Metformin - To Take or Not to Take?

High blood glucose (sugar) levels, often seen in people with Type 2 diabetes, are known to be harmful to the body. High blood glucose can cause both short and long term problems such as heart disease, kidney disease, nerve problems, and eye problems. 

Yet, I often hear people who are content to live with blood glucose levels that are above target blood glucose levels because they fear “taking medication.” 

Ideally we would all eat only healthy food on a regular schedule, never overeat, get daily exercise, and have body weights that are considered healthy. If only…. Making these noble changes is notoriously difficult and at the minimum takes time to impact our waistlines and blood glucose. It is possible though.  Weight loss, a carbohydrate-conscious diet and activity can significantly help to control blood glucose levels.  Diet alone has the potential to lower A1c up to 2 percent.

Until that happens, medication--metformin in particular--is a proven tool that can help many people control their blood glucose while they continue to do the hard and sometimes lengthy work of changing how they eat and how much they move.  Rather than dismissing medication, I would argue that it’s pros and cons should be considered, questions asked and that target blood glucose should be the metric by which we measure success. 

Measure your success by your A1c, not by the number of medications you take. 

3 Ways Metformin Helps Control Blood Glucose 

1. Reduces the amount of glucose made by the liver 

2. Lowers the amount of glucose absorbed in the intestine 

3. improves the ability of cells to take up glucose by improving the cell’s sensitivity to insulin 

Pros of Metformin 

• Metformin lowers blood glucose levels as seen in  A1c reductions of 1.5 to 2%. This is the same as a reduction in fasting blood glucose levels by 60-80 mg/dl 

• Metformin rarely causes low blood glucose

• Metformin does not change how much insulin is secreted by the pancreas

• Metformin is affordable costing just $5-$10 per month 

• Metformin is covered by most insurance companies

• Generic metformin is available

• Metformin has been very extensively studied and used for over fifty years and in the United States since 1995

• Weight gain is unlikely with metformin 

• Weight loss is possible with metformin unlike with many other diabetes medications 

• The mechanism of action for metformin is unique

• Metformin has been shown to lower death from all causes and stroke more than insulin and some other diabetes medications

Cons of Metformin

• Like all medications, metformin should only be taken if prescribed by your healthcare provider  

• Side effects and risks should be understood and side effects reported 

• Attention should be paid to the gastrointestinal side effects of metformin and an effort should be made to minimize these effects.  Gastrointestinal side effects include abdominal discomfort, stomach upset or diarrhea when starting metformin. To lower the chance of side effects, start taking metformin at the smallest tolerated dose and increase slowly. Take metformin with food. These side effects tend to go away over days or a couple of weeks

• Interactions with other medications should be considered 

• Excessive alcohol intake should be avoided

• Regularly taking a medication once or twice a day with food can be inconvenient

• Metformin is inexpensive but it may still be an expense. (Check with your insurance company or pharmacist)

• Metformin interferes with Vitamin B12 absorption.  B12 supplements are recommended. Labs to monitor anemia caused by B12 deficiency may be needed