Diabetes Medication

Metformin Forever

Metformin controls the insulin resistance of people who have type 2 diabetes so well that, if possible, all of us should be taking it. That’s what Roderic Crist, M.D., told me at the annual convention of the American Society of Bariatric Physicians in Denver this weekend. Dr. Crist specializes in family medicine in Cape Girardeau, Missouri.

“Not everybody can take every drug,” he added, when I followed up our conversation by calling him at his office after he returned home. “But most of the time people can take metformin if they take it carefully.”

Doctors increasingly prescribe it not only for type 2 diabetes but also for insulin resistance, polycystic ovary syndrome, and non-alcoholic fatty liver disease.

Roughly one-third of Dr. Crist’s patients have diabetes. Well over half, if not two-thirds of the people he sees are insulin resistant.

“I treat insulin resistance with that drug even if they aren’t fully diabetic.” he says. “If they have high triglyceride levels and low HDL levels, particularly if they are centrally obese, they should probably be on metformin. It helps slow the progression of the disease from one thing to the next.”

But he goes further. He prescribes metformin to almost all of his patients who have type 2 diabetes — no matter how low their A1C level is. And he tells his patients that their levels should be 5.0 or less — not the American Diabetes Association’s less stringent recommendation of 7.0 or less. “If their A1C is at 5, their diabetes is in complete remission. So I have that as a goal.”

And he still prescribes metformin to them after they reach that goal. “The two important issues are that it will prevent progression and it should be used in the earliest phases of insulin resistance. We vastly underutilize metformin.”

But he has a concern about the usual starting dose of metformin. “When most physicians prescribe metformin, they start way too high,” he told me. “Almost all medications have side effects. For metformin the typical recommended dose is 500mg twice a day. They teach almost all of us physicians to do that and to increase it fairly rapidly to 850mg and then to 1,000mg twice a day. And almost all people who do that have GI side effects, typically nausea and diarrhea.”

He recommends that we go much, much slower. “Start with 250mg perhaps for a week,” he says. “And the second week to 250mg twice a day, and the third week to 500mg in the morning and 250mg at night, and the fourth week 500mg twice a day. And keep increasing at that rate very slowly, with the ultimate goal of 850mg twice a day or 1,000mg twice a day, depending on your needs. In this fashion you will rarely have side effects.”

Furthermore, when you go off metformin for one reason or another and then go back on it, you need to follow the same slow course. “You have to start this whole process all over again — even if you go off metformin for just a few days,” he says. “Taken correctly, it is far more well-tolerated.”

He also prescribes other medications to essentially all of his patients who have diabetes. He says that he follows the recommendations for doctors to prescribe either ACE inhibitors (angiotensin-converting-enyyme inhibitors) or ARBs (angiotensin II receptor blockers) to everyone who has diabetes to protect their kidneys, unless they have low blood pressure.

Is there a third drug that everyone with diabetes should take? I asked Dr. Crist.

“That’s a tough one,” he replied. “Perhaps aspirin, if there are no contraindications. Generally 81mg, but if you want to cover the entire spectrum of clotting disorders, perhaps two baby aspirin. I usually have most of my patients on aspirin, unless there is a contraindication.”

I am still considering whether to follow Dr. Crist’s advice to go back on metformin. I did decide to again take a baby aspirin every day. All of his recommendations are certainly provocative and well worth our careful attention.

Metformin helps people with type 2 diabetes to control the amount of glucose in our blood. It decreases the amount of glucose we absorb from our food and the amount of glucose made by our liver. Metformin also increases our body’s response to insulin, a natural substance that controls the amount of glucose in the blood.

Metformin is one of the most effective of our diabetes medications, one of the safest, and now that generic forms are available is the least expensive. For several excellent reasons it is the most widely prescribed diabetes drug in the world.

This article is based on an earlier version of my article published by HealthCentral.

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  • BarbS June 12, 2016 at 10:47 am

    I’m pre-diabetic. A1C 5.5 past 2 years. FBS 89-107
    Very low carb diet (20 gm). Still need to lose about 40 lbs. I’m taking Metformin 500 mg ER daily with no GI discomfort. Would increasing this dose to twice daily help me lose weight? Would 1000 mg BID be even better?

    • David Mendosa June 12, 2016 at 11:02 am

      Increasing the metformin might well reduce your A1C level, but it doesn’t sound like you need to do that with a level of 5.5. But since metformin is generally weight-neutral, it would probably not help you to lose much weight. Maybe just a bit typically.

  • Barb June 7, 2016 at 8:14 pm

    I’ve been prescribed Metfromin recently 500mg once a day at evening meal. I am prediabetic but creeping up to diabetic range …I take Crestor 40 mg daily and carvidilol 3.25 mg 2 x day. Keeping both blood pressure and cholesterol #s in ideal range including triglycerides . I’m overweight and moderately active. I’m vegeterain but do love carbs 🙁 I occasionally like to include wine with my meals , sometimes on occasion a few glasses . I’ve read that this is unwise with Metformin , true or not??

  • Ken May 30, 2016 at 4:00 pm

    Increasing the dosage of metformin slowly is definitely a good idea. I can’t tolerate any amount of this though, even 250 mg, although 500 mg is worse 🙂 It’s not the GI stuff that does me in it’s the lack of energy, which I’ve seen happen to some others as well.

    A1C targets need to be put in perspective. Risk goes up geometrically from normal, the monsters only really start coming over 8, although it’s definitely good to have a better A1C than that, but only if the price is right. With dietary restriction though the price is always right. With drugs, well that’s often a different story.

    When I read stuff like all diabetics should be on ACE inhibitors or such to protect their kidneys or any prescription med given just because someone is diabetic just makes me cringe. These things do have side effects and at the very least should be used in cases where the benefits outweigh the risks. That’s not a popular yardstick though.

    • David Mendosa May 30, 2016 at 4:21 pm

      I cringe just like you with these blanket drug recommendations, Ken. ACE inhibitors and even worse are the blanket recommendations for the statins.

  • Lucy green May 22, 2016 at 5:53 pm

    For 57 years never had a sugar problem until I was put on pedisone for over 2 years 10 mg daily. November of last year I started winging myself off it. 3 1 16 I stopped it n a month later got food poison n stopped the matformin. Start a1c was 7.7 2013, November of 2016 was 6.5. Son took his life n it went up 6.8. January of 2016 6.8 n april it is 6.7. Off the matformin for over a month n predisone almost 3 months. How do I lower it without going back on the matformin. My liver is very toxic. ..next week to get blood work to see if I have hipatitus B.

  • Tracey May 12, 2016 at 2:12 am

    My partner was diagnosed diabetic 3 months ago! His glucose was 13.5 and cholestoral 12.5. He is normal weight. Went to doctors due to painful feet plus sleeping all the time. He was put on one statin tablet and 2 X 1000mg of metform per day. He is 54 years old. For last 3 months has been on low sugar low carb diet. Plus excercise 5 times per week Result blood sugar down to 5.5 and has lost 4 kg. Doctor halved his metform 1 week ago. His blood glucose is already up to 7.5 and another 1 kg lost. His feet in agony and is now feeling faint and dizzy. His blood pressure is normal.He is on good diet and does not need to loose any more weight. What does he do next. He has had no side effects from metform and is still on statins

    • David Mendosa May 12, 2016 at 7:01 am

      Your partner needs to tell his doctor what you told me, specifically “His feet in agony and is now feeling faint and dizzy.” Only a thorough examination will be able to address his situation.

  • maria May 11, 2016 at 12:26 pm

    My dr wants me to start metformin. My question is if I keep a diet and exercise can I get off metformin?

    • David Mendosa May 11, 2016 at 2:58 pm

      Absolutely, Maria. Personally, I got off metformin more than 10 years ago. Use the metformin as a help to bring your blood glucose level down to normal. Use the metformin combined with losing weight and eating fewer carbohydrates is the easiest way to success.

  • Emily May 2, 2016 at 7:41 pm

    Thanks for the response-I will get my A1C levels tested in a month or so because my readings have come WAY down since I lost 80 pounds and have been low carb dieting. My latest readings are in the 80’s and 90’s. Still need to lose at least 100 more pounds so I’m assuming as long as I continue low carbing and losing weight the situation will continue to improve.

    I have heartburn, acid reflux. I read Metformin can cause acid stomach?

    And yes, I was concerned that I might develop dairy intolerance like my sister has. It’s so severe she can’t even eat a tiny bit of butter without having bad diahrea.
    But you are suggesting that Metformen probably did not cause the dairy intolerance?

    • David Mendosa May 3, 2016 at 7:23 am

      I don’t know if metformin can cause heartburn or acid reflux, Emily. But it definitely can cause nausea and stomach upset when you increase the dosage too fast.

      I am suggesting that you need to consider that something else may have caused your lactose intolerance.

  • Emily May 1, 2016 at 6:35 pm

    My sister has developed a severe case of intolerance to any kind of dairy and her doctor told her it was due to having taking Metformen (for PCOS)
    I currently take 1000 mg. 2 times a day for diabetes, but having lost weight and changed my diet could likely stop taking it.
    If my blood sugar levels are normal without it, is there any reason to continue taking it?


    • David Mendosa May 1, 2016 at 8:07 pm

      Are you making a connection between what your doctor apparently told your sister, Emily, and with your own situation? Actually, it would be most unusual if not unprecedented for metformin to cause dairy intolerance. But back to you: when you get your A1C level down below 6.0, only then can you consider it to be normal. What is your A1C level now?

  • Venia April 28, 2016 at 11:36 am

    I agree. For two years his numbers have been normal and glucose great and I’ve asked but no clear answer and he’s never been on the meds o I may get a second opinion or just change doctors. She actually called in the prescription the FIRST time we went in before getting blood results and they ended up being normal??? If he has recurring high end numbers from a blood draw then I have no problem with the meds but I would think he would need to show numbers before prescribing. Thanks for answering my questions.

  • Venia April 27, 2016 at 7:37 pm


    • David Mendosa April 28, 2016 at 7:01 am

      I am sorry that I missed this in your first question, Venia. Now I understand your concern! An A1C level is either non-diabetic or diabetes in total remission, depending only on whether your son ever was diagnosed with diabetes. So I don’t understand why your doctor would want to start your son to take metformin. I think that he needs to clarify this proposed treatment with the doctor.

  • Venia April 27, 2016 at 10:16 am

    Ok…His glucose was 76 and 80! Do u see my confusion?? Ok thanks for the responses.

    • David Mendosa April 27, 2016 at 11:00 am

      The real question, Venia, is what was his most recent A1C test. Please let me know.

  • Venia April 26, 2016 at 6:16 pm

    Ok…greaT so if the glucose range is between 65-100 per the doctor, he should try to keep his closer to 65 even though he’s normal..just too high in the range? Thanks for explaining!! 😉

    • David Mendosa April 27, 2016 at 7:35 am

      That is a normal blood glucose range, Venia, although 65 is a little too low. Your son needs to keep his level at about 83, according to Dr. Richard K. Bernstein.

  • Venia April 26, 2016 at 2:49 pm

    For his first nonfasting blood draw, all numbers were within a normal range but he is a stocky kid. He always have been and even the doctor said he’s firm and doesn’t “look” to weigh that much. She STILL wanted to put him on the meds. Does the fact that “grandparents” on Dad’s side drive the force to put him on meds? I guess I’m not understanding. Help…

    • David Mendosa April 26, 2016 at 3:22 pm

      I’m sure that your son’s doctor is concerned about him is because his blood glucose is too high.

  • Venia April 26, 2016 at 2:43 pm

    Thanks so much for your reply in regards to my high school son but once on Metformin, will he be able to GET OFF? I’m confused when told to get on Metformin before told to try to lose the weight FIRST and then if that doesn’t work, get on Metformin. I’m just nervous that his body will adjust to it over a period of time and will HAVE to have it. Thanks.

    • David Mendosa April 26, 2016 at 3:20 pm

      Thanks for asking, Venia. The answer is clear that he will be able to get off metformin when his blood glucose is well enough controlled without it. Many people, myself included, have definitely had this experience. Your son need to get down to a normal BMI (body mass index, or weight) and when he stops eating so many carbohydrates, he can get off any and all diabetes medication. I know from my own experience.

  • Maralyn April 24, 2016 at 6:32 am

    Hi there David
    Just an update since last i posted. I have now l8st 4 stone since october last year using the 2000 mg metformin taken with water and food 4 times a day l8w carbs high protein diet
    Got an average glucose reading of 4.3 average over 60 days

  • Venia April 23, 2016 at 11:52 pm

    Hello!,My son is 17, 6’5, weighs 330 and plays football. His A1C has been 5.5 two YRS in a row (1st yr/fasting, 2nd/non fasting) and glucose of 80 & 76. Because grandparents on his Dad’s side have diabetes, the doctor us suggesting he take 500 mg of Metformin evetybody day. He has high blood pressure (both parents do too but no diabetes). Should he start so early with Metformin good A1C levels? Really do not want to start if he doesn’t have to.

    • David Mendosa April 24, 2016 at 6:16 am

      Your son is in the pre-diabetes range, Venia. This means that he is quite likely to get diabetes if he keeps on the the way he is going. Please read my recent article, “The Metformin If You Have Prediabetes.”

  • muruganantham March 9, 2016 at 12:28 am

    does metformin after 10 years why is resistant?

    • David Mendosa March 9, 2016 at 9:18 am

      Sorry, but I do not understand your comment. Can you clarify it please?

  • Pearl February 17, 2016 at 11:57 am

    In December 2014, I gave up all foods with any type of sugar. And limit my carbs. I eat whole foods. I have kept my a1c at 5.5 for over a year. I took myself off diabetes meds and kept normal range and so far lost 93 pounds. However I have been on a plateau for months even with increasing exercise. My doctor put me back on Metformin. Still sluggish weight loss. I still need to lose 100+
    I’m frustrated and don’t see need for Metformin. Just wondering you think..

    • David Mendosa February 17, 2016 at 12:27 pm

      Your 93 pound weight loss is fantastic, Pearl! Keep it up, and I know that you intend to do. The increasing exercise won’t help that nearly as much as reducing your carbs. Of course, one of the GLP-1 receptor agonists (like Trulicity, Bydureon, Victoza, and Byetta) will help you to lose your weight even better than metformin will because these diabetes medications will reduce your hunger. I suggest that you discuss this with your doctor.

  • Swati Dave February 8, 2016 at 4:24 pm

    Hi David,

    I have just been asked by my Doctor to start taking Metformin 500mg as my a1C reading was 7.2 and fasting BGL was 9mmol
    I have been controlling until now with diet and exercise but I guess fell off the bandwagon sometime last year hence the numbers creeped up. I am confused whether to start taking the med or go back to strict diet and exercise control again before taking the med.

    • David Mendosa February 11, 2016 at 12:41 pm

      Good question, Swati! But I think that if I were in your shoes I would do BOTH. It is important to get our A1C level down to normal — below 6.0 — as quickly as possible in order to minimize the risk of complications.

  • Maralyn January 21, 2016 at 5:43 pm

    yes and one last tip 5hat just may help new takers of Metformin or newly diagnosed diabetics. when depression sets in from the sheer HUNGAR and the “what can I eat everything seems to have sugar content” water actually does help taken with food to make you feel fuller minimum 2litres a day for the first 4 weeks till your stomach get used to the new way of life. Sweet Potato does IN MODERATION give you something sweet tasting and does not spike your sugar as seems slow release. hope this helps. if anyone wants any tips that I can help just leave message. more than happy to help if I can. Remember there are many things you are advised to eat on a diet plan that you simply can’t eat as a diabetic xx

  • Maralyn January 21, 2016 at 4:45 pm

    Many Thanks David I will do just that next week.
    thank you for your input which has a wealth of information that can only help us try and adjust to a new way of trying to live with diabetes.
    One thing I want to say.. Metformin is a great drug to HELP our problem but alone it can’t work unless we try and do our part by trying to watch what we eat and definitely don’t take Meteor min without food and bring dose up gradually. And most importantly DRINK PLENTY OF WATER EVERY DAY. helps stop the effects of the drug that many people suffer when taking it.
    Thanks to all on the forumx

    • David Mendosa January 21, 2016 at 5:33 pm

      Great suggestions, Maralyn. Anyone taking metformin needs to be aware of all of your tips. I especially appreciate your writing that we have to watch what we eat. This is particularly true about eating carbohydrates, which have by far the greatest effect on our blood glucose.

  • MARALYN January 21, 2016 at 10:05 am

    I have been on metformin since October 15th 2015 had an average glucose reading of 12.5 I have using low carb. Diet and a gradual increase from 1000 mg -2000 over 4 week period always taking with food by the way lost 3 stone .
    I wish I had been given metformin 10 years ago when at age 53 I was told I was type 2 , I manged to control it by diet for 10 years alone but it just crept up . I would advise anyone to keep the regime being careful what you eat. Metformin has not caused me any problems to date. I have a daily glucose average now of 6.4 . However my question is I am on 25 mg A ten ell every day for blood pressure but since losing weight I get lightheaded can this be that losing weight long with metformin is the problem
    Thanks in Advance

    • David Mendosa January 21, 2016 at 10:59 am

      I am glad for you, Maralyn, that you are taking metformin to manage your diabetes and that you titrate it so well and take it with your food. But as to your question:

      Being lightheaded may well be a sign that your blood pressure is actually too low. Weight loss does lead to lower blood pressure — that is indeed one of its great side effects. Perhaps now you need to see your doctor to see if you should reduce the dose of the blood pressure medicine that you are taking. All sounds good!

  • Rhonda January 19, 2016 at 3:26 pm

    Thanks for discussion about metformin. Have you ever heard of it causing someone to have shortness of breath (with me it is with exercise ) and something like a general all over tiredness almost depression?

    • David Mendosa January 21, 2016 at 3:59 pm

      I haven’t heard about any connection between metformin and the symptoms you describe, Rhonda. Of course, all of us are different, so it isn’t impossible Something is of course going on. So it would be a good idea to discuss it with your doctor.

  • Juanita November 7, 2015 at 6:13 pm

    I just decided to go back on metformin….is ER better than reg. do you think I can get off insulin ( lantus)

    • David Mendosa November 7, 2015 at 7:06 pm

      I would guess that ER is better, Juanita. But I really haven’t heard of any studies about it.

      Unless you have type 1 diabetes, you certainly can get off insulin — and in fact you can get off all diabetes medications. All you have to do is to eat on a very low-carb diet of about 50 grams of carbohydrates per day. That certainly sounds simple, but it is one of the hardest things to do. Eventually, however, if your experience is like mine, you will be grateful for it and totally accept that we can live without bread or any grains or in fact many carbohydrates. Hard at first to be sure. But eventually something that I now take for granted and don’t miss the carbs one bit.

    • David Mendosa November 13, 2015 at 6:13 pm

      Yes, ER is probably better, Juanita. And you can get off insulin when you reduce the carbs you eat far enough.

  • Prince November 7, 2015 at 6:18 am

    Hi Dave,
    I have been on metformin(glucophage) for 5 yrs now. Taking between 1500 to 3000mg per day depending on my diet. I try to stay away from carbs but do take a little sometimes for energy. I’ve lost weight from 89 to 84kg. Lately my numbers are not coming down even when I take my drugs. Last night my number read 112, I had oats and took 1000mg. Woke up this morning and it reads 170. I’m I becoming resistant to metformin? What can I do to make my numbers go down? I also take Gabapentin for the leg spikes in the nights.

    • David Mendosa November 7, 2015 at 8:25 am

      Thanks for asking, Prince. My major suggestion is to count the carbs you eat (total, not net). You will probably find that you are getting more than 50 grams per day. If so, start cutting back, the first step being with the high glycemic carbs in potatoes and wheat and rice. BTW, we do not need carbs for energy once we have converted our metabolism to burning fats for fuel.

  • TB September 8, 2015 at 7:33 am

    I have been taking Metformin 500 mg 2 x’s daily for 17 months; my blood A1C was at 8.5, it dropped down to 6.5 three months after starting metformin, and now its at 6.2 for the last 6 months. Methformin is starting to make my legs swell w/lots of pain, and I feel very sluggish when walking. I stropped taking methformin for 2 days my swelling has gone down, my leg pain is getting much better, and my energy is getting better. Should my doctor take me off methformin?

    • David Mendosa September 8, 2015 at 7:45 am

      You should definitely schedule an appointment with your doctor as soon as you can, TB. The leg pain and swelling is not something that I have ever heard being a side effect of metformin, but of course everyone of us is different. If your doctor takes you off metformin, you will need to take something else, probably insulin or one of the GLP-1 agonists (Bydureon or Victoza probably), because you still need to bring your A1C level considerably lower. The better alternative, of course, is to get your weight to normal, if it isn’t already, and bring your A1C level down to normal, both by following a very low-carb diet. Your doctor may or may not support you in this effort, but it is your choice and not for me to advise.

  • lois July 21, 2015 at 9:51 am

    Can you ever come off met for min or is it something you always have to take even with diet regulated ???

    • David Mendosa July 21, 2015 at 10:20 am

      That doctor recommends that you take metformin forever. But personally I am able to control my diabetes without it, Lois.

  • Pawan February 2, 2015 at 3:17 am


    I had been taking metformin (500 mg) + glimeperide combination (2 mg) combination for last 2-3 years and still my Hb1Ac went to about 9. Now doctor has advised me to go for 2 doses of metformin (850mg) +3 mg. However, I get severe acidity with this combination and I am unable to sleep at night due to this problem. Use of antacid is an alternative but I heard long term use of antacids is not good. Worse, even this doesnot seem to work as my fasting sugar is over 250. Have I grown intolerant to metformin? Is insulin the only alternative? Thanks in advance

    • David Mendosa February 2, 2015 at 11:55 am

      Dear Pawan,

      I have never heard that anyone can grow intolerant of metformin but you must build up the dose very slowly. See:

      And most of your beta cells in your pancreas may have failed. But even more likely you are eating too many grams of carbohydrates, which are the only things that raise our blood sugar level very much. I mean particularly grains and grain products like bread, potatoes, and sugar. Cutting WAY back on carbs is by far the best alternative. Next best and necessary if your beta cells are mostly gone is insulin shots.

      With metta,

  • Kellie January 24, 2015 at 10:20 am

    My husband has been on Metformin for the past 4 months. He had had very serious side effects, including mental confusion, Flu-like symptoms, cough, and all this started when he started on the higher dose. His blood sugar level is 83. He is taking 2500 mg daily. He also is pre-diabetics.

    • David Mendosa January 24, 2015 at 5:20 pm

      Dear Kellie,

      Your husband’s symptoms may be a coincidence. But they could be a result of the higher metformin dose. Everyone is different. Those are certainly not anything like typical symptoms of the medication and I would not be able to suggest that he stop the metformin with examining him. But he absolutely needs to go back to his doctor and say what’s happening. Please encourage him to do that!

      With metta,

  • Juanita W January 20, 2014 at 9:11 pm

    I went on the Atkins diet eating lots of good veggies, for two weeks, without cheating and stopped taking insulin (was on levemir 25 units 2x a day ), my fasting glucose kept running from 145 to 175…..even when carbs were 20 grams or less a day!!! Only lost 4 pounds in two weeks. Can it be done….to stay off insulin….and control D? I do take 1000 metf 2x per day. I’m 71.

    • David Mendosa January 20, 2014 at 9:25 pm

      Dear Juanita,

      You are right that your level was too high for the very low-carb diet you were following. The only thing that I can think of is that you have type 1 diabetes or at least very few beta cells. Still, anyone who has type 1 can reduce their insulin on a very low-carb diet.



  • Susan Schneider January 12, 2014 at 2:22 pm

    Hi David: I was diagnosed with Type II 5 years ago, and have been under great control since, but have had HORRIBLE explosive metformin induced diarrhea around 11 am every day until a month ago. My father who is turning 90 is an internist, and was just also diagnosed with Type II, and had the same side effect. However, he suddenly recalled he had learned in medical school (Northwestern Medical School ’45 in Chicago) that if a drug causes diarrhea, take the cure for it at the same time you take that medicine. So I am now taking a 1 mg. Imodium tablet with my a.m. Metformin, and suddenly I am diarrhea free for the first time in 5 years. I suppose it would have been helpful if someone had mentioned this 5 years ago. Neither my nephrologist or GI guy knew this trick. Thought you might know how to get it out to the right people. Thanks for your great columns and website! Susan Schneider

    • David Mendosa January 12, 2014 at 6:08 pm

      Dear Susan,

      Thanks for sharing. That is certainly one way to manage using metformin if your stomach can’t tolerate it. Of course, some people have no problem with it, and I never did when I used it.



  • liz greene August 4, 2013 at 10:26 am

    I am using metform in a compounded form,
    in a vanishing cream base. I have been unable
    to tolerate taking it orally because of the GI
    side effects, even starting with tiny doses
    125 mg. at a time. People with PCOS have been
    using the drug compounded this way for several
    years. It works for me, and there are NO SIDE EFFECTS–it doesn’t go thru the gut at all,
    just thru your skin into your circulatory system. I’m using 50 mg. per 1 ml of cream,
    3x/day (three applications on each forearm
    over the day, for a totel of 300 mg. per day).
    May have to up the dose one more time, but
    it definitely knocks down blood sugars.

    Big drawback is that Medicare won’t pay for
    it and a 1 month supply is currently costing
    me $287.00 (ouch). But I will keep paying
    for it myself if I must.

    I found the information on compounding it
    thru one of the websites on PCOS–there’s an article called Metformin Without the Misery.

    Be curious to know what you think about this.

    The article I read on this is in diabetes self management, http://www.diabetesselfmanagement.com/


    • David Mendosa August 6, 2013 at 11:49 am

      Dear Liz,

      I am not familiar with taking metformin topically. But I do know that many people stop using metformin orally because of the gastric side effects. That, however, is only because their doctors don’t tell them to build up the dosage very very slowly (they call this to titrate the dose). I would hope that you could try it again this way. Please read my article headed “Metformin Forever.”



  • liz greene August 4, 2013 at 10:22 am

    I am using metform in a compounded form,
    in a vanishing cream base. I have been unable
    to tolerate taking it orally because of the GI
    side effects, even starting with tiny doses
    125 mg. at a time. People with PCOS have been
    using the drug compounded this way for several
    years. It works for me, and there are NO SIDE EFFECTS–it doesn’t go thru the gut at all,
    just thru your skin into your circulatory system. I’m using 50 mg. per 1 ml of cream,
    3x/day (three applications on each forearm
    over the day, for a totel of 300 mg. per day).
    May have to up the dose one more time, but
    it definitely knocks down blood sugars.

    Big drawback is that Medicare won’t pay for
    it and a 1 month supply is currently costing
    me $287.00 (ouch). But I will keep paying
    for it myself if I must.

    I found the information on compounding it
    thru one of the websites on PCOS–there’s an article called Metformin Without the Misery.

    Be curious to know what you think about this.


  • Priya May 6, 2013 at 6:21 pm

    My husbands blood sugar rose very high due to change in place and stress. Hba1mc went upto 120. He is 40. He is on 3 metformins 500 g daily. But fasting sugars still seem to be high around 10-11. He takes oats fur breakfast, salad for lunch and some carbs and curry for dinner. He has a busy working schedule which involves walking. What else should we do. Is there anything we need to add or cut down?

    • David Mendosa May 6, 2013 at 7:26 pm

      Dear Priya,

      Good question. It is the carbs that he is eating and only the carbs that make his blood sugar level go up. That includes the oats and particularly whatever grains, like bread, pasta, and rice that he may be eating. The fewer the carbs he eats the better his blood sugar will be.



  • Sharon October 11, 2012 at 9:53 am

    Diet alone hasn’t worked for me. Morning fasting numbers usually very high. Take vitamin d & fish oil. Often other supplements have caused problems. Don’t eat junk or fried foods & don’t want to lose any more weight.

  • Sharon October 10, 2012 at 3:28 pm

    When my former doctor diagnosed me as diabetic based on the so called metabolic syndrome, my A1C was 6.2. Since then I’ve taken Metformin for many years & maintained my A1C at around 6.0. I had no apparent side effects & my weight dropped from 170 lbs. to 130lbs. Recently I was having various unrelated health problems, including pneumonia, but was found to have critically high lactic acidosis, a rare side effect of Metformin. I no longer take anything for diabetes, as my daily numbers show. My arms & legs still ache all the time,especially the left side. Don’t know what to do now.
    My current doctor doesn’t seem to think my numbers are that bad & thinks an A1C of 7.0 is fine.

    • David Mendosa October 10, 2012 at 3:35 pm

      Dear Sharon,

      What a shame that you got lactic acidosis. You are right that is a rare side effect of metformin, which does have a black-box warning that it can cause that. But you are the only person I have ever heard of that it affected. I wonder if that caused your arms and legs to ache? If so, that will probably resolve itself. Still, if I were you, I would concentrate on improving my diet and vitamin/minteral intake and also work with a doctor to see if it could have another cause.

      Best regards


  • Arun Prabhu June 1, 2012 at 9:45 am

    David, has there been any conclusive evidence or study to show that an A1C below 5.5 is the right figure to prevent any complications?

    • David Mendosa June 1, 2012 at 12:00 pm

      Dear Arun,

      The two biggest studies ever, the Diabetes Control and Complications Trial or DCCT, and the United Kingdom Prospective Diabetes Study or UKPDS, both established that as A1C levels rise above normal the risk of complications increase dramatically. That is not to say that we can be absolutely sure that any level “is the right figure to prevent any complications.”


  • David Mendosa May 30, 2012 at 9:15 am

    Dear Anna,

    Two good theories, but I think a third one is the answer. I do not think that the effect of metformin wears off and I certainly don’t think that diabetes is naturally a progressive disease (as I have written elsewhere). But it does get progressively worse when we don’t manage it well. And we don’t manage it well by following the lax guidelines that the “experts” say to follow. When we manage our diabetes, like with an A1C level always below 5.5 or so, we don’t get complications. So, please rethink your idea to “wait until absolutely necessarily.”


  • Anna May 30, 2012 at 6:58 am

    Hi David, thank you for this very thorough point of view. One thing that has made me hesitate to take metformin is that I have heard anecdotally that the medication loses its effectiveness over time. Since I am still at an early stage of diabetes, I feel as if I should wait it out until absolutely necessary. Do you think the effectiveness of metformin ‘wears off’, or is it that the diabetics who experienced this had a worsening of the disease as a matter of course, and couldn’t tell the difference?