New to Metformin - any tips?
February 10, 2019 6:21 PM   Subscribe

Prediabetic (AC1 at 6.4 for many months) and have started Metformin (500 mg once a day). I'm on Day 3 and so far no side effects. If you've taken it, can you share if and when side effects kicked in / how effective you've found the medication / any optimistic bits about how this will help me lose weight ? I am hoping to be less hungry soon, but that hasn't yet happened.
posted by Ink-stained wretch to Health & Fitness (10 answers total) 4 users marked this as a favorite
I haven't been on it for years, but IIRC when I was I was at about your dose. I never got any side effects.

It's hard to say how effective it was; I also changed my diet pretty dramatically at the same time and started exercising much more. I did lose 40-50 lbs. but I don't know how much of that is attributable to the medication.
posted by asterix at 7:05 PM on February 10, 2019 [1 favorite]

Talking with my dr I got the impression that the cases that had strong side effects were where they needed to go on high doses immediately.
posted by sammyo at 11:12 PM on February 10, 2019

I think I went to 1500mg pretty quickly. More side effects at higher doses and especially so if I didn't have a full stomach when I took the dose (I'd really pay the next morning if I had an evening dose on a light dinner).

I never really lost much weight on it and actually ate worse sometimes to mitigate the constant low grade nausea. But it did reduce my dramatic hunger spirals where I'd feel like I could gnaw my own arms off. I guess that was it helping me stop getting low blood sugar crashes.

My endo had me on 2000mg which was gruesome. He wanted me to lose weight but would not understand that the side effects made it hard to cope and then I'd be non compliant...So find a happy balance (obviously with your docs guidance)

I was insulin resistant though, not yet prediabetic
posted by kitten magic at 12:23 AM on February 11, 2019

I started Metformin the 1st of November. My A1C had jumped from 6.5 to 7.7 in 6 months. Was on 500 ER (extended release) for 4-6 weeks, then switched to 500 ER twice a day, because I was taking my fasting blood sugar every morning, and it was higher than they wanted.

Went back at the end of January and my A1C was down to 7.1, so am on the same dose indefinitely, because it appears to be working. I'd seen a dietician and followed her advice to begin counting carbs and eat more fiber.

I take my morning dose with my oatmeal, to which I also add 1 egg and 2-3 small turkey sausage links, and some curry powder to flavor it. Then I usually have a turkey sandwich on whole wheat bread for lunch. Sometime after lunch, maybe an hour or two, I suddenly have to use the bathroom. That's a common side effect. It has gotten slightly better over time. I don't have any of that after I take it in the evening.

Have not lost a lot of weight so far (I also am on thyroid meds, that is in normal range now, so the thyroid issue could have also contributed to my slow metabolism, yay). But have seen a dietician twice, and she said I'm doing pretty well. I also talked to the nurse at my dr.'s office quite a bit, when we were tweaking my dosage, and she gave me some great tips, like switching my bread to whole wheat -- the stuff I'd been eating seemed healthy, but it was huge slices, and had things like raisin syrup in it, etc. So not so healthy after all! The new bread is just generic whole wheat bread, small slices, so I can have it for a sandwich and stay within my target for carbs per meal.

I'm also supposed to move around after every meal, sometimes TBH I don't, but moving around, any form of exercise, helps lower your blood sugar after eating.

I will say that I am finally less tired after taking it for a few months. The way it was explained to me, having glucose in your blood stream means it's not getting into your cells and giving you energy, and Metformin helps facilitate that, opening the "doors" to your cells and letting the glucose get in (someone else might be able to explain it better).

Have you seen a dietician? I've actually been through this before, and taken a class and had one-on-one diet counseling, so I know the routine, and how to read labels, measure and weigh portions, etc. (even if I don't always follow it to a T, I know how to adjust and get back on track). I test my blood sugar every morning before eating or drinking anything, was taking readings more often, but they said just do the fasting blood sugar, because that's the one they care about. They may not feel it's necessary for you at this time, just do the A1C every few months and go by that.

I've also become very conscious of fiber, because the more fiber, the better. Beans, etc. (measured). I have a booklet that tells me the amount of carbs in everything, or I Google it if I want a quick answer. If I am hungry between meals, I'll eat a small piece of fruit (apple or pear, pears have lots of fiber!) and some cheese (not too much, because I lurve me some cheese and all things fatty). If I must have dessert, I eat a frozen yogurt bar (Yasso brand), a small yogurt, or 2 squares of dark chocolate, or even a very small piece of cake (think tiny cupcake sized, not giant muffin sized). I've tried low carb ice cream but hate the artificial sweeteners they use, probably just as well. I'm allowed 15-20 grams of carbs for a snack and it has to be paired with protein, and yogurt has both. Greek yogurt is better than regular, as it has more protein. Berries are better than other fruits because they are also lower carb. So sometimes I'll do a blueberry smoothie, using plain Greek yogurt, 1/2 a banana, a splash of lowfat milk, and frozen blueberries (which make it thick). I use Teddie peanut butter, as it has no sugar, and will sometimes add a tablespoon of that to my smoothie.

I go back in May to get the A1C checked again and my challenges are exercising more often and on a consistent basis (which I was into before, and it helped a LOT in losing weight, maybe I didn't want to eat a bunch of stuff and "waste" my exercise, IDK), and to not let myself slack on portion sizes, that is, use the measuring cups and not try to eyeball a serving of rice or pasta, because I WILL put an extra scoop into a bowl and say it's fine, but nope, my eyes lie. I tend to go for squash more than rice or potatoes, as you can have more squash because it's high in fiber (but if I really crave potatoes, I will eat them, just measure the portion). I really don't eat pizza anymore, as that's limited to 1 slice, and who the hell only eats 1 slice of pizza? I will sometimes have a small sub sandwich, as that's okay, or a wrap sandwich, which is better (again, reading the labels, some wraps are higher than others in carbs). Sub sandwich only once a month, tho', not once a week, been avoiding takeout for the most part. I made wonton soup last week, 8 wonton wrappers have 31 grams of carbs, which is in my range for carbs per meal (women are allowed 30-45 grams per meal and I've found the lower end to be better for me, especially if I don't want to gain any MORE weight).

So the extra bathroom "time" was a side effect for me, and it was worse in the beginning, not so bad now. It was also explained to me that it takes up to 1 year to really make the lifestyle changes, so try not to get too discouraged at the start. 500 is a really low dose, and I wouldn't expect it to help with large amounts of weight loss, I'm on 1000 a day and it just comes down to carb and calorie counting, and exercise. If you haven't seen a dietician, ask your doctor about it, I'm the type of person who needs the extra support and accountability, or I will just eat stuff that's high in calories and kid myself about it. The main thing is small amounts of carbs, paired with protein, to keep your blood sugar levels consistent throughout the day, no very high or low spikes. I still have a long way to go, but I've done this before, so am confident I can get it back under control, because the alternative sucks.
posted by Marie Mon Dieu at 1:40 AM on February 11, 2019

I am on Metformin, at higher doses there were digestive issues. They got better with time. I never had any reduction in hunger. It did help with A1C but so did eliminating processed foods, watching calories and especially carb portions.
posted by ReiFlinx at 3:02 AM on February 11, 2019 [1 favorite]

I briefly took Metformin years ago at a low dose and discovered that I’m in the very small number of those who cannot tolerate it. For me the unpleasant side effects kicked in more or less immediately and included stomach cramps, nausea, and fatigue. My endocrinologist noted at the time that so severe a reaction was pretty rare. Upon promptly discontinuing the medication I bounced back pretty quickly. I did lose weight while taking it but I attribute that mostly to not feeling like eating much due to the unpleasant side effects. Hope it works for you - mine is very much an outlier of a reaction to a drug that is, as far as I know, one of the most widely prescribed and well tolerated type 2 medications available.
posted by cheapskatebay at 4:00 AM on February 11, 2019

Cheapskatebay - I think you were sold a story about how rare your side effects were, as I had the same ones. In fact, if I had to travel I would skip my dose, as I did not want to be far from a restroom while taking it. I lost no weight while on it.
posted by 41swans at 4:19 AM on February 11, 2019

I've been on metformin, 1000mg twice a day, for about a 18mo, with a slow-release Glipizide in the mornings; the only side effect I've noticed is feeling bloated and heartburny if I eat too much carbs (also peanut butter for some reason) in one sitting, otherwise nothing notable. I tried probiotics early on, as a big change in gut flora sounds common, but it didn't really help. But I didn't notice anything really in the beginning.

Haven't lost any weight, despite my food intake being waaayy down and an increase in exercise; my A1C is hovering around 7 and the doc would like to get it lower, we're still trying to figure out what to do next. I had been on a regular-release glipizide but it would make my sugars way too low by lunch.

As far as feeling hungry: I don't think Metformin does it entirely on its own, you still have to make a conscious effort because it seems to me that what I thought was "hungry" was just my body wanting to continue what it was always doing, i.e. a bunch of toaster waffles with a lot of syrup in the morning vs a bagel and creamcheese; I had to train myself that I could just eat the bagel and creamcheese and I'd be fine, my body's panic that it wasn't enough was a midread of the situation.
posted by AzraelBrown at 4:51 AM on February 11, 2019

Insulin resistant, started metformin in September. The ramp up to my 1500 dose was hell - I got debilitating fatigue until day 10 or so, while on the full dose I regularly had sharp gut pain and sometimes incidents of indigestion and fever until vomiting. Switching to 750 extended release twice a day helped like a charm. I now have just the normal manageable changes in bathroom habits.

It evened out my blood sugar enough that it was quite easy to follow the prescription to stop snacking and limit myself to three meals a day. With aerobic exercise every other day for half an hour, I went down two clothing sizes in three months and keep losing weight now that we've added thyroid medication. It took about a month for this to show up - it did take behavioural work, especially getting used to the sensation of an empty stomach.
posted by I claim sanctuary at 6:47 AM on February 11, 2019

I've been on metformin since I was diagnosed with diabetes in 1999. I went through quite a long period of settling down with it - I don't remember feeling sick but do remember having to rush to the toilet quite often (my mom was also put on metformin and had to give it up because of the side effects. Unfortunately she was then prescribed roziglitazone).
I think my weight stabilised and I certainly notice when I don't take it as my sugars go up even with the insulin I'm also on. Then I get tired really quickly.
Overall I've found it more of a benefit and the side effects manageable, and there has been some talk about other beneficial properties as well.
posted by Martha My Dear Prudence at 6:53 AM on February 11, 2019

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