When people start taking Metformin, it can take a while to see any positive change in blood sugar levels or weight.
If you’ve recently added this medication to your daily routine, you may be anxious to see results and fast.
This article will investigate how you will know if your Metformin is or isn’t working, and what you can do about it.
Why do people take Metformin?
Metformin is a first-line therapy for prediabetes and type 2 diabetes.
The American Diabetes Association recommends Metformin for people who have:
- prediabetes between the ages of 25-59 years old
- an HbA1c of 6% or higher
- a BMI of 35 or higher
- fasting plasma glucose (fasting at least 8 hours) of 110 mg/dL or higher
- a prior gestational diabetes diagnosis
- a type 2 diabetes diagnosis.
Taking Metformin regularly can help improve insulin sensitivity, reduce appetite, lower blood sugar, and HbA1c levels, and can even help people lose a modest amount of weight when used in conjunction with a healthy diet and regular physical activity.
Side effects of Metformin
Experiencing side effects of any new drug, including Metformin, is extremely common. Most of these side effects are minor and subside within a few weeks of taking the medication.
Experiencing side effects is not an indication that your Metformin is working, per se.
Keep a watch out for the following symptoms and call your doctor if any of these get worse or do not go away on their own after a few weeks:
- Decreased appetite
- Weight loss
- Low blood sugar (especially if you also take insulin)
- Metallic taste in your mouth
- Stomach pain
Seek emergency medical attention if you’re experiencing severe nausea and have low blood sugar, and cannot keep anything down with which to treat it.
You can learn more in our guide Metformin Side Effects: What You Need to Know.
Signs Metformin is working
There are a few signs that your Metformin is working, and the effects of the medication may build over time, so do not worry if you do not see immediate results.
Lower blood sugar levels
If you check your blood sugars regularly at home, you may notice that your blood sugar levels are consistently lower once you start taking Metformin, especially after eating, when you may be used to elevated levels.
Lower HbA1c level
If you do not check your blood sugars at home, you can contact your doctor’s office after a few months on Metformin and they can run a glucose test (A1c test), which measures your average blood sugar level over the previous three months.
Your average blood sugar level should be lower after a few months on Metformin. If not, discuss alternative medications to Metformin and/or lifestyle changes with your doctor.
You can also measure your HbA1c at home with a simple test kit you can buy at your local pharmacy or online.
You’ve lost some weight
Additionally, you may notice that you’re losing some weight, especially if you’re taking Metformin in conjunction with a healthy diet and increased physical activity. However, weight loss is often modest and can be inconsistent.
Signs Metformin is not working
If you’ve been taking Metformin for a month or more, but notice the following symptoms, it can be a sign that Metformin is not working, and you may need to either increase your dose, work with your doctor and experiment with combination drugs, or seek an alternative medication.
Keep a watch out for the following signs.
Your blood sugar levels have remained stubbornly high
If your blood sugars continue to spike after meals, or you have been routinely waking up with high blood sugars despite taking Metformin, it may be a sign that Metformin isn’t working and you should call your doctor.
It’s easiest to track your daily blood sugar levels if you have an at-home glucometer.
Your HbA1c level has not improved
If your baseline HbA1c level was higher than you’d like it to be, but after a while on Metformin (usually 3 months after beginning treatment), your HbA1c hasn’t budged. This is a sign that Metformin is not regularly bringing your blood sugars down.
It’s important to be cognizant of the signs of high blood sugar. These include:
- Increased hunger
- Increased thirst
- Blurry vision
- Increased and frequent urination
- Body and headache
- Fruity-smelling breath
- Weight loss (which may be confused with Metformin working, but is also a sign of dangerously high blood sugar levels)
You’re not losing weight or you’ve gained weight
Metformin doesn’t cause weight loss in everyone who takes it, but many people do enjoy modest weight loss (less than 10 pounds) after taking the medication for several months.
However, if you’re eating healthy and exercising regularly in conjunction with taking Metformin, but your weight hasn’t budged or you’ve gained weight, this could be a sign that you may need to increase your dose or seek an alternative. This may be a sign that you need to contact your doctor.
Frequently asked questions
The medication needs time to build up in your system, and oftentimes, your doctor will start you on a low dose, to avoid uncomfortable side effects.
Do not expect a miracle within the first week of treatment, but after a few weeks, you should start to notice lower blood sugar levels, especially after meals.
Any weight loss and improvements in HbA1c levels, however, may take several months of taking Metformin at your full dose.
Don’t stop taking Metformin before it has a chance to fully work within your body, which can take up to a month (or several).
Never stop taking a prescribed medication before talking with your doctor. Quitting any drug cold turkey can cause unpleasant side effects, so weaning under the guidance of your doctor is key.
Metformin by itself is not a miracle drug. To enjoy the maximum benefits from the medication, it is best combined with healthy eating and regular physical activity.
Work with your doctor or a registered dietitian (RD) to develop a meal plan and set of healthy activities that you can fit into your lifestyle.
The Centers for Disease Control and Prevention (CDC) recommends that most adults aim for 150 minutes of moderate activity per week, or about 30 minutes (or more!) per day (like walking, jogging, swimming, or biking), plus 2 days per week of muscle-strengthening activities, like weightlifting.
If Metformin truly isn’t working for you, there are alternatives. Some people with unmanageable blood sugars may be best suited to start insulin therapy.
Other people may opt for an SGLT-2 inhibitor such as Invokana, Farxiga, Jardiance, or Steglatro.
Other alternatives to Metformin include GLP-1 receptor agonists such as Bydureon, Byetta, Ozempic, Adlyxin, Rybelsus, Trulicity, or Victoza.
Some people may opt for oral medications including Sulfonylureas (SFUs), and DPP-4 inhibitors such as Tradjenta, Onglyza, Nesina, Januvia, or Thiazolidinediones (TZDs).
Finally, if you’re experiencing low blood sugar levels or don’t feel well on Metformin, you may be able to wean yourself completely off the medication without starting anything new. Talk to your doctor to learn more.
Metformin is an affordable and accessible drug that millions of people take for better blood sugar management. However, it is important to keep track of any side effects you’re experiencing and take notes to see if the prescription medication is or is not working for you and your health goals.
Do not sit and suffer in silence if Metformin is causing you uncomfortable side effects for more than a few weeks, or if you’re not seeing the results you were hoping for. There are alternatives that may work better for you and your health goals.
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