In this article, we’ll look at the most common questions people have about metformin and help you understand how it might work to lower your blood sugar. We’ll also discuss possible side effects and reasons this drug may not be right for you and what other options you have.

What is Metformin?

Metformin is an oral drug used to reduce blood sugar levels in type 2 diabetics. It has also been used to treat infertility in people with polycystic ovary syndrome and shows promise for reducing the risk of dementia and in fighting pancreatic cancer. Metformin is widely considered to be the most effective drug to treat type 2 diabetes and is more regularly prescribed than any other blood sugar-lowering oral medication.

What is Metformin For?

Most metformin prescriptions are given to patients with type 2 diabetes as a means to lower their blood sugar levels and increase their body’s insulin sensitivity. While metformin can be used alongside insulin treatment in T2Ds, it is not used for treating type 1 diabetes and is not typically used to treat gestational diabetes.

Is Metformin Insulin?

Metformin is not insulin and does not work to lower blood sugar by the same means as insulin. Metformin is an oral drug that is typically taken daily, usually with a meal. Insulin, on the other hand, must be taken by subcutaneous injection either daily, following meals, or a combination of both.

How Does Metformin Work?

The physical pathway metformin uses to reduce blood sugar is not fully understood. But we do know that it decreases gluconeogenesis in the liver. Most T2Ds produce about three times the normal amount of glucose in the liver. Studies have found that metformin can decrease this rate by over a third. It also appears to make tissues throughout the body more sensitive to insulin, thereby reducing insulin resistance.

What is the Brand Name of Metformin?

Metformin is most commonly sold under the brand names Fortamet, Riomet, Glucophage, Glucophage XR, and Glumetza. Not all of these drugs are identical. Some have been approved in children as young as 10 while others should not be used by anyone under the age of 18.

What is the Average Metformin Dose?

The typical starting dose for metformin is 500mg per day. This dose can be adjusted as needed until blood sugar levels normalize, but metformin is rarely given in doses higher than 2,000mg per day. Patients with sensitive stomachs may require their dose to be started very low and increased slowly to avoid gastrointestinal upset.

Does Metformin Have Side Effects?

The most common side effect of metformin is digestive upset, including stomach pain, nausea, vomiting, and diarrhea. This issue is more commonly associated with metformin than most other T2D drugs. Lactic acidosis is a rare but serious complication seen in people on this drug. While more recent studies have found no strong link between the drug and lactic acidosis, metformin should not be prescribed to patients with severe kidney disease as this appears to increase the risk of lactic acidosis. It also may not be appropriate for people with heart failure, certain respiratory diseases, or alcoholism.

As with all blood sugar lowering medications, hypoglycemia is a potential side effect of metformin but is rare if taken in the appropriate dose.

Is Metformin Safe?

Generally speaking, metformin is considered very safe. The ADA recommends metformin as the first treatment to be used in most cases of type 2 diabetes. And the World Health Organization includes metformin on its list of essential medicines, a yearly report that names drugs considered to be the most effective and safe in treating important needs within the global health system.

Are There Alternatives to Metformin?

There are a number of other blood sugar-lowering medications that may be an option for people who prefer not to use metformin. These include SGLT inhibitors, DPP inhibitors, sulfonylureas, and glitazones. All these medications have their own considerations and switching to any new drug is something you should discuss with your doctor.

Some people find success with herbal treatments like fenugreek, psyllium, holy basil, and bitter melon as a means to lower blood sugars naturally.

If you prefer to avoid drugs of any kind, working with a nutritionist and exercising consistently might be your best chance of getting off of metformin or avoiding the need for it altogether.

Deciding What’s Right for You

In the end, metformin is a proven effective drug with minimal side effects which is widely considered safe for use in treating type 2 diabetes. But, if you suffer from severe kidney issues or already know that metformin does not work well for you or causes side effects, don’t be afraid to discuss your concerns with your doctor.