana and Farxiga

Metformin has become the go-to drug for type 2 diabetes. It’s easy to understand why. The drug works to control blood sugar and it is incredibly inexpensive compared to many of the newer diabetes drugs. Of course lifestyle remains the number one most important way to manage this metabolic disease. Metformin for diabetes can enhance the benefit of diet, exercise and other lifestyle changes.

A Question from a Reader:

Q. I have been diagnosed with type 2 diabetes. I’ve been trying to control my blood sugar levels with the help of a nutritionist for about a year now. I am thin, work out regularly and eat really well. It’s not enough.

My doctor has now prescribed metformin. What are your thoughts on this drug? And do you know of anything else I could try? I am still asymptomatic and feel great. I wish I could help myself through diet and exercise.

Q. Don’t give up on your good diet and exercise habits! They will help with the effectiveness of your treatment, even if you haven’t been able to control your blood sugar with them alone.

Metformin is a first-line drug for type 2 diabetes, as well as one of the oldest and best-studied. It improves the body’s response to insulin and can be quite effective. In addition to its ability to keep blood sugar down, metformin has also shown promise for its anti-cancer activity (Acta Biochimica et Biophysica Sinica, online Oct. 7, 2017).

Metformin Side Effects Can Be Hard to Handle:

There are potential side effects, however. The most common are digestive: nausea, stomach ache, indigestion, loss of appetite, diarrhea and flatulence. The most serious side effect, lactic acidosis, is rare, but you should be alert for the symptoms: abdominal pain, irregular or rapid heart rate, low blood pressure and anxiety. Such symptoms signal a medical emergency.

Stories from Readers:


Orlean in Georgia has had trouble with metformin for diabetes:

I went on metformin when my HbA1C went up to 6.2. There were no sign of me being a diabetic. I had no symptoms that there was anything going on. After three months on 500 MG 3 times per day, my A1C dropped to 5.9. My doctor checked my kidneys; then started me on 500 MG twice per day.

“At first I was nauseated and had stomach cramps. That subsided. Then, a few days later, I started having diarrhea really bad. After the diarrhea came the heart burn. That is the worst so far. Even without eating I get heartburn.

“The latest side effect is feeling like my bladder is full, and when I go to empty it there is only a drop of urine and I still feel like there is pressure. I will see my doctor to have my kidneys and my A1C checked. I am hoping that my A1C is lower than 5.9. I need to get off this medication to start feeling like myself again. I like the fact that it seems to help with all the different cancers, because that runs rampant in my family.”

Larry in central New York also had GI problems while taking metformin for diabetes:

I’m 69 years old, and I too have GI problems with metformin. I’ve been using it for about 4 years and initially was taking 500mg 2x a day and tolerated it quite well. The doc raised the script to 1000 mg 2x per day, and the diarrhea and gas began.

“My doc told me to take Metamucil fiber wafers to boost fiber intake which supposedly absorbs excess water in the intestines. Works somewhat but not 100%.

“On my own I began taking probiotics, the ones for adults over 50. This seems to mitigate the symptoms somewhat too but not 100%. Sometimes taking 1 pill 4x daily seems to alleviate the GI problems but, once again, not fool proof. Good to hear about the anti-cancer properties because I have a family history of kidney & colorectal cancers.”

Anyone who would like to learn more about metformin and other strategies for helping control blood sugar may find our Guide to Managing Diabetes of interest. Share your own metformin story below in the comment section.

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  1. Jan
    Natrona Heights, Pa

    I have T2D since dx christmas eve 2015.

    I have been on metformin 500 2x day. Not controlled. Diet and exercise is essential. (yes, ketogenic)
    I’m working on this. Also on hypnosis ( I’m a hypnotist and nurse) which can help reprogram mind for healthier habits).

    I hate meds and squabbled with my doc who is very cutting edge. He insists metformin is still the best therapy, and now I start 1000mg 2x day. I have some GI effects and believe in doing the holistic and natural stuff. I don’t plan to be on this lifelong. (concerned about long term effects). We know meds are big business. Be well, all. Do whatever natural interventions you can.

  2. Carole
    Sydney, Australia

    Why is over 5.5ml/dl (?) suddenly diabetes? It used to be over 7, then in the 70s was 6.5, when did 5.5 became the new normal?

    You should add that a number of women who had had trouble getting pregnant, got pregnant on Metformin. I used to belong to a low carb forum, and it does seem that Metformin acts just like a ketogenic diet, there too, many pregnancies.

    • DarL

      Very good point, Carol. why? Because it makes companies more money is all I can think of.

  3. Ted
    Orlando, FL

    You answered a question about fungal infections between the toes in today’s newspaper. I have found that Vick’s Vapor Rub, rubbed generously on the affected area will clear up the infection within a few days. I have not tried vinegar but will the next time.

  4. Ted
    Orlando, FL

    According to many articles about diabetes found on the internet, the statin drugs, Crestor, Lipitor, Metformin and all the other statins are bad. As you stated above statins have undesirable side effects. When prescribed a statin, you also should take CO-Q10 because the statins interfere with the production of that item by the body. A replacement for statins is a supplement Red Yeast Rice. You should take CO-Q10 with this supplement also. Check with your doctor.

  5. Rachel
    New York, NY

    I lost over 80lbs and am not diabetic anymore due to 2000 mg a day of Metformin XL. I do have dry mouth- especially at night. However, I have little appetite and am so happy with the weight loss! I tried losing weight for decades! Even a lower dose of metformin XL didn’t do the trick. My doctors say that 2000mg a day of Metformin XL is the best dose for weight loss, and also helps prevent cancer- as Metformin originally started out as a cancer drug!

  6. l22
    North Carolina

    Been on metformin extended for 17 years. I am now 86. I take 5,000 of vit B as metformin washes the b vit out. My A1c is 7. dr. wants it at 6-7. dr. said that elderly should be a little more then the younger people and as we age, it is a little higher, although, he stresses exercise, 30 mins a day, which I do. Two mile walk daily, chair yoga, ti chi for balance.

    I am doing well on this problem and do everything a younger person can. of all of this,exercise is very important to me. we need to move. I take care of me. Do not want to be a burden to anyone. Metformin has never been a problem for me.

  7. Mary

    When I was diagnosed with Diabetes Type 2 many (24 years) ago, I had gastro problems almost from the first pill. Nausea beyond belief – worse than being pregnant! So my wonderful doctor and I started down the road with everything on the pharmacy shelf. Nothing worked. But then REZULIN (I think that’s the name) came on market and it worked wonderfully. Smooth sailing until drug was suddenly taken off market because of side effects – bummer! But along comes Januvia. Great, and great!!! Have been on this ever since and now at 88 years of age, am still taking l00 MG daily. Biggest problem is the price …………..gone out of sight!!! So what else is new? HELP! MJS

  8. Greg

    Some people do better on the extended release version of metformin. I used regular metformin for 10 years and it worked well, gradually getting used to the intestinal side effects. Then I landed i the hospital with extreme vertigo and aphasia; my family doc thought it was lactic acidosis and took me off the metformin. The ER doctors thought it was a TIA. Once off the metformin none of the other pills worked as well, so I ended up on Insulin. Insulin does work, and it doesn’t trick the body in the way the other medications do, but it is more work to keep track of, and it forces you to take what you consume more seriously.


  9. Dave
    Frankfort, KY

    I feel I could use the medication to control my blood sugar, but don’t want to have to deal with the side-effects.

  10. Deane
    Afton, VA

    What about the negative interaction between metformin and vitamin B12?

  11. SJ

    There are other ways to control diabetes. Yes, diet and exercise help but making sure you supplement with minerals is very important. Vanadyl sulfate, chromium, and magnesium are all important. There are herbs that help balance sugar in the blood stream, also. Just do some research or see a naturopath.

  12. Ruth

    My doctor prescribed 500 mg twice per day. After a few weeks my leg cramps were impossible to deal with. I didn’t want to go to bed at night because as soon as I moved a leg, my calf muscle would cramp. I stopped taking Metformin. Six months later I tried again, first taking only one a day, eventually adding the second. I also added bananas to my diet—about 3 a week. That has solved the cramping problem. If I skip a week of bananas, I can feel my leg muscles tightening up, ready to inflict pain sometime in the night.

  13. Judith

    When I started experiencing unpleaseant GI side effects from Metformin, my doctor switched me to Metformin ER. The extended release form of Metformin helped significantly.

  14. Wally

    I started taking metformin about a year ago. My physician recommended 100 mg or extended-release metformin 2x per day, as the extended-release version seems to have fewer GI side effects. It is working nicely on A1c, and I have no side effects at all. Those of you having GI side effects (gas, bowel, etc.) might want to talk to your physician about shifting to extended-release tablets. PLease note that 500 mg extended-release tablets are quite cheap. 1000 mg. extended-release tablets are quite expensive. So if you are taking doses of 1000 mg., ask that the RX be filled with 500 mg. tablets.

  15. Marcia

    I think it borders on criminal that people with T2D are not given a ketogenic diet to try first – before the drugs. I’d be willing to bet that these patients are being told to eat large amounts of carbs and small amounts of fat. Check Dr. Jason Fung’s website for the skinny on handling T2D with diet. You’ll be amazed – and perhaps saddened – that the diabetic associations of this country are still dishing out the wrong advice on diet.

  16. Jo
    Port Saint Lucie, Florida

    I used metformin for years without a problem. I suddenly developed many of the symptoms described. The drug company changed manufacturers. I had the rx transferred to my local pharmacy that used a different company and my side effects disappeared.

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