Metformin: What It Is, How It Works, and What to Expect

If you’ve just been diagnosed with diabetes, your head might be swarming with thoughts of what’s to come. How will this affect my life? Do I need medication long-term? What kind of side effects are there?

In this article, we’ll dive into the most common diabetes medication with everything you need to know about how it works.

What Is Metformin?

Metformin works to lower your blood sugar and make it easier for your body to use insulin.

Blood sugar (glucose) is the main form of sugar in your bloodstream. It goes up when you eat carbs, and your body takes it into its cells and uses it as fuel.

Insulin is a hormone made by your pancreas. It’s what moves glucose from your blood into your cells.

With type 2 diabetes, however, your cells don’t respond well to insulin. That means that glucose stays in your bloodstream, instead of being taken in by your cells. Over time, this can damage your blood vessels and nerves, leading to fatigue, blurred vision, cardiovascular and kidney issues, and more.

How Does Metformin Work in Your Body?

After you eat, your body breaks carbs into glucose. The glucose then goes into your bloodstream. Normally, this is when insulin moves glucose from your blood to your cells. When you have type 2 diabetes, your cells don’t respond to insulin well, so they don’t take up glucose as efficiently.

Metformin improves your cells’ sensitivity to insulin so they can take the glucose out of your blood in two ways. One is by activating an enzyme that helps your muscle cells take in glucose.

The other method involves your liver, which naturally makes and releases glucose between meals. With type 2 diabetes, however, your liver can release more than you need. Metformin decreases this extra glucose production, giving your blood sugar less of a chance to spike.

Unlike some other diabetes medications, this one doesn’t force your pancreas to make more insulin. It just helps your body make better use of the insulin it already produces.

Who Takes Metformin and Why?

Metformin is mostly prescribed for these health conditions.

Type 2 Diabetes

It’s often recommended as the first medication to prescribe after a type 2 diabetes diagnosis. It can manage the condition and help keep blood sugar in a healthier range, ideally along with a healthy diet and exercise. Some people may need other types of medication as well.

Prediabetes

Prediabetes happens when your blood sugar is higher than normal, but not quite enough to be diagnosed with type 2 diabetes. It’s a warning, letting you know that should lifestyle habits not change, a diabetes diagnosis is likely.

Many doctors first recommend an experienced diabetes dietitian for diet and exercise changes, but can also prescribe metformin if necessary.

Other Uses

Polycystic ovary syndrome (PCOS) is a common hormonal and metabolic condition, now often called polyendocrine metabolic ovarian syndrome (PMOS). It affects people during their reproductive years when there’s a hormonal imbalance.

Insulin resistance is common in PCOS, which can lead to higher insulin levels. This can then drive the ovaries to produce excess male hormones.

Metformin is often prescribed to improve insulin sensitivity and help lower blood sugar and insulin levels.

What to Expect When Taking Metformin

If you’re reading the long list of side effects and instructions, you might be feeling a little overwhelmed. Here’s a first general introduction to what to expect.

Starting the Medication

You’ll likely be prescribed a lower dose to start that gradually increases as you adapt. Depending on the prescription, you might take it once or twice a day with a meal.

Taking it with food can help with stomach upset, which is especially common during the first few weeks.

Common Side Effects

Here are some side effects you can expect:

• Fatigue
• Diarrhea
• Headaches
• Metallic taste
• Loss of appetite
• Gas and bloating
• Nausea and vomiting
• Cramps and upset stomach

Gastrointestinal issues are the most common, affecting up to 75% of people taking metformin.

Serious Side Effects to Know About

Some of the more serious side effects include:

• Muscle pain
• Feeling cold
• Lactic acidosis
• Trouble breathing
• Unusual sleepiness
• Slow or irregular heartbeat
• Extreme weakness or tiredness

If you experience any of these symptoms, call for immediate medical attention.

How Well Does Metformin Work?

Metformin can improve your blood sugar levels, but how much depends on many factors, such as other health conditions, diet, exercise, and age.

Your doctor will measure its effectiveness through your hemoglobin A1C levels. This is basically your blood sugar report card: it gives the bigger picture of your blood sugar levels by measuring the percentage of red blood cells that have glucose attached to them. This is because when glucose enters your bloodstream, it naturally sticks to hemoglobin.

A normal A1C range is below 5.7%, and 6.5% or higher is diabetes, with anything in between considered prediabetes.

With this method, doctors can see your average blood sugar levels over the last two to three months, since red blood cells live for about three months, and sugar stays stuck to them for the cells’ entire lifespan.

Important Things to Remember About Metformin

Metformin is pretty straightforward once you get into a routine. A few habits, and alarm reminders, can make it easier to take safely.

• Taking it consistently: Take it daily as prescribed with a meal, even if you feel fine, since type 2 diabetes doesn’t usually show noticeable symptoms, so you won’t exactly feel your blood sugar improving.
• Watch alcohol consumption: While alcohol isn’t healthy in general, heavy drinking can turn into serious side effects with metformin, like lactic acidosis.
• Medical procedures and tests: Every healthcare provider you meet should know you’re taking metformin. You might even need to stop taking it before certain tests, if advised by your doctor. Otherwise, don’t stop or restart it on your own; always follow your doctor’s advice.

Working With Your Healthcare Team

With proper care, a health condition like diabetes can be managed and improved. A healthy lifestyle can both prevent and even reverse diabetes. Regular check-ins with your doctor are key, along with someone to help you manage lifestyle factors.

A registered dietitian (RD) specialized in diabetes works alongside you, learning about your habits and goals. They don’t just offer a generic diet plan and leave you on your own. They work to truly understand what gets in the way of eating healthier, and find small ways to improve your nutrition, without leaving you feeling overwhelmed or restricted.

A systematic review of 12 studies showed that RD interventions can lower A1C levels, reduce body weight and BMI, and improve blood pressure and cholesterol when compared to standard care.

Mental Health Support

Finally, managing a health condition like diabetes can deeply impact your mental health. There’s a well-reported influence between anxiety, depression, and type 2 diabetes: not only can diabetes worsen your mental health, but having anxiety and depression can increase your risk of developing or worsening symptoms, too.

That’s why it’s so important to see professionals who understand what it’s like to live with a chronic condition. They work on stress management, self-criticism, and practical aspects like habit development and goal-setting techniques.

Research backs this up, showing that getting mental health care can improve anxiety, depression, and blood sugar levels.

If you feel like you’ve always struggled with your health, don’t hesitate to reach out to a professional. A registered dietitian can help with nutrition habits, and a psychotherapist can dive deep into overall stress management, habit development, and mindset.

If you’re managing type 2 diabetes or prediabetes, you can check if your insurance covers a dietitian before you get started.

Frequently Asked Questions

What is metformin, and how does it work to lower blood sugar?

Metformin is a medication that helps your body respond to insulin better. That allows your cells to take more glucose out of your blood and use it for energy.

What are the most common side effects of metformin, and how can I reduce them?

Symptoms often decrease as you get accustomed to the medication, especially if you take it with food. The most common symptoms you can expect are diarrhea, nausea, gas, and an upset stomach.

How long does it take for metformin to start working?

It starts working within days, but can take a few weeks to show on your blood tests.

What should I avoid while taking metformin (alcohol, foods, medications)?

Talk to your doctor about this, especially if you have any other health conditions or medications. In general, it’s recommended to avoid alcohol.

Can metformin help with weight loss?

It doesn’t always help with weight loss, but it can. It’s not a weight loss medication on its own, and should be taken as prescribed.