What are the pros and cons of metformin?

Metformin can be used alone or with the addition of insulin if sugar levels are still too high. Not having to inject, less risk of low blood sugars and few side effects, the benefits of use are easy to see. Side effects if experienced are most commonly nausea and diarrhoea which should settle soon after commencing.

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How to Take Metformin

It is really important to start on a low dose of usually 500mg once a day with food, increasing after 2 weeks to either twice daily or at an increased daily dose with your evening meal. You will then increase doses at these time-points as instructed by your doctor depending on the effects on your blood sugars. This is because most side effects are gastrointestinal, with nausea and diarrhoea being the most common (Metformin and diarrhoea). The usual dose of metformin is 2000mg to 3000mg daily in divided doses. It can be taken three times a day with meals to try and further regulate blood sugars. Tablets need to be swallowed whole, not crushed (a liquid formula is available if unable to swallow). If you forget to take a dose it is best to miss and take the next dose as usual.

When to Take Metformin

When someone with diabetes first starts taking metformin, typically it’s started as a once-daily dose with dinner (or your last meal). After one to two weeks, a second daily dose of metformin is added (taken at breakfast time). When taking metformin, it should be taken at about the same time every day and with a glass of water.

Side Effects of Metformin

Like many medications, there are some some side effects associated with taking metformin. Here are the side effects and what to do about them.

Diarrhoea, bloating and flatulence

Stomach Pains

Nausea

Vitamin B12 deficiency

Metallic taste

Unusual body odour

Diarrhoea

If you have have started metformin, you might be wondering: 'why do I get diarrhoea with metformin?' About 10-50% of people report some diarrhoea when starting on Metformin (The Prevalence of Chronic Diarrhea Among Diabetic Patients). The introduction of extended release formulations has significantly decreased the incidence of this to about 10%. Flatulence, abdominal bloating also can happen and symptoms are often dose related. The good news is, if you are experiencing mild or infrequent diarrhoea and it does not resolve within 2 weeks. If the diarrhoea is severe, you must talk to your doctor as a reduced dose or change in formula can often be the answer. Most people do tolerate this drug well and with less than 5 % of all people on metformin having to stop taking it as a result of side effects.

Nausea

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Nasuea is another common gastrointestinal side effect of metformin. This affects about 7% of people but is reported to be higher if not taking a slow release formula (definitely worth checking out what you have been prescribed) (Metformin in Noninsulin‐Dependent Diabetes Mellitus). If it is continuing then it is not normal and will need to be discussed with your doctor. It is important to have this medication at mealtimes to minimize these effects.

Vitamin B12 Deficiency

About 30% of people taking metformin experience a reduced ability to absorb B12 from the intestine and this results in about 5-10% having a B12 deficiency (Vitamin B12 deficiency and diabetes). A low B12 level can result in fatigue and other symptoms seen in anaemia but also causes peripheral neuropathy- pins and needles or numbness in the feet or hands. B12 levels can be checked via routine blood tests. B12 supplements are available by a small monthly injection over 3 months if levels are depleted as it is difficult to get enough in our diet to increase levels.

Metallic Taste

A few people complain of a metallic taste (up to 3%) (Metformin in Noninsulin‐Dependent Diabetes Mellitus) and this should resolve once your body gets used to the medication. If it continues talk to your doctor.

Odour

Some people have noticed an odour from the metformin tablets that is fishy or like a “locker room sweat”. Again, this is an unusual experience but If concerned speak to your pharmacist as a different brand can be given.

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