If you were recently diagnosed with Type 2 diabetes, your doctor may have prescribed metformin. This first-line medication has been used since the 1990s and is now one of the most widely prescribed treatments for type 2 diabetes. 

Did you know? 

Metformin has botanical roots that go back to a plant called French lilac (Bailey, 2017), and its discovery from this natural source helped inspire the modern treatments we use for diabetes today. 

Let's take a look at how this medication can help keep blood sugar stable.

What Does Metformin Do?

Normally, the liver makes sugar to help keep energy levels stable between meals and overnight. However, when a person has type 2 diabetes, the liver often makes too much sugar – this can make blood sugar harder to control. Metformin, which belongs to a class of drugs called biguanides, helps lower blood sugar by telling the liver to make less sugar. Metformin has the added benefit of making muscle and fat in the body more sensitive to insulin, helping to bring blood sugar down more efficiently after meals.

Who Usually Takes Metformin?

• Adults newly diagnosed with type 2 diabetes, especially those with normal kidney function.
• Some doctors may prescribe it for individuals with prediabetes, to help prevent progression to type 2 diabetes.
• People with polycystic ovarian syndrome (PCOS), as it may help regulate insulin levels and regulate menstruation. 

How Do You Take this medication?

Metformin comes in two pill forms, and both should be taken with food or at the start of a meal. 

• Regular (Immediate-Release): Works quickly and is usually taken 2–3 times daily with meals.
• Extended-release (ER or XR): Releases the medication more slowly and is usually taken once daily with the evening meal. This form is often easier on the stomach and may be recommended if the regular form causes nausea, diarrhea, or other stomach discomfort.

Your doctor will decide the right dose for you based on your condition and how well you tolerate the medication. Metformin generally starts at 500 mg once daily and can be gradually increased as needed, up to 2,000 - 2,500 mg per day for the regular pill or 2,000 mg per day for the extended-release version, under your doctor’s guidance.

💡 Tip: Taking metformin with food can help reduce stomach upset and allows your body to absorb it (especially Metformin ER)  more steadily (Corcoran & Jacobs, 2023). It also works on an empty stomach, but side effects are more likely, so meals are recommended.

Side Effects and Things to Know

• Kidney health: Metformin can actually help protect your kidneys by keeping blood sugar in check. However, it’s not prescribed if kidney function is poor, and your doctor may stop it if kidney function declines over time.
• Stomach upset: Some people get nausea, diarrhea, or tummy discomfort. Taking metformin with meals can help, and the extended-release (ER) form is often gentler.
• Vitamin B12: Long-term use of metformin may lower vitamin B12. Your doctor may check your levels if you notice fatigue or tingling in your hands or feet.
• Low blood sugar: Metformin alone rarely causes low blood sugar, but medicines like insulin, glimepiride, glipizide, or glyburide can. Use extra caution and keep an eye on your blood sugar if you take these.

Cost and Access

• Metformin is one of the most affordable diabetes medications available.
• Extended release forms may come at a higher cost depending on the pharmacy and insurance coverage.
• Discount programs through Good Rx and Single Care can help reduce out-of-pocket costs, even for those without insurance.

Everyday Habits That Support Metformin

• Move Your Body: Physical activity can help your body use metformin more effectively. The American Diabetes Association recommends a mix of aerobic exercises (like walking or cycling) and strength training (like bodyweight exercises or light weights) to improve blood sugar control. Try adding a 10-minute walk or light activity after your next meal and check your blood sugar about 2 hours later to see the difference.
• Eat Smart: Balanced meals and consistent timing help keep blood sugar steady and reduce extra sugar production by the liver. Include fiber-rich foods like vegetables, whole grains, and legumes, pair them with lean protein, and space out your meals every 4–5 hours. This approach helps your body use the food you eat efficiently and supports the effects of metformin.

Tips for Success

• Stay in touch with your provider if you notice new symptoms or if your blood sugars don’t improve. A small dose change, or a different version of the medicine, could make the difference.
• Take metformin as prescribed with balanced meals to support stable blood sugar levels. 
• Monitor blood sugar at various times of the day to see how well your medication is working.

Takeaways

• Safe for your kidneys: Metformin does not damage healthy kidneys and can even help protect them by keeping blood sugar in check. Your doctor will monitor kidney function to stay safe.
  Multi-action: Reduces sugar production in the liver and helps muscles and fat use insulin better.
• Manageable side effects: Taking it with meals or using the extended-release form often prevents stomach upset; long-term B12 monitoring may be needed.
• Lifestyle boosts results: Regular activity and balanced meals make metformin work even better.